“Study Reveals Disparities in 911 Responses and Patient Care in the US”

Patients in the United States who call 911 for medical emergencies may receive different levels of care depending on their location and the nature of their condition, according to a recent study conducted by researchers from Mount Sinai in New York. The study, which analyzed all 911 responses in the US for the year 2019, revealed that nearly one-third of patients with suspected stroke did not receive a stroke assessment over the phone or by ambulance staff, leading to delays in time-sensitive treatment. Additionally, at least half of emergency medical service (EMS) agencies demonstrated performance below 35 percent for five out of the ten national measures evaluated.

The study, the first of its kind, examined more than 26 million responses from 9,679 EMS agencies across the country. It found that pain relief for trauma patients improved in only 16 percent of cases after treatment by 911 operators and ambulance medics. Patients rated their pain on a scale of 1-10 when they first contacted 911, and at the end of their encounter with emergency services. Shockingly, 84 percent of patients’ pain scores had not improved. Furthermore, 39 percent of children with wheezing or asthma attacks did not receive breathing treatments from EMS agencies, despite the fact that earlier treatment can lead to earlier relief of distressing symptoms.

The researchers recommended that EMS agencies establish “quality improvement collaboratives to pool data and rapidly test change ideas.” They also emphasized the importance of including rural agencies in these efforts, as disparities in care for those living in rural settings have long been noted. Dr. Michael Redlener, the lead author of the study and associate professor of emergency medicine at Icahn Mount Sinai, stressed that the purpose of the research was not to blame EMS services but rather to identify opportunities for improving patient care. He stated, “We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat.”

This groundbreaking study is the first to use specific safety and clinical quality measures to assess patient care across the entire 911 system in the US. Traditionally, emergency services metrics have focused on response times and cardiac arrest survival outside of the hospital. However, in 2019, the National EMS Quality Measure Set was developed, consisting of 11 measures spanning eight key clinical areas across EMS practice. These measures include the percentage of patients who called 911 in which lights and sirens were not used during the response or patient transport.

The researchers also analyzed the performance of all EMS agencies, taking into account agency size and location (urban, suburban, and rural). They discovered significant differences between agencies that primarily responded in rural communities compared to those in urban and suburban areas. Agencies in rural areas were less likely to treat low blood sugar or improve pain for trauma patients, and more likely to use lights and sirens unnecessarily. This unnecessary use of lights and sirens can lead to a higher likelihood of accidents, injuries, and even death.

Dr. Redlener emphasized the notable difference between the highest- and lowest-performing agencies on these key measures. He stated, “EMS systems in the US have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side.” While fast response times are crucial for critical incidents such as cardiac arrest or choking, the majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency.

The national standard for EMS response time is eight minutes and 59 seconds, meaning that a response must be under nine minutes. However, a 2017 study found that the average time between a call for help and the arrival of emergency medical services in the US is about eight minutes. In rural areas, this time can increase to 14 minutes, with some patients waiting nearly 30 minutes. On average, responders arrived 7.9 minutes after the call for help was placed. The waiting time was seven minutes in urban settings, 7.7 minutes in suburban areas, and 14.5 minutes in rural areas.

This study sheds light on the disparities in 911 responses and patient care across the US. It highlights the need for improvements in the quality and safety of care provided by EMS agencies. By focusing on specific clinical measures and addressing the discrepancies between rural and urban/suburban areas, the researchers hope to enhance patient outcomes and experiences during medical emergencies. The findings of this study serve as a call to action for EMS systems, government officials, and the public to work together to improve the overall quality of emergency medical care in the US.