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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:

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 PackageE.-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 StatementEMS responses originating from a 911 request for patients receiving treatment to correct their hypoglycemia during the EMS response.
Denominator StatementAll 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
     (
          4832 ("Glucagon"),
          4850 ("Glucose"),
          377980 ("Glucose Oral Gel"),
          376937 ("Glucose Injectable Solution"),
          372326 ("Glucose Chewable Tablet"),
          237653 ("Glucose 500 MG/ML Injectable Solution"),
          260258 ("Glucose 250 MG/ML Injectable Solution"),
          309778 ("Glucose 50 MG/ML Injectable Solution"),
          1795610 ("250 ML Glucose 50 MG/ML Injection"),
          1795477 ("500 ML Glucose 100 MG ML Injection"),
          1794567 ("Glucose Injection")
          1165823 ("Glucose Oral Product")
          1165822 ("Glucose Oral Liquid Product")
          1165819 ("Glucose Injectable Product")
     )
or   eProcedures.03 Procedure is in
     (
          710925007 ("Provision of food"),
          225285007 ("Giving oral fluid")
     )

Denominator Pseudocode

(
     (
               eSituation.11 Provider's Primary Impression matches/^E16.2/ ("Hypoglycemia, unspecified")
          or   eSituation.12 Provider's Secondary Impressions matches/^E16.2/ ("Hypoglycemia, unspecified")
     )
     and
     (
               sum (eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, eVitals.21 Glasgow Coma Score-Motor) is equal to 15
          or   eVitals.26 Level of responsiveness (AVPU) is 3326001 ("Alert")
     )
)
or
(
     (
               eSituation.11 Provider's Primary Impression matches/^R41.82/ ("Altered Mental Status, unspecified")
          or   eSituation.12 Provider's Secondary Impressions matches/^ R41.82/ ("Altered Mental Status, unspecified")
     )
     and  eVitals.18 Blood Glucose Level is less than 60
)
and  eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)")
and not
(
     (
               ePatient.15 Age is less than 24
          and  ePatient.16 Age Units is 2516003 ("Hours")
     )
     or
     (
               ePatient.15 Age is less than or equal to 120
          and  ePatient.16 Age Units is 2516005 ("Minutes")
     )
)

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.


Seizure

Seizure-01 Blood Glucose Evaluation

ID

Seizure-01

Measure Title

Blood Glucose Evaluation
NEMSQA PackageNone (see note)

Description

Measure of seizure patients who received an evaluation of their blood glucose

Numerator StatementPatients receiving a blood sugar evaluation
Denominator StatementPatients 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 ExclusionsNone

Numerator Pseudocode

     eVitals.18 Blood Glucose Level is not null

Denominator Pseudocode

(
     eSituation.11 Provider's Primary Impression is G40.901 ("Epilepsy, unspecified, not intractable, with status epilepticus")
or   eSituation.12 Provider's Secondary Impressions is G40.901 ("Epilepsy, unspecified, not intractable, with status epilepticus")
)
and  eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)")

Note: This EMS Compass measure was retired by NEMSQA, but the NEMSIS TAC continues to make it available.

Note: 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 PackageI.-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 StatementEMS 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 StatementAll EMS responses originating from a 911 request for patients with a primary or secondary impression of status epilepticus.
Denominator ExclusionsNone

Numerator Pseudocode

eMedications.03 Medication Given is in
(
3322 ("Diazepam"),
6960 ("Midazolam"),
203128 ("Midazolam Hydrochloride"),
6470 ("Lorazepam")
)

Denominator Pseudocode

(
    eSituation.11 Provider's Primary Impression matches /^G40...[1,3]/ ("Epilepsy, ..., with status epilepticus")
or   eSituation.12 Provider's Secondary Impressions matches /^G40...[1,3]/ ("Epilepsy, ..., with status epilepticus")
)
and  eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)")


Stroke

Stroke-01 Suspected Stroke Receiving Prehospital Stroke Assessment

ID

Stroke-01

Measure Title

Suspected Stroke Receiving Prehospital Stroke Assessment
NEMSQA Package

J.-NEMSQA-EMS-Compass-2.0-Stroke-01.pdf

Description

To measure the percentage of suspected stroke patients who had a stroke assessment performed by EMS

Numerator StatementNumber of suspected stroke patients who had a stroke assessment performed (CPSS, LAMS, etc.)
Denominator StatementPatients with a provider impression of stroke originating from a 911 request
Denominator ExclusionsNone

Numerator Pseudocode

       eVitals.29 Stroke Scale Score is not null
or     eVitals.30 Stroke Scale Type is not null

Denominator Pseudocode

(
     eSituation.11 Provider's Primary Impression matches /^(I60)|(I61)|(I63)|(G45)|(G46)/
("Nontraumatic subarachnoid hemorrhage...",
"Nontraumatic intracerebral hemorrhage...",
"Cerebral infarction...",
"Transient cerebral ischemic attacks...",
"Vascular syndromes of brain in cerebrovascular diseases…")
or   eSituation.12 Provider's Secondary Impressions matches /^(I60)|(I61)|(I63)|(G45)|(G46)/
("Nontraumatic subarachnoid hemorrhage...",
"Nontraumatic intracerebral hemorrhage...",
"Cerebral infarction...",
"Transient cerebral ischemic attacks...",
"Vascular syndromes of brain in cerebrovascular diseases…")
)
and  eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)")
and not ( sum (eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, eVitals.21 Glasgow Coma Score-Motor) is less than or equal to 9 or eVitals.26 Level of responsiveness (AVPU) is 3326007 ("Unresponsive") )

Note: 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

K.-NEMSQA-EMS-Compass-2.0-Trauma-01.pdf

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")
and
(
      sum (eVitals.19 Glasgow Coma Score-Eye, eVitals.20 Glasgow Coma Score-Verbal, eVitals.21 Glasgow Coma Score-Motor) is equal to 15
or   eVitals.26 Level of responsiveness (AVPU) is 3326001 ("Alert")
)
and  eResponse.05 Type of Service Requested is 2205001 ("911 Response (Scene)")
and  eDisposition.12 Incident/Patient Disposition is 4212033 ("Patient Treated, Transported by this EMS Unit")

Note: 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.


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

N.-NEMSQA-EMS-Compass-2.0-Safety-01.pdf

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

O.-NEMSQA-EMS-Compass-2.0-Safety-02.pdf

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)")
and  eDisposition.12 Incident/Patient Disposition is 4212033 ("Patient Treated, Transported by this EMS Unit")

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 with regard to 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




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