EMS World

JUN 2015

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Driving fast is not a key indicator of quality. — Brian LaCroix Greater emphasis on developing evidence- based measures of clinical quality is required. — Steve Knight, PhD Brian LaCroix, President, Allina Health EMS N o. But ignore them at your peril. If EMS is the practice of medicine, measuring the value of a system based on how fast you drive seems archaic and overly simplistic. However, it wasn't all that long ago when all most ambulance agencies had to offer was a quick response. Prior to the 1960s, most well-intended "ambulance drivers" had two skills: comfort around chaos and driving fast. This rapid-response model was rooted in the experience of our of police and fire colleagues. But the majority of EMS calls are not related to time-sensitive problems. There are certain calls when response time is important, but that list is a small one, and it's shrinking over time (think how the proliferation of AEDs has shifted the importance of getting an ALS rig on scene). I concede there is also a huge issue of perception. In an emergency there is often a high degree of anxiety, and the sooner someone shows up to help, the sooner that anxiety might be relieved. But speed is dangerous. It is well documented that the higher the collision speed, the more serious the consequences in terms of injury and material dam- age. Most studies demonstrate that the time saved driving with lights and siren is modest at best. So if we decide to drive fast to save time, we ought to be sure we need to perform some sort of lifesaving intervention that is time-sensitive. Otherwise it does not make sense. I opened these comments about response times by saying "Ignore them at your peril." This is an acknowl- edgement that even though there are plenty of reasons to slow down, responses times are still the common currency by which the general public judges quality in EMS. For now we can't ignore that. But it's incumbent on EMS leaders to continue to educate the public that EMS is indeed the practice of medicine, and driving fast is not a key indicator of quality. Steve Knight, PhD, Senior Associate, Fitch & Associates R esponse time has historically been used as a sur- rogate measure for system effectiveness. The assumption was that faster is better: The quicker the system responded, the higher the quality of clinical outcomes. Recent evidence-based research has allowed us to better understand the relationship between clinical outcomes and response times. This current research has suggested that our response times have little impact on clinical outcomes outside a small subset of call types. From this perspective, response time is not the best measure of system per- formance, and greater emphasis on developing evi- dence-based measures of clinical quality is required. However, establishing a system's response-time performance is still a good method of articulating service levels to the community and stakeholders and for holding the system accountable for performance. I suggest this should continue until such time that we have a robust set of evidence-based clinical mea- sures that are readily available and easily accessible. Through this lens, the fact that the desired service level is established and reported, and the system is held accountable, may have greater value than the response-time measure itself. Bruce Moeller, PhD, Assistant County Administrator, Pinellas County, Fla. You must look at this from two perspectives: Does a better response time provide greater benefit to the patient? And can we "measure" it with a degree of accuracy and consistency? Surprisingly, the answer is: not really. The literature shows that response time has a positive impact on patient outcome in only a small number of cases. And therein lies the problem: We expend significant energy and resources to address a relatively small number of incidents. It is understood that if your family member is in distress, you want an almost-instant response from EMS. But is this the best use of limited public resources? What should the response-time criteria be? Historically EMS response-time criteria were developed for cardiac arrests—about 1% of cases. And in cases of trauma, many agencies struggle to get patients off the scene quickly and to definitive care, thereby mitigating the impact of a rapid response time. a Performance Indicator? Time is easy to measure— response times are not. — Bruce Moeller, PhD EMSWORLD.com | JUNE 2015 47

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