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

Abstract

Objectives: To describe national performance on complete vital sign assessment during emergency medical services (EMS) encounters resulting in non-transport, stratified by patient, agency, and incident characteristics.

Methods: We conducted a retrospective analysis of the 2023 National EMS Information System (NEMSIS) Public Release Research Dataset. Adult (≥18 years) patients from 9-1-1 incidents resulting in non-transport were included, excluding cases with cardiac arrest prior to EMS arrival. A complete vital sign set was defined as heart rate, respiratory rate, pulse oximetry, systolic blood pressure, and level of consciousness. Descriptive statistics and univariable logistic regression were used to evaluate performance across demographic, agency, and incident-level variables.

Results: Among 5,983,628 eligible non-transport incidents, only 54.6% (n = 3,267,407) had a complete set of vital signs documented, while 9.8% (n = 586,968) had no documented vitals. Assessment and documentation of individual vital signs ranged from 70.9% (SpO₂) to 86.0% (heart rate). Agency-level performance varied widely, with Advanced Life Support units achieving 57.3% complete assessments compared to 44.7% for Basic Life Support and 26.8% for Emergency Medical Responder units. Vital sign assessment varied with scene time, significantly improving when scene time exceeded 15 min. Vital sign completeness was highest for dispatches related to chest pain and breathing problems and lowest for behavioral issues and motor vehicle collisions. Falls in patients aged 60 years and older represented a large subset of incomplete assessments, accounting for 15.1% of all non-transport incidents with incomplete vital signs and 18.2% of patients with no vital signs.

Conclusions: Nearly half of EMS non-transport incidents lack complete vital sign assessment, and 10% have no vitals recorded. Given the critical role of vital signs in evaluating a patient's clinical condition and patient safety, these findings highlight substantial variability in EMS performance and a need for targeted quality improvement-particularly in high-risk populations such as older adults following falls.