2026 ESO EMS Index Finds One in Five EMS Patients Drives Nearly Half of All 911 Responses

Built on more than 17.3 million 911 records—the largest dataset in the Index's history—the ninth edition also documents an opportunity in prehospital adoption of new ACOG obstetric guidelines and introduces a new dispatch-to-outcome measure on stroke recognition

AUSTIN, Texas, May 06, 2026 (GLOBE NEWSWIRE) -- ESO Solutions, Inc. (“ESO”), a leading data services and software provider for EMS, fire departments, hospitals, and government agencies, today released the 2026 ESO EMS Index, the annual benchmark for prehospital care built on the industry’s largest integrated emergency outcome data asset.

The ninth edition’s most significant findings included:

• One in five patients drove 44% of all responses, indicating a greater need for alternative care pathways for patients with recurring medical needs.
• Prehospital treatment for severe hypertension in pregnancy remains at 5%, indicating an opportunity to implement the new guidelines from the American College of Obstetricians and Gynecologists (ACOG).
• A new measure shows that when dispatchers identified a patient with stroke, EMS clinicians completed the stroke bundle 72% of the time, compared with 47% when the call came in under a different category.
  

Across 8.8 million unique patients identified through ESO's Longitudinal Patient Record, 19% called 911 more than once in 2025, accounting for 44% of all responses. The most common dispatch complaints among repeat callers—sick person, falls, breathing problems, chest pain and convulsions—point to chronic conditions and recurring medical needs rather than emergency events. Identifying these patients through longitudinal tracking is what makes targeted, community-level interventions possible.

"When numbers like these come out, the temptation is to infer the system is being misused. What's actually happening is more nuanced,” said Dr. Brent Myers, M.D., MPH, chief medical officer at ESO. “For many of these patients, calling 911 is the most accessible option for receiving care, as our health care system doesn’t always provide readily available alternatives. And yet, every ambulance dispatched for a chronic condition is one not available for the next emergency. The task for each agency is matching the right care to the right need—community paramedicine, chronic disease management, alternative care pathways—so that the emergency response stays available for everyone who needs it, no matter how often they need it."

Obstetric treatment gap persists

In April 2025, ACOG released three model EMS guidelines for prehospital obstetric emergencies, establishing that severe hypertension in pregnancy should be treated based on blood pressure numbers alone, regardless of symptoms. The 2026 EMS Index indicates opportunities for improvement. Treatment for severe hypertension and postpartum hemorrhage remain relatively unchanged from the prior year at 5% and 17% respectively.

"Given the time needed to change EMS protocols and formularies, it is expected that new guidelines may not be immediately adopted. This is particularly true when the new guidelines include medications not currently carried on most ambulances," said Myers. "What this data makes visible is the significance of the opportunity for improvement. Most agencies have magnesium sulfate on their EMS units. What many don't yet carry are the antihypertensives and oxytocin that the updated ACOG guidelines call for. Driving conversation around those gaps, and giving agencies the data to track their progress in closing them for their communities, is exactly what the EMS Index is designed to do."

More from the 2026 EMS Index

New to this year's Index, the stroke recognition at dispatch measure examines how early identification in the 911 call shapes outcomes further down the chain of survival. The 25-percentage-point gap in stroke bundle completion underscores what is at stake at the moment of dispatch: Patients describing a fall, headache or general weakness may be categorized under non-stroke dispatch protocols, and that initial impression shapes everything that follows, from EMS recognition to facility selection.

Consistent with prior editions, the 2026 EMS Index also found that opioid-related encounters declined as a share of 911 responses for the third consecutive year, mirroring national CDC data, while documented prehospital buprenorphine administrations more than doubled between 2023 and 2025—a signal of growing field-initiated treatment programs. Other measures in this year’s report include prehospital blood administration, pediatric behavioral health emergencies and a new measure aligned with the NEMSQA Syncope-01 quality measure, which tracks 12-lead ECG acquisition among 911 patients presenting with syncope.

The ESO EMS Index is one of three annual reports produced by the ESO Research and Performance Improvement team alongside the ESO Fire Service Index and ESO Trauma Index. Access the 2026 ESO EMS Index here. For more information on ESO, visit www.eso.com.

Methodology and Limitations
The dataset for the 2026 ESO EMS Index report is real-world data, compiled and aggregated from more than 17.3 million de-identified records that occurred in calendar year 2025 across the United States. The purpose of the ESO EMS Index is to support agency-level quality improvement efforts to meet and exceed existing performance trends and serve as a body of literature that adds to the discussion about EMS best practices and quality improvement efforts to enhance patient outcomes. It is not meant as a scientific study nor comprehensive in nature.

All measures in this edition are descriptive and observational. Each measure uses its own inclusion criteria, as described in the report. Year-over-year comparisons use rate-based metrics wherever possible to account for the growing dataset. This report is a descriptive analysis using retrospective data. It does not establish causation and should not be interpreted as a performance evaluation of any individual agency, provider, or patient population.

About ESO
ESO’s mission is to improve community health and safety outcomes through the power of data. Founded and led by emergency responders and medical professionals since 2004, ESO advances the industry by combining deep domain expertise with innovative technology, impactful research and the industry’s largest integrated emergency outcome data asset. The company delivers the world's most trusted and connected emergency ecosystem—an open, interoperable platform that unites emergency medical response, fire, hospital and government stakeholders across the full emergency continuum through real-time data exchange and embedded intelligence in frontline workflows. ESO’s solutions deliver actionable insights to decision-makers, enable smarter coordination across the emergency continuum and uphold the highest standards of data security and patient privacy. The company helps customers around the world deliver measurable improvements in clinical, operational and financial outcomes with dedicated teams in the United States, Canada, United Kingdom, Denmark, Czech Republic, India and Costa Rica. For more information, visit www.eso.com. 

Media Contact:
For ESO,
Anika Grendell
Red Fan Communications
eso@redfancommunications.com
512-662-7078

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