ESO Releases 2023 ESO EMS Index

April 11, 2023
Index adds pediatric respiratory assessment and takes a deep dive into opioid overdose and ketamine administration with weight documented.

April 11, 2022 – AUSTIN, Texas – ESO, the leading data and software company serving emergency medical services (EMS), fire departments, hospitals, state and federal agencies, today announced the findings of its 2023 ESO EMS Index tracks data for more than 2,600 EMS agencies nationwide across clinical performance and public health surveillance measures: stroke assessment for  emergency department- diagnosed stroke, 12-lead EKG for patients with emergency department- diagnosed STEMI/NSTEMI, ketamine administration with weight recorded and end-tidal carbon dioxide release (EtCO2)EMS transport without lights and sirens, pediatric respiratory assessment, bystander CPR, critical incident reporting, and patients with suspected opioid overdose who were treated in place by EMS.

Additionally, this year’s Index takes a deeper look at patient race/ethnicity and gender across metrics to identify inequities in care.

“This is the sixth year of our annual EMS Index, and we continue to see how agencies and departments are using data to make meaningful and deliberate decisions that have a positive impact,” said Dr. Brent Myers, Chief Medical Officer for ESO. “As healthcare providers, we care about the well-being of our patients; research gives us a catalyst to identify gaps and disparities in care so we can overcome them.”

Key Findings Include: 

  • 12-lead EKG: Approximately 83% of EMS patients who were diagnosed with a STEMI and 65% diagnosed with a NSTEMI in the emergency department had a documented 12-lead EKG. This indicates there is room for improvement in prehospital STEMI/NSTEMI identification.
  • Pediatric respiratory assessment: Out of nearly 64,000 EMS encounters for pediatric patients with respiratory distress, 86% had both oxygen saturation (SpO2) and a respiratory rate documented.
  • Ketamine administration with weight recorded and end-tidal carbon dioxide release (EtCO2) documented: In 80% of cases, patients administered ketamine had their weight documented in the EMS record – a 3% drop compared to 2021. Additionally, 60% of patients who received ketamine at a sedation-level dose had documented EtCO2 monitoring.
  • Opioid overdose and treatment in place: Overall, encounters for patients with suspected opioid overdose accounted for 2% of 911 records in 2022, which is slightly below the 2.6% margin in 2021. Eight percent of patients given naloxone for suspected overdose were not transported by EMS either due to patient refusal or protocol allowing treatment in place.

“This year we’ve seen some fantastic improvements compared to our 2021 numbers, but also areas that warrant further attention across the entire EMS landscape,” added Dr. Myers. “Ketamine use in EMS has been a topic of interest in recent years due to patient safety concerns. As with any clinical intervention, selecting appropriate indications, dosage, and monitoring are foundational elements of patient safety. Additionally, as the Index findings indicates, there is opportunity for improvement in monitoring a patient’s EtCOfollowing administration of ketamine.”

The full 2023 ESO EMS Index can be downloaded here.

About the Index

The dataset from the ESO Data Collaborative used for the ESO EMS Index is real-world, de–identified data, compiled and aggregated from more than 2,600 agencies across the United States that use ESO’s products and services and agreed to share their data for research and performance improvement purposes. This report is based on 11 million anonymized 911 encounters between January 1, 2022 and December 31, 2022, representing a full calendar year.

About ESO

ESO (ESO Solutions, Inc.) is dedicated to improving community health and safety through the power of data. Since its founding in 2004, the company continues to pioneer innovative, user-friendly software to meet the changing needs of today’s EMS agencies, fire departments, hospitals, state/provincial offices, and national/federal agencies. ESO currently serves thousands of customers throughout North America with a broad software portfolio, including the industry-leading ESO Electronic Health Record (EHR), the next generation ePCR; ESO Health Data Exchange (HDE), the first-of-its-kind healthcare interoperability platform; ESO Fire RMS, the modern fire Record Management System; ESO Patient Registry (trauma, burn and stroke registry software); and ESO State Repository. ESO is headquartered in Austin, Texas. For more information, visit


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