The Role of Response Time in EMS Performance

Several months agoáRob Lawrence of the Richmond Ambulance Authority started a thread on the High Performance EMS Groupáof LinkedIn by asking “So what does the phrase ‘High Performance EMS’ mean to you?” áThis innocent sounding question sparked immediate debate even within the small group at that time. áBenjamin Podsiadlo of AMR quickly tied the quality of EMS performance to “experience” and “outcomes” stating further that “response time is not an evidence based factor in ALS performance.” áHe later backed up his assertion by writing that “the catch 22 of pushing the workforce to be responsible and accountable drivers while simultaneously achieving narrow response time goals to the vast majority incidents that have no medical need for such high speed driving is also a bizarre and irresponsible contradiction.” áThis is a point that even Lawrence admits could foster the “mentality of ‘arrive on time and the patient dies – good outcome, arrive late and the patient lives – bad outcome’” that has already been affecting common sense both in the UK and increasingly in the US sinceáNFPA 1710 set response time standards several years ago.

While there were other good comments, I would like to focus on the specific assertion that measuring response time (a well established practice today such as at Huron Valley Ambulance’s public webáPerformance Dashboard) is not an “evidence-based” practice. áThere are many specific accounts of individual lives saved that I have heard mentioned by different agencies, but I will concede that the plural of “anecdote” is not “data”. áHowever, one of the best stories of response time saving lives was made on February 9 when Richard Sposa of Jersey City Medical Center EMS discussed an interesting finding in a recent webcast. áThe chart reproduced here shows a correlation between

Return of Spontaneous Circulation vs. Response Time

response time and the Return of Spontaneous Circulation (ROSC). áThis unexpected finding clearly traced an upward trend of ROSC with the decline in Average Response Time for Priority 1 Calls graphed quarterly from the beginning of 2005 to the end of 2007. áThis is a verified statistical trend (Mount Sinai Hospital reviewed these findings) and I suggest you click to view the graph in full detail. áThis shows not just living anecdotes, but a statistical increase patients with restored heartbeats.

Many things about our business can and should be questioned, but this is exactly the sort of evidence I would like to see investigated at other services. áCan what Jersey City Medical Center is experiencing be reproduced elsewhere? áAnd probably more importantly, does fast response necessarily mean “high speed driving”?

The point of System Status Management (SSM) is that ambulances canábe effectively pre-positioned through scientificástatistical forecasting in order to reduce the time of a response even without driving faster to the call. á Zoll Software Solutions, as an example, considers the elimination of inefficiencies to be a core component for closing the loop on your dispatch process and is even offering free medical equipment to customers who use this technology to improve their system. áOne customer who has done this already with Zoll technology is Grand Rapids who was also featured in the following FOX News video on Predicting Where your Next Emergency will Happen.

If you believe that knowing where your next calls are likely to come from in time to allow you to safely prepare for that response, the science is available today. You just need to be able to integrate that knowledge into your process.

1 Comment

  • Ben Podsiadlo says:

    Hello
    Chris Rinn and his successors and Frank Mineo have done amazimg things at JCMC. I am proud they are my colleagues and friends. BLS rapid response to true life threats makes logical and evidencesense. Extending that same logic to ALS is a land grab jump. While NJ EMS has come.under scrutiny from itself, one thing they for right a long time ago was right sizing ALS to actual demand for ALS. With so many bright national EMS leaders in and from NJ EMS, such as Deputy Commissioner Rinn, Dan Gerard, Scott Kasper. and many others, it will be exciting to see how the rest of the country learns from NJ smartly blending the best ideas that have stood the test of time in NJ (eg population regional ALS) with new ideas and technologies, such as the ones driving the fantastic JCMC EMS Renaissance.

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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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