An awful lot can happen in five years. I know that my own understanding of EMS deployment has deepened a great deal in that time. It was that long ago that I wrote a post about The Cost of Saving Money using Lexington County, SC, as an example. The county EMS Director, Brian Hood, and the now-retired county GIS Manager, Jack Maguire, made a huge statement about how EMS and GIS can work together and achieve incredible results. At that time, Lexington County EMS credited technology with giving them an advantage that helped them plan and respond better. Even though they were experiencing an average annual growth rate in calls-for-service of about 7-1/2 percent, they had gone over 4 years without adding a single new truck to their fleet. The close relationship EMS had developed with their GIS group also benefited everyone by improving the quality of their street data for all county users. I have repeated this story over the years but when I revisited them recently for a follow-up, I was amazed to learn how much we had both matured.
Chief Hood began by stating that ten years ago their average response time was 11 minutes. Since then, growth in demand for services has continued to range anywhere between 3.5 and 11 percent annually. Still, they have not added a new ambulance to their fleet, but through continual improvement they have that same average response time of 11 minutes today. Their goal is 12 minutes at the 90th percentile. However, pending legislation in the state of South Carolina known as R.61-7 may require times at the 95th percentile for Advanced Life Support (ALS) response. Guaranteeing service at that level can be a daunting challenge for any manager. The response of Chief Hood was to develop a process to address the demands as well as the realities of his agency. At the core of that process is MARVLIS Deployment Planner (a tool for automating system status management) and MARVLIS Deployment Monitor (a live view of current resources and demand with real-time recommendations.) These tools give the Chief and his staff the information they need to know for scheduling and dynamically deploying resources. “If you took these tools away from me, I could not do my job,” said Hood. “History absolutely repeats itself and this system is frighteningly accurate.”
In addition to facing increasing demands and tighter response times, Lexington is facing a lack of paramedic resources the same as many other areas of the country. It is recognized that sending ALS level resources to every call can be expensive and even wasteful of these limited resources when record reviews show that 70 percent of responses only require a Basic Life Support (BLS) level of care. The new solution they have just begun testing is a tiered approach where calls are being triaged based on nearly 200 determinate descriptors to categorize the initial response level. To prevent dispatching high acuity resources to low priority calls, it is not always the closest unit that is assigned to a call by dispatchers. The lowest categories of Alpha and Bravo level are only sent BLS providers in a vehicle that could otherwise provide ALS care. Rather than requiring an ambulance intercept in the event an upgrade of care is required, command staff will arrive in a quick response vehicle to supplement the care available and effectively transform that ambulance into a full ALS unit.
They are also looking at improving provider safety by questioning the use of lights and sirens on most calls. Just as calls can be categorized for the level of responders, they can be categorized for “cold” and “hot” responses that can limit the dependance on lights and sirens. This is still very much a work in process, but key to making it successful will be in the support of county commissioners. The goal of arriving on scene to the highest priority calls on-time 95 percent of the time will mean that other calls designated in the lowest priority responses will take longer. It’s just common sense that decisions must be made when a system has a defined budget with limited resources to get an important job done. The vision to see the larger picture and to achieve the greatest good for all who are involved is the hallmark of real leadership. Problems never really go away, the list just keeps changing and they keep solving them.