Nordic-Baltic EMS benchmarking-important progress but fragile data foundations.

BACKGROUND: The Nordic-Baltic EMS Network has worked for years to establish comparable quality indicators and benchmarking across emergency medical services (EMS) in participating countries. Three reports, including the recent 2025 edition, promote transparency and collaboration. While these efforts are commendable, concerns remain about the validity of the underlying data. This commentary focuses on such data issues within Denmark and Norway. MAIN BODY: The 2025 report provides descriptive information on EMS organization and proposes shared indicators such as dispatch times, bystander cardio-pulmonary resuscitation rates, and conveyance statistics. However, meaningful comparison depends on standardized, validated data-currently lacking. EMS data across the region are collected under varying definitions and frameworks, making cross-country benchmarking prone to misinterpretation. In Denmark, operational data from the electronic prehospital medical record (ePMR) and separate dispatch systems require extensive processing before research use. Norway faces greater fragmentation, relying mainly on AMIS dispatch data with limited linkage to patient records or registries. Consequently, apparent performance differences may reflect documentation practices rather than true quality disparities. Both countries have strong registry cultures for hospital and primary care data, yet prehospital registry infrastructure is absent. Temporary projects and limited indicators cannot replace sustainable, validated registries. Without these, longitudinal analyses and international benchmarking remain unreliable. SHORT CONCLUSION: The Nordic-Baltic EMS reports represent significant progress, but reliance on operational data introduces uncertainty. Establishing validated, registry-based EMS data systems should be a national priority, supported by the Nordic-Baltic EMS Network, to enable meaningful benchmarking and evidence-based improvements in patient care.