Emergency Response

 

Recently, WGGB News Channel 40 in my old stomping grounds up in Springfield, MA posted a news article about “Emergency Response” in the city of Springfield.  The source of this story is said to be anonymous, however many of us have our speculations as to where it came from, none of which will be shared here, because they are after all speculation.

WGGB raises concern over 350 responses that were considered “lengthy” by the city.  A concern created by one of those “lengthy” responses on a snowy morning January where a shooting victim waited 17 minutes for a response due to system overload.  There are, however, a few facts in the story that WGGB does not do a good job at pointing out that I feel need to be brought to light.

• The city contract, as documented in pages seen in the report, calls for a response of under 10 minutes 95% of the time to “Priority 1” calls.  According to the report, AMR in Springfield meets that standard 97% of the time.  They exceed expectations set for them.
• Annually in the city of Springfield, there are approximately 35,000 calls for 9-1-1 service.  WGGB is taking issue over 350 of these.  I do not have to break out my calculator to be able to tell you that this is 1% of their responses.

Take a trip to Detroit, Philadelphia, or Washington DC and ask them how they would feel if they got an under-10 response 97% of the time.  Ask them how they would feel if they got that response 80% of the time.  Chances are, they would be thrilled with that improvement.

In my opinion, WGGB and Brendan Monahan are trying to make a story out of a non-story.

Medicine is a constantly evolving creature.  That is why we say we “practice” medicine.  Recently, I watched Killing Lincoln on the History Channel about the days leading up to and following the assassination of President Abraham Lincoln.  After he was shot, a doctor is shown telling two men to “move his arms up and down to expand and contract the thorax.”  Do you know why we don’t do that anymore?  Because we know it does not work.  CPR has evolved, and the care we provide has evolved with it.

Emergency Medical Services is no exception to this rule.  The evolution for us does not just happen in the back of the bus where we take care of our patients.  Response modes and delivery models are changing every day.  Computer programs now exist that allow us to actually predict where the next call is going to come in at and Priority Medical Dispatch which, like it or not, gives us a better means by which to triage a call to get an appropriate response exist today.  Thirty years ago, they were not even on the radar.

One final thing on the “non-story” part of WGGB’s story.  There is a great article written in JEMS Magazine by Matt Zavadsky from MedStar in Fort Worth, Texas called “The Great Ambulance Response Time Debate Continues.”  Have a look at the article it touches on a lot of important points, and backs them up with one extremely telling and important piece of evidence.  Here is a short excerpt from the article.  I suggest however, if this sort of thing interests you, that you read the whole thing.  It’s worth it.

As sports fans poured into the Dallas-Ft. Worth area to see the Pittsburgh Steelers take on the Green Bay Packers in Super Bowl XLV, MedStar geared up for what was anticipated to be a busy week. However, no one could have predicted what happened next. Just days before the game, a severe winter storm blanketed the region in 13 inches of snow and ice. The weather was so severe that for a 48-hour period, MedStar, with the approval of its Medical Control Authority, the Emergency Physician’s Advisory Board suspended the use of lights and sirens. When the storm was over, Zavadsky compared cardiac arrest and chest pain responses during that 48-hour period to those of the previous week. “That kind of study is hard to do prospectively,” he says.

What he found was little difference between the patient outcomes between the two weeks. “Very few EMS calls required an immediate response,” he says. “The time critical responses were CPR/AED.” Even with chest pain calls, the problem was that the patients waited too long to call 9-1-1—not that the ambulance took too long to arrive.

The MedStar example tells a lot.  While there are instances where time is of the essence, cardiac arrest being the big one, the capabilities of the provider responding to the call is far more important.  Like I said, go check out the article.  It tells the facts a heck of a lot better than I ever could.

Since AMR’s exceptional response time compliance is a non-story here, what is the story?  What should WGGB have focused on?

How about they spend a little bit of time talking about what happens after the ambulance gets there?  I’ve said it time and time again in a variety of articles on this blog: the days of you call, we haul, that’s all are far behind us.  We are no longer ambulance attendants.  Frankly, we are barely “first responsders.”  We are instead the first link in the access to health care.  Once those life threats are ruled out, we provide the first steps in essential patient care.

There is a reason that every ALS ambulance out there has cabinets full of supplies and medications, and a cardiac monitor.  There is a reason that each paramedic carries a stethoscope and why each of them goes through a minimum of two years of school to be able to practice as a paramedic.  That is not two years of how to drive fast and carry people.  Scope of practice expands, treatment modalities change, and people need to know that when they call 9-1-1, the people that are walking up to their door are trained medical professionals who have the capability of saving their lives.

That life-saving does not start with a “diesel” bolus as an ambulance throws its lights on and goes screaming through the city hoping to get there in the NFPA’s fictional number of 7 minutes and 59 seconds.  It starts when a provider of patient care walks up to someone and introduces themselves.  Or it starts when that trained Emergency Medical Dispatcher describes to the untrained bystander what they need to look for in a chest pain patient, or what they need to do to provide hands only CPR.

Emergency Medical Services and “Emergency Response” as WGGB refers to it is about a lot more than just lights and sirens.  It is about patient care, and the capabilities of the provider.  That is where the story is.