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Home > Topics > EMS Management
February 11, 2014
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EMS News in Focus
by Arthur Hsieh

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?

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. In the profession 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 published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.
Comments
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Dana Arbeit Dana Arbeit Tuesday, February 11, 2014 11:08:27 PM Response times are an "objective" way of evaluating a system. Unfortunately it fails to evaluate all the variables that have a greater influence on outcomes. It is a "no-guilt" way to grade a system that doesn't require any hard work. EMS has so many variables that the people that make these evaluations really need to develope the courage to apply subjective standards. Sadly this would require too much work and risk for those doing the 'evaluating'. When I taught CPR in the 70s, I used to start each class by congratulating all the students for volunteering to become a key part of their emergency service system. Even then, before I had much experience, I realized that outcomes relied more on 'bystander' intervention than how soon rescuers got to the scene. Now, retired after 3 years of private ambulance work and 25 years as a Paramedic on a fire service-based ambulance service, I have seen over 25,000 instances of the truth of that conclusion. Time is critical, yes, but competence and efficiency are even more important. EMS has so many aspects and participants that the "scientific method" cannot alone be applied in evaluation. The "team" starts with the 'bystander's' actions or inactions and goes through the 'first responder' to the 'advanced skill responder' to the transport, to the ER, to the long-term care at the hospital and all the different people and "teams" involved that basing the evaluation of a service on "response times" or "does the patient walk out of the hospital" criteria borders on the absurd. EMS and its managers have to find the courage to evaluate more subjectively using whatever objective criteria that can reasonably be applied as a part of that evaluation but not the whole evaluation. In short, the best evaluation of a medic is when another medic tells them: "if I have a problem, I want to see you getting out of the ambulance".
Dean Pearce Dean Pearce Wednesday, February 12, 2014 7:42:12 AM One issue revolves around the model of "Dispatch" that most EMS systems rely on. The triage ability of many systems in the "call taking" section is limited. Tie that in with the litigation happy society that we live in and it is hard to not respond to the flu like we do to an MI. I agree that we do not have adequate scientific studies concerning our responding times as well as modes of treatment once on the scene. Unfortunately, we are still in a profession where funding such studies is a low priority. While I am in a different line of "serving others" now, I keep my ears (& heart) in the business. Thanks for your articles and insight.

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