“No Available EMS”

No one really wants to read a bad story about some other EMS agency, but it isáeven worse to read a similar story about your own.á The purpose of this post is not to make Detroit intoásome EMSá”posterchild”ábut intended toáshed some light onásimilar problems that may be all too common at other locations as well.ááFor instance, I am sure that the Detroit EMS is not alone in being accussed of having their service underfunded and their resources understaffed.á I alsoáknow there are many other agencies out there paying penalities for “exceptions”á(calls outside the expected response time), but holding a call for an hour before dispatch as claimed by EMS workers in a Detroit Examier storyáis certainly not a common trait of a High Performance EMS.á Actions like thisáare certainly worthy of examination, however, the thing that hasáreally set Detriot apart right nowáis the realignment of its fleet áeffective January 3rd in response to the death of Gordon Mickey shortly before Christmas of 2010.

According to Detroit Free Press reporters ináan article publishedá in EMS World just today, the plan is to reallocate eight ALSá(Advanced Life Support) ambulances to Basic Life Support (BLS) units by reorganizing the Paramedic/EMT teams.á Jerald James, Detroit EMS Chief, said that the model “will help better address non-emergency runs” which can make up about 65% of theároughly 130,000 dispatches each year.á But in the same article, a “city paramedic”áwas said to have expressed concern that the wrong ambulances will end up at the wrong calls identifying dispatch’s difficultyáwith properly priortizing EMS response.á Interestingly, Detroit hadáalreadyáreorganized its EMS service back in 2004 by adding Echo units (paramedic equipped vehicles without transport capabilities) to its formerly all-ALS ambulance fleet but concern was expressed even back then that “tiering” the system to add Echo units and converting certain ALS units to BLS years ago was not an answer to increasing service.

While the specific case in Detroit may have many conditions or particular circumstancesáleading to their current status, the idea I want to spotlight is the not-so-unique idea of reallocation of staff and resources just to improve the emergency response statistics rather than looking more broadly to improve overall EMS response.á As David Konig, The Social Medic, describes the situation in his recent blog, downgrading certain 911 calls from ALS emergencies to BLS status is just “shuffling the deck” to improve response time stats in one category over another.á I believe he correctly deduces a major part of the answer by saying that “systems improve service and response through intelligent deployment.”áá

It is exactly that type of “intelligent deployment” that is the driving motivation behind the Mobile Area Routing and Vehicle Location Information System (MARVLIS) suite of products.á Using an agency’s own historical data, MARVLISápredicts future demand geographically highlighting most likely demand areas with 80% probability.á It is also the only system to dynamically predict vehicle response zones to calulate up-to-the-minute demand and geographic coverage based onávehicle status and location – even when moving!á This proven system has reduced response times, held growth in future spending, and improved the clinical outcome while working with EMS staff to improve operating conditions not squeezing productivity.

We would love to hear your comments or experiences on this topic, so pleaseáadd a comment below and check back often for future discussions.

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High Performance EMS

High Performance Emergency Medical Services (HP-EMS) systems provide effective clinical care promoting positive patient outcomes and community wellness while maintaining a focus on improving economic efficiency of the system.  This site is dedicated as a community seeking to increase agency performance by promoting useful information regarding the developing trends and improvements in the efficiency of delivering basic and advanced medical care in the field.

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Comments
Rob Lawrence
What is CAEMS and Why Should I Care?
Also catch the CAEMS panel at EMS Today in Feb 2015 also. Will have a few too name lined up for the panel.
2014-12-22 11:56:19
daleloberger
Culture of Safety
The idea of changing administrative behavior at the very core of how they function regarding issues of safety is also seen in the promotion of a "Just Culture" in EMS. The Center for Patient Safety discusses this idea at their website: http://www.centerforpatientsafety.org/just-culture-in-ems/
2014-12-19 18:09:59
daleloberger
Community-Based Programs
How EMS can become a financially stable function of a local government is a hot topic right now. Jamie Davis discusses the NAEMT efforts towards changing the funding stream from the federal level in this podcast: http://www.mediccast.com/blog/2014/12/19/naemt-wants-congress-and-the-president-to-fund-ems/
2014-12-19 18:06:14
daleloberger
Communicate, Communicate, Communicate
It only takes one bad story like this: http://www.emsworld.com/video/12029267/philadelphia-paramedic-in-hot-water-over-anti-police-image to make the public question a whole service (or even incite violence.) If your service doesn't already have a social networking presence, how can you effectively counter such bad media? You need to engage before problems arise in order to have credibility and a voice when…
2014-12-18 13:51:43
Mark
How To Perform CPR: The Crucial Steps You Should Know (and Share!)
The majority of people who survive a cardiac arrest are resuscitated from ventricular fibrillation (VF) by the administration of a defibrillatory shock. This is most likely to be successful when it is given very soon after the onset of VF; emergency service personnel are often unable to arrive soon enough to help a victim. Automated…
2014-12-16 17:32:19

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