Monthly Archives: January 2011

EMS "Frequent Flyer" Abuse

A recent article at JEMS.com on EMS System Abuse told of examples of “frequent flyers? (that is non-emergency patients requesting multiple transports by EMS agencies on a fairly regular basis) many of which would be amusing if they weren’t so sad. The author offered up that while it is a serious practice of abuse by the public, it is also a problem with no solution. Perhaps, however, that is somewhat of an over-simplification as the article did suggest after all that if we could first cure poverty, homelessness, mental illness, substance abuse, domestic abuse, lack of primary care and education then we could perhaps eliminate the indiscriminate use of emergency services.

From a quick review of the solutions implemented in the past by multiple agencies to avoid abuses involving non-emergency transport including taxi vouchers, bus passes, referrals to physician offices, etc. which have been implemented and then often abandoned it is clear that the problem is not easily solved.  The fear of litigation for under estimating the urgency of a call is a strong motivator to permit these abuses, but that also comes at a cost.

While it may be easy for those who are not responsible for managing the budget to say it simply can’t be solved, can agency management continue to utilize resources in an inefficient manner indefinitely by weighing the cost of a potential lawsuit as the cost justification? How does a High-Performance EMS agency balance the unfettered demand for transport with optimization of services to control costs? We’d like to hear about your experiences or insights.

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Filed under Administration & Leadership, Dispatch & Communications, ems, Funding & Staffing, News, Opinion

EMS “Frequent Flyer” Abuse

A recent article at JEMS.com on EMS System Abuse told of examples of “frequent flyers” (that is non-emergency patients requesting multiple transports by EMS agencies on a fairly regular basis) many of which would be amusing if they weren’t so sad.  The author offered up that while it is a serious practice of abuse by the public, it is also a problem with no solution.  Perhaps, however, that is somewhat of an over-simplification as the article did suggest afterall that if we could first cure poverty, homelessness, mental illness, substance abuse, domestic abuse, lack of primary care and education then we could perhaps eliminate the indiscriminate use of emergency services.

From a quick review of the solutions implemented in the past by multiple agencies to avoid abuses involving non-emergency transport including taxi vouchers, bus passes, referrals to physician offices, etc. which have been implemented and then often abandoned it is clear that the problem is not easily solved.  The fear of litigation for under estimating the urgency of a call is a strong motivator to permit these abuses, but that also comes at a cost. 

While it may be easy for those who are not responsible for managing the budget to say it simply can’t be solved, can agency management continue to utilize resources in an inefficient manner indefinitely by weighing the cost of a potential lawsuit as the cost justification?  How does a High-Performance EMS agency balance the unfettered demand for transport with optimization of services to control costs?  We’d like to hear about your experiences or insights.

4 Comments

Filed under ems

"No Available EMS"

No one really wants to read a bad story about some other EMS agency, but it is even worse to read a similar story about your own. The purpose of this post is not to make Detroit into some “failed EMS poster child? but intended to shed some light on similar problems that may be all too common at other locations as well. For instance, I am sure that the Detroit EMS is not alone in being accused of having their service underfunded and their resources understaffed. I also know there are many other agencies out there paying penalties for “exceptions? (calls outside the expected response time), but holding a call for an hour before dispatch as claimed by EMS workers in a Detroit Examier story is certainly not a common trait of a High Performance EMS. Actions like this are certainly worthy of examination, however, the thing that has really set Detroit apart right now is the realignment of its fleet effective January 3rd in response to the death of Gordon Mickey shortly before Christmas of 2010.

According to Detroit Free Press reporters in an article published in EMS World just today, the plan is to reallocate eight ALS (Advanced Life Support) ambulances to Basic Life Support (BLS) units by reorganizing the Paramedic/EMT teams. Jerald James, Detroit EMS Chief, said that the model “will help better address non-emergency runs? which can make up about 65% of the roughly 130,000 dispatches each year. But in the same article, a “city paramedic? was said to have expressed concern that the wrong ambulances will end up at the wrong calls identifying dispatch’s difficulty with properly prioritizing EMS response. Interestingly, Detroit had already reorganized its EMS service back in 2004 by adding Echo units (paramedic equipped vehicles without transport capabilities) to its formerly all-ALS ambulance fleet but concern was expressed even back then that “tiering? the system to add Echo units and converting certain ALS units to BLS years ago was not an answer to increasing service.

While the specific case in Detroit may have many unique conditions or particular circumstances leading to their current status, the idea I want to spotlight is the not-so-unique idea of reallocation of staff and resources just to improve the emergency response statistics rather than looking more broadly to improve overall EMS response. As David Konig (The Social Medic) describes the situation in his recent blog, downgrading certain 911 calls from ALS emergencies to BLS status is just “shuffling the deck? to improve response time stats in one category over another. I believe he correctly deduces a major part of the answer by saying that “systems improve service and response through intelligent deployment.?

It is exactly that type of “intelligent deployment? that is the driving motivation behind the Mobile Area Routing and Vehicle Location Information System (MARVLIS) suite of products. Using an agency’s own historical data, MARVLIS forecasts future demand by geographically highlighting the “most likely demand areas” with a confidence of approximately 80%. It is also the only system to dynamically predict vehicle response zones to calulate up-to-the-minute demand and geographic coverage based on vehicle status and location – even when units are moving!  This proven system has reduced response times, held growth in future spending, and improved the clinical outcome while working with EMS staff to improve operating conditions not squeezing productivity.

We would love to hear your comments or experiences on this topic, so please add a comment below and check back often for future discussions.

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Filed under Administration & Leadership, Dispatch & Communications, ems, EMS Dispatch, EMS Topics, Fire Dispatch, Funding & Staffing, News, Opinion, Technology, Technology & Communications, Training & Development

“No Available EMS”

No one really wants to read a bad story about some other EMS agency, but it is even worse to read a similar story about your own.  The purpose of this post is not to make Detroit into some EMS “posterchild” but intended to shed some light on similar problems that may be all too common at other locations as well.  For instance, I am sure that the Detroit EMS is not alone in being accussed of having their service underfunded and their resources understaffed.  I also know there are many other agencies out there paying penalities for “exceptions” (calls outside the expected response time), but holding a call for an hour before dispatch as claimed by EMS workers in a Detroit Examier story is certainly not a common trait of a High Performance EMS.  Actions like this are certainly worthy of examination, however, the thing that has really set Detriot apart right now is the realignment of its fleet  effective January 3rd in response to the death of Gordon Mickey shortly before Christmas of 2010.

According to Detroit Free Press reporters in an article published  in EMS World just today, the plan is to reallocate eight ALS (Advanced Life Support) ambulances to Basic Life Support (BLS) units by reorganizing the Paramedic/EMT teams.  Jerald James, Detroit EMS Chief, said that the model “will help better address non-emergency runs” which can make up about 65% of the roughly 130,000 dispatches each year.  But in the same article, a “city paramedic” was said to have expressed concern that the wrong ambulances will end up at the wrong calls identifying dispatch’s difficulty with properly priortizing EMS response.  Interestingly, Detroit had already reorganized its EMS service back in 2004 by adding Echo units (paramedic equipped vehicles without transport capabilities) to its formerly all-ALS ambulance fleet but concern was expressed even back then that “tiering” the system to add Echo units and converting certain ALS units to BLS years ago was not an answer to increasing service.

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Hello World. Welcome to HP_EMS!

The world of the EMS provider is changing.  Whether you call it EMS 2.0 or Next Generation 911, it is no longer enough to simply do a good job resulting in positive clinical outcomes for patients.  Increasing budget pressures require that these quality services be maintained while providing them within a context of higher economic efficiency.  High Performance EMS (HP_EMS) is not about just balancing patient needs with operational costs but simultaneously enhancing both clinical and economic performance.  While there are many tools to assist with this goal, there is no single “magic bullet” just as there is also no single performance metric.  This market dynamic is the reason behind the HP_EMS blog: to faciltate a discussion between agencies, industry insiders, and subject matter experts about how we can collectively do better on all measures.

We encourage you to participate by responding to posts with answers and suggestions or even your doubts and skepticism.  You may even submit your own guest blog posting for others to learn from or make comment.  This forum is all about what you do in EMS from the time someone calls 911 until the Pt arrives at the hospital!  It is hosted by Bradshaw Consulting Services (BCS) and our partners because we want to help you get the information you want to have in order to make the decisions you need to make that deliver the services your public expects.  All of us have data (and opinions), but together we can transform it all into meaningful and actionable information that is useful to the entire community.  Moderation of the discussion will be minimal and limited to igniting conversation and maintaining a respectful and useful conversation focused on the topic High Performance EMS.

So, join the discussion!  It’s about your work – to help you and others do a better job delivering high quality emergency management services to the public within a new era of accountability.  Please share your thoughts… 

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Filed under Administration & Leadership, EMS Topics, News, Opinion, Patient Management, Technology & Communications, Training & Development