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PERFORMANCE BENCHMARKS these systems has fewer opportunities to manage critical patients and perform invasive skills.3 One study showed that patients who were intubated by experienced paramedics were more likely to survive than patients intubated by medics with less experience.4 Adding too many paramedics with the intent of improving response times may inadvertently harm the quality of care delivered. This is not to say response times don't matter, only that no clinical outcomes have proven to be affected by the time it takes for paramedics arrive. In the absence of evidence supporting response time goals for anything besides cardiac arrest, goals should be based on customer service outcomes instead of expected clinical ones. Our citizens allow us the privilege of serving their medical needs. Measuring their feedback is important, and customer service should be more than an agency's sales pitch. Our patients deserve to know how quickly we arrive and how their EMS system measures it. From their perspective, fractile reporting provides the most accurate picture of performance.5 It defnes expected response times, clearly states when the clock starts and stops, and states how frequently that goal is expected to be met. An example of this type of reporting for hot responses would be for frst responders to arrive within 5:59, and for a paramedic ambulance to arrive within 11:59 90% of the time, based on when the phone rings at the 9-1-1 center to when vehicles stop at the residence. Regardless of the clinical impact of response times, patients also deserve to have the closest appropriate unit sent when they call for help. This should be obvious, but it's not widely done. In a survey of the 200 most populated U.S. cities, only 55% of EMS services reported sending the closest unit.5 Why do we make the sick and injured wait longer than necessary? Reasons include dispatching based on response grids, not knowing where the closest unit to the caller's location is or that the closest unit is from another agency. Each reason is understandable, notes author Dave Williams, but they're just justifcations for practices that aren't in patients' best interests—in other words, more excuses. Response time goals must strike a balance between meeting customer expectations, maintaining adequate clinical experience for EMS practitioners, cost and providing enough time for providers to recover between calls. It is reasonable for a community to be informed about how response times are measured and to have the closest appropriate units sent to calls. Clinical Performance What happens after caregivers arrive at the patient's side? It is diffcult to measure quality of care because few evidence-based clinical performance measures exist. To date, the most comprehensive clinical performance benchmark proposal was published in 2008 by the U.S. Metropolitan Municipalities EMS Medical Directors Consortium (also known as the Eagles).1 Their paper recommends treatment bundles for cardiac arrest, ST-segment elevation myocardial infarction, diffculty breathing and seizures (Figure 1). Using a "number needed to treat" formula, it describes the beneft patients receive from that bundle. It can also be used to calculate the harm incurred by patients who do not receive that treatment.1 These benchmarks are based on both the quality of supporting scientifc literature and the ease of measuring their delivery. Responding to EMS 800.558.6270 Have you seen us lately? We're proud to have served the EMS industry for over 40 years and we continuously strive to make ordering supplies a simple process. New website, new catalog, new warehouse and new product offerings, like our recertifed line of AEDs, are just a few of the ways we can help you help yourself. buyemp.com You order. We ship (free).* It's that simple. *For terms and conditions please visit www.buyemp.com/customer-service.html For More Information Circle 29 on Reader Service Card EMSWORLD.com | JUNE 2013 35