System Status Management (SSM)

System Status Management (SSM) is the science of being in the right place with the right resource at the right time to meet the patient’s need.  Some say it is the practice of placing ambulances on street corners, but the crucial thing we must remember is that the patient is having the emergency so we must be poised to respond with minimal delay and maximum impact. SSM takes the intelligence products of demand analysis of both time and space and matches manpower and availability to deploy a responder as close to the patient as possible.  This achieves a minimal response time for the patient and reduces time spent running under emergency conditions for the crew (and distracted pedestrians!).

7 responses to “System Status Management (SSM)

  1. Skip Kirkwood

    EMS is the only service in the country where matching supply of service and demand for service is the least bit controversial. United Airlines does it, MacDonalds does it, high-end restaurants do it.

    The difference is that many in EMS have decided to implement the “matching” using a strategem that is harmful to employees – street-corner posting. It’s not the dynamic deployment and the peak-load staffing that medics object to – it is the sitting in uncomfortable spots, without basic amenities, for unknown periods of time, with no ability to do anything useful. The later does not have to go with the former. When it does, it does so by the choice of leaders who appear to put profit ahead of the well-being and health of their staff.

  2. Alan Murray

    EMS clinicians will only buy SSM if they can be shown that it’s a means of enhancing patient services. If you’re presenting it in that light, you have to mean it and behave accordingly, otherwise you’ll lose the staff. Start throwing away low-demand zones to chase statistical compliance and you’ll see what I mean. And you need to mind your language. Stop talking about response times and start talking about clinically effective response to patients with life-threatening and serious emergencies.

  3. Jordan Collins

    We were punished for “late response times” by being exiled from our quarters overnight and placed on street corners. We had high morale; we would play basketball and football, as well as making potluck dinners once a rotation. Morale was at an all-time high, quarters and the trucks were kept cleaned and polished.
    Fast forward six months to a diesel bill through the roof, 8/9 frontline trucks OOS, morale in the crapper, and the facilities and equipment being in atrocious condition. None of the crews interact and the animosity towards management has multiplied exponentially.
    Should I mention, prior to that time, there has been no known unfavorable outcomes to patients due to “late hits”. Dale and I have discussed this before; you won’t be able to convince of the “merits” of SSM.

  4. Eric Wanta

    You don’t see police chiefs posting police officers on street corners, or fire chiefs predicting the next fire and sending their fire apparatus hours in advance. I know of no EMS agency that can consistently meet a response time of less than 5 minutes (Pell et. all, 2001). If you would like me to risk DVTs on top of my discomfort and inability to do anything productive, then please provide me with wages similar to fire fighters, police officers and nurses; provide me with an ambulance with room to stretch my legs (and one where my legs won’t be crushed in an accident). Until then, please provide us with a little respect in what we do. Provide us with limitedly dynamic bases with basic amenities. Realize that constant driving between street corners with uncomfortable conditions (subjectively) increase fatigue, decrease morale, and likely have their own impact on patient care. There has got to be a middle ground.

  5. daleloberger

    I totally agree with Eric that constant driving between street corners is not being respectful of your staff. I also agree that there are many cases where basic amenities or even limited stations would be the best post. But if you think that police are not looking at predictive policing (“assisted patrol”) or that fire doesn’t also consider the implications of moving crews and apparatus based on demand, you aren’t seeing the evolving trends across public safety.

    • I would say we all agree that spending 12 hours in the cab of ambulance and moving from post to post is not ideal. Unfortunately most contracts involve tight response times and penalties, clinical sophistication and the latest technology – things that cost a tremendous amount of money without the benefit of taxpayer money. Yes, we need to be efficient, but also humane. Your line staff should be involved in the process of shift building and the vetting of the posts and post plans. We encourage feedback and the field crews suggest new post locations. We have partnered with several hospitals to provide an EMS room with food and recliners. Lastly, using tools like MARVLIS dials in the plan and our goal is to be close to the next call and limit the amount of RLS driving.

  6. John Nelson

    Wow… I would have thought that by now, the impact on patient outcomes would have been a part of the discussion.
    Look, the entire purpose of SSM is to run a “more efficient” operation, and still meet some arbitrary maximum response time threshold with a certain degree of reliability. What nobody seems to talk about is the fact that a maximally “efficient” system has excluded the “waste” of all the shortest response times. As the “system” is tuned, units not necessary to meet that arbitrary goal are removed from service. We’re still meeting that goal, but the system sees inevitably fewer of the shortest response times.

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