The 2020 ESO EMS Index: COVID-19 Special Edition is a technical report that analyzes data from approximately 2,000 agencies and departments across the United States, focusing on 911 calls and related metrics during the COVID-19 pandemic. This report compares data from January 1, 2020, to July 31, 2020, with the previous year to evaluate the impact of COVID-19 on emergency medical services (EMS). Key metrics include overall 911 call volume, personal protective equipment (PPE) usage, and vital sign documentation. The report documents a significant decrease in total 911 call volume, particularly during April 2020, alongside an increase in non-transports and cardiac arrests. It raises questions regarding PPE documentation and highlights trends in opioid overdose calls. The report aims to provide EMS organizations with a framework for performance evaluation and resource allocation, emphasizing the importance of data in understanding the pandemic's effects on emergency services.