Applying EMS benchmarks to other agencies

[DrParasite]

So I was thinking, what if EMS benchmarks were applied to other agencies?

Response times seems to be a big one. Contracts are signed and violated based on them. 90% of calls need to have someone on scene in under 9 minutes, regardless of complaint.

I know the NFPA has a standard of 4 minutes for the first unit arrives, regardless of complaint, with the full assignment on scene (typically 3 to 5 trucks) on scene in under 8, 90% of the time. and most paid departments use this as a bargaining point to get more staff and apparatus.

Does Law enforcement have similar standards? I know in the city where I work, you can call 911 requesting PD, and a cop will get there within 4 to 6 hours. In this urban city, they are just backed up with higher priority jobs.

If you call 911, you may or may not get an answer. it might right 10-20 times, before the neighboring city answers. if you call their non-emergency number, and they have no operators available, you will get put in the "holding pattern" which is the "all operators are busy." if you call 911 with a non-emergency, they will tell you to call back on the non-emergency number.

for the hospital, are their standards for wait time until you get scene by an MD? walk into triage with a hangnail, you will see a doctor within 20 minutes? what about time until discharge, are their any standards that say a patient in the ER needs to be admitted or discharged within 4 hours?

The local gas and electric company tells emergency responders they will be out within the hour, for an emergency complaint. for a regular customer, 6-8 hours, depending on how busy they are.

What about the local bars, clubs? Would any establishment say "you will be allowed entry in under 9 minutes 90 % of the time?" or at a restaurant, "you will be seated in under 9 minutes"

I guess my questions is, are we setting ourselves up to fail, by setting impossible standards that only 1 other system actually uses? and if a system does use it, it's the AHJ that funds and sets staffing levels, and if the agency doesn't meet those standards, well, it's the city management that doesn't staff with enough units (by allocating the funds to do the job right).

But with EMS, esp non-municipal ems systems, often the goal is what is striven for, and mandated, but actually accomplishing that goal involved cutting corners or skewing numbers or running your crews into the ground, because the agreed upon numbers are unrealistic, or impossible to provide without the proper funding from the city (which rarely happens).

 

[mycrofft]

Follow the money, and follow the chain of administration. If no one is an enforcer, or if enforcement is a joke, then abuses will occur regularly. If there's money to be made and it's competitive, then shortcuts will be taken.

 

[DrParasite]

any other thoughts?

 

[EpiEMS]

If we could triage better, it'd be a heck of a lot easier to prioritize responses. I can't say anything about FD or PD, but hospitals can have non-physician practitioners accurately triage patients?

 

[Chimpie]

The pd I used to ride with had benchmarks for types of calls. Domestics, fights in progress, etc were a Priority 2 (maybe 1, it's been awhile) and had to an officer on scene in less than 5 minutes (i believe, again, it's been a while). Criminal mischief not in progress required an officer be on scene in (for example) 8 hours.

So yes, at least one dept I know has benchmarks.

 

[bahnrokt]

It's always a race to the scene between fire and ems when we are both dispatched.

My favorite **** move when I am first on is to call myself on scene and ask if FD has acknowledged or inquire about mutual aid being toned for them, even if I can see them in my mirrors.

It sounds childish, but they started it.

 

[Chimpie]

It's always a race to the scene between fire and ems when we are both dispatched.

My favorite **** move when I am first on is to call myself on scene and ask if FD has acknowledged or inquire about mutual aid being toned for them, even if I can see them in my mirrors.

It sounds childish, but they started it.

So is saying, "they started it".

If you think something is a "**** move", be the bigger person and don't do it.

 

[WolfmanHarris]

Benchmarks are important where are various sphere meet to ensure we're comparing like to like.

For example in the ongoing debate over FD response to medical calls in Ontario the 4 minute response time is constantly touted in comparison to the EMS 8 minute response time. However, FD reports response times from wheels rolling to arriving scene and as a mean time. EMS reports response times as call received at dispatch to arrive scene at a 90th percentile. In other words comparing these response times are meaningless. If we want to thoughtfully examine resource utilization across multiple services we need to speak the same language.

Another great example is the SCA survival numbers that were coming out of King County WA. Amazing when compared to national average, but less impressive when we consider they were reporting patients found in VF/VT not all SCA's.

The problem is we all play the numbers game to ensure funding, secure our place, pump up public relations, etc. While there may be times when organizations might cooperate for research purposes and consistently apply benchmarks, when they need to present to politicians they are going to present the numbers that best serve their purpose.

Right now where I work Council requested a 30 second decrease in response times as a condition of some other project funding that had been requested. This is very difficult to do when dealing with a 90th percentile time yet in the first quarter of 2012 we managed a 1:30 decrease. How? Certainly a push to staff to decrease chute times and to start rolling in the general direction of the call while finding it on AVL helped. As did infastructure changes such as automatically closing bay doors. But what do I think made the biggest impact, having us report times to the second on our PCR's. Suddenly chute times weren't 2 minutes (1858 to 1900) but maybe only a minute and change (18:58:55 to 19:00:00). While I'd hardly call more accurate reporting cooking the numbers, you can see what a small change can do to the data. Have our actual response times really decreased 1:30? Probably not, but it's now reported that way.