What defines a high volume/busy system?

[greensquid347]

Ok so in looking for jobs and researching educational opportunities I have come across the terms high and busy areas/systems. Is there a predefined threshold for that designation or is that something that is opened to interpretation? I understand that the more urban your areas is the more likely that you will be considered one of these terms but what about the subs or rural areas?

Example: I live 45 minutes outside of a major city with a pretty big University but I always see our local ambulances posted (outside my current job) for hours on end (but we are close to the local Dunkin Donuts ), but we have special seasons (when the snow birds come down, Spring break, BCR, etc) that I see them less.

So I guess I am wanting to know if they considered a normal company that had high calls two or three times a week would cut it or if you had to be no stop the whole time you were on shift?

Thanks for any help provided, since Google and quick search came back with nothing of relevance.

 

[chaz90]

These terms are completely subjective. There certainly aren't any defined criteria, and defining a system or experience by call volume alone is a recipe for disaster. Furthermore, many urban systems that like to brag how "high volume" they are have extremely short transport times with low patient acuity most of the time.

I may not run 20 calls in a 12 hour shift (thank God!), but in my last tour of 4 shifts I personally transported one status seizure secondary to a head bleed, one unresponsive, hypothermic patient found down in his house, worked a cardiac arrest, and had two respiratory patients in need of CPAP. Having time to actually work with sick patients is far more important than shuffling 10 drunks a day to the drunk tank to show how many calls you've run.

If a job you're applying for requires what they consider high volume experience, explain what experience you do have and what you got out of it. As long as you're running enough calls to stay competent and see sick patients, volume is one of the least important components of experience.

 

[greensquid347]

OK that is good to know, thank you.
I figured that it might not matter compared to what you know how to do but a lot of job postings seem to have that as a main requirement.
(Almost every ER tech job that I see shows at least 1 year of experience in high call role)
Again thank you for the input.

 

[unleashedfury]

Like chaz said outline your current enviroment.

My last job I may only do 3 transports in a 8 hour shift. but transport times were 30(+) minutes. and turn around was about 2 hours.

My current job I do between 8 and 10 transports a day, with a 1 hour turnaround and about a 15 minute transport time.

When speaking of high volume be subjective to other factors. such as transport times and the like.

We have a squad here that may go days even weeks without a call, they average about 300 calls a year, where as our busier squads run in the upwards of 5 to 7k calls a year.

So if your squad that you work at has a call volume of lets say 2k calls a year but a extended transport time explain that. most squads with heavy call volume have lots of patient contacts, but often minor or even taxi ride patients. I'd rather have a EMT that could manage a much more critical patient for 20 minutes but only sees 200 calls a year vs. a EMT who touches 1000 patients for 5 minutes but 960 of them are stubbed toes, toothaches and drunks

 

[NomadicMedic]

It varies from place to place. I worked for an agency in Washington that ran a ridiculous number of calls. We had a medic and basic on each truck, and the call volume was staggering. It was great experience, but nobody could sustain that for very long.

Chaz and I work for the same agency. It can be said that our current call volume is not particularly high, but the calls we do see are normally high acuity and require greater levels of ALS management then would the typical intoxicated male or "sick person". I'd much rather work for an agency where you see sicker patients, but have a chance to breathe in between them… being able to explain the difference between high volume and high acuity is invaluable when you're in an interview

You also need to take into consideration the type of experience you may receive outside of running calls. Is there an opportunity to assist with developing training? Are there opportunities to move into supervisory roles? Can you take on additional duties such as equipment management or working as an FTO? All of these make you a more well-rounded employee and add more dimensional layers to your resume.

 

[unleashedfury]

^ thats whats invaluable about being in a chase car.

BLS gets stuck with the drunks, and nonsense. and You actually have legit calls.

 

[medicsb]

I've probably thought too much about what is "busy" or "slow". I'd say once your truck is pushing past 3,000 dispatches/year, you can say you're "busy". I think of <2000 as "slow." Of course, this is a per ambulance volume. There's a service in SE PA that responds to 12,000 calls and they refer to themselves as busy even though they have 6 ambulances in service. Maybe one of their trucks is actually busy.

As far as acuity, that is an important distinction, especially in a tiered system. If dispatch/system is good, a truck may only transport 1000 patients, but for a truck in another system to see the same number of sick patients, they may need to see 3-5 times as many transports.

This is all based on my personal preferences and experiences in both types of systems. So, whatever.

 

[Handsome Robb]

We're called a high performance EMS system. We run ~75-80k calls per year. Some days we run back to back the. Other days you sit and do nothing. It's the luck of the draw.

I haven't heard an arbitrary number as far as call volume to determine which systems are "high performance" and which aren't.

 

[WolfmanHarris]

I've read in a few consultants reports that Unit Hour Utilization (UHU) above 0.6 is considered too high to ensure response time targets. In other words if your units are occupied for more than 60% of their service time than coverage and response time targets will suffer. I think UHU regardless of the threshold chosen is a good point for comparison as it's objective and considers transport time and turn around time and can be scaled between small and large services.

I know our UHU is fairly low (around 0.4), but not considered in those numbers are the time we spend driving from station to station to balance coverage and return time from hospital. This has a disproportionate impact on crew fatigue/burnout that's not reflected in response times.

 

[DesertMedic66]

We have a 911 company who say they are a busy system. They do 24 hour shifts and average maybe 2-3 calls in that time.

I personally consider that a pretty slow system. We average 5-6 in 12 hours which I consider busy. My old unit averaged 10-11 in a 12 hour shift, that was suicide.

 

[Mariemt]

Depends on how many trucks you have and staff you have. You can run 600 calls a year with 10 staff and be busy. 1200 calls with 50 staff and be slow.

 

[DrParasite]

We get between 14 and 20 calls per BLS units in 12 hours, and between 6 and 12+ ALS dispatches per 12 hours. Inner city area, lots of abuse cases (ie, taxi rides or patient could have gone by POV but for various reasons called an ambulance), and quite a few major respiratory and serious trauma calls.

Agency wide, we do about 70,000 calls a year, and are considered a high volume/busy system.

While overall call volume shows one thing, I agree that calls per shift is what is really important. a buddy of mine used to work for FDNY EMS. system wide, they get about 1.2 million calls a year. in an 8 hour shift, if he did 6 calls, he considered it getting slammed. is he in a busy system? it up to you to decide.

 

[TheLocalMedic]

I'll second the notion that "low volume" areas on average produce higher acuity calls. If a job you are applying for stipulates that they want you to have "high volume" experience and you don't, stress the acuity issue in your cover letter. Say, 'Hey, while we only average 6 calls in a 24 hour shift, we transport patients who are generally much sicker and have to spend a lot more time treating them due to our long transport times.'

 

[ZombieEMT]

Around here, we generally consider high volume vs low volume based off of average numbers of calls per shift per crew. If one agency runs one truck and does 8 calls in a 12 hours shift that is considered high volume compared to the other agency that runs 9 calls in 12 hours between 2-3 trucks. Depends what you consider high volume I guess?

 

[emt11]

Our system ran right at 128,000 calls last year. Though we have about 15 trucks up during the day and about 8 at night for our 911 area. Plus some about 5-6 BLS trucks during the day for IFT only and another 3-5 ALS IFT primary/911 backup and 2 BLS trucks and 2 ALS trucks at night on the IFT side.

 

[jeepdude911]

Chaz90 was right. I have worked the majority of my career in the inland empire, the area of southern California east of L.A. encompassing the metropolitan parts of San Bernardino and Riverside Counties. But I have also worked in San Francisco. The term "high volume" is relative. You can run 4 calls in a 24 hour shift and if the transport is from one of the ski areas in the S.B. mountains to a level 1 trauma center, you are looking at a total of 3-4 hours to go available again, but in the city by the bay, high volume could be an average of 2 calls an hour due to short transport times.

 

[abckidsmom]

I'll second the notion that "low volume" areas on average produce higher acuity calls. If a job you are applying for stipulates that they want you to have "high volume" experience and you don't, stress the acuity issue in your cover letter. Say, 'Hey, while we only average 6 calls in a 24 hour shift, we transport patients who are generally much sicker and have to spend a lot more time treating them due to our long transport times.'

Agreed. One thing I notice is that while I might only transport 4-5 people in a 24 hour shift, when I change out my drug box, people from my agency take up more than half the slots in the log. For all the other surrounding counties, we are changing out 1/3 to 1/2 of the ALS boxes. Acuity matters.

Working hard to develop yourself as a clinician and sell yourself as such matters too. Detecting issues and managing them matters much more than flashy hero stuff.

 

[rlcpr]

I think it just depends on where you are working, the population, the types of calls, etc.

For example, I live in a coastal community where the population fluctuates between the winter and summer. We usually staff one ambulance during the winter, then as the tourists come in (and the population usually quadruples), we will do two trucks during high volume hours. We do a lot of MVAs, water rescues, and traumas during this time.

I think one of the other important things to think about is how many resources you have vs. the amount of calls. A 2,000 call/year service that operates one truck is vastly different than a 10,000 call/year service that runs 20 trucks.

 

[Handsome Robb]

I've read in a few consultants reports that Unit Hour Utilization (UHU) above 0.6 is considered too high to ensure response time targets. In other words if your units are occupied for more than 60% of their service time than coverage and response time targets will suffer. I think UHU regardless of the threshold chosen is a good point for comparison as it's objective and considers transport time and turn around time and can be scaled between small and large services.



I know our UHU is fairly low (around 0.4), but not considered in those numbers are the time we spend driving from station to station to balance coverage and return time from hospital. This has a disproportionate impact on crew fatigue/burnout that's not reflected in response times.

That's interesting I'd love to read those if you had them handy. Be awesome to see what they had to say.

We routinely run UHUs of .75-.85, the highest I've ever had mine was north of a 1.1. Pretty ridiculous. It's not just once in a while either, it's every day, all day, everyone gets their butts kicked.

 

[chaz90]

I've read in a few consultants reports that Unit Hour Utilization (UHU) above 0.6 is considered too high to ensure response time targets. In other words if your units are occupied for more than 60% of their service time than coverage and response time targets will suffer. I think UHU regardless of the threshold chosen is a good point for comparison as it's objective and considers transport time and turn around time and can be scaled between small and large services.

I know our UHU is fairly low (around 0.4), but not considered in those numbers are the time we spend driving from station to station to balance coverage and return time from hospital. This has a disproportionate impact on crew fatigue/burnout that's not reflected in response times.

I agree that UHU is a great tool in the majority of systems. The problem with using it with dual medic chase car units is that the vast majority of calls are handled by 1/2 of the crew, with the full unit being committed to the call only for the response time and the initial few minutes on scene. I suppose we could add a factor of 0.5 to the equation and calculate that in, while adding the additional time of the second medic if they get another call while their partner is out and using the standard equation if both medics transport.