Monthly Archives: February 2012

The Role of Response Time in EMS Performance

Several months ago, Rob Lawrence of the Richmond Ambulance Authority started a thread on the High Performance EMS Group of LinkedIn by asking “So what does the phrase ‘High Performance EMS’ mean to you?? This innocent sounding question sparked immediate debate even within the small group at that time. Benjamin Podsiadlo of AMR quickly tied the quality of EMS performance to “experience? and “outcomes? stating further that “response time is not an evidence based factor in ALS performance.? He later backed up his assertion by writing that “the catch 22 of pushing the workforce to be responsible and accountable drivers while simultaneously achieving narrow response time goals to the vast majority incidents that have no medical need for such high speed driving is also a bizarre and irresponsible contradiction.? This is a point that even Lawrence admits could foster the “mentality of ‘arrive on time and the patient dies – good outcome, arrive late and the patient lives – bad outcome’? that has already been affecting common sense both in the UK and increasingly in the US since NFPA 1710 set response time standards several years ago.

While there were other good comments, I would like to focus on the specific assertion that measuring response time (a well established practice today such as at Huron Valley Ambulance’s public web Performance Dashboard) is not an “evidence-based? practice. There are many specific accounts of individual lives saved that I have heard mentioned by different agencies, but I will concede that the plural of “anecdote? is not “data?. However, one of the best stories of response time saving lives was made on February 9 when Richard Sposa of Jersey City Medical Center EMS discussed an interesting finding in a recent webcast. The chart reproduced here shows a correlation between

Return of Spontaneous Circulation vs. Response Time

response time and the Return of Spontaneous Circulation (ROSC). This unexpected finding clearly traced an upward trend of ROSC with the decline in Average Response Time for Priority 1 Calls graphed quarterly from the beginning of 2005 to the end of 2007. This is a verified statistical trend (Mount Sinai Hospital reviewed these findings) and I suggest you click to view the graph in full detail. This shows not just living anecdotes, but a statistical increase patients with restored heartbeats.

Many things about our business can and should be questioned, but this is exactly the sort of evidence I would like to see investigated at other services. Can what Jersey City Medical Center is experiencing be reproduced elsewhere? And probably more importantly, does fast response necessarily mean “high speed driving??

The point of System Status Management (SSM) is that ambulances can be effectively pre-positioned through scientific statistical forecasting in order to reduce the time of a response even without driving faster to the call.  Zoll Software Solutions, as an example, considers the elimination of inefficiencies to be a core component for closing the loop on your dispatch process and is even offering free medical equipment to customers who use this technology to improve their system. One customer who has done this already with Zoll technology is Grand Rapids who was also featured in the following FOX News video on Predicting Where your Next Emergency will Happen.

If you believe that knowing where your next calls are likely to come from in time to allow you to safely prepare for that response, the science is available today. You just need to be able to integrate that knowledge into your process.

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Filed under Dispatch & Communications, EMS Dispatch, EMS Topics, Opinion, Rescues, Technology & Communications, Uncategorized, Vehicle Operation & Ambulances

ATale of Two Cities

Just today I have watched two very different stories about two very different Michigan cities. The first one in the news was Detriot and then later it was Grand Rapids. The common thread between the two is about getting control of the EMS system and improving its performance.

The situation in Detroit is truly sad and stems from a variety of problems spanning years. At this point the Governor is considering the appointment of an emergency manager while the system faces financial difficulties and now possible privatization. The comment that struck me in the video, however, was when the union president suggested that outsourcing would mean the city loses control of EMS. Is this really a system “in control??

The story in Grand Rapids is very different. They began looking for control by trying to understand their existing system. What did they already know and how could that help them do a better job? They turned to study habits in their system and employ “System Status Management?. The sucess they found also earned them a local news story, but the tone was very different than the one above.

The question you need to answer is who is really in control of your system? That answer will determine whether the next news story about your service will be more like the one in Detroit or more like Grand Rapids. What is working for you?

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Filed under EMS Dispatch, Opinion, Technology & Communications

A New Look

Whether you have been one of our followers this past year or just found us recently, we appreciate your interest in High Performance EMS and our revised blog site. We are excited to now be a part of the FireEMS Blogs network and look forward to the possibility of reaching a larger audience and hearing from additional voices. Please bookmark the URL at http://HighPerformanceEMS.com in place of any previous addresses and visit back here often. You can expect to find conference reviews, technology updates, topical opinions, and profiles of High Performance EMS agencies along with links to key topics and constantly updated news feeds and tweets.

As an additional resource, we have a Solutions tab that links you to providers that enhance the capabilities of your EMS agency to become more efficient and effective in delivering prehospital care. This is not a paid advertisement listing, but an “invitation-only? section where vendors earn their inclusion by proving their value in successful implementations that show a positive return on investment. The Guest Blog tab provides information on how you can submit a posting to be considered for inclusion in this blog. There are some rules and we reserve the right to accept or reject content based on its perceived value to our community. If you want to learn more about why this blog was created and what we hope to accomplish, check out the About tab. If you have comments or suggestions, we love to hear those too. So feel free to post a comment anytime.

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There are also other ways to keep in touch with High Performance EMS topics and the discussion around them through various social media options. We are on Twitter and Facebook and would love to have you “follow? or “like? us to keep in touch.

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Filed under Uncategorized

A New Look (and Updated URL)

Whether you have been one of our followers this past year or just found us recently, we appreciate your interest in High Performance EMS and our revised blog site. We are excited to now be a part of the FireEMS Blogs network and look forward to the possibility of reaching a larger audience and hearing from additional voices. Please be sure to click and bookmark the URL at http://HighPerformanceEMS.com in place of any previous addresses and visit back here often. You can expect to find conference reviews, technology updates, topical opinions, and profiles of High Performance EMS agencies along with links to key topics and constantly updated news feeds and tweets.

As an additional resource, we have a Solutions tab that links you to providers that enhance the capabilities of your EMS agency to become more efficient and effective in delivering prehospital care. This is not a paid advertisement listing, but an “invitation-only” section where vendors earn their inclusion by proving their value in successful implementations that show a positive return on investment. The Guest Blog tab provides information on how you can submit a posting to be considered for inclusion in this blog. There are some rules and we reserve the right to accept or reject content based on its perceived value to our community. If you want to learn more about why this blog was created and what we hope to accomplish, check out the About tab. If you have comments or suggestions, we love to hear those too. So feel free to post a comment anytime.

Leave a comment

Filed under Uncategorized