Category Archives: Technology

What is CAEMS and Why Should I Care?

Two weeks ago, we started a Community of Practice to discuss EMS Deployment. The larger issue of deploying resources is all about efficiency and effectiveness in care, those are also the aims of any High Performance EMS group. However, that message is too often confused with meaning simply “better, faster, cheaper”, when in practice it must be rooted in “doing what is best for the patient” in order to be anything of lasting value.

In the following episode of ‘Word on the Street’, an EMSWorld podcast hosted by Rob Lawrence, representatives of the Coalition of Advanced Emergency Medical Systems (CAEMS) chat about the professional association and exactly what makes EMS systems “high-performance.” Give it a listen (or even download it) here: http://www.emsworld.com/podcast/11327832/word-on-the-street-coalition-of-advanced-emergency-medical-systems.

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Filed under Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Health & Safety, EMS Topics, Technology, Technology & Communications, Training & Development

Fore Thoughts of EMS Today 2015

For the last few years I have written my initial impressions of conferences in blog posts shortly after, or sometimes even during, a conference. The post “Quick Thoughts from the EMS Today 2012 Conference,” for instance, described my first EMS Today experience and captured the fact that I actually had the opportunity to give ‘two thumbs up‘ to my boyhood idle ‘Johnny Gage’ (aka Randolph Mantooth) among other professional icons. I also had the opportunity to ride along with a BCFD crew and documented that experience in the post “A Country EMS in the Big City” that year. The next year, I got to experience EMS Today in DC along with the much hyped ‘Snowquester‘ that abbreviated the EMS on the Hill advocacy opportunity, but where I did still get to witness a small ‘Gathering of Eagles‘ slaughtering a number of ‘sacred cows.’ A summary of that experience is recorded in the post “Quick Thoughts from EMS Today 2013 Conference.” Last year provided a very different perspective as I got to document EMS Today from the viewpoint of a pre-conference presenter and spent much of my time as an exhibitor on the show floor. One of my favorite learning experiences, however, was the ‘Resuscitation Academy‘. Some of my experience that year was covered in the post “Quick Thoughts from EMS Today 2014.” But this particular post is a unique first, as I am writing this time about a conference that hasn’t even happened yet – EMS Today 2015!

My interest in this coming conference is as a blog reporter. I hope to attend this conference as an official blogger tasked with documenting once again my experience as a participant in all of the fascinating aspects of this powerful and educationally-packed conference. If you are planning to attend the conference, we can help each other. Your registration using the code ‘EMSBDALE’ gets you a discount, even beyond the early bird discount rate, and provides a vote of confidence in me to be selected as the official blogger for this coming event. To make it an even better deal for you, each registration using my code will be entered into a drawing for a mini Apple iPad this month and another for anyone who enters my code during registration for January as well.

I hope that you do get to go to this keystone EMS event and that you will help me get there as well. If we do win, you will hear about it first on this blog page. PennWell and JEMS is working closer with its Fire EMS blog network than ever before in order to bring you a more intimate view of the conference and the larger industry of EMS as well through independent blogs, Facebook pages like High Performance EMS, and Twitter feeds including @hp_ems. So even if you don’t get to the 2015 EMS event of the year, you can still experience some of the excitement and continue to learn all throughout the year.

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Filed under Administration & Leadership, Conferences, EMS Topics, Fire Rescue Topics, Funding & Staffing, News, Technology, Training & Development

Quick Thoughts from EMS World Expo 2014

I love Nashville, so one of the highlights from my trip to EMS World Expo was eating at Jack’s BBQ on Broadway, but there was also plenty more to be excited about at the actual show held in the Music City Center this week. While I missed the Preconference sessions and World Trauma Symposium, I arrived on Tuesday for the opening ceremonies. The keynote presentation was by Dr. Alexander Eastman on the subject of “Improving Survivability During Mass Shootings”. EMS1 did a quick article on the talk covering his two main points: first, that EMS must train more closely with other services such as law enforcement, and the second that we must take better advantage of hemorrhage control technology and become true “experts” at controlling blood loss. After all, the mass-shooting scene resembles the battlefield and people die there from the same wounds that soldiers do in war.

Choosing which classes to attend is always a difficult task; however, it is the key to getting the most value from a major EMS conference like this one. Sessions varied from the High Performance EMS Master Class on the “10 Top Tips for Improving Your Operations” with Rob Lawrence to “The Psychology of Pediatric Resuscitation in the Field” with Dr. Peter Antevy. They can both be frightening in their own way, but facing your fears for the benefit of others is what we do. So choose the topic where what you learn can be directly applied in your service. Learn everything you can and go home determined to make a difference with your new found knowledge. In some cases, that knowledge may be applied at a more personal level, as David Page reminded us in a session about our own mental health. He asked us to “Repeat after me: We diagnose and we are OK with that.”

It is also good to check out some of the less traditional learning opportunities such as watching (or even participating in) live podcast recordings, labs, and topical panel discussions. Several thought-provoking ideas came out during the EMS Education panel yesterday where instructors shared openly while earning CE credit. For instance, “you know there’s a problem with our standards when our EMTs can’t give Narcan, but our LEOs can.”  And ideas that challenge current thinking such as how to move out of the classroom in order to provide more realistic field experience or simulating that experience by integrating smartphone apps that can do everything a book can do, and even cost less while still being more mobile.

The simulation lab in the exhibit hall was an excellent opportunity to play with some of the latest in patient simulation technology. I specifically sought out an infant CPR simulator from Laerdal Medical that not only helped me feel the right depth and rhythm of compressions, but it provided feedback on respiration quality with various infant ages/sizes too. This is experience I seldom get in the field or have the experience to feel comfortable doing well. Many other exhibitors also provided simulation manikins and an equal number provided moulage aids to make up real volunteers as trauma victims. EMS World recognizes the top innovators in the exhibit hall each year with an award and links articles to their products on its website. You can check out the latest award recipients here.

For those who could not make it to the show in person, you were certainly not alone. My friend Greg Friese, who normally posts Everyday EMS Tips, was also not able to attend this year but described how he followed what was happening by using social networking and posted his observations here. No matter how you get your news, just be sure to get the news and stay current in the exciting and changing field that is your profession.

 

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Filed under Administration & Leadership, Conferences, EMS Health & Safety, EMS Topics, News, Patient Management, Social Media, Technology, Training & Development

Static v. Dynamic: A Continuum of Cost

In our recently published book, “Dynamic Deployment: A Primer for EMS“, John Brophy and I established a dichotomy between the standards of static deployment and dynamic deployment in the very first chapter.  Fortunately, that strong polar perspective has spurred some interesting discussions for me. While the check-out lane analogy was effective in distinguishing some of the differences of static and dynamic deployments, its simplicity only recognized the extreme ends of the spectrum and failed to acknowledge what I would describe as a “Continuum of Cost” between them.

Few systems (at least those with more than just a few ambulances) probably function exclusively at either extreme. The static model will necessitate some flexibility to provide “move-ups” to fill holes, just as dynamic systems will have reasons to keep specific posts filled as long as enough ambulances are available in the system. The reasons for moving, or even fixing locations, may have something to do with demand necessity or even the political expedience of meeting community perceptions.

While there are many differences between static and dynamic deployments that we could discuss, there are also some elementary misconceptions. For instance, dynamic deployment does not mean vehicles are constantly in motion. The term dynamic refers to the nature of their post assignments which can vary between, and even within, shifts. As alluded to in the book, proper post assignments also reduce, not increase, operational expenses. In at least one example we stated, the dynamic deployment strategy was shown to significantly reduce the number of unloaded miles actually driven, which in turn increases the percentage of overall miles that can be billed. This situation not only increases revenue while simultaneously reducing expenses, it also reduces fuel costs and wear on the vehicles (and crews) too which potentially extends their useful life. All this is still in addition to reducing response time and improving crew safety by positioning ambulances closer to their next call so that fewer miles need to be driven under lights and sirens.  The inherent efficiency of this management strategy allows a system to achieve response compliance at the 90th percentile with the smallest possible fleet.  To achieve the same compliance level with a static deployment of crews and posts, the fleet must grow significantly larger. Another recent sample calculation showed that both staff and fleet size would need to grow by well over double in order to reach the same goal. The resulting cost continuum, therefore, clearly shows that a static fleet has operational and capital expenses multiple times the costs of the dynamic deployment model without burning crews out with excessive and unhealthy UHU figures.

For the sake of validating my argument, it is unfortunate that these examples are from private ambulances companies who do not wish to openly share details of their calculations at this time for competitive reasons. It would be safe, however, to assume from these competitive reservations that these results are not automatic, but dependent on proper management and the use of good tools. There are certainly numerous examples of poorly managed systems or ineffective operational tools. To achieve similar positive results in your own system requires certain knowledge, an underlying reason for having written the book in the first place, and an assurance that the deployment tools are proven to be effective.  Just as managers should have references checked during the hiring process, vendors of operational deployment tools should be able to provide ample references for successful implementations of their technology in comparable systems to your own. It is also important that any solution be able to address a continuum that includes your specific objectives to find a balance between geographic coverage with anticipated demand coverage at an acceptable workload and schedule for your staff.

There is no “magic bullet” to achieving operational nirvana, but the combination of effective management with operationally proven tools has shown that cutting costs while improving performance is an achievable goal in most any size system. It is also fair to say that performance can be enhanced with less skill through the application of significant sums of money; but honestly, who can afford that sort of strategy in the competitive arena of modern mobile integrated healthcare.

It is our desire to produce yet another, even more extensive, volume on the topic of dynamic deployment to make the achievement of efficient and effective high performance EMS a reality for more systems. Stay tuned for future details!

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Filed under Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Topics, Fire Dispatch, News, Opinion, Technology

Is 'SSM' Still a 'Bad Idea'?

Ideas often take time to saturate a market. Even if the idea is generally recognized as a good one, complete with compelling evidence, change can still take time.  As a current example, how many agencies still have a protocol for complete spinal immobilization on a long spine board for “any fall” or “significant impact”?  On that very point, Dr. Ryan Jacobsen puts forth a lengthy argument in this recording of a  presentation at a NAEMSP conference.  The process of acceptance can be even worse yet if the idea has been controversial – as in the case of “System Status Management” introduced by Jack Stout in 1983. This distinction means it takes longer still in order for it to receive a “fair hearing” even if the evidence now shows a positive impact. In an ideal world, the best ideas would always be automatically and universally adopted, but that simply isn’t how the world works.  And for any professional industry it is a good thing that ideas are properly “vetted”over time to determine what is truly “best” before wholesale adoption or, in the case of “bad ideas”, that they are discarded only when a fair reading of the evidence discredits them.

CycleDynamicsGartner, Inc. of Stamford, Connecticut, has built both a reputation as an information technology research and advisory firm and a booming business of annually publishing their signature “hype cycle? graphs by industry segment.  For those unfamiliar with these charts, the basic structure starts with a technology trigger near the origin of time and is visibility followed by a quick rise to the “peak of inflated expectations” that is often driven by a combination of unrealistic claims by proponents and the hopes of users desperate to believe those claims.  The exaggerated peak of hype is inevitably followed by a crash of popularity into the so-called “trough of disillusionment.”  Many ideas just die here and drop off the curve, but for others, a more realistic set of expectations develop as ‘believers’ (the “early adopters” according to Everett Rogers’ “Diffusion of innovations”) begin to experience measurable benefits and serves to push the idea (sometimes with changes) up the “slope of enlightenment.” This gradual advance passes an important point of inflection on the performance “S” curve known as the “attitude confirmation” identified by Joon Shin.  The next landmark is crossing a social “chasm” identified by Geoffrey Moore at another critical inflection point called the “attitude plateau.”  Once an idea successfully crosses the chasm, it plateaus as a generally recognized productivity concept for that industry. Some ideas fly quickly along these curves passing other older ideas that seem to just plod along at a much slower pace.

So, is “SSM” still on the curve? And if so, where is it?  We must first realize that ideas evolve and sometimes morph into other names (just as “Emergency Medical Services” is known by some as “Mobile Integrated Healthcare” now.)  One apparent synonym for “SSM” is a broader idea of “dynamic deployment.”  If we look at the literature and practices of emergency ambulatory services, we find that the underlying concept is still quite popular despite attempts of detractors to further discredit or simply ignore it.  One such potentially damning article was written by Bryan Bledsoe back in 2003 after a crash of industry expectations for the idea.  This could easily be explained as the time that SSM passed its own pivot point where its value was questioned in the trough of disillusionment. (Some may also claim that hypothermia treatments for cardiac patients was also recently in this trough.)

Computing performance has increased dramatically since the 1980’s (or even the early 2000’s) and algorithms are discovering patterns in many human activities.  Demographic data show socioeconomic clustering that leads to similar health issues and traffic patterns with road designs that see more accidents than they should. These patterns are proving to be key in forecasting demand for EMS services. Automated Vehicle Location systems allow far better tracking than ever before and traffic patterns are being used to calculate more realistic routes. These are some of the advances that help explain the numerous agencies that are significantly improving response performance and making use of resources. Where field providers take an active part is developing strategies, there are also reductions in post moves, unloaded miles driven, and better disbursement of work loads.  The efficiency gained by its use in mainstream agencies beyond the initial public utility model organizations seem to vindicate Stout’s early vision and research as the concept moves up the slope of enlightenment toward the plateau of general acceptance.

Ideas are not static entities, so our understanding must continue to evolve and incorporate new thoughts.  As the iconic American social commentator, Will Rogers once said, “even if you’re on the right track, you’ll get run over if you just sit there.”  So, to honestly argue an idea, proponents of either side must continue to evolve their understanding and witness the current thought and evidence of an idea.  There is little point in continuing to attack past grievances which have been addressed while ignoring the mounting evidence out of sheer disbelief.  If “SSM” is not a “good idea’ yet, it is certainly moving in that direction all the while being shaped by those who are concerned over the future of EMS (or MIH.)

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Filed under Administration & Leadership, Command & Leadership, Dispatch & Communications, EMS Dispatch, EMS Topics, Fire Dispatch, Opinion, Technology, Technology & Communications, Vehicle Operation & Ambulances

Impressions of the Ferno iN/X

I’m sure that the interested audience for the new Ferno iN/X “power stretcher? was smaller at FDIC 2014 than it would have been if it were released in time for the EMS Today conference earlier this year. But maybe that was a good thing for me because, even though the booth was still crowded, I got to spend some “quality time? with this stretcher and thought it would be worth posting my impressions here. There were several things I wanted to confirm for myself after watching the announcement videos, but what ended up surprising me most were several other innovative features I didn’t even expect to see.

FernoiNX

My first concern was all about weight. I was curious about how much this unit weighed and more importantly how much would I have to hold when it is loaded with a patient. But now to be honest, I still have no idea what the unit weight is since I never had to actually “lift? anything – the unit really did at all the work. Even loaded with a Ferno sales rep as a simulated patient, I never had to hold any of the weight with my back or legs. The front and/or rear wheels operate either together or independently using a simple set of only two buttons (“+? or “-?) and the application of a little pressure. When the weight is basically even, the stretcher raises or lowers horizontally. When loading it on to a simulated ambulance floor, the stretcher can be raised above the floor level (to a preset height) moved into the rig and lowered until the wheels of the head end touch the ambulance floor removing just enough pressure to cause the forward axle to automatically lift during the lowering process. A red laser on the stretcher shows a line on the rig’s floor to let you know when it is far enough forward for the total weight to be distributed between three sets of wheels already inside. The design of the X-shaped frame allows the stretcher to be pushed forward past the mid-line balance point where the weight is held on the floor and my effort is to simply “balance?, not “hold? the load while the axle at the foot-end is raised.  At this point, the stretcher is rolled completely inside without that extra “bump? I experience with the current stretchers used at my service. A middle set of wheels have an added feature that allow them to pivot in order to more easily align the stretcher if it is not inserted correctly and eliminates any further jostling of the patient. The locking receiver is unique to Ferno, but backward compatible to accept stretchers of another make or model. What is different about the Ferno receiver is that it charges the stretcher battery whenever it is locked in place during transport.

illustration courtesy of Ferno EMS

illustration courtesy of Ferno EMS

But rolling a stretcher around a showroom floor is different than the obstacles I normally face navigating a yard or home. This was simulated at FDIC with various barriers. To navigate them, the medic at either end where the axle needs to raised, will simply “pull up? on his end while the “-? button is held in order for the sensor to intelligently lift the end with less pressure until the button is released. The sensing mechanism allows for unique changes in height to be navigated even with just these two simple buttons. I also appreciate that the handles on the foot end can extend to allow my hands to operate directly at my sides for good posture and body mechanics.

There is an LCD display that gives operational cues and battery status along with a few extra buttons. These buttons turn on lights beneath the stretcher to illuminate dark hallways or turn on lights along the side rails for extra lighting. At the scene of a night-time traffic accident, the side rails can also alternate red and white flashing lights for extra visibility to motorists and improve my own safety.

Some specific “feedback? I had prepared was a complaint about the lack of “side rails? like I am accustomed to using, but heard that options are currently in development. In the meantime, I began to understand that instead of ‘flip up side rails’, the Ferno design uses ‘fold down arm rests’ that also lock in outward angling positions to accommodate (and help secure) bariatric patients. Further, the straps are not just the traditional cross waist, cross legs and cross chest, but a full 5 point style harness to no only keep the patient centered but also secure when laying flat if the ambulance should have a sudden stop (such as an accident.) While it is clearly equipped for safety, there was no compromise in functionality since the shoulder straps attached low enough in the front to avoid being in the way if CPR was required.

fernomonitor

Finally, if all that was not enough to impress me, I saw how to quickly attach an optional monitor shelf between the foot rails to keep the monitor secure, visible, and conveniently ‘attached’ to the patient during transport. The same attachment design on the rails for this feature is also used for attaching optional IV poles or even the future “side rails? (if I decide that I still need them.) Of course there were other small details as well that showed that the designers were either practicing medics themselves or that they at least listened closely to the feedback of field providers who use stretchers like these in the field daily. I was thoroughly impressed and not only hope to get the chance to use one for real soon, I am now even more dissatisfied with what I currently use since I have come home from the show.

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Filed under Conferences, EMS Topics, Opinion, Technology, Vehicle Operations & Apparatus

What Twitter, and These EMS Influencers, Mean to Me

The thing I love most about conferences is the unexpected things I learn. Like everyone else, I attend certain sessions on topics I need to know more about, but in-between these official talks there are millions of opportunities (casual conversations) to hear things I never knew I needed to know. To me, this is the greatest value of being with a group of individuals who share some common field of interest. With Twitter I get to hang out “between sessions? all day, every day for as long as I want. I can even go back and review conversations I missed. The result is that the growth and learning never ends. I appreciate the immediacy of learning what worked (or didn’t) for a colleague just this morning. Certainly there are issues with hearing things right away. There are comments that must be filtered or excitement that may be premature. Sometimes we just flat get the news wrong. But I consider myself an adult and a professional and ultimately I am in control of my own personal growth.

The question then, is who do I “hang out? with in these virtual conversations. Just like being at a “real? conference, you can choose to listen to the “disgruntled crowd? who use the venue as an opportunity to vent their frustrations, or you can choose to listen in on the “mentors? who are willing to share their wisdom, opinions and thoughts about progress in the field. In the world of social media, we are all given a level playing field to start. Some people grow their audience (both Following and Followers) with other influencers and a natural attraction gravitates them into groups. Fortunately these affiliations are not necessarily just of like-minded folks, but at least they have a like-interest or like-approach to learning and sharing.

There are many ways to find the people who can become your virtual mentors over time. As you become more adept at using social media, you will refine your own lists. By using a service called Little Bird, I was able short-cut that process and generate a report on the top influencers using the term “EMS?. It is not simply a list of who uses that hashtag the most, but a comparison of who they follow and who follows (and RTs or otherwise engages) them. The list is sensitive to how it is “seeded? and it took me several attempts to get a list that I felt had some meaning. While it has an implied interval hierarchy to it, I wouldn’t get as caught up in individual positions as a larger view of the relative ranking. Adding 100 follows to whatever your list currently contains shouldn’t be a problem for those who are truly engaged. �But if you feel you can only add a portion, start at the top of this list. �Regardless of how you use social media, or Twitter in particular, if you are interested in what is happening in the evolving field of Emergency Medical Services, these are the folks I would suggest you follow.

The Top 100 Influencers of the EMS Topic on Twitter:

1. @gfriese
2. @EMS1
3. @ChroniclesofEMS
4. @STATter911
5. @jemsconnect
6. @setla
7. @FireCritic
8. @theHappyMedic
9. @EMSWorldNews
10. @podmedic
11. @SteveWhitehead
12. @geekymedic
13. @firenation
14. @FireRescue1
15. @FDNY
16. @EMS12Lead
17. @Ckemtp
18. @everydayemstips
19. @EMSEduCast
20. @MedicSBK
21. @romduck
22. @NFPA
23. @FirehouseNews
24. @FireDaily
25. @InsomniacMedic
26. @rescue_monkey
27. @ssgjbroyles
28. @AmboDriver
29. @SamBradley11
30. @UKMedic999
31. @MsParamedic
32. @EMSBlogs
33. @hp_ems
34. @emssafe
35. @LAFDTalk
36. @JEFF_EMT
37. @Jeramedic
38. @hybridmedic
39. @LAFD
40. @TheSecretList
41. @scottthemedic
42. @PenguinEMT
43. @NancyEPerry
44. @zollemsfire
45. @RescueDigest
46. @NJDiveMedic
47. @RVaMedic
48. @EMSUnited
49. @AmbulanceJunkie
50. @FRNtv
51. @chicagomedic
52. @TheRoadDoctor
53. @iParamedic
54. @FireMedic
55. @DispatchDemon
56. @fireengineering
57. @NFFF_News
58. @RichGasaway
59. @EngineMedic
60. @EMSLegacy
61. @NYCEMSwebsite
62. @Paramedicine101
63. @davidkonig
64. @flobach
65. @tbouthillet
66. @jeffmedic
67. @medicTHREE
68. @epijunky
69. @emsgarage
70. @FireBlogger
71. @DiverMedic
72. @imagemedic
73. @ems_products
74. @NorthwestFire
75. @CAL_FIRE
76. @CalFireNews
77. @Emergency_Tweet
78. @FossilMedic
79. @TheFireTracker2
80. @PedroParamedic
81. @Ldn_Ambulance
82. @EMSWeek
83. @BostonFire
84. @Paramedic_Mike
85. @MattTheMedic
86. @uniwiredmedic
87. @JonEMTP
88. @CarissaO
89. @medic61
90. @BobbyHalton
91. @ambulancemandan
92. @Medic_Marshall
93. @garytx
94. @WmRandomWard
95. @NIOSH
96. @sunmedicgirl
97. @MadMedic1
98. @quebecmedic
98. @PhysioControl
99. @chrismedic
100. @BOSTON_EMS

I don’t suggest that these are the only people to follow. There are many more who I had hoped would make this list, or who would likely be added to some version future of it. Don’t be afraid to allow someone else into your own “group?. Just because they are not currently a “Top 100″ doesn’t mean they don’t have something valuable to contribute. Watch for the #FF hashtag on Twitter that denotes suggestions for a traditional “Friday Follow?. Also watch for who adds value to the conversation. This is how you find these new contributors to your group. Also, don’t view your list as ever being “complete?. Make changes often to met your own needs and interests.

 

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Filed under Conferences, EMS Topics, News, Social Media, Technology, Technology & Communications, Training & Development

EMS in the Cloud

According to the Gartner Hype Cycle for 2010, “Cloud Computing” and “Cloud/Web Platforms” have reached the infamous “Peak of Inflated Expectations” and are already sliding down like a fog into the unavoidable “Trough of Disillusionment”.  But the story doesn’t end there as the cloud is expected to rise back upward and eventually reach the ultimate “Plateau of Productivity” within the next 2 to 5 years.  What does this mean for EMS?  Well, first, it means that there is probably still plenty of confusion about what the “cloud” actually refers to and its waning excitement at the moment means the enthusiasm of its promoters is more easily dismissed as the ramblings of zealots “with their heads simply stuck in the cloud.”   However, it is the critical review and appropriate response to technology offerings in just this state that separates the industry leaders from the rest of the pack.

Notice that I did not say the “full adoption” of a new technology, but rather the “appropriate response” to its availability.  As you will see in this post, my forecast of cloud computing is that tomorrow will only be “partly cloudy”.


According to Wikipedia,  “cloud computing describes a new supplement, consumption, and delivery model for IT services based on Internet protocols” (IP).  This means that the cloud really becomes just another computing resource similar to existing enterprise servers except that these cloud-based resources are physically located (and maintained) somewhere else in the world and access is typically provided on a subscription basis that allows them to “scale” (increase or decrease available resources) more dynamically based on demand than traditional hardware installations within an agency.  Additionally, the IP nature of cloud-based resources means that these services can be accessed through a variety of distributed devices from a desktop web browser to a smart phone.  That broad availability raises legitimate questions about security, but cloud-based providers often address these concerns based on the specific security demands of an organization making the broad access more of an advantage to distributed workforces (such as EMS) than a threat.

If you send messages with a Gmail account, listen to Pandora, share your thoughts on Twitter or Facebook, check-in on FourSquare, look up addresses on MapQuest, share files using DropBox, or pay bills online – you already use cloud computing services.  Even the blog post you are reading now was written and delivered using WordPress as a hosted cloud service.  Another WordPress site recently described using the cloud service Google Calendars to create an EMS shift calendar in place of a paper schedule.  A more sophisticated online scheduling system specifically designed for EMS employees is available from Aladtec and used by Deputy Fire Chief Kris Kazian of Countryside Fire Protection District in Illinois who said, “It is one of our better decisions relating to migrating office processes into the ‘e and green’ world!”  Applications like these, or even billing systems which are not as adversely affected by potential temporary outages related to disaster events, are perfect examples for outsourcing to the web.

But not all applications should be considered for hosting off-site just yet.  Besides security, is the question of availability when internet connectivity is down.  For mission critical applications, this type of interruption can be a worst case scenario.  While applications like ArcGIS by Esri are moved to the web, an EMS agency functioning in a pure cloud model could be effectively running blind without any access to their GIS.  However, hybrid models (only partly cloudy) utilizing select web resources from the cloud can be very efficient and still remain effective.  Orthographic imagery, whether satellite or aerial photography, and oblique photography, such as Pictometry can be very resource intensive and difficult to update.  But as a cloud-based web service, they can be very fast, current, and efficient.

To say that the cloud is too confusing, or that the technology is not ready yet is clearly a misunderstanding of the resources available from the cloud.  On the other hand, it is not necessary to go overboard by planning to completely outsource everything to the cloud either.  Now is the perfect time, however, to evaluate and plan for how your agency will leverage this technology in the future.  The cloud is not coming – it is already here!

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GIS for EMS

Both acronyms (GIS and EMS) represent not just technologies, but fields of study and service that have very old roots even though each can trace their modern form to research starting in the 1960s.  Both have witnessed explosive growth and application far beyond their original vision.  But most importantly, these two names definitely belong together.

Those who have any knowledge of Geographic Information Systems (GIS) will often think first of maps at the mention of its name.  Maps, however, are simply the form GIS professionals use to express the actual work done with a GIS.  That work consists of maintaining a descriptive spatial database and using that database to perform analysis that answers real-world questions or solves domain specific problems.  There are many examples of how it can be applied, but here we will discuss just those in support of Emergency Medical Services (EMS).

At the very simplest end of the spectrum is printed mapbook production.  Because GIS “maps” are stored as data rather than graphics, they are easily edited and symbolized in different ways to meet different objectives.  For use in ambulances, maps should be quick references primarily showing roads (with street names and block addresses) and landmarks essential for navigation.  Street index creation is an automated function of the GIS that can make a printed book of maps more useful for crews attempting to find a specific street.  Better still is an interactive map – one that can locate your current position using GPS and can automatically search an address (a process called “geocoding” or “geovalidation“) and recommend an efficient route between these two points.  This function is manual in printed form but interactively can leverage historic “time-aware” travel impedances (the actual time it takes to travel a certain road segment in a specific direction given the current time of day based on your own past experience) and even access known road closures due to ongoing accidents or scheduled construction to provide realistic travel times and routes given current conditions.  The database can also be used to locate not just the closest vehicle, but make unit recommendations based on additional criteria such as special equipment or training.  When these interactive maps are used with ruggized touch-screen computers or new tablet devices, you have a powerful combination that can also support ePCR charting or other applications.

When a fleet of ambulances can provide positional and status information to the call center, the dispatchers have a better situational awareness of the functioning system in real time.  Then by using additional GIS functionality to map previous incidents, a “hotspot” map (a map showing the areas of highest likeliness for generating a call) can be created to forecast future demand using simple predictive analytics.  In the past, some organizations have poorly implemented a form of System Status Management (SSM) that failed to meet the objective of increasing efficiency and left many paramedics soured on the idea of post moves.  Effective implementations (some highlighted in past blogs here) have shown that Jack Stout’s idea can be properly done in almost any system using modern technology.  Moreover, by positioning ambulances closer to their next call, not only is response time reduced but the incentive to be hasty in that response is also reduced leading to less risk in travel.

Beyond these daily tactical applications of GIS, there are many potential strategic ones.  Preventing a call is better than an emergency response at any speed.  By looking beyond just the calls for service in the coming hour, we can begin to look further into the future and recognize specific risks of target lifestyle groups.  Preventive care or community wellness programs can be directed at the most vulnerable populations to maximize the investment of such a program.  Locating groups with increased potential for cardiac problems can aid in locating a blood pressure screening event as one example.  Some agencies have turned to GIS to help them find new recruits or volunteers.  I encourage you to communicate with your local GIS staff and let them know how they can help you.  After all, assisting you to become more efficient helps them show value as well.  You do not need to know the details behind the analytical tools, it is your existing knowledge of the community and its needs that will help your GIS staff address them.  If you lack those resources locally, or have specific questions, please make a comment below and I will follow up with you directly.

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Dynamic System Status Management

System Status Management (SSM) is the fluid deployment of ambulances based on the hour-of-the-day and day-of-the-week in order to match supply, defined as Unit Hours of Utilization (UHU), with expected demand, expressed as calls for service, in the attempt to provide faster response by locating ambulances at “posts” nearer their next calls.  While the practice is still not unanimously embraced by all services, it has a sound foundation both in the research literature dating back to the 1980’s as well as in practice today.  Experience has shown that ambulance response times can be dramatically decreased using this type of dynamic deployment, but it is also recognized that it is possible to reduce performance when these techniques are not applied properly.  The direction of the results of a system implementation are typically influenced by the system design, competence of the managers creating the plan, and commitment of the workforce in implementing it.  Therefore the best practice is a simple and straightforward implementation that will show positive results quickly.  This methodology ensures a positive return on investment along with garnering the necessary buy-in from staff to make the project a success.

In his article, “System Status Management – The Fact is, It’s Everywhere“,  published in the Journal of EMS (JEMS) magazine back in 1989, Jack Stout explained the concept of SSM and tried to dispel certain myths.  Based on foreseen Geographic Information System (GIS) technology and even general computing capabilities of that time, it was quite logical to assume in his Myth #2 that “no matter how thoroughly the response zone concept is fine-tuned in practice, it cannot be made to cope effectively with the dynamic realties of the EMS environment.”  But systems implemented today around the US are capable of calculating dynamic response zones in a small fraction of a second while even being based on time-aware historic driving patterns making a truly dynamic system status management process a reality.  A practical and proven example of a dynamically functioning system status management application is the Mobile Area Vehicle Routing and Location Information System, or simply MARVLIS.

The following Slideshare presentation does an excellent job of telling the story of why and how the system works:

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