No one really wants to read a bad story about some other EMS agency, but it is even worse to read a similar story about your own. The purpose of this post is not to make Detroit into some “failed EMS poster child” but intended to shed some light on similar problems that may be all too common at other locations as well. For instance, I am sure that the Detroit EMS is not alone in being accused of having their service underfunded and their resources understaffed. I also know there are many other agencies out there paying penalties for “exceptions” (calls outside the expected response time), but holding a call for an hour before dispatch as claimed by EMS workers in a Detroit Examier story is certainly not a common trait of a High Performance EMS. Actions like this are certainly worthy of examination, however, the thing that has really set Detroit apart right now is the realignment of its fleet effective January 3rd in response to the death of Gordon Mickey shortly before Christmas of 2010.
According to Detroit Free Press reporters in an article published in EMS World just today, the plan is to reallocate eight ALS (Advanced Life Support) ambulances to Basic Life Support (BLS) units by reorganizing the Paramedic/EMT teams. Jerald James, Detroit EMS Chief, said that the model “will help better address non-emergency runs” which can make up about 65% of the roughly 130,000 dispatches each year. But in the same article, a “city paramedic” was said to have expressed concern that the wrong ambulances will end up at the wrong calls identifying dispatch’s difficulty with properly prioritizing EMS response. Interestingly, Detroit had already reorganized 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 unique conditions or particular circumstances leading 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. 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. I believe he correctly deduces a major part of the answer by saying that “systems improve service and response through intelligent deployment.”
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. Using an agency’s own historical data, MARVLIS forecasts future demand by geographically highlighting the “most likely demand areas” with a confidence of approximately 80%. It is also the only system to dynamically predict vehicle response zones to calulate up-to-the-minute demand and geographic coverage based on vehicle status and location – even when units are moving! 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 please add a comment below and check back often for future discussions.