HP-EMS Profile: MedStar Mobile Healthcare

As I was going to be in Dallas for the Fire Rescue conference, I decided to go a little early and pay a visit to MedStar Mobile Healthcare (the renown “birthplace of Mobile Integrated Healthcare”) just over in Fort Worth, Texas.  For anyone who may not have been paying attention to the industry during the last few years, community paramedicine has become a hot topic at conferences for EMS systems that are looking to fill a gap in the healthcare needs of the community.  Significant savings can be realized just in reducing transport demand, especially by “loyal EMS customers”, but additional cost avoidance is available to the hospital in preventing re-admittances.  If you are looking for additional information about implementing a similar program, Matt Zavadsky, director of public affairs at MedStar Mobile Healthcare, has written an excellent description of Community Paramedicine and why it’s the future of our profession.

There is really no doubt that EMS as a practice is changing. However, Paramedics and EMTs will always be critical in responding to emergency calls for service, but MedStar has helped show that they can also be effective in using their skills far beyond that traditional role. While it was the MedStar reputation for innovation in delivering high performance EMS related services that enticed me to visit, I was really most impressed by the back-end systems that keep the care providers on the road and doing their job effectively. Community Care Paramedics like Jimmy Aycox, pictured here with his Panasonic Toughbook, rely on the MARVLIS Client software not only for accurate routing information but also patient details presented from the CAD for filling out patient care reports.

But what makes it all work in the field actually starts in the dispatch center, whether the calls are emergent or scheduled.  Technology is a critical piece used to find the right resource and route the closest paramedics to the right call.  In many routing systems, the travel impedance (the factor that tries to model the real-life movement of a vehicle) is based simply on speed limits to calculate the time required to move from one intersection to another. These systems are static and do not account for various traffic patterns throughout the day or any seasonal variations such as school being in or out of session.  Then there is also the issue of planned road closures or closures due to accidents that can also significantly affect navigation. In this news story about MedStar, the problem with traffic and road closures is highlighted along with their response in employing new technology to account for these issues. During my visit, System Status Controller, Stacey Sokulsky told me that their “older GPS technology could be up to 2 minutes off [in predicting drive times], but I have not seen MARVLIS be off by more than 10 or 15 seconds.” This can make a big difference in selecting which vehicle to dispatch.

Having the right tools makes the job much easier and allows progressive systems like MedStar Mobile Healthcare to do more outside of the traditional role and thinking. Thanks for letting me get a peek at the heart of your system.

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HP-EMS Profile: Cetronia

Growth in both the industrial and residential populations has dramatically changed the Lehigh Valley of Pennsylvania since 1955 when the non-profit ambulance service,�Cetronia Ambulance Corps, first began its all-volunteer BLS services.� In response to the communities need for an increase in public health and safety services, Cetronia has grown to include ALS service, 24-hour dispatch, and non-emergency medical transportation.� Additionally, Cetronia provides billing services, community outreach, education, special events coverage and special operations teams.� The diversity of their fleet�allows the most appropriate level of service for the customer�s need from a doctor�s office visit to a critical care transport.� Cetronia continually strives to understand the medical needs of its communities and remains �Always Ready� to accommodate any pre-hospital emergency care and medical transportation needs.� This attitude of adaptation is not new to Cetronia, rather a continuing legacy of a truly innovative EMS system and a commitment to providing �Health on Wheels�� for its residents.

In recent years, Cetronia recognized the enormous challenges facing the EMS industry including severely diminished reimbursement rates.� Since EMS billing specialists must be ready to meet these ever-changing reimbursement and additional compliance issues with competency and expertise, Cetronia has maintained their own team of nationally certified ambulance coders who offer an exceptional blend of ambulance billing experience, knowledge, and customer service to ensure fiscal stability and the organization�s continued success.

The increasing demand for healthcare services which threatened their ability to maintain response times is another example of what motivates their mindset of continual improvement.� Choosing to be a�

HP-EMS Profile: Huron Valley Ambulance

This month’s high performance profile is Huron Valley Ambulance (HVA), a nonprofit service that has distinguished itself as being high quality and achieved CAAS certification for service in southeast and south central Michigan.  HVA was created in 1981 as a nonprofit organization by five hospitals in Washtenaw County following the failure of several previous commercial ambulance services there.  The hospitals invested $2 million dollars in the new ambulance service, purchasing new vehicles, equipment, and facilities.  New leadership and staff were hired and advanced life support service was begun in early 1982.  By 1984, the ambulance service was breaking even financially and gaining the trust and support from the community.

The owner-hospitals asked community leaders to volunteer to serve on the HVA Board of Trustees and they continued to improve service delivery.  Once they were successful in their goal of stabilizing emergency medical services for county residents, the hospitals gave HVA to the community in 1985 as a free-standing nonprofit, charitable organization.  Although no longer HVA’s owners, the hospitals have continued to play a part in the governance and success of the organization ever since.

The HVA Board of Trustees has always placed accreditation as an important achievement and measure of quality.  Additionally, emergency response times and driver safety are recognized as being important to patient outcome as well as a measure of meeting community service expectations.  HVA has a benchmark of providing a response to life-threatening emergencies within 10 minutes (urban) and 15 minutes (rural), 90% of the time.  HVA has consistently met this goal for 30 years and even publishes a Performance Dashboard on their website.  The response time is calculated from the time the patient’s call is received until the paramedic arrives at the address.  Exceptions in this measure are included in cases which are beyond HVA’s control, such as ice storms, trains blocking roads, and unsecure situations where the police must make the scene safe.

An important tool to help HVA continue to meet response time standards has been MARVLIS from BCS.  John Vary, Technical Services Manager at HVA, said that “the implementation of MARVLIS has given our dispatchers a new way to visualize and position resources.  An important aspect is in enhancing our placement of ambulances to safely meet our designated response times.”  While there are many parts that must come together correctly to make an agency effective and perform with greater economic efficiency, advanced technology is clearly an essential part of the mix.

HP-EMS Profile: Jersey City Medical Center EMS

The High Performance EMS we examine this month is Jersey City Medical Center EMS  located just across the Hudson River from Lower Manhattan.  It is a triply accredited service, receiving the CAAS, NAED’s ACE, and CoAEMSP accreditations all in the same year.  As a part of the LibertyHealth System, it serves the residents, workers, and visitors of Hudson County, NJ by responding to nearly 90,000 calls a year.  JCMC EMS provides both Basic and Advanced Life Support as well as services for special operations, neonatal transfers, critical care inter-facility transports, regional EMS communications, and more.

Few modern ambulance services can claim over 100 years of history, but this organization has been providing prompt, professional pre-hospital care since the days of taking patients to the Medical Center in horse-drawn ambulances.  Today, however, JCMC EMS is one of the most technically advanced EMS agencies in the country with an impressive response time averaging 6:02 – well below the 7:59 city standard.

Richard Sposa, EMS Communications Coordinator at JCMC EMS, describes how they continually improve their service saying “positive patient outcomes are the goal for any EMS agency, and at Jersey City Medical Center, it is our guiding light.  The Jersey City Medical Center’s EMS Department has taken a leadership role in positive patient outcomes by examining real life scenarios.” More specifically Sposa says, “we made a self-realization in 2005 that the system as a whole was in need of improvement in a multitude of areas, and the most notable were our response time and asset deployment.  With the help of Bradshaw Consulting Services and the MARVLIS system we were able, in less than a years time, to reduce our response by over two minutes.”

The MARVLIS application forecasts demand dynamically and displays the probability of incoming calls as a colored surface.  As paramedic David Pernell describes it, they “chase the blob” likening the constantly updating application to an animated weather forecast showing upcoming need allowing resources to be better deployed when called upon.

As one of the largest and busiest EMS systems in the state, they are proud to play a vital role in domestic preparedness education, homeland security response and educating the public and healthcare providers in CPR and advanced adult and pediatric life support.

“With an in-house study we have undertaken,” said Sposa, “we have seen that the drop in response time has improved patient survivability.  With the data collected so far we hypothesize that by reducing our response time by two minutes we will have the ability to return pulses to as many as thirty more patients a year.”  What more could be said about high performance in EMS!

HP-EMS Profile: Sedgwick County EMS

It has been much more than a month, but we will return to featuring a monthly profile of High Performance EMS sites in order to inspire others to reach beyond just compliant services to provide advanced out-of-hospital care while focusing on improved efficiency.  This time, our spotlight is on Sedgwick County Emergency Medical Service of Kansas.

Sedgwick County EMS

The public EMS agency in Sedgwick County is responsible for ALS out-of-hospital care and transportation for both acutely ill and injured patients as well as providing scheduled ambulance transportation services within an area of 1,008 square miles serving a population of approximately 498,000 residents.  In 2010, Sedgwick County EMS responded to 52,815 calls for service.  They are also proud to be part of an elite group of CAAS accredited agencies across the nation signifying that they have voluntarily met the “gold standard” determined by the ambulance industry to be essential in a modern EMS provider.  The CAAS standards, which often exceed those established by state or local regulation, also define High Performance EMS as they are designed to increase operational efficiency and clinical quality while decreasing risk and liability to the organization.

In addition to efficient performance, another hallmark of a High Performance EMS provider is community involvement.  Sedgwick County EMS is a regional BLS Training Center for the American Heart Association teaching CPR classes and frequently participates in local school programs by visiting classrooms to educate children on accessing the emergency system and demonstrating their equipment to make students more familiar with EMS should they ever need to access it.

This past summer, Sedgwick County EMS was selected as a 2011 “Health Care Hero” by the Wichita Business Journal.  The award was given in the health care innovations category which honors a person or organization for breakthroughs in medical technology ranging from research to a new procedure, device or service.  In addition, Sedgwick County EMS received the 2011 advanced life support (ALS) Ambulance Service of the Year award from the Kansas Emergency Medical Service Association (KEMSA) in recognition for promoting EMS in Kansas.  These honors recognize Sedgwick County EMS for the implementation a number of software upgrades that improved automated scheduling, patient care reporting, and deployment practices, among others.

Sedgwick County EMS Director Scott Hadley said in an EMSWorld article this week, “We needed a communications platform and software solution that would support our latest enhancements and upgrades to dispatch and deployment practices, automated scheduling, and patient care reporting for the entire health care system. In Motion Technology and Bradshaw Consulting Services are providing us with the tools we needed to support our mobile healthcare technology to benefit the citizens of Sedgwick County.”

Showing that properly implemented System Status Management can ensure the right response at the right time, Hadley says, “EMS crews have been hitting their goal of getting to destinations in less than nine minutes more than 90 percent of the time for 24 straight months.  That means technology is doing what it’s supposed to do and furthering the mission of the agency.”  Demonstrating the final component of a successful High Performance EMS, Hadley says “it’s our responsibility to continually improve our patient care.”

HP-EMS Profile: MEDIC

Each month we will feature a profile of another High Performance EMS to show the variation in these services and inspire others to reach beyond just the basic services to provide advanced pre-hospital care with a focus on high economic efficiency.

In 1996, the Mecklenburg EMS agency was one of the slowest in the US with an average call response time of about 16 minutes.  Today, calls average around 7 minutes.  That incredible transformation began when two competing hospital services joined together to create MEDIC which now contracts to serve the county of 540 square miles with a fixed population of 850,000 that swells to a routine daytime total of around 1 million people.

MEDIC Emergency Dispatch Center

Barry Bagwell, Deputy Director of Operations, is proud to state that MEDIC has been compliant regarding performance every month since 1998.  “While there is no ‘silver bullet’, all of the pieces must work together,” says Barry, “it requires technology plus the people to run it.”  But a truly High Performance EMS must not be tempted to over-utilize response times as the only measure of success. The original focus for system improvement was on routing, but the partnership with Bradshaw Consulting Services has led to many operational enhancements including successful demand prediction and dynamic System Status Management planning.  “Dispatch posting is a ‘chess game’,” Barry admits and real efficiency comes by balancing moves between the 60-65 posts to meet service demand with reducing fuel costs and minimizing disruption of ambulance crews.  With a holistic view of clinical outcomes, MEDIC has achieved a 33-minute turn-around time from hospital to availability and 82 minutes from a call to having a Code Stemi patient on an operating table with the artery open.  MEDIC also provides bicycle paramedics, ATV, and buses for special events to meet the needs of their community.

The dispatch center has used ProQA Dispatch Software protocols in both EMS and Fire since 1993 to assist dispatchers in quickly determining the appropriate determinant code.  Voice communication with vehicles is maintained with a Motorola 800 MHz shared backbone radio system with priority.  Non-emergency numbers are provided only to hospitals with the public being triaged through the 911 system.

While recognized as a High-Performance EMS already, MEDIC does not intend to rest where they are now but constantly looks toward additional improvements.