ATale of Two Cities

Just today I have watched two very different stories about two very different Michigan cities. áThe first one in the news was Detriot and then later it was Grand Rapids. áThe common thread between the two is about getting control of the EMS system and improving its performance.

The situation in Detroit is truly sad and stems from a variety of problems spanning years. áAt this point the Governor is considering the appointment of an emergency manager while the system faces financial difficulties and now possible privatization. áThe comment that struck me in the video, however, was when the union president suggested that outsourcing would mean the city loses control of EMS. áIs this really a system “in control”?

The story in Grand Rapids is very different. áThey began looking for control by trying to understand their existing system. áWhat did they already know and how could that help them do a better job? áThey turned to study habits in their system and employ “System Status Management”. áThe sucess they found also earned them a local news story, but the tone was very different than the one above.

The question you need to answer is who is really in control of your system? áThat answer will determine whether the next news story about your service will be more like the one in Detroit or more like Grand Rapids. áWhat is working for you?

3 Comments

  • Ray Mickol says:

    Great article. Unfortunately, as in other places, I am sure the EMS system in Detroit is run by politicians and career bureaucratic that haven’t a clue how to proper run a system. Until politicians can leave their hands off and trust the professionals to do the job they were hired to do we will always have excessive waste ans mismanagement.

  • Skip Kirkwood says:

    Here’s a simple fact. It costs money to provide quality EMS in a community. It is a rare community where “transport reimbursement” will pay for all the pieces of a quality, comprehensive EMS system. This is particularly true where many people are uninsured or under-insured (read “Medicaid”). The EMS system is not the only problem faced by Detroit, but it is symptomatic of the issues faced in what looks a lot like a distressed city.

    If the city wants quality EMS, they have to fund it. If they want to get out of the business, do so – but don’t let the service die a lingering death (because the citizens will, too). “Privatizing” is a temporary fix at best, because if the city can’t make it work, it is unlikely that a private company can make it work in the long term either. Savings from “private sector business practices” will either go towards company profit (a good thing in the private sector) or will come at the expense of patient care.

    Not an easy issue to address!

  • Dan Gerard says:

    I agree with Skip. Regardless of service provider/model, the system has to be adequately funded, with clear expectations spelled out (response time parameters, QA parameters, prevention activities, community education, etc.)

    My heart goes out to the residents of Detroit, the men and women in Detroit F.D. who are providing EMS.

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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.

Comments
Roger Thayne
Static v. Dynamic: A Continuum of Cost
Totally agree. I would add that response and transport need to be understood. Within busy urban areas an ambulance can be both the response and transport vehicle. In rural areas response can be achieved efficiently by a Community Paramedic in a car within 8 minutes supported by an ambulance within 20 to 30 minutes i.e.…
2014-08-10 10:28:37
daleloberger
About
Jodi, it took a while, but we have begun putting this sort of information together in book form. Our first attempt is "Dynamic Deployment: A Primer for EMS" (http://www.amazon.com/Dynamic-Deployment-A-Primer-EMS/dp/1500428574/ref=sr_1_1?ie=UTF8&qid=1407501551&sr=8-1&keywords=dynamic+deployment). We are already in the process of building its sequel that we hope to be a broader compendium of cases, authors, and opinions regarding the measurement…
2014-08-08 07:44:52
Alex
Could Busier be Better?
Since medical calls are now the focus of fire service. Maybe it's time for a rebranding if you will to new terms like "EMS Based Fire Service". Paramedics are constantly upgrading thier knowledge and skills and get thier butts kicked daily but don't enjoy the same pay or benifits that firefighters do. Something is wrong…
2014-08-05 03:55:31
Lauren
Could Busier be Better?
This article is more about understanding evidence based research then applying it rather then replying on personal experience and tradition. Even if you don't like what research says.
2014-07-19 20:30:03
Paul
Could Busier be Better?
High quality comes from seeing multiples of truley sick patients with strong training and support from an experienced partner, not just from being a busy transport vehicle.
2014-07-19 08:26:57

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