EMS data collection and decision accuracy
Data-driven decision making: triaging emergencies with computer-aided dispatch systems
In the public service sector, we must increase accountability and the accuracy of our decisions. Now, there are more information management systems available to first responders, as well as an increase in the education levels of both municipal administrators and emergency service executives. But how much accuracy in data-driven decision making and data collection is sufficient?
One of the areas under debate in emergency services is incident triage. Many organizations have purchased computer-aided dispatch (CAD) systems. These systems are programmed with many different types of calls, in order to limit sending out unnecessary equipment.
However, triaging is still completed by trained people who take what frantic citizens tell them and translate that information into the best treatment option for victims. Due to time standards under NFPA, they need to complete this triage and other dispatching in roughly a minute. This places the call taker and/or dispatcher in the difficult position of sacrificing accuracy or speed. Which is a better sacrifice?
With today’s public administration focus, we want to run first responder organizations like businesses. We seek to make precise decisions, based on cost/benefit, cost per citizen and a whole host of other fad management measurements. Many of us in the emergency services field have been asked to include the latest management trend for data measurement.
But how does public safety particularly fit into this business trend? While I understand there is a prevailing trend in area and hazard analysis equations, NFPA standards, and a whole host of helpful tools written primarily by emergency service personnel, how does this translate to public administration programs and teachings?
I understand both sides of the argument. We must have more development and teaching of public administration programs that involve these types of hazard analysis and service demand standards, as well as more input at the ground level from public administrators.
When you have misalignment of these two groups, this disparity is not going to end in a positive manner for municipal administrators or emergency services directors. They must revert to having a good understanding of each other’s needs and hoping that their decisions will not be questioned by the public.
Legal issues involved with data collection
Even if we can prove trends through the collection of data and precise analysis, where do we stand legally? The field of emergency medical services is an area fraught with legal issues that sometimes trump common sense.
Some cities utilize services such as Uber for non-emergency transports. However, there may be a misdiagnosed medical emergency that causes a victim’s death during that Uber ride.
We will then be back to where we were a few years ago with the “you call, we haul” mentality. This trend does not look like it will improve. Also, doctors with malpractice insurance and savvy attorneys make it difficult to create a public education campaign telling citizens that they should not call for minor health issues, such as stubbing a toe.
Hazards drive emergency services
I have conversed with many people who say that if we run the fire department as a business, we could seek to pay contract workers really well a few days a year to fight fires. We could also have only a few people on ambulances to make the majority of the calls.
After all, the majority of fire alarms are false. Also, EMS calls are mostly non-emergency, depending on the community.
However, this concept would not work well in reality. It would cost a few people their jobs if we guessed wrong about the day the big fire was supposed to occur.
Also, if every community tried this idea simultaneously, we could not rely on automatic and mutual aid to supplement the on-duty force. That would leave community leaders with high costs and create political nightmares for politicians.
Both sets of leaders would have to answer why no one showed up to the fire. Residents would feel unsafe and the business owners would feel underinsured.
We have many standards that have been scientifically developed around hazard, fire growth and life safety probabilities. Preserving safety and saving lives should be our focus. We should be able to speak intelligently about the extra potential demand caused by community growth.
Setting data collection standards
First responder organizations should have conversations with municipal administrators and elected officials about how we translate qualitative data from citizens into verifiable, quantitative measurements. As someone who works in one community and lives in another, for example, I cannot tell you the tax cost for the fire department in the town for which I live.
However, I can tell you how far away the station is located from my home and what the approximate medical/fire results will be, based on first responders’ travel time. If my local first responders’ response and performance does not meet my preconceived expectation, I will be a dissatisfied customer, despite the cost of the emergency services bill I’ll receive.
We must educate the public on the realistic expectation of first responder services and fiscal demands. There should be conversations in our communities about what citizens expect from their first responders.
In addition, first responder organizations should use the opportunity to educate local citizens on what service levels first responders can provide, the various costs of emergency medical services and how many more expenses are involved in various levels of service. Ultimately, the citizens set the standards for our performance as first responders.
About the Author
Dr. Randall W. Hanifen is a shift captain for the West Chester Fire Department in Ohio and a fire service consultant. He is also a faculty member at American Military University, teaching courses in its Emergency & Disaster Management program. He has a B.S. in Fire Administration, an M.S. in Fire Service Executive Leadership and a Ph.D. in Executive Management of Homeland Security. He is the associate author of Disaster Planning and Control. Randall serves as the executive chairperson of a County Technical Rescue Team, a taskforce leader for FEMA’s Ohio Task Force 1 US&R team, and is the vice-chair of the IAFC Company Officers Section. He serves as a member of NFPA 1021 Fire Officer and NFPA 1026 Incident Management committees. He is credentialed as a fire officer by the Center for Public Safety Excellence and has been accepted as a fellow to the Institute of Fire Engineers. Randall has provided presentations and trainings for the Ohio Fire Chief’s Association, Fire Rescue International, Emergency Management Institute and the IAFC Board of Directors. To contact the author, send an email to IPSauthor@apus.edu. For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter