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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). 12 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 18 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 23 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 69 Project Contacts Cindy Raisor [email protected] 919-923-1529 Greg Mears [email protected] 919-843-0201 www.EMSPIC.org