Oregon EMS & Trauma Systems Program, Public Health Division, Oregon Health Authority
Last Updated: 2022-01-20
The Oregon EMS & Trauma Systems Program develops and regulates systems for quality emergency medical care in Oregon, ensuring that EMS Providers are fully trained, that emergency medical vehicles are properly equipped, and emergency medical systems are functioning efficiently and effectively. EMS includes dispatch centers (the initial 911 call point of contact), emergency medical response, field triage, treatment and stabilization, and transport by ground or air ambulance to a hospital. EMS provides inter-hospital transfers, by ground ambulance, helicopter or fixed-wing aircraft between hospitals. Inter-hospital transport (IHT) can span hundreds of miles and is an integral aspect of the continuum of care, moving complex patients to higher levels of care.
Senate Bill 52 (2017) required Oregon licensed EMS Agencies report patient encounter data to the Oregon EMS Information System (OR-EMSIS) in the form of a standardized electronic Patient Care Report (ePCR). These data are used for purposes of EMS care quality improvement, disaster and mass casualty event planning and response, trauma research, public health prevention, tracking patient outcomes, and ensuring high-quality emergency medical care throughout the state. This dashboard presents data related to EMS care in Oregon for 2020.
All data used in the preparation of this dashboard is drawn from OR-EMSIS the Oregon EMS License Management System (LMS) except where otherwise noted. Direct any questions regarding Oregon EMS & Trauma to EMS.Trauma@dhsoha.state.or.us.
This chart draws on data about EMS agencies reporting NEMSIS 3.X data to the OR-EMSIS system in 2020. Transporting agencies in Oregon are reporting to the system by an overwhelming margin (89.6%). Of the remaining agencies, half are currently scheduled to onboard to the system. These numbers also reflect a small degree of churn in EMS agencies. Year 2020 saw 3 entities drop their licenses, and three new ones apply for a license. A small number of agencies currently still have waivers in place that give them until the end of 2021 to report.
Note that under statute non-transporting agencies are not currently required to report to OR-EMSIS. Only 13.1% of non-transporting agencies currently report to OR-EMSIS. Another 6.7% are scheduled to onboard to the system.
This chart draws on license data for EMS personnel over the last 3 years. These data indicate that the workforce is relatively stable and that at the EMT and Paramedic levels 2020 saw an increase in licensed providers
This plot draws on data for all ambulances licensed to active transporting agencies with documented certification level = “Ground.” The box plot represents the distribution of ambulance age in years. The box in the center represents the middle half of ambulance units, with the line in the center representing the median, or middle value. Individual data points are superimposed over the box plot to show frequency/density, and allow drill down to the level of the individual ambulance.
This figure indicates that the median age of ambulances serving Frontier areas is considerably greater than that of urban or rural areas. The age range of ambulances serving rural and frontier areas is wider than that of ambulances in urban areas, with the distribution skewed toward older units. Nearly a quarter of ambulances in service in frontier areas are older than the oldest ambulance currently in use in urban areas statewide.
This analysis does not take into account wear and tear on the vehicle, or mileage due to lack of data.
This chart draws on EMS response data on the service of level (ALS, BLS, Special Critical Care) of ambulances responding to frontier, rural and urban areas. The chart represents the percentage of calls at each service level to allow comparison between regions with very different populations.
Frontier areas of the state rely more heavily on Basic Life Support (BLS) ambulances (21.2%). Rural and Urban areas are served predominantly by Advanced Life support (ALS) ambulances (92.8 and 92.1% respectively).
Limitations of this analysis are the presence of missing values for zip code, and, to a lesser extent, service level. Designation is based on zip code, and there are a considerable number of records with missing zip codes, zip codes that contain an error, or zip codes that do not correspond to a geographic area. An attempt has been made to classify zip codes that correspond to P.O.boxes, based on the location of the post office. These zip code errors may be disproportionately in Frontier and rural areas. Additional work is required for data validation.
This chart draws on data from the Oregon EMS License Renewal survey completed each year by EMS agencies in Oregon.
Starting in 2018, Oregon EMS and Trauma Systems has required transporting agencies in the state complete a survey as part of the license renewal process. This information helps identify key problems that EMS agencies in Oregon face, and is used to inform grants and programs created by the Oregon EMS and Trauma Program and our partners.
The three issues most commonly reported by EMS agencies are recruitment, obtaining equipment, and obtaining continuing education.
This chart draws on data from the Oregon EMS License Renewal survey completed each year by EMS agencies in Oregon.
USDA Rural Urban Commuting Area (RUCA) codes were used to classify Oregon EMS transporting agencies. The RUCA codes were compressed down to four levels: Urban, Large Town, Small Town and Rural. Survey responses were analyzed to find statistically significant differences between the groups.
Rural and small town agencies were more likely to identify an issue, and reported more issues on average than other groups. The key issues reported by rural agencies were the same as the key issues identified statewide: recruitment, equipment and continuing education.
This chart is based on all EMS incidents in Oregon in 2020 (n = 509,317). The graph shows all calls and those in which a patient encounter occurred (n = 418,472). The graph also shows a precipitous drop off in EMS incidents commensurate with the start of the COVID-19 pandemic in April 2020. The number of calls bounced back in the summer and remained stable through the end of the year.
This tiled heatmap is based on all EMS incidents in Oregon in 2020 (n = 509,317). The graph shows all calls broken out by day of the week and time of day. The color of the cells in the graph represent the percentage of total calls that occur at that time on that day of the week. The graph also shows how EMS incidents tend to be clustered between 10 AM and 6 PM, and on week days.
This graph is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). The graph indicates that the number of EMS incidents increase as we move from younger to older age groups. The graph also shows a consistent drop off in EMS incidents across all age groups commensurate with the start of the COVID-19 pandemic in April 2020.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). Data for this chart are drawn from the ePatient.13 data element, Patient Gender, but align with EMS personnel’s assessment of patient biological sex. The unknown category is a combination of missing data, “Unknown” and “Not Documented” values. More complete information will be available in 2021 when transgender codes and descriptors will be added to the national data standard.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). Note that Race and Ethnicity are represented in NEMSIS 3.4 in a single list. All percentages are calculated as the percentage of all EMS patients for whom a particular race or ethnic category was selected. Multiple values may be selected, resulting in percentages that will sum to greater than 100%.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). The graph shows the distribution of EMS incidents across Area Trauma Advisory Board (ATAB) regions. The ATAB is on the x axis with bar height representing the number of EMS patient encounters. Unsurprisingly patient encounters are more prevalent in densely populated urban ATAB regions. The number of encounters tracks with regional population.
This map is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472) County color coding is based on the rate at which county residents were transported in 2020, calculated as the number of transports divided by the population of the county multiplied by a base of 1,000. Rates are standardized based on population estimates from the Portland State University’s Population Resource Center. These rates may be interpreted as the number of EMS transports per 1,000 people in one year.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). The graph shows the distribution of EMS incidents across frontier, rural and urban zip codes. Rural designation is on the x axis with bar height representing the rate of EMS patient encounters per 1000 population. Frontier, rural and urban areas of the state are assigned to incidents based on the zip code in which the incident occurred using definitions from the Office of Rural Health. Rates are standardized based on population estimates from the Portland State University’s Population Resource Center. While there are considerably more calls in urban areas, rural and frontier areas lead the state in the number of calls per person. This may reflect demographic differences between urban and rural areas, with rural areas tending to be older.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 17 records ( 0.0%) that had a missing or undocumented value for dispatch complaint. Percentages were calculated as the number of incidents in which a dispatch complaint was reported divided by the total number of incidents for each year. Please note that because only the top 15 complaints are reported in the graph, the sum of all percentages will be less than 100%.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 352,776 records (84.3%) that had a missing or undocumented value for cause of injury. Most of these were non-injuries, but 29,677 had an ICD-10 code for their primary impression or symptom indicating an injury or poisoning. This will require further review. Percentages were calculated as the number of incidents in which the cause of injury code was reported divided by the total number of incidents for each year. Please note that because only the top 15 causes of injury are reported in the graph, the sum of all percentages will be less than 100%.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 133,275 records (31.8%) that had a missing or undocumented value for primary symptom. Percentages were calculated as the number of incidents in which a primary symptom was reported divided by the total number of incidents for each year. Please note that because only the top 15 primary symptoms are reported in the graph, the sum of all percentages will be less than 100%.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 0 records ( 0.0%) with no documented procedures performed. Percentages were calculated as the number of incidents in which a procedure was performed divided by the total number of incidents for each year. Please note that because more than one procedure may be performed during each EMS incident, the sum of all procedures will be greater than 100%.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 13,524 records ( 3.2%) that had a missing or undocumented value for primary impression. Percentages were calculated as the number of incidents in which a primary impression was reported divided by the total number of incidents for each year. Please note that because only the top 15 primary impressions are reported in the graph, the sum of all percentages will be less than 100%.
This chart is based on all EMS incidents in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 5,649 records ( 1.3%) that had a missing or undocumented value for scene type. Percentages were calculated as the number of incidents in which a scene type was reported divided by the total number of incidents for each year.
This chart is based on all EMS incidents in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 0 records ( 0.0%) that had a missing or undocumented value for disposition. Percentages were calculated as the number of incidents in which a disposition was reported divided by the total number of incidents for each year.
This chart is based on all EMS incidents reported in Oregon in which there was a patient during 2020 (n = 418,472). For the year considered there were 52,832 records (12.6%) that had a missing or undocumented value for destination type. Percentages were calculated as the number of incidents in which a destination type was reported divided by the total number of incidents for each year.
NEMSQA Pediatrics-01 Pediatric Respiratory Assessment
Percentage of EMS encounters originating from a 911 call for a patient less than 18 years of age with primary or secondary impression of respiratory distress for whom a respiratory assessment was performed and documented.
Population:
The population for this metric is drawn from EMS encounters in Oregon where the patient was under 18 years of age for 2019 (n = 13,509) and 2020 (n = 8,991).
Denominator:
EMS encounters for pediatric patient with a primary or secondary impression indicating respiratory distress. Respiratory distress may include impressions of Asthma, Dyspnea, Unspecified Orthopnea, shortness of breath, diagnosis of a respiratory ailment, and complaint or condition commonly associated with dyspnea.
Numerator:
EMS responses originating from 911 requests for patients who received both a SpO2 and respiratory rate measurement during the EMS response.
Measure specification:
https://www.nemsqa.org/wp-content/uploads/2020/11/F.-NEMSQA-Pediatrics-01.pdf
NEMSQA Pediatrics-02 Administration of Beta Agonist for Pediatric Asthma
Percentage of EMS responses originating from a 911 request for patients 2-18 years of age with a diagnosis of asthma who had an aerosolized beta agonist administered.
Population:
The population for this metric is drawn from EMS encounters in Oregon where the patient was under 18 years of age for 2019 (n = 13,509) and 2020 (n = 8,991).
Denominator:
All EMS responses originating from a 911 request for patients 2-18 years of age with a primary or secondary impression of asthma exacerbation or acute bronchospasm.
Numerator:
EMS responses originating from a 911 request for patients who had an aerosolized beta agonist administered by an EMS professional during the EMS response. Beta agonist medications may include Albuterol, Levalbuterol and Metaproterenol.
Measure specification:
https://www.nemsqa.org/wp-content/uploads/2020/11/G.-NEMSQA-Pediatrics-02.pdf
NEMSQA Pediatric-03 Documentation of Estimated Weight in Kilograms
Percentage of EMS responses originating from a 911 request for patients less than 18 years of age who received a weight-based medication and had a documented weight in kilograms or length-based weight estimate documented during the EMS response.
Population:
The population for this metric is drawn from EMS incidents in Oregon where the patient was less than 18 years of age for 2019 (n = 13,509) and 2020 (n = 8,991).
Denominator:
All EMS responses originating from a 911 request for patients less than 18 years of age who received a weight-based medication during the EMS response.
Numerator:
EMS responses originating from a 911 request for patients in which a weight value was documented in kilograms or a length-based weight was documented during the EMS response.
Measure specification:
https://www.nemsqa.org/wp-content/uploads/2020/11/H.-NEMSQA-Pediatrics-03.pdf
NEMSQA Safety-01: Use of Lights and Sirens During Response to Scene
Percentage of EMS responses originating from a 911 request in which lights and sirens were not used during response to the scene. Safety-01 and Safety-02 focus on the judicious use of lights and sirens during response to scene (Safety-01) and during patient transport (Safety-02). The intent of these two measures is to determine how often EMS professionals are using lights and sirens during response and transport, and ensure that this balances concerns of patient outcomes and ambulance safety.
Population:
All EMS patient encounters originating with 911 call.
Denominator:
The total number of EMS responses originating from a 911 request.
Numerator:
EMS responses originating from a 911 request in which lights and sirens were not used.
Measure specification:
https://www.nemsqa.org/wp-content/uploads/2020/11/N.-NEMSQA-Safety-01.pdf
NEMSQA Safety-02: Use of Lights and Sirens During Transport
Percentage of EMS transports originating from a 911 request in which lights and sirens were not used during transport from the scene. Safety-01 and Safety-02 focus on the judicious use of lights and sirens during response to scene (Safety-01) and during patient transport (Safety-02). The intent of these two measures is to determine how often EMS professionals are using lights and sirens during response and transport, and ensure that this balances concerns of patient outcomes and ambulance safety.
Population:
All EMS patient encounters originating with 911 call.
Denominator:
The total number of EMS transports originating from a 911 request.
Numerator:
EMS transports originating from a 911 request in which lights and sirens were not used.
Measure specification:
https://www.nemsqa.org/wp-content/uploads/2020/11/O.-NEMSQA-Safety-02.pdf
Use of Provider Personal Protective Equipment (PPE) for Possible Infectious Disease Patients
Percentage of EMS patient contacts with possible infectious disease where EMS providers used personal protective equipment intended to reduce the transmission of infectious disease. Oregon EMS and Trauma adopted NEMSIS national custom elements related to PPE at the beginning of the COVID-19 pandemic. These elements track PPE type and use by EMS crews during patient care and transport. This measure tracks the documentation and use of PPE in transports with patients displaying symptoms commonly associated with COVID-19.
Population:
This metric is drawn from all EMS episodes of care reported to OR-EMSIS in 2020.
Denominator:
All EMS responses where patient care is provided and symptoms or impressions indicate possible infectious disease.
Numerator:
EMS responses where EMS providers used personal protective equipment (excluding gloves).
This chart is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days of their positive test (n = 7,448). The number of COVID-19 patients transported has risen with the total number of cases. While the percentage of total cases has fallen, the number of transports of COVID-19 patients has increased as a percentage of total transports. Percentages were calculated as the number of patients matched to a positive COVID-19 test divided by all positive COVID tests (n = 166,721) and all EMS patients (n = 418,472).
This chart is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days of their positive test (n = 7,448).
While most COVID patient transports take place after a positive test has been recieved, a significant number of COVID patients are transported prior to testing or diagnosis.
This tiled heatmap is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days prior to their positive test (n = 1,250).
This heatmap indicates that COVID-19 patients present to EMS with a variety of complaints. While most COVID positive patients do get a documented primary impression that is included in the NEMSIS ILI definition, many patients do not, and may present with other non-respiratory conditions.
This chart is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days prior to their positive test (n = 1,250). Percentages were calculated as the number of patients for whom a symptom was reported divided by the total number of patients.
This chart indicates that while many patients may display symptoms we commonly associate with COVID-19 such as fever, cough, or other respiratory symptoms, the most frequently occurring symptoms are weakness and altered mental status. Furthermore, patients are likely to present with various types of pain.
This chart is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days prior to their positive test (n = 1,250). Percentages were calculated as the number of patients for whom a given procedure was reported divided by the total number of patients.
Procedures performed on COVID patients include isolation procedures (3.9%) and surgical face mask placement (2.2%) that are likely COVID related precautions in a small percentage of transports.
This chart is based on all 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days of their positive test (n = 7,448). Percentages were calculated as the number of patients for whom the destination type was reported divided by the total number of patients.
This chart indicates that these patients are most commonly transported to the ED, and to a lesser extent non-emergency hospital admission. Smaller percentages are transported to assisted living facilities or to their homes.
Documented Use of Provider Personal Protective Equipment (PPE) in Treatment of COVID + Patients
Percentage of EMS encounters with patients who tested positive for COVID-19 where EMS providers documented use of personal protective equipment intended to reduce the transmission of infectious disease. The Oregon EMS & Trauma Systems Program adopted NEMSIS national custom elements related to PPE at the beginning of the COVID-19 pandemic. These elements track PPE type and use by EMS crews during patient care and transport. This plot tracks both documentation and use of PPE by EMS personnel.
Population:
All patients treated by EMS in 2020 in Oregon documented in the OR-EMSIS system.
Denominator:
All 2020 EMS incidents in Oregon in which the patient could be matched to a positive COVID-19 test in the ORPHEUS system on name, date of birth, and date of transport within 14 days of their positive test.
Numerator:
EMS responses where EMS providers used personal protective equipment (excluding gloves).