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Insights, actions and the future of EMS: The 2025 ESO EMS Index

In this data-packed EMS One-Stop episode, Drs. Brent Myers and Remle Crowe share 7 critical metrics, from opioid overdoses to pediatric behavioral health, reshaping prehospital care

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In this special data-driven edition of the EMS One-Stop podcast, host Rob Lawrence is joined by Dr. Brent Myers, chief medical officer, , and Dr. Remle Crowe, ESO鈥檚 director of clinical and operational research, to unpack the newly released .

This annual report provides a powerful, real-world snapshot of national EMS trends 鈥 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

鈥淭his is just really a conversation starter plus, and as long as we get to that point, then I think we鈥檙e having a conversation about something besides response time.鈥 鈥 Dr. Brent Myers

鈥淭his is not an ESO-specific document ... anybody can look at these metrics and take one small action toward improvement.鈥 鈥 Dr. Remle Crowe

鈥淚 would be very surprised if we don鈥檛 see a different method of documentation鈥攎ore of an ambient listening 鈥 we鈥檙e very close and headed in that direction.鈥 鈥 Dr. Brent Myers

鈥淏ack in the day, we just had the 鈥業 feel, I think, my gut reaction is.鈥 Now, I鈥檝e got the piece of paper with the peer review or the absolute information on it that I can say, here鈥檚 the proof in the pudding in order to generate the change that we need to make.鈥 鈥 Rob Lawrence

鈥淥ne out of every eight pediatric EMS encounters involves a behavioral health or potential substance use disorder component.鈥 鈥 Dr. Remle Crowe

鈥淚f they don鈥檛 embrace it, we haven鈥檛 designed it correctly 鈥 this should be making their day easier, not harder.鈥 鈥 Dr. Brent Myers

鈥淲e鈥檙e not judging systems 鈥 we鈥檙e asking, 鈥楢re your protocols in alignment with the best evidence today?鈥欌 鈥 Dr. Remle Crowe

Timeline

01:08 鈥 Overview of the ESO EMS Index and its intent

02:59 鈥 Origins of the report and data methodology

05:46 鈥 Database scale: 14M+ records, 3,000+ agencies

07:14 鈥 Metric 1: Pain management for long bone fractures

10:53 鈥 Documentation, AI in EMS, and future documentation tools

14:30 鈥 Metric 2: Suspected opioid overdose and buprenorphine use

18:51 鈥 Best practices, COWS scoring, and naloxone delivery strategy

21:31 鈥 Metric 3: Invasive airway confirmation using waveform capnography

28:06 鈥 Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)

34:34 鈥 Metric 5: Prehospital whole blood surveillance

40:22 鈥 Metric 6: Pediatric behavioral health and substance use disorder cases 44:54 鈥 Metric 7: High utilization patient group (HUG)

52:48 鈥 Final thoughts, calls to action, and Rob鈥檚 reflections

55:47 鈥 Episode wrap-up and subscription reminder

Related resources

Previously on EMS One-Stop

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK鈥檚 Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is the President of the Academy of International Mobile Healthcare Integration (AIMHI) and former Board Member of the American Ambulance Association. He writes and podcasts for SA国际传媒 and is a member of the SA国际传媒 Editorial Advisory Board. Connect with him on .