Download EMS Response Time - EMS Performance Improvement Center

Emergency Medical Services:
National Priorities and State EMS
Systems of Care
Greg Mears, MD and Cindy Raisor, RN
The EMS Performance Improvement Center
University of North Carolina-Chapel Hill
Dedicated to
Janet Reaves
1964-2008
Leadership
 “We can’t win at home. We can’t win on the
road. As general manager, I just can’t figure
out where else to play.”
 1992 Pat Williams, Orlando Magic
3
Event/
Recognition
Access 911
Prevention/
Education
Dispatch
First
Responder
Rehabilitation
Specialty
Center
EMS
Response
Specialty Care
Transport
Emergency
Department
6
Recognition and
Activation
The Dispatch Center
Call Location
E911
Mobile Phone (Phase II)
Emergency Medical Dispatch
GIS/Navigation
9
EMS Response Time
911 Call Time
EMS Dispatch Time
EMS Notification Time
EMS En Route Time
EMS On Scene Time
EMS At Patient Time
10
Know your Community
11
Fatal Injury Rates
EMS Systems by 90% Fractal Total EMS Response Time
Total 90% Fractal EMS Response Time
(mm:ss)
Injury Fatality Rate
(deaths/100,000 Pop)
Top 10 Average
14:00
62.4
Bottom 10 Average
35:12
75.0
EMS System
There is a 21:12 (151%) difference between the top 10
and bottom 10
There is a 20% increase in the injury fatality rate
The average EMS System Total Response Time for
North Carolina is 21:40 (mm:ss).
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What is our Goal?
Patient Care Outcomes
Service Delivery
Personnel
Performance
Patient Care
Discomfort
Disease
Disability
Death
Dissatisfaction
Destitution (Cost)
13
EMS Service Delivery
Preparedness Based Design
Geography or Distance
Speed or Time
Care Potential or Level of Provider
Equipment and Technology
Medications and Skills
14
EMS Equipment, Skills,
and Medications
What skills are used
in your community?
What medications are
available to your
patients?
Is it consistent with
the outpatient care
provided in your
community?
15
Example
Hospital
1
EMS 911 Transport
10
EMS
First Responder
20
16
EMS vs. Hospital
Reimbursement
EMS
Fixed, Bundled
Transport Only
Preparedness Based
EMS goes to the
Patient
Hospitals
Fixed, Unbundled
Patient Care
Individual Patient Based
Patient Comes to the
Hospital
17
Public Health vs. Individuals
Public Health
Individualized Care
Immunizations
Disaster Triage
Targeted Complaints
Maximize Care to the
Individual
Focus on BLS
Focus on ALS
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Example: Cardiac Arrest
Public Health
Public Education
CPR
Public Access
Defibrillation
First Responder
Programs
Individual
Rapid ALS
Response
Defibrillation
ACLS
Drugs
IV Access
Intubation
19
Destination Policies
All to Community
Hospital
Triage based on
condition
Triage based on
Distance
Triage based on
Specialty Center
20
Specialty Care Transport Services
Who provides it?
Do you need it?
How timely is it?
Choices
Local EMS
Private EMS
Receiving Hospital
Air Medical
21
Outcome
Who Impacts Outcome
Community
Patient
EMS
Service Delivery
Personnel
Patient Care
Hospitals
22
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National EMS Information System
www.NEMSIS.org
Goals and Objectives
Standardize Definitions
Electronic EMS Data
Local
State
National
Current Status
NEMSIS Dataset
Local Data Systems
State Data Systems
National EMS Database
NEMSIS Dataset
Over 400
standardized data
elements
Version 2.2.1
Version 3 revision
process underway
Becoming a part of
the National
Electronic Healthcare
Infrastructure
Also working with HL7
Local EMS Agencies
State Progress
www.NEMSIS.org
National EMS Database
Linkage
EMS
Performance
Improvement
Toolkits
34
Six Sigma meets Public Health
Detailed Report
Evaluates an EMS
specific topic
Implement
Intervention
EMS
Toolkit
Reports
Patient Care
Service Delivery
Personnel
Performance
Benchmarking with
state and similar
systems
Recommendations for
improvement
Continuous use
Identify
Intervention
Analyzed
And
Trend
Results
35
The Perception
Its NOT:
Judgmental
Negative
Degrading
Difficult
It IS:
Easy
Useful
Helpful
Educational
Enabling
Positive
Worthwhile
Does the Toolkit Concept
Work?
Easy of Use
Statistics
Visual Graphics
Six Sigma
Standards Based
Great Support
BENCHMARKING
PEER PRESSURE
FUNDING
EMS
Acute Cardiac
(STEMI)
Care
Toolkit
39
EMS Acute Cardiac Care Toolkit
EMS Acute Cardiac Care Overview
Data Quality
County CV Disease/Patient Statistics
EMS System Capability
EMS System Performance
EMS Personnel Performance
EMS Patient Outcomes
EMS Education and Community Outreach
40
Overview
41
Destination Overview
42
Patient Demographics
43
Clinical Demographics
44
Decision Demographics
45
EMS System Capabilities
46
EMS System Performance
47
Performance
48
Outcomes
Number needed to Treat = 15
49
Outcomes
50
Community Education/Prevention
51
EMS
Acute Stroke
Care
Toolkit
52
EMS Stroke Care Overview
53
County Statistics
54
Destination Decisions
55
System Capabilities
56
Emergency Medical Dispatch
57
Patient Demographics
58
Symptom Duration/Onset
59
EMS Response Times
60
Personnel Performance
61
Patient Outcomes
For every 12 patients who are treated optimally by EMS, one
bad outcome will be avoided.
62
Community Outreach
63
How Do you Build A
System?
Systems
Require
Standards
EMS Protocols
65
Systems Require Plans
66
Systems Require Data
Systems Require
Cooperation:
It’s easy to get good
players. Getting them to
play together, that’s the
hard part.
Casey Stengel
68
Systems are Teams
Relationships
Trust
Communication
Before
During
After
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Project Contacts
Cindy Raisor
[email protected]
919-923-1529
Greg Mears
[email protected]
919-843-0201
www.EMSPIC.org