title: Evaluating clinical care in the prehospital setting: Is Rapid Emergency Medicine Score the missing metric of EMS?
abstract: BACKGROUND
  The Rapid Emergency Medicine Score (REMS) was developed to predict emergency department patient mortality. Our objective was to utilize REMS to assess initial patient acuity and evaluate clinical change during prehospital care.
  
  
  METHODS
  All non-cardiac arrest emergency transports from April 1, 2013 to March 31, 2014 were analyzed from a single EMS agency. Using age, pulse rate, mean arterial pressure, respiratory rate, oxygen saturation, and Glasgow Coma Scale, initial and final REMS were calculated. Change in REMS was calculated by initial minus final with a positive number indicating clinical improvement. Descriptive analyses were performed calculating means and 95% confidence intervals.
  
  
  RESULTS
  There were 61,346 patients analyzed with an average initial REMS of 4.3 (95% CI: 4.2-4.3) and an average REMS change of 0.37 (95% CI: 0.36-0.38). Those patients classified with the highest dispatch priority had the highest initial REMS (5.8; 95% CI: 5.5-6.2) and the greatest change (0.95; 95% CI: 0.72-1.17). Patients transported with high priority had greater initial REMS, as well as greater improvement in REMS (high priority 7.3 [95% CI: 7.1-7.4], change 0.61 [95% CI: 0.53-0.69]; middle priority 5.3 [95% CI: 5.2-5.4], change 0.55 [95% CI: 0.51-0.59]; low priority 3.9 [95% CI: 3.8-3.9], change 0.32 [95% CI: 0.31-0.33]).
  
  
  CONCLUSIONS
  Descriptive analyses indicate that as dispatch and transport priorities increased in severity so too did initial REMS. The largest change in REMS was seen in patients with the highest dispatch and transport priorities. This indicates that REMS may provide system level insight into evaluating clinical changes during care.
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Alter
authors.affiliation: Mecklenburg EMS Agency, Charlotte, NC, United States.
authors.forename: Allison
authors.initials: A
authors.lastname: Infinger
authors.affiliation: Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC, United States; Mecklenburg EMS Agency, Charlotte, NC, United States.
authors.forename: Doug
authors.initials: D
authors.lastname: Swanson
authors.affiliation: Mecklenburg EMS Agency, Charlotte, NC, United States. Electronic address: jonst@medic911.com.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Studnek
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003422:Critical Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D014218:Triage / Q000379:methods / Q000592:standards*
keywords: Emergency medical services; Epidemiology; Health status indicators