Response times: Still the Holy Grail?

Paramedics in Fla. question use of $500,000 technology aimed to help decrease response time

By Art Hsieh
EMS1 Editorial Advisor

An EMS agency's use of $500,000 technology that aims to predict where and when an emergency will happen next is being questioned — by its own paramedics.

Lee County, Fla., EMS has been using "Optima" for the past six months. The computer software calculates future 911 calls based on the time and location of EMS responses over the previous four years.

But more than 100 paramedics at the agency have complained of problems with the new technology, according to a report on ABC 7 on Tuesday, with one branding it "a waste of resources and fuel" after the system dispatched responders to areas where they waited for hours to get a call.

You can see the full details of the article in the accompanying video. I looked through it and sighed. In the year 2010, what we know today is that there are few clinical situations where time may be critical to patient outcomes, namely cardiac arrest, critical trauma, and acute myocardial infarction and stroke. Even in these situations, critical timing issued may be influenced by non system factors. For example,

  • Bystander CPR and early defibrillation appear to be the difference in cardiac arrest outcomes, not early ALS.
  • Early detection and notification in AMI and stroke can decrease time to treatment (as well as prehospital 12-lead EKGs)
  • Even the concept of the "golden hour" has been essentially debunked in trauma resuscitation.

We simply do not have the data to support that response standards built for cardiac arrest should be applied for the vast majority of EMS calls. We do have public perception to contend with, that's for sure, but can't we admit that we've shaped that opinion ourselves?

Here is the other side of the response time coin — ambulance crashes are common. It seems like every day there is a crash being reported in the press. Of course, we know that most are not. How many of these events are occurring in the lights and siren mode? Are we causing unnecessary injuries and deaths in the pursuit of this Holy Grail?

All I'm saying is please let's not get completely wrapped up in a concept that currently has little or no proof in its effectiveness.

The use of prediction software is an evolution of technology that may prove to be helpful. In theory, by placing vehicles in position in response to probability of actual calls, rather than just by geographical distribution, it can be much more precise and possibly reduce the amount of time posting one from place to the next.

By reducing drive time, the probability of crashes may also be reduced. As importantly, if a call's criticality could be predicted, that would a game changer — making sure that EMS resources would be available for true time-dependent events. Now, that's the Holy Grail we should be pursuing.

Don't get me wrong, all of this should not be at the expense of the most critical part of the system — the field provider. Sitting in an ambulance all day, driving from one street corner to the next is not healthy.

Being up for most of a 24 hour shift is not healthy either. (Neither of these conditions appear to be happening in the cited system, by the way.) But not getting injured in an unnecessary crash is healthy, isn't it?

Kim Dickerson, Lee County EMS Chief, told ABC 7 that after the software marks its one-year anniversary, the agency will evaluate effectiveness on response times and determine if it is worth the cost to taxpayers.

Chris Callsen, chief operating officer of Optima, explained how the software uses "historic information within the community to generate a series of call 'hot spots' that show up and based on the hours of the day and days of the week within that specific community."

What that allows agencies to do, he said, is more accurately position vehicles with the likelihood of having them near the locations where calls are most likely to happen during that specific time of day and day of week.

From my perspective, I hope that the system is gathering as much data as possible about its operations. Not only would it help to refine the technology, but I'm sure system medical directors, operation directors and field personnel would be very interested in its impact.

Arthur Hsieh has no formal or financial affiliations with the organizations or manufacturers involved in this story.

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