Let's Recap: What is SSM?

[Flying]

I'm wanting to know more about my local system and would appreciate some input from our more seasoned members.

As the title asks, I would like to know what you know about SSM and PUMs, who Jack Stout is, and why certain people seem to have an obsession about this man.

I'm familiar with the Dr. Bledsoe's 2003 JEMS articles and would like to know if there has been any change in the acceptance of these ideas over the past decade or so.

From recent conversations I've had, there has been talk about street posting being the "way of the future". Strange, considering that this way of doing things came about in the 80s. Has there been a recent resurgence, are there any grounds for this, or is this just another fanciful trend in EMS we deal with?

Note that this is coming from Central Jersey, where we're a touch slow.

 

[DrParasite]

Note that this is coming from Central Jersey, where we're a touch slow.

Oddly enough, I'm from Central Jersey, and wasn't slow.... maybe it's just you?

SSM isn't the way the future; rather, it's a ways many systems try to do more with less, often at the expense of their employees. It doesn't do much, but larger systems are doing it because, on paper, you don't need resources to cover a certain area.

Ask the guys in Newark, Jersey City, or MONOC how much they like it.... I know that the Newark guys have been burned by SSM more time than I care to admit.

It looks good on paper, but you can't predict when someone will get sick.. or do something stupid and get hurt. that's why most EMS providers in Central NJ don't use it (although one large system recently forced it upon their crews....)

 

[DPM]

It's a terrible idea. My agency uses a posting plan, listing them in the order that they need to be filled by based on available units. SSM / marvlis / call tracking data from the last 5 years is used to make this model, which changes at least every month. We have a few fixed posts, either in BLS Fire areas or some of the more rural areas, but it's not uncommon for crews to be away from these stations and posting anyway.

An interesting point that my preceptor brought up to me was this: When crews have quarters to get back to they clear the hospital quicker. When it's 4am and you know you're going to be heading back to a street corner, what is your motivation to leave the ER early? This impacts the system, you have less units available, so the remaining units are moving up and changing posts etc. This usually means that the next units to the ER are probably going to do the same and run out their timer so they can get a break... And rinse and repeat.

 

[Bullets]

SSM is dumb, im also from NJ and i hate dealing with Jersey City brass because they cant help but talk about MARVLIS and how wonderful it is....if you dont care about system morale or staff well being.

 

[46Young]

SSM is simply managing scarcity. Basically, it's all good until you get a surge in calls, then you don't have enough units to cover. You run down units quicker due to mileage, and also run down your crews. It may be appropriate in a system that has 12-16 hr days and 8 hr nights, but certainly not 24's or 12 hr nights. Basically, it turns 911 into IFT-like busyness, running many calls, and having to drive around with little to no time to hit a local 7-11, much less heat up a meal that you can't get to at the station.

It makes supervision look good because they can improve response times at a lower cost, but it creates high turnover. I'm willing to bet that these places that use SSM are the first ones to look to the FD for ALS first response to boost their inadequate deployment.

The tradeoff for having to go to work at a monent's notice, frequently interrupted meals, training, and sleep, is that you should have downtime if not on a run. SSM sees that downtime as a waste, and takes that away. Unless you consider eating your lukewarm or cold meal out of a tupperware in the front seat of your ambo on a street corner. Been there, done that, ain't going back! Sleeping on the cot in the back of the rig is miserable, and the bench seat isn't typically wide enough. There may also be a policy against sleeping in the rig.

Employers have it backwards - when the bean counters screw you on budget, instead of trying to make more out of less, stick with the conventional model, and force them to increase your budget, get grants, whatever. DC had to hire a private ambulance service to cover some of their call volume recently.

 

[bizzy522]

SSM is a great way to save your agency money on paper but there are a lot of hidden costs. First off you have ambulances idling in a parking lot all day and driving from post to post.. it wastes a lot of gas and puts a significant amount of wear and tear on the engine, breaks, transmission, etc. Secondly It kills employees morale! Having unhappy employees is going to increase the amount of call offs, No call no shows, and employee turnover in general. This is going to add a significant amount of overtime and the associated costs of hiring and training new employees on a regular basis.
During my time street corner posting I noticed my morale had become extremely low and I contributed to the following factors.
1. There is almost no down time.. The down time you do get you're usually sitting in the front seat of an ambulance idling at a street corner. The AC may or may not be in working order. But regardless there you sit.. waiting for your next call and trying to get caught up on charts.
2. You eat like crap! Gas station food, fast food, food trucks, etc. Very expensive and very unhealthy living that way. You can bring a lunch from your house if you're trying to eat healthier and save some money. But in doing so you will have to somehow fit a day's worth of food into a cooler that you can stash somewhere in the ambulance.. Oh and you'll have to beg one of the gas stations or one of the hospitals to use their microwave.
3. Every time a call drops all the ambulances shuffle and move to fill the coverage gaps. So in a high call volume service it seems every 10 to 20 minutes you are driving to the next post. At that point it has turned into more of rolling coverage.
4. You and your partner are stuck together in a enclosed area for 10, 12, or 14 hours per day, firefighters or paramedics that are based out of a station can choose to take a break from their partner.. go relax somewhere and have a minute of time to themselves.
5. The street medics and dispatchers become enemies.. it's not their fault that we are the closest unit and it's not our fault that we had to get gas but somewhere along the line dispatchers and paramedics make it each others faults.

System status management is the future of ems. When done correctly with an adequate amount of trucks it's a good idea. But when done in the wrong manner it can result in high turnover, low employee morale, and ultimately poor patient care.

 

[DrParasite]

Employers have it backwards - when the bean counters screw you on budget, instead of trying to make more out of less, stick with the conventional model, and force them to increase your budget, get grants, whatever. DC had to hire a private ambulance service to cover some of their call volume recently.

I've been saying this for years........

 

[DrParasite]

System status management is the future of ems. When done correctly with an adequate amount of trucks it's a good idea. But when done in the wrong manner it can result in high turnover, low employee morale, and ultimately poor patient care.

SSM might be a good theory, on paper. I have yet to see it done in any manner other than wrong.

 

[46Young]

SSM might be a good theory, on paper. I have yet to see it done in any manner other than wrong.

I could say exactly the same thing about multi-level marketing, stuff like Amway and Herbalife lol

 

[Tigger]

My AMR operation experimented with software that basically laid an amorphous and approximately mile square blob over a map that moved around and "predicted" the next call. The software used previous call data, time of day, weather, and some other variables to do this, and it was apparently eerily accurate. They used primarily to post the level 1 ambulance. It ended up being too expensive and we went away from it, but it's an interesting idea.

Now we do SSM based on a posting plan, which is adorable since I can't remember the last time I actually reached a post. Usually we get a call right out of the hospital or enroute to a post. Our posting plan is also flawed in that we have to post excessively south and east to cover tough to access unincorperated county area that still gets an 8 minute response time per the contract. The plan basically relies on ambulances being available at thhe hospitals which are all central and north, which is of course a mixed bag.

 

[DPM]

The blob sounds like MARVLIS, which superimposes the weird blobs on the map, predicting call volume. No blob = normal likelihood, yellow = higher, red = higher still etc up to really dark purple. In my system it constantly sticks a big blob over "down town" which occasional blobs over sports arenas, concert venues etc.

I'm sure it costs a lot of money, and we don't deploy our ambulances according to this system.

 

[Tigger]

The blob sounds like MARVLIS, which superimposes the weird blobs on the map, predicting call volume. No blob = normal likelihood, yellow = higher, red = higher still etc up to really dark purple. In my system it constantly sticks a big blob over "down town" which occasional blobs over sports arenas, concert venues etc.

I'm sure it costs a lot of money, and we don't deploy our ambulances according to this system.

Looks like it. I'm pretty sure we use their deployment monitor as well.