In this special data-driven edition of the EMS One-Stop podcast, host Rob Lawrence is joined by Dr. Brent Myers, chief medical officer, ESO, and Dr. Remle Crowe, ESO’s director of clinical and operational research, to unpack the newly released 2025 ESO EMS Index.
This annual report provides a powerful, real-world snapshot of national EMS trends — drawing on more than 14 million anonymized records to surface opportunities for clinical and operational improvement.
The conversation dives into key metrics that move beyond response times and into areas like pain management, opioid overdoses, airway confirmation, obstetric emergencies, whole blood use, pediatric behavioral health and high-utilization patient populations.
Throughout the episode, Drs. Myers and Crowe share the motivation behind each metric, explain how the data was gathered and analyzed, and reflect on how EMS agencies can use these insights to guide better care delivery and system design. From confronting equity in pain management, to pushing forward innovations like buprenorphine administration and whole blood programs, this is a compelling call to turn data into meaningful change.
Memorable quotes
“This is just really a conversation starter plus, and as long as we get to that point, then I think we’re having a conversation about something besides response time.” — Dr. Brent Myers
“This is not an ESO-specific document ... anybody can look at these metrics and take one small action toward improvement.” — Dr. Remle Crowe
“I would be very surprised if we don’t see a different method of documentation—more of an ambient listening … we’re very close and headed in that direction.” — Dr. Brent Myers
“Back in the day, we just had the ‘I feel, I think, my gut reaction is.’ Now, I’ve got the piece of paper with the peer review or the absolute information on it that I can say, here’s the proof in the pudding in order to generate the change that we need to make.” — Rob Lawrence
“One out of every eight pediatric EMS encounters involves a behavioral health or potential substance use disorder component.” — Dr. Remle Crowe
“If they don’t embrace it, we haven’t designed it correctly … this should be making their day easier, not harder.” — Dr. Brent Myers
“We’re not judging systems — we’re asking, ‘Are your protocols in alignment with the best evidence today?’” — Dr. Remle Crowe
Timeline
01:08 – Overview of the ESO EMS Index and its intent
02:59 – Origins of the report and data methodology
05:46 – Database scale: 14M+ records, 3,000+ agencies
07:14 – Metric 1: Pain management for long bone fractures
10:53 – Documentation, AI in EMS, and future documentation tools
14:30 – Metric 2: Suspected opioid overdose and buprenorphine use
18:51 – Best practices, COWS scoring, and naloxone delivery strategy
21:31 – Metric 3: Invasive airway confirmation using waveform capnography
28:06 – Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)
34:34 – Metric 5: Prehospital whole blood surveillance
40:22 – Metric 6: Pediatric behavioral health and substance use disorder cases 44:54 – Metric 7: High utilization patient group (HUG)
52:48 – Final thoughts, calls to action, and Rob’s reflections
55:47 – Episode wrap-up and subscription reminder
Related resources
- Download the 2025 ESO EMS Index Report: 2025 ESO EMS Index — ESO
- Prehospital Care Research Forum
- Misplaced endotracheal tubes by paramedics in an urban emergency medical services system
- EMS One-Stop: Barriers to prehospital whole blood implementation
- EMS One-Stop: Future-proofing EMS — How a new course is building results-driven problem solvers
