Coordination of Resources

RedAirplane

RedAirplane

Forum Asst. Chief
Messages
515
Reaction score
126
Points
43
(Background: I'm a Computer Science guy so sometimes I get interested by questions of efficiency. I'm also relatively new as a volunteer first-aid/EMT guy, so if I am making no sense, please just let me know).

My understanding is that there is typically a 911 ambulance provider, and other non-emergency ambulance providers that can be drafted into the 911 system in times of high demand.

However, take the following instance: on Wednesday I was in San Francisco and saw a Rural/Metro paramedic ambulance at coffee shop. Rural/Metro doesn't usually do 911 in SF, but suppose somebody in the apartment upstairs called 911 for chest pain. One of the 911 providers would certainly respond, but it would seem to be ironic and wasteful if there were two medics downstairs unaware of the situation, especially since seconds make the difference between life and death.

My ride-alongs to get my EMT revealed that the 911 ambulance companies tend to have fancy equipment that allows efficient dispatch and diversion to as needed. What if you hooked up all the IFT ambulances to this system, letting them focus on their IFT business, but with the 911 dispatcher able to override their assignment if they were closest to a major emergency? Wouldn't this eliminate the ironic situations that arise because of lack of awareness?

I saw two sides of this on my ride alongs. One was with the IFT company, where we were delayed 20-30 minutes before transporting a patient to a Cath Lab Hospital because we were waiting for our company's ALS to show up-- for such a patient, wouldn't drawing an ALS unit out of 911 have been faster? And conversely, with my ride-along with 911, we responded to a man with CP over 30 minutes after the original 911 call, and he arrested as soon as we were on scene (thankfully, 200J later he was A&Ox4). In such a situation, if somebody else was closer, wouldn't it have been prudent to give them the call to take?

I'll toss this out to those of you with experience, but this is something that grabbed my curiosity. Thank you.
 
Drawing any local ALS unit would certainly have been faster, but it would have lost the IFT company money... Private providers will put up with longer waits as long as they get to be the ones billing the PT. They're not really interested in being more efficient.

Hooking up the IFT units to the county dispatch systems is hugely expensive, and there is still a system in place for major emergencies. A 30 min wait is far too long, the wait is not usually that long in my experience.
 
Municipal contracts are usually tied to a certain response time, say 8 minutes from call time to on-scene time. The 911 provider will be required to meet these response time 90-95% of the time or risk losing the contract. Most have contingency plans when resources are low to pull IFT units or otherwise shuffle around for cover. Of course there is that 5% of the time that you just can plan for and will have a late response.

There are lots of problems with tying every ambulance into 911. First off, who's going to pay for, maintain, and routinlely inspect communication equipment, and crew training? Even more of a problem would be 3 companies trying to jump the same call. Also, not all IFTs will be willing to divert a garaunteed, covered dialysis run for an urgent CP call that might never get paid.
 
Local municipalities are responsible for ensuring 911 response. They do this by operating EMS systems directly or contracting with private services. There are generally lots of specifications that go into the RFP and eventual qualification of a private service that provides 911. Dispatch tracks the movement and location of ambulances and tries to dispatch the most appropriate one.

A private IFT service, on the other hand, often isn't even part of the 911 system. They haven't met any of the requirements of the local system and the local dispatch doesn't track them or know where they are.
 
I guess I am looking at this whole thing overly idealistically. I have the same problem with taxis -- call one company and they guarantee a cab within 15 minutes, and as soon as I hang up, another company's cab appears to be around the corner. I think taxicabs would be more efficient with something like Flywheel, that dispatches whoever is closest regardless of the company. However, it doesn't get me as angry because nobody's going to die if I don't get to a meeting on time.

With regard to EMS response, it reminds me of when we were setting up a phone pager system for first responders in college. I suggested that we take turns so that we could each have some nights without the possibility of a phone ringing, and a friend/colleague of mine did not like that idea. She said that when someone needs help, you want everyone qualified to respond to be there-- what if the "closest" person happens to be "off duty" under my proposed system? Certainly they would still help if only they knew.

That changed my outlook on things. The job is to do the most good for the ones who need it most, not simply to have a response in a reasonable amount of time. Under my system, someone would have responded within 2 minutes, but under her system, the response time was even lower.

I am familiar with the response time requirements in my area (on a high-priority call, 8 minutes for ALS fire, 12 minutes for ALS contracted ambulance, 95% of the time). That just seems too much like my old idea--someone will respond within a reasonable amount of time. The analog of my friend's system would be-- if an emergency were to happen, EVERYONE qualified will respond so that whoever is closest will be there in seconds (if we can get the technology to work, I would love for this to mean off-duty EMTs who happen to be driving by, IFT ambulances, or CPR trained bystanders with an app on their phones--everyone in the community coming together to help someone in time of need).

Am I completely misguided here? Or am I just being perhaps a bit too idealistic?
 
You must log in or register to reply here.
Back
Top