Where would I find national statistics for response times on medical calls? I'm interested in comparing data for similar jurisdictions as mine showing times from when the call was received at the call center to the time the apparatus/ambulance arrives at the scene.

Is there such data collected nationally?

Thank you in advance.

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Steven,

As far as I know, the answer to your question is no. This data is not collected nationally nor is there a government mandate or national clearinghouse for it. Most jurisdictions or communities look at the AHA and NFPA 1710, Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments, when establishing response time targets. They also look at what they're able and willing to pay for in EMS response. The NFPA standard puts first responders with AEDs on the scene of medical incidents within 4 minutes 90% of the time. ALS response is within 8 minutes for 90% of the incidents.

Hope this helps.

Kathy
This data is collected in the National EMS Information System (NEMSIS), submitted by participating agencies to their states, who then submit to NEMSIS. Not all agencies and not all states participate.

Here is the link to the NEMSIS data center: http://www.nemsis.org/dataCenter/index.html

But beware - there is NO "national standard" for EMS response. The NFPA has published a standard, but it is absolutely without medical validity. You hear lots of talk about "the 8:59 national standard" but that's a lot of wishful thinking. At best, it's a common contracting standard, but again, picked out of thin air.
Hey Skip,

Thanks for the link! EMS response is in need of resuscitation if you look at that 90th fractile. Too bad everyone isn't mandated to participate.

Kathy
Skip, how do you define "medical validity"? Are you referring to proven impact on morbidity and mortality or something else?
Chief -

There's plenty of evidence that certain emergencies are time sensitive, but 9 minutes (lets not delude ourselves into thinking of 8:59 as 8 minutes) was picked from thin air. That's not even getting into the discussion of how response times are measured (i.e., wheels up to wheels down, call received to wheels down, call received to patient's side, etc).

I would argue that there is an emerging consensus about how we report our response times, if not a consensus about what those times should be. In most communities around the country, cardiac arrest patients are pretty much written off, if not by conscious choice then by simple neglect.

Tom
Acad Emerg Med. 2005 Jul;12(7):594-600.

Paramedic response time: does it affect patient survival?

Pons PT, Haukoos JS, Bludworth W, Cribley T, Pons KA, Markovchick VJ.

Click here:

http://www.ncbi.nlm.nih.gov/pubmed/15995089

The characters in the abstract are being interpreted as html so it's not transferring correctly.
Hi Tom and thank you for the link too.

Kathy
Tom,

My question about the definition wasn't just oriented at morbidity and mortality.
EMS response times (and fire and police response times, for that matter) should be oriented toward quick response times to life-threatening emergencies, particularly ones with ABC compromise.

There are other factors at work in response times, though. How about early pain relief for fractures and burns? How about early intervention in active, uncomplicated labor? How about rehab set-up for working fires? And...how about communty expectations and external customer service standards? Relief of distress from an asthma attack? Etc.?

EMS is a lot more than responding to life-threatening emergencies.

I have no problem with defining response times as from when the 911 phone rings until providers make patient contact. Remind me at work, and I'll show you the 2000 EMS Task Force study from Greenville County where that exact definition was recommended. (BTW, I was a member of that Task Force, and I was one of the members that pushed that definition.)

I agree that there isn't a lot of scientific data to support a national EMS response time standard.
That standard will vary a lot depending upon demographics, geography, system funding, and system design.

And...8:59 isn't 8 minutes, it's a lame attempt to redefine the hash marks on the clock.

Ben
I used "medical validity" to include both the proven impact on morbidity, mortality, or patient outcome, as well as even any logical nexus. We've known for a long time that cardiac arrest survival possibility decreases 10%/minute, so why would any rational human pick a "standard" that would result in 80-90% mortality?

Aside from our sometimes illogical efforts at being driven by science, I submit (in the absence of any more medical evidence than Dr. Pons' one narrow paper) that the determination of acceptable response performance should be driven by the wishes of those that pay the bill (the taxpayers). Rather than whip ourselves about finding medical evidence, how about just asking the citizens how long they are willing to wait, and at what cost?

We should, with a reasonable degree of probability and modern simulation tools, be able to demonstrate how many unit hours of ambulance service are required to achieve a particular response goal. It would be relatively easy (using, for example SIREN PREDICT from the Optima Corporation) to provide a sliding scale - with X unit hours you get Y response performance, with X+2 you get Y-n, etc. Then, knowing the cost per unit hour, an "expert" could say to the community "for $1 per 100,000 assessed property value, you can get 7 minutes 90% of the time - or for $1.25 per 100,000 you can get 5 minutes 90% of the time." You, citizens, choose what you want!

I'd bet you'd be surprised at what they'd pick!

I'd be surprised too!
Thank you for your replies everyone. Very helpful.
Skip,

Thanks for the clarification. If we're talking about cardiac arrest survival vs. response times, are we talking arrest to BLS and AED/defib, or are we talking about full ALS?

With early CPR and early defib being so strongly correlated to reduced morbidity and mortality, is that a hint that we need to think about running a BLS first response model with four or five-minute 90% fractile first response with later-arriving ALS, or maybe even a three tiered BLS engine, ILS ambulance, ALS ambulance or chase car model?

And...morbidity and mortality aside, if I have an angulated tib-fib fracture from a fall at home, I'm hoping that I get the analgesia a little sooner than 10 minutes. I'm not sure that my neighbors are willing to pay for that, though.

Ben
Skip,

Does the model you're discussing assume that 1 call = 1 hour for UHU calculations, or is there some type of real time plug in that calculates the actual time a single unit has been on duty as the denominator with the actual time spent on calls as the numerator for the fractile calculation?

Ben

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