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!


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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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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

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.”


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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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Preparedness Reminder

I know that today is the last day of National Preparedness Month, but preparedness is not seasonal and these videos are great reminders of what we can do to be prepared for ourselves, our families, and our communities.  I hope you never need to know anything they teach, but ask that you look through them and take action anyway.  You never know when or where some sort of disaster or emergency can strike – Be Prepared!

Being prepared while traveling.

Being prepared at the office.

Preparing your family includes your pets.

FEMA Chief Craig Fugate Issues a Challenge

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Social Media – To Filter or Not to Filter?

I have to admit that I didn’t notice when the DC Fire/EMS Twitter account feed went silent on August 30.  A fact that I continued not to recognize until I read the article “#Silence: Fire and EMS Twitter Feed to be ‘Filtered'” broadcast in a tweet just this morning.  According to Chief Kenneth Ellerbe in a press conference yesterday, the account had not actually been shut down completely, but rather that its use was “being reconsidered” after what was explained as incorrect information sent out that had “imperiled the operation of another [federal] agency.”  You can review the history of past tweets from @DCFireEMS and make your own determination of their sensitivity.  The gag order, however, seems to contradict Mayor Vince Gray’s campaign promise of increased government transparency.  Most shocking, though, were statements coming after the press conference when the new department communication director, Lon Walls, stated, “I’d rather be slow and right than fast and wrong” (a statement which one of the comments pointed out as a “false choice”) while adding, “Social media is for parties.  We ain’t givin’ any parties.”

There were comments to the article pointing out that the “24-hour news cycle” of the 1980’s has been reduced to “milliseconds” these days and that information is currently being disseminated by various means regardless of its official confirmation or not.  The mere fact that the fire department has the ability to easily provide minute-by-minute news of their activities doesn’t mean that it has become a public right to expect that level of service.  However, the suggestion that “there are channels to go through for communicating with community liaisons in the event of a crime or emergency” seems to come from an earlier era.  By continuing the suggestion in saying, “perhaps they should simply put more resources into making those channels more appealing” seems to deny the notion that social networks already exist.  There may be fear that some will try to use these networks to start “flash mobs for senseless riots”, but technology is only single-purposed if the other half of the population decides not to use it at all.

One of the comments gave a very detailed example of how the @DCFireEMS Twitter feed was used by a local resident.  He claims that “earlier this summer I smelled a ton of smoke wafting into the open window of my apartment in the middle of the night.  I was going to call 911, but decided to check the Fire/EMS twitter feed first, and learned that there was a house fire a block away and it was under control, so I was able to just go to sleep and not bother the 911 staff.”  This is exactly the type of interaction that “Government 2.0” proponents recommend by allowing citizens to interact with their government in a meaningful way precisely when it is needed.

The barrage of mostly negative comments flew across the social media this morning and finally a new story reported “The Party’s Still Going: No ‘Filter’ For FEMS Twitter Feed” saying that Pete Piringer, the PIO originally authoring tweets, (and a new assistant) will once again be sending tweets without any official “filter” to control it.  This development was said to be a “big win for local tweeters”.  I am more circumspect about the result however.  Certainly a major winner was the @DCFireEMS account who gained over 100 new “followers” in the time it took me to write this post.  I also think that the public has regained a useful service as they continue to benefit from the good work begun long ago in building communication with FEMS.  It is the process that I think has lost something.  How do we go from “social media is for parties” to “no filter required” in less than a day?  Perhaps this is an example of exactly the type of communication that social media can be used to explain – in dialog form as opposed to a press release.


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Quick Thoughts from TriCON 2011

I apologize that these “quick thoughts” are actually being posted after this conference has ended, but I will blame the fact that the TriTech organizers, namely Jenny Clavero, kept us busy the entire time in Boston.  Attendance was similar to last year with around 230 people but it was made up of a slightly different cross-section of TriTech users with a few more EMS agencies and stronger representation from the eastern half of the US.  Still, there were the stalwart VisiNet users from New Zealand and Australia half way around the globe.

True to its theme of “Fresh Ideas” and “New Perspectives”, there were talks about the future of CAD, PSAPs, and healthcare information exchanges interspersed with VisiNet product updates and current technical best practices.  The opening keynote was presented by Jeff Robertson, Managing Partner at Robertson & Associates, on Wednesday morning to challenge thinking about public safety technology and the future.  Jeff pointed out that the Computer-Aided-Dispatch (CAD) application is to the dispatch center (PSAP) what MS Outlook is in most businesses – the application interface that facilitates communication and organizes your work.  His vision was a consolidation of functionality, similar to an Enterprise Resource Planning (ERP) system, combining the dispatch function with records management and mobile access all coordinated geographically through a map with interactive “drag and drop” capabilities.  A favorite line was “passing data serially from 911 to the CAD is sooo 1980’s.”  However, consolidation should not be occurring just at the software level but should continue at the very least to the pooling of resources to permit better information sharing as well as cost savings at the administration level.  He noted that other nations, his example was Germany, have a small handful of coordinated Public Safety Answering Points to service the entire country.  The United States is an outlier in having distinct PSAPs for each county and sometimes even separate systems by agency within that county.

There were hands-on labs, user groups, product updates, and vendor exhibitions filling out the afternoon.  The session by Frank Gresh, CIO of EMSA, on the ecosystems for Healthcare Information Exchanges (HIE) was particularly enlightening and will hopefully lead a future blog posting here.  His demonstration of SMRTNET in Oklahoma provides an example of how a national program could function to provide Field EMS with life-saving background medical data on patients in addition to helping hospital staff.

On Thursday, the day began with a keynote from Colin Lawrence of The Order of St John in Christchurch, New Zealand describing the infamous earthquakes from September 2010 to February 2011.  Using GIS maps and YouTube videos, he told the story of the geology of his country and how it led to the devastating damage upwards of $7.1B (which when compared as a percentage of national GDP far outweighs the effects of either Katrina on the US or Fukushima on Japan.)  While the number of calls for service increased dramatically, the communication center was able to maintain service and triage calls effectively because of ProQA from Priority Dispatch and a decision to return calls for more minor incidents after a brief period.  Another lesson they learned was that by not securely mounting computer displays to desks, many were smashed as a result of a serve quake and while these computers were otherwise operational they could not be used without their screens.  But after all the horrifying details, the presentation ended with a video demonstration of the traditional resilience of the New Zealand people called a “haka” and a plea for the World Rugby Cup.  Normalcy is always a priority after any disaster.

Special sessions were devoted to developing topics such as social media, consolidation, and also best practices for GIS.  Corporal Melinda Gutierrez of the Dallas Police Department and Chris Kummer, EMS Communications Manager for Hennepin County, shared their experiences learning their way through developing social media sites for their services and the policies regarding the use of these networks.  Jim Lake discussed the differences and problems of consolidating multiple agencies into a single dispatch,  Likewise TriTech GIS Analyst Karen Pankey and Adam DeMars of Columbia/Richland County shared practical tips for editing in ArcGIS and integrating it with GEO.  Then VisiFest!

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