Compromising on EMS system design

Communities are trying to answer the question of what they expect and what they are willing to pay for


Jack Stout had an incredible impact on the EMS profession – and on many individuals who knew him personally or were affected by his vision. Because of the pandemic, no public celebration of his life was held was ever held. An informal celebration of Jack Stout’s life will be held Wednesday evening, July 27, at Pinnacle 2022 where attendees can share stories and remembrances of Jack.

That same week, there will be more than 40 seminars, general, concurrent and special sessions that will help leaders learn how to achieve an appropriate balance. The Pinnacle EMS Leadership Forum will be held July 25-29 at the JW Marriott Marco Island Beach Resort in Marco Island, Florida. Hope to see you there!

— Jay Fitch, PhD

By Jay Fitch, PhD, Fitch & Associates

Clinically sophisticated, fast, cheap: Pick any two!

It was the wisdom coined by EMS pioneer Jack Stout back in the early 1980s. The logic of course is that an EMS system that’s both excellent and fast will not be the least expensive. Likewise, if the system is cheap, it may be fast, but the quality may be lacking. The overlying theory is that when budget is a concern, you can’t have it all and compromises must be made.

Communities are trying to answer the question of what they expect from their systems and what they are willing to pay for.
Communities are trying to answer the question of what they expect from their systems and what they are willing to pay for.

Contemporary thinking is that while everyone believes their emergency is ultra-time sensitive, clinical evidence tells us that is not necessarily so. Few calls are truly time critical and as call reception, prioritization and telemedicine enhancements are made, more systems will further match response time requirements to clinical needs. From the community’s perspective, reasonable response times are required but the days of requiring that all patients receive advanced life support transport capable service within 8 minutes are almost a thing of the past. Communities have determined that the costs are simply too high.

Fully deployed systems may be faster and cheaper than a completely static station-based deployment approach, but there are other impacts in terms of caregiver satisfaction and fatigue that must also be considered. In striving for cost savings, some systems have increased productivity to the point that the service cannot retain highly experienced staff. And that can impact the service’s level of clinical sophistication.


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On demand: Fatigue in EMS - Measuring the prevalence and efficacy of fatigue management initiatives

Learn the results of the recent EMS1 survey on provider fatigue, as well as ongoing research into fatigue and strategies to both prevent and manage it


Developing meaningful quality and accountability processes and the use of learning management systems that make training available anytime and anywhere are key investments that EMS systems should be making. When budgets get tight, systems that reduce QI efforts, training and supervision are being short-sighted and those decisions ultimately impact the clinical levels the service can achieve.

The pandemic stressed our people as well as system’s operational and financial processes. Many organizations have had to make uncomfortable compromises to survive. Communities are trying to answer the question of what they expect from their systems and what they are willing to pay for. Jack Stout had it right that balancing all three factors is required for a sustainable EMS system. The landmark articles he wrote about system design over 40 years ago are still relevant today.

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About the author

Jay Fitch, PhD, is a founding partner of EMS/public safety firm Fitch & Associates. Caregiver, director, consultant and author, his body of work in public safety spans nearly 50 years. He can be reached at jfitch@emprize.net.

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