What If We’re Wrong About Response Times?

Anyone who follows my posts here, or on Twitter, will recognize that I consistently argue for the value of prompt responses by emergency vehicles to nearly all incidents. However, this post will be different thanks to an inventive challenge through EMS Basics asking bloggers to consider an opposing view to their favorite topic. You can read about the challenge and link to other participating blog posts in The Second Great EMS What-If-We’re-Wrong-a-Thon.

There actually are some valid arguments against rapid responses, so let me begin with pointing out the lack of a recognized national standard. If a short response was really an evidence-based practice, there should be some agreement on exactly what a “short response” means. The NFPA and NIST standards suggest response times for all hazards, but are really focused on requirements for structure fires and have more to do with the central placement of stations than the speed of fire spread in a structure. The nature of this fixed deployment strategy becomes even more problematic for medical responses as there tends to be far fewer ambulances in comparison to fire suppression apparatus.

A shortage of resources is therefore, a compounding problem. Ambulance response time goals often vary tremendously by locality and type of service. Response time goals become a result of compromise matching community expectations with financing – not the science of resuscitation. Often contracts with private services are drafted to simply improve on the current response times rather than meet an objective goal with a defined clinical outcome.

The clock is an easy measurement device that is more easily understood than many other proxy measures of the quality of our service. And pushing for more (faster) response makes a contract negotiator look like a winner. Unfortunately, there is a heavy cost to pay to chase these ever increasing goals. And for services who cannot meet these objectives, there is either embarrassment, financial ruin or the flexibility built in to the start and end times for the clock. In other cases, there are rules for simply ignoring exceptions to the goal as outliers. Without standards on measurement, why do it?

Trends are showing a higher demand for services which translates to an increased demand in resources which in turn raises system costs unnecessarily. Recent studies have also shown that response times do not improve clinical care in the vast majority of cases. In fact, there are a significant number of responses that don’t even require an ambulance at all. Proper emergency medical dispatching through improved triage at the call taking phase can reduce the effective number of emergent calls that demand immediate responses.

Finally, there is also a growing awareness lately to the safety of providers. Studies show that the use of lights and sirens are risking the lives of responders and even the public. Ambulances driving at excessive speeds for most calls is just illogical and unsafe.

I would like to thank Brandon Oto for issuing this writing challenge. Viewing a problem from a new perspective is quite a liberating opportunity. I believe that in this case, there clearly is still a good reason to debate the need for rapid responses. However, I will continue that debate in a follow-up article from my own perspective.

5 Comments

  • Warren says:

    This is so true even in Australia. Our governments work on 8 minutes from time of call to on scene as the recognised standard. Our triage system is our biggest failure as it relies on the callers opinion. An example of this is a caller will ring stating their partner is sick and has been vomiting for several days. Our call taker is prompted by the computer system to ask if the patient is breathing normally. The caller in their mind says no not really (their vomiting) which generates a lights and siren response. Suddenly lives are put at risk getting there only to be met at the door by a person surprised by all the attention. Then while you are transporting the patient talks the entire way about their life’s stories. Yes, we need a better system too.

  • S. Benson says:

    One other factor in the apples & oranges, i.e. Fire & EMS response time issue.
    Generally speaking, fire calls are structurally dependent: types of structures, density of construction, etc.
    However, buildings don’t move so deployment in non-moving Fire Houses works.
    In the EMS world, we treat people and they move.
    A deployment matrix for a workday at 2pm won’t necessarily work for 2 am because the population moved.

  • John says:

    I take issue with the reliance on EMD. We get absolutely no consistency from our dispatchers, despite their supposed use of EMD. Dispatched emergency status for difficulty breathing=leg pain x 4 days. Lift assist=fall down stairs with head injury. The vast majority of our patients are using the ED as their family doctor, or their family doctor is sending them to the ED because he doesn’t make housecalls or have an appointment available. We also have several assisted living/nursing homes advertising “24/7 Emergency Care” that call 911 every time someone takes an unscheduled nap or slips out of their chair, and then demands we transport. The system is going to implode if we can’t fix it.

  • timothy says:

    A metric must be in place to assure adequate EMS resources are available when needed. News stories across the country document ambulance shortages in cities such as Detroit, DC, Cleveland, San Francisco and Buffalo. While response times may not matter to someone who in need of pain managment for a chronic condition that flared up two days ago, Rapid response is still beneficial to many time-sensitive medical emergencies, especially respiratory distress, multi-system trauma, status seizures, Cva’s, MI’s and cardiac arrests.

    While priority dispatch is an improved system, it is far from perfect because it relies upon leading questions asked of non-medically trained personnel, which often results in miscoded calls.

    As such, while response times may not be the perfect standard, I challenge someone to come up with a better standard to assure that adequate ems resources are available when needed.

  • Mark says:

    I agree the problem is with the 911 call taker and the leading questions they have to ask. Sometimes, I feel that they don’t ask the right questions. For example, I responded to a “fall patient possible leg fracture”. I arrived to find a person who had a deformity of the leg but was also covered head to toe in blood because they had tried to cut their throat and stabbed themselves 11 times. Seems to me the EMD system could work, but their definitely needs tweaking!

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