Administration and Leadership, Training

EMS Compass Steers Industry Toward Performance Improvement Culture

Issue 2 and Volume 41.

EMS Compass is a national initiative created to help EMS systems improve patient care by using their data to measure performance. Managed by the National Association of State EMS Officials (NASEMSO) and funded through a cooperative agreement with the National Highway Traffic Safety Administration (NHTSA), the EMS Compass initiative is developing a process that will allow the EMS community to design and test evidence-based performance measures that can be used at the local level to support improvement efforts.

Robert R. Bass, MD, FACEP, currently serves as chair of the steering committee for EMS Compass.

Robert R. Bass, MD, FACEP, currently serves as chair of the steering committee for EMS Compass. Photo courtesy RedFlash Group

Robert R. Bass, MD, FACEP, currently serves as chair of the steering committee for EMS Compass. Bass retired in 2014 after 20 years as the director of the Maryland Institute for EMS Services. Bass previously served as a local EMS medical director and also participated in a number of national initiatives, including the 1996 “EMS Agenda for the Future.” We spoke with him to learn more about EMS Compass and creating a culture of performance improvement in EMS.

JEMS: You interrupted your retirement to take on a leadership role with EMS Compass. Why is this initiative so important?

Bass: When I was asked to chair the steering committee, it was something I didn’t have to think about very long. I believe that collecting and utilizing data to make changes in systems that improve patient outcomes and safety is very important. We’ve been working on this for a long time with a lot of support from our federal partners, starting decades ago with efforts to develop national standards for data elements [of an electronic patient care record] and the creation of NEMSIS [the National EMS Information System], which utilizes these data standards to populate the national EMS database. So obviously it’s important to figure out how we’re going to use these data to improve the care EMS provides to patients.

JEMS: How does EMS Compass compare to other national projects you’ve been a part of?

Bass: Clearly the EMS Compass project is an important milestone on the road to implementing the recommendations of the “EMS Agenda for the Future.” It’s going to provide the means for us to be more focused on system improvements through the use of data to make changes that will improve the efficiency and effectiveness of EMS. It just makes sense. Over the past two decades, we’ve spent a lot of time developing data standards so that we could have interoperability of datasets. Now we have to develop the tools that will enable EMS providers nationwide to use data in a meaningful, evidence-based way to improve patient outcomes and safety.

JEMS: What’s the potential impact of performance measurement on EMS?

Bass: Using data to improve patient care and safety through the development of a small set of core measures is currently the principal focus of EMS Compass, but the project has the potential to improve almost everything we do in EMS. In the future, we hope there will be an opportunity to develop measures that will improve operations, fleet management and the safety of our workforce. These are all important aspects of an EMS agency that are worth improving in their own right, but also because improvements in the efficiency of EMS operations could free up resources that could be put into improving patient care.

JEMS: EMS Compass launched about one year ago. What have we learned so far?

Bass: Even though I knew this was going to be a difficult project, designing the performance measures themselves has not been the hardest part. The hardest part has been figuring out how to develop a process that is inclusive of the EMS community, but at the same time, addresses foundational issues of science. We want these measures to be evidence-based. How you blend together the interests of field EMS providers, managers, medical directors, researchers, public health officials, and other stakeholders to develop a core set of evidence-based measures has been the biggest challenge.

JEMS: What’s surprised you most during the first year of EMS Compass?

Bass: It comes back to this issue of how difficult it’s been to blend the needs of EMS providers and stakeholders with the science aspects of this project. For example, one of the issues that has been raised is that we should be developing measures that only uses data that’s in NEMSIS because it’s too difficult or not possible for some agencies to access hospital data. Yet the science says that in the case of sudden cardiac arrest, the outcome we should be measuring is the percentage of cardiac arrest patients that are discharged from the hospital alive and functional.

We hope to find a middle ground on this issue. We could end up having two measures: a definitive evidence-based measure that requires hospital data to calculate, and another measure that’s easier for EMS to calculate, but is not as meaningful. If we take this approach, it will be important to point out that the evidence-based measure is the gold standard and that we all need to work together—with our federal partners, EMS services, state partners, and hospitals—to make sure that, as a system, we all have access to the data that’s necessary to do evidence-based performance improvement.

JEMS: You’re talking about data that not everyone has access to. Will EMS Compass help us figure out which data to collect?

Bass: Absolutely. Anyone that’s done performance improvement knows that it’s an iterative process. You develop measures, and you find out you’re missing data, or the data is collected wrong. There are always adjustments to make.

JEMS: How has the EMS community’s participation benefited EMS Compass?

Bass: It’s been very helpful. If we construct something in isolation, then we’re potentially going to end up with measures that don’t work or won’t be used. I was really gratified to see how much interest there is out there in performance measures and how much people have really been thinking about them. We had hundreds of suggestions, but what was interesting was that there was a lot of overlap, and we could see clusters where there seemed to be clear consensus. When you see those large clusters, and it lines up with what science says is important to patient outcomes, that’s the best of both worlds.

JEMS: EMS Compass is creating a system for designing performance measures, but how do we create a culture of performance improvement in EMS?

Bass: First of all, it’s critical that this project be a transformational project. We’ve seen performance improvement revolutionize healthcare, and before healthcare we saw it in industry. In EMS, there are a number of services in the U.S. that have been at this for quite a while. A great example is Seattle, where they have been measuring cardiac arrest outcomes for decades. Expanding that approach and using data more broadly to measure patient outcomes beyond cardiac arrest—trauma, stroke, pediatric issues and safety, for instance—that whole concept is so important, and this project needs to be transformational in that regard. We have to make sure EMS as a whole—managers, medical directors, field providers, and regulators— understands how important this is.

JEMS: Can EMS Compass and measuring performance improve the EMS industry’s standing in the healthcare community?

Bass: Absolutely. Much of the healthcare industry is already participating in performance improvement. We know there are EMS agencies that are doing it, some to a greater degree than others. But if we don’t do it more broadly and comprehensively as an industry, we’re not going to have the credibility in the healthcare community that we need to have. This is something that we must do. We need to develop these measures and then use them to demonstrate that we can improve outcomes.

JEMS: What risks exist for EMS agencies not using data to measure performance?

Bass: The principal risk is that the patients you serve won’t have the outcomes you desire. Beyond that, communities increasingly want to know how well their local services are performing. If you can’t provide that data, then you’re going to potentially lose the trust of the community that you serve.

JEMS: What’s the future of EMS Compass? How can the EMS and prehospital community sustain the initiative?

Bass: If we were to simply publish a set of measures and not follow through with education and support for EMS agencies that are implementing performance improvement, then our efforts wouldn’t be transformational. We know we’ve got many issues to address in the future: how to improve access to all the data that are needed, how to build on what we have learned and how to develop future measures and update existing measures when the science changes.

We need to engage national EMS organizations in a discussion on how we can collectively build on the work of the EMS Compass project and support EMS systems at all levels as they undertake this major transition to adopting a culture of performance improvement. This is definitely worth the time and investment and will ultimately benefit EMS systems and the patients they care for.

EMS Compass

For more information on EMS Compass visit, attend the fullday EMS Compass summit and conference sessions at the 2016 EMS Today Conference (, and look for our comprehensive EMS Compass supplement included in our May issue.