In the early days of EMS, response times were a way to measure how well a system was performing. It was easy to measure, and there was the prevailing thought that having a “fast ambulance” arriving at your door translated to better patient outcomes.
Fast forward a few decades and research continues to prove what most old timers have known for decades - short response times, in most circumstances, have very little to do with saving lives or improving outcomes. However, this idea does unwittingly reinforce the public’s expectations about what our industry is all about, and reinforces unsafe work practices that contribute to crashes, injuries and deaths.
I’m not criticizing how the idea came about - history is what it is. But it frustrates me greatly that in 2015 we continue to sign EMS contracts that include response times as an assumed parameters of “success,” which translates to “compliance.” No doubt there are a few time sensitive incidents - airway obstruction, anaphylaxis, cardiac arrest - where two to three minutes may make the difference. But greater public participation and easier access to lifesaving procedures could just as easily - and more cheaply - cover that difference.
Meanwhile, the focus on response times has blurred our vision on what we really do - provide care, compassion and continuity of health services to our communities. This is one study that points to the need to look more closely at our critical role as the gatekeepers of health care in a prehospital setting. What we say or do with our patients can help set the tone for the rest of their experiences within the health care continuum.
For instance, identifying STEMI and stroke, and channeling them to appropriate receiving centers - that’s making a difference. Providing follow-up care, preventing medical maladies from happening in the first place - that will make a difference. Running hot to a stubbed toe - not so much.
It would be pretty awesome for EMS system planners to take the risk of educating government officials and policy makers as to what the EMS system version 3.0 should look like. We could save lives, save money, and save grief using the evidence that has accrued over the past 15 years about response times. It would be far sighted to build contractual parameters that explore all of the services an EMS system could provide as a cohesive, integrated approach to field care, referral and transport.
It’s really time to move on and get with the times; just not the response times.
