Introduction
The National EMS Quality Alliance (NEMSQA) maintains a set of EMS performance measures, including measures that were originally developed by the EMS Compass initiative, to support measurement and improvement in the quality of EMS care at the local, regional, state, and national levels. Some NEMSQA performance measures are based on NEMSIS data elements that are available in the national EMS database ("national" elements). The NEMSIS TAC is implementing those performance measures one-by-one and making them available nationally for analysis via two tools:
- V3 Public Performance Measure Dashboard (for the public)
- V3 Public Performance Measure Web Service (for software developers)
Each currently-available performance measure is documented here. The NEMSIS TAC was careful to implement the performance measures exactly as defined by NEMSQA, even if NEMSIS TAC staff perceived weaknesses or limitations in the definitions. As each performance measure is released, it will be added to this page.
In all measures, the numerator criteria implicitly include the denominator criteria. In other words, the numerator can only select records that are selected in the denominator. The number of records contributing to the numerator can never be larger than the number of records contributing to the denominator.
Some measures that were originally developed by EMS Compass were re-specified (modified) by NEMSQA after they were initially implemented by the NEMSIS TAC. Details about re-specifications are noted below.
Hypoglycemia
Hypoglycemia-01 Treatment Administered for Hypoglycemia
ID | Hypoglycemia-01 |
Measure Title | Treatment Administered for Hypoglycemia |
NEMSQA Package | E.-NEMSQA-EMS-Compass-2.0-Hypoglycemia-01.pdf |
Description | Percentage of EMS responses originating from a 911 request for patients who receive treatment to correct their hypoglycemia. |
Numerator Statement | EMS responses originating from a 911 request for patients receiving treatment to correct their hypoglycemia during the EMS response. |
Denominator Statement | All EMS responses originating from a 911 request for patients with hypoglycemia and a GCS of <15 or an AVPU of <A or patients with a primary or secondary impression of altered mental status and a blood glucose level of <60. |
Denominator Exclusions | Patients less than 24 hours of age. |
Numerator Pseudocode | eMedications.03 Medication Given is in |
Denominator Pseudocode | ( |
The NEMSQA measure uses eVitals.23 Total Glasgow Coma Score, which is not in the national database. The NEMSIS TAC modified the denominator to use the sum of eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, and eVitals.21 Glasgow Coma Score-Motor.
Pediatric Respiratory
Pediatrics-01 Pediatric Respiratory Assessment
ID | Pediatrics-01 |
Measure Title | Pediatric Respiratory Assessment |
NEMSQA Package | |
Description | Percentage of EMS responses originating from a 911 request for patients less than 18 years old with primary or secondary impression of respiratory distress who had a respiratory assessment. |
Numerator Statement | EMS responses originating from 911 requests for patients who received both a SPO2 and respiratory rate measurement during the EMS response. |
Denominator Statement | EMS responses originating from 911 requests for patients <18 years of age with a primary or secondary impression of respiratory distress. |
Denominator Exclusions | None |
Numerator Pseudocode | eVitals.12 Pulse Oximetry is not null |
Denominator Pseudocode | ( |
Pediatrics-02 Administration of Beta Agonist for Pediatric Asthma
ID | Pediatrics-02 |
Measure Title | Administration of Beta Agonist for Pediatric Asthma |
NEMSQA Package | |
Description | Percentage of EMS responses originating from a 911 request for patients 2-18 years of age with a diagnosis of asthma who had an aerosolized beta agonist administered. |
Numerator Statement | EMS responses originating from a 911 request for patients who had an aerosolized beta agonist administered by an EMS professional during the EMS response. |
Denominator Statement | All EMS responses originating from a 911 request for patients 2-18 years of age with a primary or secondary impression of asthma exacerbation or acute bronchospasm. |
Denominator Exclusions | None |
Numerator Pseudocode | eMedication.03 Medication Given is in |
Denominator Pseudocode | ( |
Seizure
Seizure-01 Blood Glucose Evaluation
ID | Seizure-01 |
Measure Title | Blood Glucose Evaluation |
NEMSQA Package | None (see note) |
Description | Measure of seizure patients who received an evaluation of their blood glucose |
Numerator Statement | Patients receiving a blood sugar evaluation |
Denominator Statement | Patients with ongoing status seizure activity (also known as status epilepticus, defined as seizing for 5 minutes or more or two or more status seizures in a 5-minute period without regaining consciousness) originating from a 911 request |
Denominator Exclusions | None |
Numerator Pseudocode | eVitals.18 Blood Glucose Level is not null |
Denominator Pseudocode | ( |
This EMS Compass measure was retired by NEMSQA, but the NEMSIS TAC continues to make it available.
If the intent is to capture all seizures with status epilepticus, the code G40.901 in the denominator is overly restrictive and should be replaced with the pattern G40...[1,3]. However, the measure is implemented as defined by EMS Compass.
Seizure-02 Patient with Status Epilepticus Receiving Intervention
ID | Seizure-02 |
Measure Title | Patient with Status Epilepticus Receiving Intervention |
NEMSQA Package | I.-NEMSQA-EMS-Compass-2.0-Seizure-02.pdf |
Description | Percentage of EMS responses originating from a 911 request for patients with status epilepticus who received benzodiazepine aimed at terminating their status seizure during the EMS response. |
Numerator Statement | EMS responses originating from a 911 request for patients who received benzodiazepine aimed at terminating their status seizure during the EMS response. Benzodiazepines may include: Diazepam, Lorazepam, Midazolam. |
Denominator Statement | All EMS responses originating from a 911 request for patients with a primary or secondary impression of status epilepticus. |
Denominator Exclusions | None |
Numerator Pseudocode | eMedications.03 Medication Given is in |
Denominator Pseudocode | ( |
Stroke
Stroke-01 Suspected Stroke Receiving Prehospital Stroke Assessment
ID | Stroke-01 |
Measure Title | Suspected Stroke Receiving Prehospital Stroke Assessment |
NEMSQA Package | |
Description | To measure the percentage of suspected stroke patients who had a stroke assessment performed by EMS |
Numerator Statement | Number of suspected stroke patients who had a stroke assessment performed (CPSS, LAMS, etc.) |
Denominator Statement | Patients with a provider impression of stroke originating from a 911 request |
Denominator Exclusions | None |
Numerator Pseudocode | eVitals.29 Stroke Scale Score is not null |
Denominator Pseudocode | ( eSituation.11 Provider's Primary Impression matches /^(I60)|(I61)|(I63)|(G45)|(G46)/ |
The NEMSQA measure uses eVitals.23 Total Glasgow Coma Score, which is not in the national database. The NEMSIS TAC modified the denominator to use the sum of eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, and eVitals.21 Glasgow Coma Score-Motor.
Trauma Pain
Trauma-01 Pain Assessment of Injured Patients
ID | Trauma-01 |
Measure Title | Pain Assessment of Injured Patients |
NEMSQA Package | |
Description | Recognizing that pain is undertreated in injured patients, it is important to assess whether a patient is experiencing pain |
Numerator Statement | Patients with pain scale value present |
Denominator Statement | Patients with injury originating from a 911 request |
Denominator Exclusions | None |
Numerator Pseudocode | eVitals.27 Pain Scale Score is not null |
Denominator Pseudocode | eSituation.02 Possible Injury is 9922005 ("Yes") |
The NEMSQA measure uses eVitals.23 Total Glasgow Coma Score, which is not in the national database. The NEMSIS TAC modified the denominator to use the sum of eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, and eVitals.21 Glasgow Coma Score-Motor.
Trauma-03 Effectiveness of Pain Management for Injured Patients
ID | Trauma-03 |
Measure Title | Effectiveness of Pain Management for Injured Patients |
NEMSQA Package | |
Description | Percentage of EMS transports originating from a 911 request for patients whose pain score was lowered during the EMS encounter. |
Numerator Statement | EMS transports originating from a 911 request for patients with two or more documented pain scores and a final pain score value less than the first documented pain score. |
Denominator Statement | All EMS transports originating from a 911 request for patients with injury who had an initial pain score of greater than zero. |
Denominator Exclusions | None |
Numerator Pseudocode | last (eVitals.27 Pain Scale Score where eVitals.01 Date/Time Vital Signs Taken is not null |
Denominator Pseudocode | eSituation.02 Possible Injury is 9922005 ("Yes") |
NEMSQA does not specify how to handle scenarios where multiple sets of vital signs are recorded with the same non-blank date/time and different pain scores. The NEMSIS TAC ignores blank pain scores. Where multiple sets of vital signs are recorded with the same date/time and different non-blank pain scores, the NEMSIS TAC uses the highest pain score.
Vehicle Operations Safety
Safety-01 Use of Lights and Sirens During Response to Scene
ID | Safety-01 |
Measure Title | Use of Lights and Sirens During Response to Scene |
NEMSQA Package | |
Description | EMS responses originating from a 911 request during which lights and sirens were not used. |
Numerator Statement | EMS responses originating from a 911 request during which lights and sirens were not used. |
Denominator Statement | EMS responses originating from a 911 request. |
Denominator Exclusions | None |
Numerator Pseudocode | eResponse.24 Additional Response Mode Descriptors is 2224019 ("No Lights or Sirens") |
Denominator Pseudocode | eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)") |
Safety-02 Use of Lights and Sirens During Transport
ID | Safety-02 |
Measure Title | Use of Lights and Sirens During Transport |
NEMSQA Package | |
Description | Percentage of EMS transports originating from 911 requests in which lights and sirens were not used during patient transport. |
Numerator Statement | EMS transports originating from a 911 request during which lights and sirens were not used. |
Denominator Statement | All EMS transports originating from a 911 request. |
Denominator Exclusions | None |
Numerator Pseudocode | eDisposition.18 Additional Transport Mode Descriptors is 4218015 ("No Lights or Sirens") |
Denominator Pseudocode | eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)") |
The disposition code in the denominator excludes some patient transport dispositions, such as “Patient Dead at Scene-Resuscitation Attempted (With Transport).” However, the NEMSIS TAC implemented the measure as defined by NEMSQA.
Contact Info
Any questions, comments, concerns, or suggestions regarding this or other reports made available by the NEMSIS TAC, please contact us or leave a comment below!
Contact information is also available on our website.
Kevin White, BS University of Utah School of Medicine NEMSIS Technical Assistance Center Phone: (801) 213-3408 Fax: (801) 581-8686 Email: kevin.white@hsc.utah.edu | Atim Effiong, MPH University of Utah School of Medicine NEMSIS Technical Assistance Center Phone: (801) 585-9158 Fax: (801) 581-8686 Email: atim.effiong@hsc.utah.edu | Laurel Baeder, BA, MStat University of Utah School of Medicine NEMSIS Technical Assistance Center Phone: (801) 587-5337 Fax: (801) 581-8686 Email: laurel.baeder@hsc.utah.edu |