The Role of Response Time in EMS Performance

Several months ago, Rob Lawrence of the Richmond Ambulance Authority started a thread on the High Performance EMS Group of LinkedIn by asking “So what does the phrase ‘High Performance EMS’ mean to you?” This innocent sounding question sparked immediate debate even within the small group at that time. Benjamin 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.” He 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.” This 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 since NFPA 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 web Performance Dashboard) is not an “evidence-based” practice. There 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”. However, 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. The chart reproduced here shows a correlation between

Return of Spontaneous Circulation vs. Response Time

response time and the Return of Spontaneous Circulation (ROSC). This 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. This is a verified statistical trend (Mount Sinai Hospital reviewed these findings) and I suggest you click to view the graph in full detail. This 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. Can what Jersey City Medical Center is experiencing be reproduced elsewhere? And probably more importantly, does fast response necessarily mean “high speed driving”?

The point of System Status Management (SSM) is that ambulances can be effectively pre-positioned through scientific statistical forecasting in order to reduce the time of a response even without driving faster to the call.  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. One 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 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
Matt Zavadsky
What Higher EMS Pay Requires
This article is spot on - the rapidly changing healthcare finance environment is a game changer for us - IF, and ONLY IF, we can prove that we bring value to the payer... Does our care make a difference in the patient's experience of care, outcome and cost of care... By assessing our patient satisfaction,…
2015-06-17 08:38:01
Steven Lichtenberg
What Higher EMS Pay Requires
The biggest issue in pay scales is one you hit on directly. Payment for service rendered is solely based on transports. Refusals/DNR/DOA etc are not reimbursed. Once Medicare determines that we are in fact medical professionals and not "ambulance drivers" and pays for care rendered we have a chance. Community paramedicine is one mechanism for…
2015-06-16 21:47:53
daleloberger
What Higher EMS Pay Requires
Thank you for making the comment, Kim. I suspect you may have missed my meaning in that statement though. The passionate folks in EMS are some of the hardest working people I know. My complaint is certainly not that "we" don't put enough into our jobs to deserve better pay, it is that we must…
2015-06-16 18:13:18
Kim
What Higher EMS Pay Requires
"Wages will change when we decide to work for them." I don't know about you but I have been busting my butt for 24 years for better wages. I continually educate myself to gain knowledge beyond my scope. My scope of practice limits what I'm allowed to do but it doesn't limit what I am…
2015-06-16 12:38:23
Kim
What Higher EMS Pay Requires
I have worked for companies that were union and companies that were non union. The pay is always the same. I have been in EMS for 24 years and I have never earned a living wage. I always have to have multiple jobs just to get by. No vacations, no credit cards and no car…
2015-06-16 12:15:12

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