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EMS News in Focus
by Arthur Hsieh

Narrowing the time gap

Getting there fast for no demonstrable benefit makes little sense

By Arthur Hsieh

Editor's note: This story is in response to the article in which a university study found that the process of activating helicopter emergency services can often delay treatment beyond recommended times. Editorial Advisor Art Hsieh says getting there fast for no demonstrable benefit makes little sense.

The use of helicopter EMS (HEMS) is on the discussion table this week. This report provides quantifiable details about the lack of impact HEMS has on getting ACS patients within the recommended time frame to hospitals that are able to perform PCI. In the vast majority of cases, traveling by helicopter does not help in narrowing the time gap. My guess is that most of us are not surprised by this finding.

What I do like, though is that the authors press on, pushing systems to optimize their request and response time to streamline the process of calling HEMS. It will be interesting to see if there are follow up actions by services to do just that.

I'd also be interested in knowing how land-based ambulances affect the door to balloon time for patients needing emergency PCI. I'd put out there that there is a systemized approach for gaining access to an emergency ambulance to transport a critical patient from one hospital to another with the appropriate interventional services.

In a 911 system, that patient can very well be the most sick that requires the highest priority dispatch. To categorize that patient as a simple inter-facility transfer could set up the wrong dynamic.

In a previous column, I've questioned the use of response times as a quality marker for an EMS system. Getting there fast for no demonstrable benefit makes little sense. In the few cases like this one, it can greatly improve the chance of survival for that patient. In challenging economic times, systems need to be innovative and creative to achieve that goal.

How does priority dispatch and patent transfer work in your system? Provide your thoughts in the comments below.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
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