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HP-EMS Profile: MEDIC

Each month we will feature a profile of another High Performance EMS to show the variation in these services and inspire others to reach beyond just the basic services to provide advanced pre-hospital care with a focus on high economic efficiency.

In 1996, the Mecklenburg EMS agency was one of the slowest in the US with an average call response time of about 16 minutes.  Today, calls average around 7 minutes.  That incredible transformation began when two competing hospital services joined together to create MEDIC which now contracts to serve the county of 540 square miles with a fixed population of 850,000 that swells to a routine daytime total of around 1 million people.

MEDIC Emergency Dispatch Center

Barry Bagwell, Deputy Director of Operations, is proud to state that MEDIC has been compliant regarding performance every month since 1998.  “While there is no ‘silver bullet’, all of the pieces must work together,” says Barry, “it requires technology plus the people to run it.”  But a truly High Performance EMS must not be tempted to over-utilize response times as the only measure of success. The original focus for system improvement was on routing, but the partnership with Bradshaw Consulting Services has led to many operational enhancements including successful demand prediction and dynamic System Status Management planning.  “Dispatch posting is a ‘chess game’,” Barry admits and real efficiency comes by balancing moves between the 60-65 posts to meet service demand with reducing fuel costs and minimizing disruption of ambulance crews.  With a holistic view of clinical outcomes, MEDIC has achieved a 33-minute turn-around time from hospital to availability and 82 minutes from a call to having a Code Stemi patient on an operating table with the artery open.  MEDIC also provides bicycle paramedics, ATV, and buses for special events to meet the needs of their community.

The dispatch center has used ProQA Dispatch Software protocols in both EMS and Fire since 1993 to assist dispatchers in quickly determining the appropriate determinant code.  Voice communication with vehicles is maintained with a Motorola 800 MHz shared backbone radio system with priority.  Non-emergency numbers are provided only to hospitals with the public being triaged through the 911 system.

While recognized as a High-Performance EMS already, MEDIC does not intend to rest where they are now but constantly looks toward additional improvements.

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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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