Aim Measurement of EMS performance and quality has been confined to response times or a small number of acute conditions and do not account for patient or system factors that may affect outcome. We developed a small set of consensus derived risk adjusted indicators to potentially measure EMS performance reflect and assessed what risk factors need to be included.

Method We developed 5 indicators:

1. mean change in pain score,

2. % accuracy of identification of 16 emergency conditions,

3. % inappropriate decisions to leave patients at scene,

4. % patients transported to ED not needing hospital facilities,

5. % survival to admission and 7 days for 16 emergency conditions.

We also created a linked dataset of ambulance, hospital and mortality data. For each indicator we used a 3 step process to build multivariable statistical models using a range of variables including age, gender, condition, environment (deprivation), health area and treating hospital.

Results 1 87 387 cases were available. One indicator (mean change in pain score) did not require risk adjustment. For all other indicators age, condition (or call reason) and deprivation were included in the final model. Gender was also included in indicators 2, 3 and 4 and hospital had an effect in indicators 4 and 5.

Conclusion We have created a set of indicators to reflect care for a broad range of EMS callers and care provided. Overall, a range of factors influence outcome and risk adjusted indicators are needed to provide fair and accurate assessments of performance.

Conflict of interest None

Funding NIHR Programme Grants for Applied Research.