Response times: A tale of two cities
We treat the patient with flu-like symptoms with the same urgency as one with acute congestive heart failure; this equal application of the standard doesn’t make sense
By Arthur Hsieh
The evolution of EMS has been happening in front of our eyes over the past few years. Much of it has been with the emergence of community paramedicine/mobile integrated health models.
But there is also a greater scrutiny of our core mission: responding to emergency calls for medical assistance. An investigation into a Chicago ambulance shortage, and a Fla. county plan to cut $2.3 million in EMS funding and reduce overnight medics highlight the conversation about response times that deserves national discussion among EMS providers.
Historically, EMS has treated response times much like the fire suppression industry: the sooner you get there, the better.
Problem is, it’s not true.
To date, we haven’t found an optimal, scientifically tested response time interval that makes a significant change in patient outcomes.
Upticks in cardiac arrest resuscitation rates have been influenced by better rates of bystander CPR and better understanding of chest compressions. Studies looking at trauma resuscitation have debunked the concept of the golden hour. And frankly, for the remaining 97 percent of EMS calls, there simply aren’t any studies, period.
Meanwhile, EMS systems struggle to continue staffing systems based upon arbitrary, unsupported response time standards. We treat the patient with flu-like symptoms with the same urgency as one with acute congestive heart failure — in most systems, both require EMS to arrive within the same time frame. We might respond a bit faster to the latter, but so long as we get to each one within the time frame 90 percent of the time, we’ve done our job.
The equal application of the standard doesn’t make sense these days.
Given that many experts believe call volume will continue to rise over the foreseeable future, the only way to maintain the current model is to continue to upstaff units. Wrap this elephant with the constraint of falling reimbursement and limited tax support, and most systems will find themselves unable to maintain these artificial standards.
I’d like to know what you think about response times — do they make sense?