How important are response times in EMS? To most communities, they mean everything. There is no greater measure of how effective an EMS system is than how quickly an EMT or paramedic gets to the scene of the call. We are, however, barking up the wrong tree. Lets compare two calls and I will explain where I am going with this:
An ambulance company has a required response time of 9 minutes 59 seconds or less ninety five percent of the time. Medic 1 is dispatched to a single family home on New Jersey Avenue on the other side of the city from where they are posted. They try the best that they can, but despite their best efforts, they arrive on scene in 12 minutes, almost two minutes after their longest allowed response time. The crew gets out of the truck, gathers their equipment, and a minute later, 13 minutes into the call, they are greeting their patient and starting their assessment.
After transporting that patient to the hospital, Medic 1 is dispatched to an apartment building on New York Avenue. This time, they arrive on scene in 9 minutes, narrowly making their response time. They again gather their equipment and start pressing buzzers. After confirming the apartment number with their dispatcher and having them make a call back, one of the patient’s family members walks down from the fourth floor to let them in. They start their trek up four flights of steps, and fourteen minutes into the call, they are at their patient’s side. Given these two situations, which patient got the better service?
In situation number one, the crew missed their response time but due to “geography” they were able to reach their patient more quickly than they did on their second call. On the second call, they provided the service that is expected of them with their 9 minute response time, but their patient waited longer. Should a question be raised about the second patient waiting as long as they did, the service provider could answer “we made our required response time.”
Taking this into consideration, are response times really what matter in EMS or are they this mythical feel good number that we share to playcate our critics? Should we be measuring response times or should we actually be measuring at patient’s side times? And if we start looking at that, how do we best account for it?
I have heard of different systems trying different methods such as calling out on the air, or the one I found most interesting, turning on the LP 12 when arrival at the patient’s side occurs. My system currently measures it but the number is largely estimated and therefore not very accurate. The bottom line is this: at patient side time is much more important than response times.
A patient in respiratory distress does not care that the ambulance got to the scene in six minutes if it takes them four more to get to him or her to give them oxygen. An apneic and pulseless patient’s heart continues to deteriorate in the minutes and seconds it might take a crew to gather their gear and get to the patient’s side.
The beauty of response times is they are concrete and easy to account for. With the addition of automated vehicle locators and GPS in many units, tracking them and knowing where they are and when they get to where they are going to is easier than ever before. We should not let the clock stop here though. Putting a truck in park does not start patient care. Engaging a patient does.
The challenges that responding to different addresses create need to be taken into consideration when we are looking at response times. We need to decide how long is too long for us to get to our patients. Is 15 minutes without care too long? In many cases maybe not, but in some that extra five minutes could mean the difference between life and death.
Here’s a question.
Why do we need response time requirements? Just to prove we’ll show up?
For all but a few calls, we don’t need lights and sirens. Do we need to go lights and sirens to the 3 am stubbed toe or to the 11 pm drunk on the street?
Don’t get me wrong, there is a need to respond promptly to calls, but we don’t need to go flying all over the place for non-life threatening calls.
I may be young, but we begin to become wise by radically questioning things.
I’ve always been one who thought that we put way too much emphasis on reponse times. What good is that metric when a large percentage of the calls are for non-emergencies?
I believe that the emphasis on response times boils down to three things:
1 It is a objective data point that local officials can understand.
2. It has been hammered home by local fire departments that it is the MOST IMPORTANT measurement in evaluating quality.
3. It is true that in a handful of situations, a faster response time COULD have had an impact on mortality or morbidity.
Fact is, however, that it costs a whole lot of money to drive response times down. In my system it costs over $1 million to put a truck on the street 24/7. What is the cost to benefit ratio to move the dial from 10 minutes to 9 minutes? I’m not sure, but I do know that their are people out there who have made the calculations.
My point is this: If you put an ambulance on every street corner you would have really good response times. Why don’t we do that? Money. The question really is, “How much are we willing to spend?”
EMS response times are not a medical or even an operational issue. They are a political issue driven by the media and their ever increasing lackeys, the politicians. It’s stupid, but people have come to expect a lights and sirens response for what amounts to no more than a cab ride to the ED where they can sit in the waiting room along with the guy that drove himself in or took a cab.
It’s our own fault because we’ve spent most of the last 30 or so years telling people to call 9-1-1 for an ambulance for any malady major or minor. Having successfully done that, we now bitch about our very success. We’ve told people that “you decide what the emergency is” and so they have. The emergency is anything that upsets their little world and they expect EMS and the ED to fix their trivial problems day or night.
We have phone triage systems that do nothing but reinforce that. Your baby has a stuffy nose, we’ll send a fire truck and ALS ambulance because it’s a “Difficulty Breathing”. You’re a diabetic and you have a headache. Fire truck and an ALS ambulance for “Altered Mental Status”. Drunken college student? Fire truck and an ALS ambulance for “Unconscious – Possible Alcohol Poisoning”.
That last is also driven by the fear of being sued on the part of colleges. So, they tell their PDs and RAs to call 9-1-1 for an ambulance every time little Billy or Susie gets shit faced and passes out.
No one is responsible for their own actions any longer.
Fix those problems and then maybe, just maybe, response times will matter.