With the recent Supreme Court decision on the Affordable Care Act (ACA), EMS could be facing some significant changes in how we operate. However, even before this, the “good old days” were already going by the wayside due to the economic crisis we've all experienced. We can’t keep doing things the same way just because that’s how we’ve always done them, and our elected officials and citizens are demanding we do more with less.
When questions are asked about how your agency is performing, what you can do better and how you're going to make that happen, can you answer those questions?
Have you taken a hard look at how your agency operates? What is it that you see when you look in the mirror? Do you see anything?
Do you have the facts and data, and are they favorable for your continued success?
People tend to become defensive when they or their organizations are questioned. From response times to productivity to outcomes, all of these are questions that are now being asked, but few agencies can provide the detailed answers that are needed to satisfy those asking the questions.
One way to begin addressing these questions is to become accredited. Whether you go through CPSE or CAAS, both processes force the agency to take a hard look at what has been done, what is currently being done and what the agency wants to get done. Terms like fractal, benchmarks, baselines and compliance become the norm, not the exception.
While the process may not answer every question being asked, you will be well on your way to being able to quickly find the data to answer the question.
Another way to answer these questions is to implement a quality improvement (QI) process that looks at measurable outcomes. EMS calls account for anywhere between 60% and 80% of a fire agency’s calls—and obviously 100% for those who only do EMS. While I would like to say that a QI process is predominant in EMS and fire agencies already, I don’t believe this is the case.
We have built a system around an eight-minute response time based on time to brain death for EMS calls and time to flashover for fires. However, these two calls types probably make up maybe two percent of your entire call volume. We also know that structural materials have changed, causing flashover sooner, and that the new CPR with other advances in technology and care are allowing us to save more patients even after the eight-minute mark.
Yet, we still use eight minutes as the goal. What about the other 98% of your calls? Do they need an eight-minute response time also?
If you get to every structure fire in eight minutes or less 90% of the time and still burn the structure to the ground, is that acceptable? What about every cardiac arrest that still ends up dying even though you met the response-time benchmark?
This is why we need to look at what our outcomes are, not just how fast we can get there; through a QI process, we should be able to make a difference. The problem is that most agencies can't tell you what their outcomes are.
Matt Zavadsky, director of public affairs at MedStar EMS, was the subject of an excellent article, “The Great Ambulance Response Time Debate,” (EMS Insider, February 2012) that discussed his presentation to the American Ambulance Association in November of last year. Mr. Zavadsky issued the challenge to look beyond speed and time on EMS calls and to begin looking at outcomes. According to the article, by looking at outcomes and performance, “it’s possible to save valuable resources and improve patient outcomes.”
Last time I checked, I think that is what we are supposed to be doing. And, we can extend that beyond just EMS calls.
Time can be critical, and the NIST studies showed that more people can make a difference in time. However, the next step is to show what the outcomes are based on people and time.
Again, if we get there quickly but have a bad result, then we are not doing our job. We need to continue to pursue research to improve the body of knowledge about our performance and what our outcomes are.
Accreditation is a form of research specific to your agency, and a QI process is an ongoing outcome study within your agency. Using the broader studies of fire and EMS along with your data will allow you to make educated decisions on what your level of service is, where you want it to be and how to get there. It will also allow you to answer those tough questions.
I’ll admit that it's never easy to critique yourself or your organization. You may find things you don’t like, but you’ll also find a whole host of things that you're probably doing well.
Take a moment and think about your organization. What do you see when you look in the mirror?
Norris W. Croom III, EFO, CEMSO, is the deputy chief of operations for the Castle Rock (Colo.) Fire and Rescue Department. He’s been a member of the EMS Section since 1998 and currently serves as the section’s director at large and as the EMS representative on the CPSE Commission on Professional Credentialing.