Why eight minutes, 59 seconds?

In this month’s cover story, associate editor Jenifer Goodwin reports on the updated National Fire Protection Association 1710 standard on response times. The debate about this topic has been heating up for some time, with one of the most interesting examples occurring at last October’s EMS Expo conference. In a session hosted by the National EMS Management Association, facilitator Skip Kirkwood, EMS chief for Wake County, N.C., asked the group some fundamental questions: What’s so special about eight minutes and 59 seconds? Where did it come from? Is there any clinical significance to the number? When no one in the room could come up with an answer, Skip speculated that the origins went back to Jack Stout, the inventor of the public utility model of EMS, when he introduced the concept to Kansas City around 1980.

Jack is now retired and living in Arizona. His son Todd worked as a para-medic in that Kansas City system and moved on to a series of management positions in EMS. In 2002 Todd developed FirstWatch, a tool that enables EMS and public health agencies to use 911 and ePCR data to monitor their operations while providing real-time early alerting on significant events. Interestingly, one of the metrics that FirstWatch monitors is response time compliance.

I saw Todd recently and asked him the questions Skip posed. He spoke with Jack, and this is what he reports: At the time the contract with Kansas City was being developed, there were punch clocks that recorded response times in minutes but not seconds. When Jack was negotiating what a reasonable response time would be, he looked at the available clinical evidence. The only scientific data at the time was from research done by Mickey Eisenberg and others associated with the Seattle EMS system. Those studies showed that an initial response (BLS/CPR) within four minutes and an ALS response within eight minutes had a significant impact on survival from sudden cardiac arrest (SCA). With no other research available, Jack decided that if he had to build the system around something, it might as well be response to SCA, based on the concept that if an EMS agency could handle this most urgent of calls, it could handle anything. (Side note: Sometimes lost in the debate, Todd says, is an innovation introduced by that first contract—that every call’s response time calculation should start as soon as three pieces of critical information Back to the punch cards. The 8:59 standard, Todd reports, was an accommodation of the punch clock technology at the time. In effect, it meant that a response that registered as eight minutes could actually be anywhere from zero seconds to 59 seconds longer than that. However, the key issue, he relays, was the provision that 90 percent of calls (measured as a fractile) had to meet that standard. That’s where the deployment of resources and cost come in, and that’s where a community should ask the tough question: What level of reliability am I willing to pay for?

Keith Griffiths can be reached at publisher@emergencybestpractices.com.