Tag Archives: EMS 2.0

What is Performance in EMS? Part 2

With the new year upon us I began to ponder what really constitutes a “High Performance EMS” and came up with several criteria. I started this discussion by posting on “Response Time? and now want to bring in a second topic.

Part 2: Effective Care

While being effective in our care of patients should be an automatic criteria, I believe there is still plenty to say on the topic. The American Heart Association re-evaluates its approach routinely to cardiac care every two years. How often do we truly examine our practices in the “out-of-hospital? emergency care profession where we know that patient demand and provider skills are constantly changing? In the past several months, I have seen articles challenging standard practices toward intubation and c-spine immobilization – basic tenets of our practice – but how many agencies have made any significant investigation toward change in these protocols? For its part, The Army Awards Follow-On Contract for Autonomous Airway Management to Energid Technologies to create robots that can perform endotracheal intubation. Before we answer the question of whether robots or people are better at ETI, shouldn’t we answer the question regarding efficacy of the practice for the patient or refine the scope of practice regarding it? Similarly, other detailed questions are being raised like Is the 6-12-12 adenosine approach always correct? Is the closest facility really the best facility and who is allowed to make the call of an appropriate destination when EMS strategy change gets heart patients faster care? Is public perception or even financial reimbursement a more important driver? Please don’t think I am just being cynical, I believe that the return of the tourniquet is a good example of evidence-based practice in practice. While we don’t want to see protocols change like fashions, we need to avoid viewing them as sacred writings as well.

This next point may need to a separate topic altogether, but as an example of considering all parties involved, lets look critically at a new protocol that has been introduced at many agencies including the service where I work. For cardiac patients requiring CPR, it is now to be done on-scene for at least twenty minutes or until ROSC. If resuscitation attempts are ended, the body is left. Just last night, I departed a scene of the cardiac arrest of a mother leaving her cyanotic body in the home with her husband and 5 yo daughter. I admit that I was relieved not to have to transport, but I was equally mortified to leave the grieving family in that way. Perhaps there isn’t always a good answer, but do we communicate the reasoning behind the decision or just the alteration of the protocol itself?

In my mind, EMS personnel are consummate professionals. But how does the system view these providers of emergency care? I was involved in a serious debate recently over whether EMTs are qualified to place the pads for 12-lead ECGs to be transmitted for interpretation at a receiving facility. I was surprised to find that there was any serious question. Are we more concerned over maintaining a strict division of labor skills for the benefit of the provider even over the needs of a patient? Think of the combined experience out there. There are many innovative EMS personnel, who out of necessity (or extreme practice) create better “mouse traps” such as the REEL Splint or WauKboard for example. Paramedics, EMTs, and even Medical First Responders must not be viewed simply as automatons that can only repeat protocol standards, but capable of some judgement within the limitations of their qualifications and skill level. But whether it is the fault of EMS personnel who attempt to skate by with minimal effort or the cautious medical director who sees the wide disparity in knowledge (or more accurately “wisdom”) in the staff, many good professionals are being short changed. It is our responsibility, whether an EMR or MD, to teach and even police, “our own.” We must hold each other up to the standards we want to examined by and to guide our profession.

You are required to bring about the next generation of EMS, the so-called EMS 2.0 revolution by your actions. EMS World recently published a article to help you move in that direction in their Quality Corner: How to Make Better EMS Providers. Don’t view “professional” as a title, but as a calling to service in always providing “effective care.”

 

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Filed under Administration & Leadership, Command & Leadership, EMS Health & Safety, EMS Topics, Funding & Staffing, News, Opinion, Patient Management, Training & Development

The Future of Prediction

I have read the positions stating that calls for emergency services are completely random (justifying the reason they are often called “accidents”) and therefore not able to be predicted.  But both academic literature and practical experience show that demand prediction can be an effective tool in helping to balance scarce resources (ambulances and their trained crews) with public demand (requests for emergency responses even without taking into account the abuses to the system as discussed in a previous posting on the problem of “frequent flyers”) while still improving response times and controlling costs.

For anyone who thinks all of this sounds too good to be true, there are examples of where expensive technology is not having the desired affect.  One such location is Lee County EMS in Florida where not only have response times not been improved, but ambulances are burning more fuel than ever and the critics include the very paramedics it is supposed to help.  While predicting where the next 911 call will come from may be similiar to “picking the winning card at a casino” as the Florida investigative news reporter suggests, that isn’t really the objective.  We don’t need to know which phone will make the next call, it is enough just knowing the probability of a call coming from any given location within the service area.  This may be a subtle distinction, but one that makes a huge difference at MedStar in Fort Worth or Life EMS in Grand Rapids where response times were dramatically improved by taking the next step beyond simple demand prediction and placing ambulances at positions where they can be the most effective.

Academic studies show that demand pattern analysis can be used without hourly, daily, or seasonal calibration to achieve potentially acceptable tolerances of demand prediction, but when adjusted with these appropriate corrections, software applications like MARVLIS (the Mobile Area Routing and Vehicle Location Information System) can effectively predict demand in practical situations.  According to Tony Bradshaw of BCS, the makers of MARVLIS, it routinely calculates where about 80% of demand will occur and when paired with realistic drive-time response zones it demonstrates valuable support for a dynamic System Status Management plan to pre-position, or “post” ambulances closer to their next call saving valuable time and increasingly expensive fuel costs.

What matters most, though, is what agencies experience in the field.  At SunStar they say ” the most significant result was improving our emergency response time from 90.2% to now over 93% in lieu of an increase in patient call volumes.  This equates to ambulances arriving on scene more than 1 minute quicker.  We additionally saw a savings of $400,000 in penalties by exceeding our contractual goal of 92% and performing above 93% compliance.”  Similarly, Steven Cotter, Director of Sedgewick EMS added that “the technology has opened our eyes to be able to understand how we are performing, where we are deficient in our performance and how we can make changes quickly and adapt to a changing environment.”  And beyond simple response times, “it’s what technology should do,” says Joe Penner, Executive Director at the Mecklenburg EMS Agency, ” take the complex and present useful, straightforward information.  It has helped us improve response times, resource utilization AND simultaneously reduce unnecessary post moves — your patients and employees will appreciate it!”

My conclusion is that proper demand prediction paired with realistic response creates significant opportunity to improve performance and cut costs even in growing communities.  When used properly, the future looks bright for High Performance EMS!

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Filed under Administration & Leadership, Dispatch & Communications, ems, EMS Dispatch, EMS Topics, Funding & Staffing, News, Opinion, Technology, Technology & Communications, Training & Development

Hello World. Welcome to HP_EMS!

The world of the EMS provider is changing.  Whether you call it EMS 2.0 or Next Generation 911, it is no longer enough to simply do a good job resulting in positive clinical outcomes for patients.  Increasing budget pressures require that these quality services be maintained while providing them within a context of higher economic efficiency.  High Performance EMS (HP_EMS) is not about just balancing patient needs with operational costs but simultaneously enhancing both clinical and economic performance.  While there are many tools to assist with this goal, there is no single “magic bullet” just as there is also no single performance metric.  This market dynamic is the reason behind the HP_EMS blog: to faciltate a discussion between agencies, industry insiders, and subject matter experts about how we can collectively do better on all measures.

We encourage you to participate by responding to posts with answers and suggestions or even your doubts and skepticism.  You may even submit your own guest blog posting for others to learn from or make comment.  This forum is all about what you do in EMS from the time someone calls 911 until the Pt arrives at the hospital!  It is hosted by Bradshaw Consulting Services (BCS) and our partners because we want to help you get the information you want to have in order to make the decisions you need to make that deliver the services your public expects.  All of us have data (and opinions), but together we can transform it all into meaningful and actionable information that is useful to the entire community.  Moderation of the discussion will be minimal and limited to igniting conversation and maintaining a respectful and useful conversation focused on the topic High Performance EMS.

So, join the discussion!  It’s about your work – to help you and others do a better job delivering high quality emergency management services to the public within a new era of accountability.  Please share your thoughts… 

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Filed under Administration & Leadership, EMS Topics, News, Opinion, Patient Management, Technology & Communications, Training & Development