05/18/07 157 W, 1 I - + 18 - 18 EMS, Ambulances, Response Times, Pittsburgh

Here's an interesting article about Pittsburgh EMS, with a television station turning their eye that EMS system after a lower-priority (e.g. non-life threatening injury) patient waited 26 minutes for an ambulance to arrive. Is that ultimately what's required for better funding, media or public reaction or outrage? Nobody typically cares until something affects them. Witness the school system business. Or does it take more direct involvement, such as an elected official who is the one experiencing the service? The article also cites "national standards" that call for paramedics to arrive at life-threatening emergencies within eight minutes 90% of the time. Couldn't easily find (via Google) references to national standards. What are Wake County's average response times? Last year's budget document cites 11:59 minutes as the FY07 target for both Wake EMS and the Wake EMS system, for "emergency responses" for an ambulance. Unknown if "emergency responses" equal "life-threatening emergencies," so comparisons could be unfair.

This article could have been written about any EMS system in the country – including Wake County. There are times, in every system, when demand far outstrips capacity. Think Friday afternoon, rush hour, with a thunderstorm cell rolling through.

There really are no “national standards” for response performance (and their probably can’t be, given that population density and demand for service varies so much. For example, in Wake County we handle someplace around 78 EMS calls per 1,000 population. In other metro areas, that demand is as low as 40 per 1,000 and as high as 312 per 1,000.

The “8:59” that everybody talks about is interesting. It has been around a long time. Some people cite the old “Seattle CPR study” by Cummings et al, who said that if you don’t get CPR in 8 minutes, brain death will occur. So who would pick a standard that would guarantee that your patiets would die? Really, it is a contracting standard (as opposed to medical) having to do with the economics of service delivery by private ambulance companies.

Also….when do you start the clock?

In many systems, they start the clock when the tones are transmitted. That totally ignores how long it takes to answer the call, interrogate the caller, and dispatch the call. In Wake County, we start the clock when the 911 phone rings (when the time begins from the view of the patient/caller). Thus we include everybody that is involved in the call in the time line. To the patient, our 11:59 and the other guys 8:59 look awfully similar!

We also don’t discuss averages, because they can hide truly awful services. Average is about the 50th percentile – half the calls will be worse and half will be better, but you can’t tell how much worse or better (without also the standard deviation, but you don’t want to go there). We use the 90th percentile – the goal is that 90% of the time the EMS unit will be there before 12 minutes. That’s much better service than “50% of the time….” Across the county, we typically achieve that standard 86-91% of the time. (What that shows is that we just barely have enough units spread around to do the job we’ve set out to do.) Can we keep doing it in the face of all the growth? We darn sure will try!

Last, what is a critical call? That varies from system to system. We measure ourselves for all calls dispatched as BRAVO, CHARLIE, DELTA, and ECHO. Many count only DELTA and ECHO, and call BRAVO and CHARLIE “serious” or something. If it’s bad enough to run hot to the call, we measure it and count it.

Enough school for today. Thanks for asking.

Skip Kirkwood (Email) (Web Site) - 05/18/07 - 09:55

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