By Tony Plohetski
The Austin American-Statesman
AUSTIN, Texas — Julie Regier, a communications captain for Austin-Travis County Emergency Medical Services, faces a computerized map showing the whereabouts of each of the agency’s 30 ambulances, their locations flashing as they move from one place to the next.
Within seconds, she relays to paramedics awaiting a call a computer-generated message that they should shift from their assigned post to another location — an effort to make sure that, at all times, Austin has ambulances evenly proportioned throughout the city.
“It’s a huge tool,” said Regier, whose agency began using the new technology in February to help dispatch supervisors see gaps in ambulance coverage.
Officials say that since then, EMS has met its goal response times for the most serious calls in the city — those that include strokes, heart attacks and traumatic injuries - for the first time.
Medics, some of whom have expressed skepticism about the new system, have long aimed to respond to critical calls within 9 minutes, 59 seconds 90 percent of the time. Officials said they also expect to end the year meeting that agency-set goal.
“We’re very excited about that,” Assistant EMS Director and chief of staff James Shamard said. “We think we are doing it right.”
According to EMS officials, the technology uses statistics from previous calls in various locations at different times of the day to predict where the next emergencies could be. Based on that information, the system tells dispatch supervisors where ambulances may be needed to fill in gaps if medics assigned to the area have already responded to other calls.
EMS union officials also credit the new technology in part for reducing response times. However, they said they fear that EMS officials are relying too much on the system to plug holes in places where more ambulances and paramedics are needed.
EMS has received no new ambulances in two years and no new medics in a year. This year, the agency had seven available positions, but they were frozen in a midyear budget move.
Meanwhile, the number of calls increased about 3 percent from 2008 to 2009.
Whether using past calls to predict future emergencies leads to better responses has been a matter of debate among EMS systems in recent years.
Dr. Bryan Bledsoe, professor of emergency medicine at the University of Nevada School of Medicine, said he has seen no studies supporting the use of such technology.
“It looks good on paper, and they have tried really hard with statistics to make it look good, but there is no evidence it makes any difference on the street,” he said.
However, Jay Fitch, a founding partner of Fitch & Associates, a national EMS consulting firm, and a former EMS director in St. Louis, said, “This is very good common sense and risk management principles to achieve the best possible outcome with the given resources.”
EMS union officials said other factors may have contributed to the agency meeting its goals. For instance, EMS officials recently reduced the number of emergencies that are considered the most serious.
Shamard said that change has given the agency more available ambulances for the most critical calls — ambulances on their way to less serious calls can be rerouted to more dire emergencies under agency rules.
Steve Stewart, president of the Austin-Travis County EMS Employees Association, said union officials also are concerned about the frequency with which medics are being required to leave their home stations and move to a temporary base, decreasing the recovery time they have between calls.
Temporary bases could be anything from another EMS station to a shopping center parking lot or street corner, Stewart said.
“We agree there is a definite advantage to using these systems to help deploy units,” he said. “We just understand it’s not the only answer.
“There is a cost to that as well,” Stewart said. “We are moving the trucks more, and we are putting more wear and tear on the individual medics. There is an ongoing burnout cost associated with it.”
According to EMS statistics, the agency has moved an average of three ambulances each day since February. Officials said they do not know the average distance of each move.
Shamard said officials have not yet begun tracking the number of times a relocated ambulance responds to a call, although he said it happens frequently. And he said they have only recently begun tracking the number of times an ambulance missed a call in its assigned territory because it had been sent somewhere else.
Shamard said dispatchers try to send medics to other EMS stations when they need to shift their locations. He said crews are generally assigned to another station for less than an hour.
Still, such movement can affect paramedics, said Guy Haskell, executive director of Emergency Medical and Safety Services Consultants, in Bloomington, Ind.
“Anything that takes away downtime between calls is going to make them less compassionate and burned out,” he said.
Shamard said EMS officials began using the technology as part of an upgrade to the city’s multimillion-dollar computer-aided dispatch system. There was no additional cost to the city for the program.
In prior years, communications supervisors would sometimes shift ambulances from one area to another when they thought an area had an ambulance shortage. Officials said such moves were much less frequent before the latest technology.
Shamard said the technology is not without flaws: Officials must still be wary of medic fatigue and wear and tear on ambulances. Still, he said he thinks the system has been useful.
“It has demonstrated, pretty dramatically, how it was able to put us in the right place at the time.”
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