TDNet Discover

Traditional emergency medical response systems consist of centralized ambulance stations in which several first responder teams are housed under one roof. Even though they are stationed together in the same building, these teams take turns responding to dispatched emergency calls. The strength of this traditional system of emergency response is that the “rotation” helps prevent one team from responding to a higher call volume than other teams, in theory preventing excess exhaustion during a shift. Sharing the same building can also be perceived as a strength, as it allows increased employee interaction and a centralized location for team-building exercises, training, and staff meetings. However, this traditional system has also been criticized for decreased emergency response efficiency, as a county is typically spread over a large geographical area, and responding from only a few centralized stations often creates longer response times. System Status Management (SSM) aims to combat the weaknesses of traditional EMS response systems. In an SSM model, ambulance units do not have traditional stations;instead, individual ambulances are “stationed” strategically throughout the area (typically spread evenly across the coverage area) to maximize response efficiency. Crews in this system typically “station” in parking lots, where they await dispatch orders. Strengths of this system are potentially increased efficiency through decreased response times, theoretically resulting in improved patient outcomes. Weaknesses of SSM are lack of ambulance stations, resulting in increased employee fatigue (especially if employees are on a typical 24 hour on / 48 hour off schedule), and increased vehicular wear and tear. Objective The purpose of this study is to determine whether System Status Management will benefit rural Emergency Medical Services as it does metropolitan areas. Specific factors to be investigated include ambulance response times, cost-benefit ratios (fuel consumption, effects on payroll, etc.), employee turnover rate, and improvement in the return of spontaneous circulation rates (ROSC) in cardiac arrest patients. The research hypothesis for this scenario is that, unlike in urban environments, traditional SSM practices will increase response times, negatively affect cost- benefit ratios through excessive fuel costs, increase employee turnover rate, and decrease return of spontaneous circulation (ROSC) rates. The objective is to compare data obtained from both urban EMS companies and individual rural county EMS companies to discern whether SSM is a feasible, practical option for improving rural county EMS metrics such as response times, patient mortality, and ROSC rates. Methods Data was received from Hamblen County in Tennessee and compared with data obtained from independent research studies out of Shiraz, Iran, and Singapore, Singapore. The data from these independent studies was then further compared with the data from Hamblen County to determine if a rural county can successfully implement SSM as in a large metropolitan area. Results Unfortunately, insufficient data was collected to compare SSM versus Traditional EMS systems, despite aggressive and persistent efforts to survey public rural and urban EMS agencies. Out of the 12 counties surveyed, only one county (Hamblen County) offered useable data. Conclusion Our investigation yielded insufficient data to accurately compare SSM and traditional EMS systems in rural and urban environments. In the setting of Hamblen County and MHEMS, our concern that SSM would be detrimental to their EMS service was reflected in the comments of Deputy Director James Purkey. In a rural setting with such a low population density, it does not make financial or pragmatic sense to implement SSM with the resource scarcity with which many rural EMS companies struggle. SSM does not currently appear to be the correct path to take in rural areas to increase efficiency. However, other options such as increased funding/resources or ‘GPS dispatching’ may increase rural EMS operational efficiency in the future, and therefore improve patient outcomes.