The “Leverage Real-Time Data for Improved Ambulance Response Times” article that Zoll posted on their blog site did a good job of explaining response times and even the benefits of System Status Management (SSM) planning to the patient. But there is still more to the story that we have learned over the years since Jack Stout first introduced it.
Of course, it is best for the patient (and the service) when an ambulance arrives to the scene in a short time. The media often picks up on poor response times with stories like the GSW patient dying in Cleveland surrounded only by police and fire personnel. Even the doctors at JAMA can’t resist publishing an article showing response times as an inherent failure of EMS in certain cases. Unfortunately, many will read the solution as medics “speeding” to the scene, yet we have learned that lights and sirens have little impact on times and may even prevent some patients from calling for an ambulance in the first place. However, when the deployment of ambulances is responsive to the dynamic demand patterns throughout the day, ambulances can literally be moved closer to the scene even before they are dispatched. Literally hundreds of High Performance EMS agencies across the US have significantly reduced their 90th percentile response rates through technology. Forecasting the future does not involve magic, at least not for predictable phenomenon like emergency calls for service. Not only can we forecast the quantity and types of calls we will receive (necessary for adequate staffing), we can determine where they are likely to originate from with significant accuracy as well. Shortening the distance that an ambulance must travel is a safer alternative than asking a crew to speed in order to achieve the same result.
Another positive impact of shorter response times is patient satisfaction. There are many reasons that healthcare providers should be using patient satisfaction surveys, both for the benefit of the patient as well as simplifying the accreditation process for your service. Beyond safety, satisfaction and simplification; proper SSM can improve finances. Some services have recognized marked reductions in the number of post moves for crews and ultimately reduce the total number of unloaded (read unreimbursed) miles driven which saves on vehicle wear and tear in addition to fuel costs. Other agencies, particularly those who contract their services, can reduce financial penalties for “exceptions,” or late calls beyond the target response time.
Frankly, the public often expects performance measured in minutes. Whether we approve of the measure or not, we are often graded and compared based on response times. Whether the penalties for missing targets are financial, patient satisfaction, or driven by bad press reports, being late simply hurts. Until EMS is designated and funded as a critical service for government, it will be dependent on political funding allocations and insurance reimbursements. As long as performance is measured by how long it takes to be on scene, response times will be critical to the financial well-being of services. The least we can do is perform to the highest safe standards possible.
Filed under Administration & Leadership, Dispatch & Communications, EMS Dispatch, EMS Health & Safety, EMS Topics, Firefighter Safety & Health, News, Patient Management, Technology & Communications, Training & Development, Vehicle Operation & Ambulances
I know there are probably agencies out there with some real control issues, but the use of technology that monitors your EMS system are not really about employee surveillance. Â Sometimes this monitoring is actually about your protection, but most often I believe it is about creating a competitive advantage that will help your agency survive in a bad economy and within an industry that is currently favoring consolidation. Â Increasing demand for emergency services is not enough to ensure that there will always be the funds needed to keep it operating at the level the community expects – especially under the same operations strategies in place since before the financial crisis of 2008 or the Patient Protection and Affordable Care Act of 2010. Â The world, and more importantlyÂ prehospital health care, is fundamentally different today and your job depends on your system adapting to it.
System monitoring typically starts by knowing where your vehicles are. Â GPS transmitters are capable of reporting location and many Computer Aided Dispatch systems are able to visualize that data and even recommend vehicles to incidents based on actual proximity and drive-time instead of a simple reported location. Â And that recommendation can even be based on the type of vehicle or skills of the team weighed against travel time. Â One concern of providers, however, is the employer always knowing where they are. Â But relax, the only way a monitor will see you somewhere you shouldn’t be is if you are somewhere you shouldn’t be. Â But again, monitoring your habits is not the important application for dispatchers knowing where available units are right now. Â Better response equals better service and can also improve safety. Â These are the keys to system survival.
Once location begins to be used effectively, concepts of system status management actually become useful. Â And for those who are concerned about that idea, remember thatÂ ‘posting’ is not a dirty wordÂ (that link will allow you to register for an upcoming JEMS webcast by that name or view the recording after the fact.) Â If you think tracking vehicles is invasive, how about tracking people? Â Â A new product currently available is GPS equipped shoes from AetrexÂ (incorporating GTX Corp technology) but fortunately it is directed at Alzheimer patients, not EMTs. Â But before you feel too comfortable, you already carry a GPS tracking device on your body if you use a smartphone. Â While the US Supreme court ruled it illegal for the FBI to secretly track suspects with GPS, it has not limited the private sector employer.
Road safety systems that monitor every aspect of the ambulance operations from seat belt usage, lights and siren activation to the G forces that apply to the vehicle are fast becoming commonplace in the public safety industry. Â Another JEMS webcast, May the G-Force Be With You will explore the implementation of such a system atÂ Richmond Ambulance Authority to reduce accidents involving ambulances, cut operating costs, and provide a smooth and safe ride for the patient.
Paramedics and EMTs are not being singled out for tracking since this type of technology is becoming standard practice in many industries that involve mobile service providers. Â The difference for us are the legal standards to which we are held accountable and the legislation (like HIPPA) that make reporting especially tricky. Â I personally welcome cameras in the patient compartment to protect me from spurious allegations and even help me improve my clinical and patient skills. Â I cannot see any difference in this from recording the 9-1-1 call that dispatched me to begin with. Â While I realize there is fear around the monitoring topic, a useful dialog must begin with an understanding of the facts surrounding the debate – our future depends on doing it right!