Tag Archives: ems response time

What If We're Wrong About Response Times?

Anyone who follows my posts here, or on Twitter, will recognize that I consistently argue for the value of prompt responses by emergency vehicles to nearly all incidents. However, this post will be different thanks to an inventive challenge through EMS Basics asking bloggers to consider an opposing view to their favorite topic. You can read about the challenge and link to other participating blog posts in The Second Great EMS What-If-We’re-Wrong-a-Thon.

There actually are some valid arguments against rapid responses, so let me begin with pointing out the lack of a recognized national standard. If a short response was really an evidence-based practice, there should be some agreement on exactly what a “short response” means. The NFPA and NIST standards suggest response times for all hazards, but are really focused on requirements for structure fires and have more to do with the central placement of stations than the speed of fire spread in a structure. The nature of this fixed deployment strategy becomes even more problematic for medical responses as there tends to be far fewer ambulances in comparison to fire suppression apparatus.

A shortage of resources is therefore, a compounding problem. Ambulance response time goals often vary tremendously by locality and type of service. Response time goals become a result of compromise matching community expectations with financing – not the science of resuscitation. Often contracts with private services are drafted to simply improve on the current response times rather than meet an objective goal with a defined clinical outcome.

The clock is an easy measurement device that is more easily understood than many other proxy measures of the quality of our service. And pushing for more (faster) response makes a contract negotiator look like a winner. Unfortunately, there is a heavy cost to pay to chase these ever increasing goals. And for services who cannot meet these objectives, there is either embarrassment, financial ruin or the flexibility built in to the start and end times for the clock. In other cases, there are rules for simply ignoring exceptions to the goal as outliers. Without standards on measurement, why do it?

Trends are showing a higher demand for services which translates to an increased demand in resources which in turn raises system costs unnecessarily. Recent studies have also shown that response times do not improve clinical care in the vast majority of cases. In fact, there are a significant number of responses that don’t even require an ambulance at all. Proper emergency medical dispatching through improved triage at the call taking phase can reduce the effective number of emergent calls that demand immediate responses.

Finally, there is also a growing awareness lately to the safety of providers. Studies show that the use of lights and sirens are risking the lives of responders and even the public. Ambulances driving at excessive speeds for most calls is just illogical and unsafe.

I would like to thank Brandon Oto for issuing this writing challenge. Viewing a problem from a new perspective is quite a liberating opportunity. I believe that in this case, there clearly is still a good reason to debate the need for rapid responses. However, I will continue that debate in a follow-up article from my own perspective.

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

Response Time Zero

The best possible response time for any emergency is immediate. This is no simple theoretical goal, but a physical reality everywhere that a Public Safety Dispatcher, using standard Emergency Medical Dispatch protocols, can be reached by phone. These calm “voices of hope? quickly perform an initial triage to determine the type of medical or trauma situation being reported, dispatch appropriate emergency services as necessary, and provide quality instruction to the caller before any additional help arrives on scene.National Academies of Emergency Dispatch

The Navigator conference in Baltimore this week, sponsored by the National Academies of Emergency Dispatch, celebrated the efforts made in the last 33 years since Dr. Jeff Clawson developed a set of protocols in an attempt to reduce the number of Code 3 medical runs through proper resourcing and to promote dispatching as a profession. Now there are 65 million emergency calls for service each year to just over 3,500 Public Safety Answering Points (PSAPs) worldwide where the best are recognized as Accredited Centers of Excellence (ACE).

But not all calls requesting service are equal. Using the Medical Priority Dispatch System (MPDS) protocols, automated through software like ProQA, the initial triage phase is automated to provide a standardized format for carrying out the practice of priority dispatching. The acuity of the call is determined to categorize the dispatch response. Increasingly that response may include the possibility of alternative service endpoints in certain systems reforming the traditional “you call, we haul? strategy where each call ends with a transport to the hospital. For systems authorized to use it, like many in Europe, PSIAM provides a secondary level of triage, commonly performed by nurses, for any lower acuity incidents that should not require an ED visit. This is a dramatic departure from the norm in the US and one that will require vertical integration of healthcare providers starting with EMS, the practical gatekeepers to a significant amount of healthcare in the community. Recognizing EMS as healthcare providers is also a shift in thinking from the prevalent public safety mindset and one not taken in current healthcare reform.

The first link in the chain of the emergency response system, however, is the Emergency Medical Dispatcher. These are the true First Responders who are immediately present at the scene providing care even though they cannot see or physically be present with the patient.

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Filed under Dispatch & Communications, Emergency Communications, EMS Dispatch, Technology & Communications