More Reasons to Support Dynamic Deployment

The “Leverage Real-Time Data for Improved Ambulance Response Times” article that Zoll posted on their blog site did a good job of explaining response times and even the benefits of System Status Management (SSM) planning to the patient. But there is still more to the story that we have learned over the years since Jack Stout first introduced it.

Of course, it is best for the patient (and the service) when an ambulance arrives to the scene in a short time. The media often picks up on poor response times with stories like the GSW patient dying in Cleveland surrounded only by police and fire personnel. Even the doctors at JAMA can’t resist publishing an article showing response times as an inherent failure of EMS in certain cases. Unfortunately, many will read the solution as medics “speeding” to the scene, yet we have learned that lights and sirens have little impact on times and may even prevent some patients from calling for an ambulance in the first place. However, when the deployment of ambulances is responsive to the dynamic demand patterns throughout the day, ambulances can literally be moved closer to the scene even before they are dispatched. Literally hundreds of High Performance EMS agencies across the US have significantly reduced their 90th percentile response rates through technology. Forecasting the future does not involve magic, at least not for predictable phenomenon like emergency calls for service. Not only can we forecast the quantity and types of calls we will receive (necessary for adequate staffing), we can determine where they are likely to originate from with significant accuracy as well. Shortening the distance that an ambulance must travel is a safer alternative than asking a crew to speed in order to achieve the same result.

Another positive impact of shorter response times is patient satisfaction. There are many reasons that healthcare providers should be using patient satisfaction surveys, both for the benefit of the patient as well as simplifying the accreditation process for your service. Beyond safety, satisfaction and simplification; proper SSM can improve finances. Some services have recognized marked reductions in the number of post moves for crews and ultimately reduce the total number of unloaded (read unreimbursed) miles driven which saves on vehicle wear and tear in addition to fuel costs. Other agencies, particularly those who contract their services, can reduce financial penalties for “exceptions,” or late calls beyond the target response time.

Frankly, the public often expects performance measured in minutes. Whether we approve of the measure or not, we are often graded and compared based on response times. Whether the penalties for missing targets are financial, patient satisfaction, or driven by bad press reports, being late simply hurts. Until EMS is designated and funded as a critical service for government, it will be dependent on political funding allocations and insurance reimbursements. As long as performance is measured by how long it takes to be on scene, response times will be critical to the financial well-being of services. The least we can do is perform to the highest safe standards possible.

 

4 Comments

  • “Doing ‘dynamic deployment’ is much easier than doing dynamic deployment ‘effectively.’ There is a difference.”

  • Joe Kubitschek Ret EMICT says:

    I am interested to hear the outcome of the former Marine that stole a pick up and hauled 30ish victims to the hospital versus EMS effect on the situation. Scoop and Go was the word in Jurassic EMS, but with EMS at 50 years of service, this ought to be a great interest.

    • Unusual events such as a terrorist attack are not discernible from the routine data of an EMS agency. Capacity should allows be planned beyond the expected, but it is never enough, by definition, in many MCI events so this is where mutual aid agreements become vital. It is also important to note that a significant EMS force was staged in the case of the Las Vegas event, but not allowed to enter, according to the protocols common across the entire US, until the scene has been deemed ‘safe’ for crews to enter. A hotly debated study (https://www.ems1.com/trauma/articles/327139048-Pros-cons-of-POV-vs-ambulance-transport-for-trauma-patients/) published in JAMA showed the critical importance of getting patients with penetrating trauma to definitive without delay. One of the criticisms of this study that would clearly apply in this case is the necessary delay caused by staging. If EMS providers are injured, they delay and divert resources from the original patients. The question you pose goes far the daily operations of EMS to some very fundamental precepts.

  • Joe Kubitschek Ret EMICT says:

    Sorry Dale, the article sparked interest in how SSM could have played a better part in the response to such situations. I agree that MCIs do create delays in setting up the system, but what if the system had been deployed prior to the concert but not put together until need? SSM must take into account unscheduled, unannounced system disturbances and be able to keep gramps having the MI at home safe at the same time.

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