Tag Archives: system status management

Index of Suspicion Includes Me

It doesn’t take long in an EMT career before the excitement of “rushing to an emergency” turns in to “just another transport call.”  The philosophy of “you call, we haul” in nearly every service can break the community servant’s spirit by turning a skilled paramedic into just an ambulance driver.  But our system “just is what it is,” right?

Well, far from being a service based strictly on tradition, EMS is constantly challenging previous assumptions and struggling to reinvent itself.  How we administer CPR has changed (again), we question the effectiveness of C-spine immobilization that we do standard on nearly every trauma patient, or argue the very validity of the “Golden Hour” around which many services have been designed.  Almost all assumptions are open to be questioned.  I say “almost” because I have found that there still are some boundaries to the willingness of many EMS practitioners to consider change.  Some limitations are easily admitted, like the aversion to legal liability that means we transport anyone who asks us to do so regardless of their suspected need or ability to pay, but there are also less easily acknowledged sacred beliefs.

One of those that comes quickly to my mind is response time.  To many, a quick response indicates excessively fast driving and is contraindicated by safety concerns.  Besides that, we can justify ourselves since very few of our daily calls actually “require” a code response.  While that point may be strictly valid medically, I would argue that our performance is often measured by the public in the agonizing minutes between the 9-1-1 call and the ambulance arriving at the curb.  A patient does not need to be in some form of arrest in order for them, or their family members, to be distressed.  Part of our job is being a calming and supportive influence.  At the same time, I admit that it does not justify putting the driving public or ourselves at risk with an ambulance speeding to every call. But is it really a given that one means the other?

System Status Management – oops, another term laden with strong negative feelings in the field – is actually all about improving performance (both time and economic efficiency) without sacrificing safety.  As advocates for patients, medics see themselves sometimes fighting the system in order to provide the best possible care.  Talk of economic efficiency is seen as just making their job harder.  But again is it really a given that one necessitates the other?

Imagine a system where patient needs are accurately forecast in advance. Where the posting of ambulances is not just another place to sit and wait, but in a practical sense it is the staging for a call that has yet to be received.  Response is thereby improved not by excessive haste, but by the strategic pre-positioning of resources.  The cost savings is not simply an amount  taken from others in a “zero-sum game”, but effectively rescues budgets for proactive wellness programs or, in the current economy, may mean simply saving jobs that allows us in turn to save lives.  This process really works and these systems do exist.  They are called “High Performance EMS” systems and many are profiled here each month while others receive recognition through accreditation agencies like CAAS.  What sets them apart is often observed in technology, but the reality is that it is a culture of seeking constant improvement by the entire staff that makes a difference.

While we consider improvements to the many technical aspects of our profession, let us not neglect the philosophical perspectives that motivate us as individuals.  We operate as a team, not just the pair on the truck, but the whole EMS system is one team with a singular goal.  A goal to do even better each day. So, as we continue to assess our profession should the index of suspicion not include our attitudes toward improving the overall system?

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HP-EMS Profile: Sedgwick County EMS

It has been much more than a month, but we will return to featuring a monthly profile of High Performance EMS sites in order to inspire others to reach beyond just compliant services to provide advanced out-of-hospital care while focusing on improved efficiency.  This time, our spotlight is on Sedgwick County Emergency Medical Service of Kansas.

Sedgwick County EMS

Sedgwick County EMS

The public EMS agency in Sedgwick County is responsible for ALS out-of-hospital care and transportation for both acutely ill and injured patients as well as providing scheduled ambulance transportation services within an area of 1,008 square miles serving a population of approximately 498,000 residents.  In 2010, Sedgwick County EMS responded to 52,815 calls for service.  They are also proud to be part of an elite group of CAAS accredited agencies across the nation signifying that they have voluntarily met the “gold standard” determined by the ambulance industry to be essential in a modern EMS provider.  The CAAS standards, which often exceed those established by state or local regulation, also define High Performance EMS as they are designed to increase operational efficiency and clinical quality while decreasing risk and liability to the organization.

In addition to efficient performance, another hallmark of a High Performance EMS provider is community involvement.  Sedgwick County EMS is a regional BLS Training Center for the American Heart Association teaching CPR classes and frequently participates in local school programs by visiting classrooms to educate children on accessing the emergency system and demonstrating their equipment to make students more familiar with EMS should they ever need to access it.

This past summer, Sedgwick County EMS was selected as a 2011 “Health Care Hero” by the Wichita Business Journal.  The award was given in the health care innovations category which honors a person or organization for breakthroughs in medical technology ranging from research to a new procedure, device or service.  In addition, Sedgwick County EMS received the 2011 advanced life support (ALS) Ambulance Service of the Year award from the Kansas Emergency Medical Service Association (KEMSA) in recognition for promoting EMS in Kansas.  These honors recognize Sedgwick County EMS for the implementation a number of software upgrades that improved automated scheduling, patient care reporting, and deployment practices, among others.

Sedgwick County EMS Director Scott Hadley said in an EMSWorld article this week, “We needed a communications platform and software solution that would support our latest enhancements and upgrades to dispatch and deployment practices, automated scheduling, and patient care reporting for the entire health care system. In Motion Technology and Bradshaw Consulting Services are providing us with the tools we needed to support our mobile healthcare technology to benefit the citizens of Sedgwick County.”

Showing that properly implemented System Status Management can ensure the right response at the right time, Hadley says, “EMS crews have been hitting their goal of getting to destinations in less than nine minutes more than 90 percent of the time for 24 straight months.  That means technology is doing what it’s supposed to do and furthering the mission of the agency.”  Demonstrating the final component of a successful High Performance EMS, Hadley says “it’s our responsibility to continually improve our patient care.”

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Dynamic System Status Management

System Status Management (SSM) is the fluid deployment of ambulances based on the hour-of-the-day and day-of-the-week in order to match supply, defined as Unit Hours of Utilization (UHU), with expected demand, expressed as calls for service, in the attempt to provide faster response by locating ambulances at “posts” nearer their next calls.  While the practice is still not unanimously embraced by all services, it has a sound foundation both in the research literature dating back to the 1980’s as well as in practice today.  Experience has shown that ambulance response times can be dramatically decreased using this type of dynamic deployment, but it is also recognized that it is possible to reduce performance when these techniques are not applied properly.  The direction of the results of a system implementation are typically influenced by the system design, competence of the managers creating the plan, and commitment of the workforce in implementing it.  Therefore the best practice is a simple and straightforward implementation that will show positive results quickly.  This methodology ensures a positive return on investment along with garnering the necessary buy-in from staff to make the project a success.

In his article, “System Status Management – The Fact is, It’s Everywhere“,  published in the Journal of EMS (JEMS) magazine back in 1989, Jack Stout explained the concept of SSM and tried to dispel certain myths.  Based on foreseen Geographic Information System (GIS) technology and even general computing capabilities of that time, it was quite logical to assume in his Myth #2 that “no matter how thoroughly the response zone concept is fine-tuned in practice, it cannot be made to cope effectively with the dynamic realties of the EMS environment.”  But systems implemented today around the US are capable of calculating dynamic response zones in a small fraction of a second while even being based on time-aware historic driving patterns making a truly dynamic system status management process a reality.  A practical and proven example of a dynamically functioning system status management application is the Mobile Area Vehicle Routing and Location Information System, or simply MARVLIS.

The following Slideshare presentation does an excellent job of telling the story of why and how the system works:

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