|
Why EMS calls aren't always random
Consider this: Stationary EMS units parked inside stations are financially inefficient
|
Tweet
|
By Art Hsieh
From the pages of a good sci fi book — except it's real. Posting units around a community is nothing new -- for better or worse, system status management has been around since the late 1980s.
Sitting on street corners isn't fun; it takes real effort to stay fit and not eat a ton of empty calories while parked at a convenience store.
I'd be more willing to do it if it somehow meant that I'd be closer to the incident and reduce my need to blaze through traffic.
In essence the ability to make that happen is becoming a reality. It's very intriguing that somehow the randomness of an EMS call is, in fact, not — at least not completely.
Some of it is intuitive — perhaps a greater number of crashes during heavy traffic periods, or a greater incidence of medical calls downtown during the weekday and in the residential areas at night.
I suspect that there is more to the concept, however, in order for greater precision in predictability.
Lest you think that this isn't a harbinger of future events, consider this: Stationary EMS units parked inside stations are financially inefficient.
It's convenient and helpful to the EMS provider, but may not be the best approach in managing the demands of a dynamic system.
The story on Houston considering the privatization of its EMS system is at least partially based on the financial capability of that system to pay for itself.
I mean, we don't expect physicians and nurses to sit around their departments waiting for patients to arrive, right? Not every hospital is a trauma center for the same reason.
The balance of this equation is that EMS providers are afforded as many creature comforts as possible while being mobile.
It's not always best to be parked in a fast food restaurant parking lot, nor is it to be driving for hours on end moving from one post location to the next.
We're human, too — and our grumpiness is just as predictable as the calls we run.
Scott Brown Sunday, February 12, 2012 8:47:10 PM The "financially inefficient" part is why privatizing and private EMS is right up there with fixed fortifications and SSM in level of stupidity. Primary, indigent healthcare...which is what EMS has become, is not a money making endeavor. The things we do to compensate for the lack of profit potential is the exact reason why you cannot serve 2 masters...public service and private profit, at the same time without degrading the part we're there for in the first place...clinical production. 
Donovan Warren Thursday, February 16, 2012 10:20:17 AM "[W]e don't expect physicians and nurses to sit around their departments waiting for patients to arrive, right?" Well, that's exactly what they ARE doing. If there are no patients, they check their equipment (just like us), stock supplies (just like us), and sit at their station with their cell phones and computers (just like us). When there are no patients in the ED, they DO sit in the department waiting, at least part of the time. Heck, they do that when they have patients, as long as there's nothing specific to do for their patients at that specific moment in time. Fire crews, even in those systems that don't perform EMS, have exactly the same problem, and nobody would EVER consider corner-posting a ladder or engine apparatus 24/7.
"Not every hospital is a trauma center for the same reason." In fact, it's not the same reason at all; your rationale is that EMS crews should be mobile and post for "predicted" calls; if that were also true for Trauma centers, they'd all be MASH units which bugged out to be near predicted Level I incident locations. The reason not every hospital is a trauma center is primarily financial, and partly hassle: it's expensive to start and maintain a Level I facility, you need a LOT of ongoing experience to make it viable from a pt. care and financial standpoint, and it's a LOT of work to get the initial "certification" to accept those kinds of traumas. So, no, it's not even close to "the same reason."
In addition, having permanent stations for EMS crews is more efficient for other reasons. Because of the limited space available, the ambulance can only carry a limited stock of supplies. Having to keep units out of service to drive across town for resupply is fuel- and time-inefficient. Crews with a permanent station become familiar with their area much more quickly when they stay in it, and are better able to respond more quickly to scenes in their familiar area than crews from halfway across town and will be better able to avoid delays due to things like small/private construction projects or local events. EMS crews with permanent stations see the same patients in their area frequently. This may contribute some to burnout while taking the same drug addict/alcoholic/drug-seeker pt. to the hospital at 0400 four shifts out of every ten or the eighth visit to the same "care" home in one shift, but it also contributes to better pt. care for those pt. who have chronic conditions, which is more efficient (spend less time on PMH and more time on "what's changed").
Having permanent EMS stations IS the right balance between crew needs and community needs. It may not be the MOST efficient thing financially, but it is the BEST thing to do when you consider all needs, not just the profit of the company. 
Dale Loberger Mon Feb 27 11:40:41 PST 2012 I also agree that some of the comparisons in this article don't really hold true, but comparing EMS to Fire is another unfair one. I am not familiar with any EMS that has an equal number of ambulances to fire trucks (meaning fewer manned posts compared to fire stations.) Part of what makes this unequal nature work is the ability to readily "move up" ambulances to another post as needed. If you map demand for any period, you will find it is not spread equally, so equal coverage of ambulance service means unequal utilization of those resources (burning some out while boring others.)
If the SSM practice leads to unnecessary moves and long waits at outlying posts, then that SSM plan isn't working as it should. It may not be the concept that is the issue, but the implementation of it. Our EMS headquarters is near our primary hospital, so restocking can be done at the end of most calls. If an ambulance posts without the necessary equipment or supplies, again that is an issue with the crew, not the plan.
It was the public service idea that brought me into this field to begin with, but now I recognize that the financial stability of it is what will keep me in this field. Efficiency is not the enemy of public service, it is the facilitator - regardless of whether a service public or private.
Chris Bowers Friday, February 17, 2012 8:47:45 AM As a nurse that works for a medium size hospital and a medic that works at a private service my views are different than most. I can see the perks of system status and understand your comparison to the hospital world. If our patient load is down we are "floated" to assist in busier areas of the hospital until our load increases. It is a way for the hospital to keep PRODUCTIVITY numbers up. System status is the exact same thing. Does it work well with 24 hr shift patterns? Absolutely not! Anyone would go crazy spending 24 hrs in a truck. If you do away with the majority of the brick and mortar stations think about the amount of money you are saving taxes payers. If you were "forced" to stay in your truck think about the things that can be done to keep the trucks looking better and better maintained. The old saying if you have time to lean you have time to clean. Think about the decrease in response times. Isn't that our main purpose anyway? Some times we have to all realize that it is a job and we occasionally have to give up our comforts. A lot of our crews have adapted and have used their posting sites for good. We have several crews that walk up to 5 miles a day during slow times. In short we all have to realize that in these economic times EMS is evolving. We have to accept that and continue doing the best we can. System status is not a fix all but where it works, it works! 
