Vital Sign Assessment in EMS Non-Transports: A National Analysis

Area of Science:

• Emergency Medical Services Research
• Health Services Research
• Patient Safety

Background:

• Vital sign assessment is crucial for evaluating patient condition during emergency medical services (EMS) encounters.
• Incomplete vital sign documentation can impact patient care and safety, particularly in non-transport situations.

Purpose of the Study:

• To assess national performance in complete vital sign documentation for non-transport EMS encounters.
• To identify patient, agency, and incident characteristics associated with vital sign assessment variability.

Main Methods:

• Retrospective analysis of the 2023 National EMS Information System (NEMSIS) Public Release Research Dataset.
• Inclusion of adult patients from 9-1-1 incidents resulting in non-transport, excluding those in cardiac arrest prior to arrival.
• Definition of a complete vital sign set including heart rate, respiratory rate, pulse oximetry, systolic blood pressure, and level of consciousness.

Main Results:

• Only 54.6% of eligible non-transport incidents had a complete vital sign set documented; 9.8% had no vitals recorded.
• Individual vital sign assessment ranged from 70.9% (SpO₂) to 86.0% (heart rate).
• Performance varied by agency type (ALS: 57.3%, BLS: 44.7%, EMR: 26.8%) and was influenced by scene time, dispatch reason, and patient demographics (e.g., older adults after falls).

Conclusions:

• A significant proportion of non-transport EMS encounters lack complete vital sign assessment, indicating substantial variability in EMS performance.
• There is a critical need for quality improvement initiatives to enhance vital sign documentation, particularly for high-risk populations like older adults following falls.
• Improved vital sign assessment is essential for patient safety and effective clinical decision-making in prehospital care.