Static v. Dynamic: A Continuum of Cost

In our recently published book, “Dynamic Deployment: A Primer for EMS“, John Brophy and I established a dichotomy between the standards of static deployment and dynamic deployment in the very first chapter.  Fortunately, that strong polar perspective has spurred some interesting discussions for me. While the check-out lane analogy was effective in distinguishing some of the differences of static and dynamic deployments, its simplicity only recognized the extreme ends of the spectrum and failed to acknowledge what I would describe as a “Continuum of Cost” between them.

Few systems (at least those with more than just a few ambulances) probably function exclusively at either extreme. The static model will necessitate some flexibility to provide “move-ups” to fill holes, just as dynamic systems will have reasons to keep specific posts filled as long as enough ambulances are available in the system. The reasons for moving, or even fixing locations, may have something to do with demand necessity or even the political expedience of meeting community perceptions.

While there are many differences between static and dynamic deployments that we could discuss, there are also some elementary misconceptions. For instance, dynamic deployment does not mean vehicles are constantly in motion. The term dynamic refers to the nature of their post assignments which can vary between, and even within, shifts. As alluded to in the book, proper post assignments also reduce, not increase, operational expenses. In at least one example we stated, the dynamic deployment strategy was shown to significantly reduce the number of unloaded miles actually driven, which in turn increases the percentage of overall miles that can be billed. This situation not only increases revenue while simultaneously reducing expenses, it also reduces fuel costs and wear on the vehicles (and crews) too which potentially extends their useful life. All this is still in addition to reducing response time and improving crew safety by positioning ambulances closer to their next call so that fewer miles need to be driven under lights and sirens.  The inherent efficiency of this management strategy allows a system to achieve response compliance at the 90th percentile with the smallest possible fleet.  To achieve the same compliance level with a static deployment of crews and posts, the fleet must grow significantly larger. Another recent sample calculation showed that both staff and fleet size would need to grow by well over double in order to reach the same goal. The resulting cost continuum, therefore, clearly shows that a static fleet has operational and capital expenses multiple times the costs of the dynamic deployment model without burning crews out with excessive and unhealthy UHU figures.

For the sake of validating my argument, it is unfortunate that these examples are from private ambulances companies who do not wish to openly share details of their calculations at this time for competitive reasons. It would be safe, however, to assume from these competitive reservations that these results are not automatic, but dependent on proper management and the use of good tools. There are certainly numerous examples of poorly managed systems or ineffective operational tools. To achieve similar positive results in your own system requires certain knowledge, an underlying reason for having written the book in the first place, and an assurance that the deployment tools are proven to be effective.  Just as managers should have references checked during the hiring process, vendors of operational deployment tools should be able to provide ample references for successful implementations of their technology in comparable systems to your own. It is also important that any solution be able to address a continuum that includes your specific objectives to find a balance between geographic coverage with anticipated demand coverage at an acceptable workload and schedule for your staff.

There is no “magic bullet” to achieving operational nirvana, but the combination of effective management with operationally proven tools has shown that cutting costs while improving performance is an achievable goal in most any size system. It is also fair to say that performance can be enhanced with less skill through the application of significant sums of money; but honestly, who can afford that sort of strategy in the competitive arena of modern mobile integrated healthcare.

It is our desire to produce yet another, even more extensive, volume on the topic of dynamic deployment to make the achievement of efficient and effective high performance EMS a reality for more systems. Stay tuned for future details!

8 Comments

  • Roger Thayne says:

    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. when the patient is likely to need transporting to hospital.

  • David says:

    Totally disagree. Your model and book tries to make EMS predictable. Ask any paramedic who operates in your model and they hate it. Stuck in truck all day trying to be in the perfect spot when a person will need assistance is near impossible. It does nothing to answer the retention, growth,prevention,funding,and burnout rate problems in EMS career. When I see fire apparatus driving from posting location to posting location waiting for the next call I will believe its a valid model, they have more call data points than EMS.( ask any fire dept crew to do that and see what they say I dare you),Mr Thayne I agree with the community Paramedic idea , but waiting 25 minutes for a ambulance with severely injuried child or CP or SOB pt is absurd, borderline crinimally negligent.
    “Problems can’t not be solved by the same level of thinking that created them”.

    • John says:

      I thought Johnny and Roy retired in the 70’s. People with a mindset like yours are what keeps the paramedicine profession from evolving like the other emergency services have. The definition of insanity…doing the same things over and over expecting something different to happen.

      • Todd says:

        David…I agree with John and Roger. EMS is a business and we’ve got to start treating it that way. The days of sitting around the station waiting for a call have come and gone. To be efficient you’ve got to be out in your service where the calls happen. This is the future of EMS and people need to realize that or get left in the past.

    • Steve says:

      Except it costs money to pay for a station. Skip the station and instead put the money you would have spent on the station and instead pay your providers more AND get more providers out on the street.

      Fire departments are going to have a hell of a time justifying their wastes in coming years…

  • David says:

    John Brophy is that you…. If having a sustainable funding source , money for research, proper equipment like power cots, video laryngoscopes, state retirement, community education funding, and not eating and pooping in a gas station makes me Emergency. Then Rampart I need orders for a lobotomy. If running more calls to bill Medicare and Medicaid more and using a gas station as a base for Paramedics with unique and advanced skill set that takes years to develop is your vision, God help us all.
    p.s. If this is my boss I was just kidding I love SSM.

  • Joey says:

    There are pros and cons with each model but the bottom line comes down to optimizing your EMS system and delivering rapid care within a cost efficient model. I have always worked in a drama series called “housewives of a static system” as well as in a nationally recognized dynamic system and I can honestly say that there is a significant delay to patient care in a static system because wheels rolling times increase significantly not to mention overhead costs. But it is nice to relax in a recliner between jobs. Why are we in EMS? Has our mission shifted? I personally choose a little discomfort and a response time of 6 minutes or less in a dynamic system over the drama series and this comes from a 30 year veteran. It’s not about me or you it’s about an efficient business model which meets or exceeds it’s delivery expectations; patient care

    • Jake says:

      I whole-heartedly agree with Joey, what is our purpose? Why are we here? We are here to provide the best possible care to our patients. Part of best possible care is an expedient time-frame. I’ve been a dispatcher for 5 years, and I hate seeing my Medics get burned-out, but I hate even more so seeing patients be harmed because I couldn’t get them help in time. I can’t tell a person their loved one died because my Medic didn’t want to drive around. I do everything I can to take care of my Medics, but sometimes you’re just going to have to move.

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