This document is a report that presents the inaugural ESO EMS Index, which analyzes trends impacting EMS organizations in 2018. The report emphasizes the importance of data utilization for informed decision-making and improving interoperability among EMS departments. It outlines various metrics for evaluating EMS performance, including stroke assessment and overdose response, based on data from over 5 million patient encounters in 2017. The index serves as a reference for EMS organizations to identify areas of alignment and opportunities for improvement. It details specific metrics such as the percentage of patients receiving complete stroke assessments and the performance of overdose response. Additionally, the report discusses best practices for monitoring and documenting assessments to enhance patient outcomes. The findings aim to guide EMS leaders in refining their tactics and resource allocation to improve efficiency and effectiveness in emergency medical services.