I’d Hate to Say “I Told You So”

April will mark the two year anniversary of the Kansas City Fire Department taking over primary ambulance response in Kansas City, Missouri and the disbanding of the Metropolitan Ambulance Trust, or MAST for short.  Needless to say, the reviews of Chief Smokey Dyer’s promises to the city have been less than spectacular.

The Kansas City Fire Department performance has been riddled with broken promises of service improvements.  The guarantee of faster response times for the city’s residents have not been met which led Chief Dyer to back pedal a few months ago, stating that meeting those response times with his current staffing would be difficult at best.  Basing their response times on nationally set standards by health organizations and the National Fire Protection Agency, Chief Dyer guaranteed an ambulance to each scene 90% of the time in fewer than 9 minutes, a standard that during its years of existence MAST had trouble reaching at times, ultimately leading to its restructuring at one point.

While KCFD’s performance has not been as bad as some other municipalities with their 87% response time compliance, the fact remains that a promise for “better service” was made because KCFD stated that they could get there faster than MAST could.  That along with a restructuring that could save the city money, and also save fire department jobs were good enough for the city council to believe the scenario that Chief Dyer had laid out for them.  Now, the Chief is facing the need to cut over $7 million from his budget, which might result in the loss of over a hundred jobs.

In May of 2011, I was on the panel for EMS Garage Episode 133, “Dyer Need” where Brad Buck, RJ Stine and I joined Chris Montera to take a look at MAST a year later.  I encourage you to listen to it and get a feeling for where the service was ten months ago, and where we saw it headed.

The saddest part of MAST’s demise is it happened because of a false promise: KCFD stated that better response times would mean better service.  When will we realize that in actuality, better patient care means better service?  Far too often, we benchmark a service’s performance based on how quickly they can get to an “emergency” but we constantly forget what is really important: patient outcomes.  Unfortunately though, the importance of the care provided by paramedics and EMTs is often over looked.

Constantly dealing with response times as the lone measure for quality in EMS service and addressing it as the only point of improvement for a system is like sticking your finger in a leaky dam.  Sure, the problem might seem to be solved for a moment, but if the bigger picture continues to be ignored, the leaks will become far too many to handle, and the flooding will be overwhelming.

The fact is we need to deal with the prehospital aspect of health care as much as we do the public safety aspect.  Determination of what is and is not an “emergency” needs to be taken out of the hands of the patient and paramedics need to be trained on how to make that triage decision.  Someone calling the police department might think their neighbor’s barking dog is an emergency because they have to be up early the next morning, but that public nuisance call does not require an immediate lights and sirens response much like the person with cold and flu symptoms should not warrant an ambulance immediately.

Many patients will often wait hours to see a doctor in an emergency room, so where is the harm in them waiting a little bit longer for an ambulance?  Or better yet: why do they have to go to the emergency room and not some alternate destination like an urgent care, or even their own primary care provider?

As long as we allow our legislators and the general public to believe that speedy care means good care, we will continue to struggle for our own identity, and high performance EMS systems such as MAST will continue to fall prey to their competition and their unrealistic, unfounded promises.  Let’s start looking at the quality of care provided by an organization’s medical practitioners.  That is what is really important here.

KCFD broke an already effective EMS system.  While it is highly unlikely that MAST could be resurrected, the rest of us need to learn from Kansas City’s mistakes and we need to make sure that they are not repeated.

Read more about KCFD’s recent struggles here.