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2015 Pinnacle EMS Leadership Forum The Pinnacle EMS Leadership Forum is the premier event for EMS leaders from all service models, for every size of service. Sponsored by Fitch & Associates, it is now in its 10th year. Pinnacle 2015 will be held at the Omni Amelia Island Plantation Resort, near Jacksonville, FL, August 3-7, 2015. For more see pinnacle-ems.com. PERFORMANCE MEASURES Time is easy to measure—response times are not. We still have no universally accepted definition of response time that utilizes the same "start-the-clock" and "stop-the-clock" criteria. Research found EMS agencies in Florida used nine different definitions of response time. More important, these agencies had a bias to use a definition that made them look bet- ter. When a single performance metric is used so frequently and so publicly, there is motivation for some EMS managers to worry about public perception rather than focusing on patient outcomes. In Pinellas County we overcame ambiguity by using a single response-time definition, from agency dis- patch until arrival on scene, for all 19 providers in our system. And since we have all the data in a regional computer-aided dispatch (CAD) system, ensuring a first responder response time of less than 7:30 for 90% of incidents is relatively easy. Response time can be a valuable performance metric for EMS agency design. However, until we use it thoughtfully and honestly, it will continue to have limited utility. Norman Seals, Assistant Chief, Dallas Fire-Rescue As an industry we have historically touted the impor- tance of response times, and our various oversight bod- ies have been trained to expect that measure in our regular reports. We have also done a very good job of training our customers to expect us to arrive at their "emergency" within an average of six minutes. However, I believe we need to begin reeducating those groups to understand that, with the exception of cardiac arrest and a few other critical conditions, response times do not have significant impact on patient outcomes. EMS leaders and administrators need to shift our strategic planning processes away from response-time metrics to the value-based metrics that appear to be looming. Within my agency, we report annually on average response times for our EMS units. We have begun the process of educating city management and city council on the changing face of EMS and the projected impacts of healthcare reform on our EMS operations. Additionally, we are working with a consultant to develop plans for moving forward with realigning operations to meet the coming changes. Scott Matin, MBA, Vice President, Clinical, Education and Business Services, MONOC Over the last decade we have learned that this obses- sion we've had for years with response time as a mea- sure of performance is grossly inaccurate. Research has shown that with the exception of high-acuity calls such as cardiac arrest, myocardial infarction, We have done a very good job of training our customers to expect us to arrive at their "emergency" within an average of six minutes. — Norman Seals EMS should continue to build systems to ensure timely lifesaving care. — Greg Mears, MD EMS agencies need to stop designing systems around response-time goals. — Scott Matin, MBA stroke, airway obstruction and severe trauma, the majority of calls to which EMS is dispatched aren't as time-sensitive and don't show better outcomes with a more rapid response. Additionally, emphasis on response time may have unintended consequences such as more motor vehicle crashes and skill degra- dation when increasing the number of paramedics answering a finite number of calls. EMS agencies need to stop designing systems around response-time goals. While EMS systems need to meet public expectations, these expectations should be weighed against available resources and the ultimate good of the community. For EMS agencies to effectively convey the message that faster doesn't always mean better, they must open an ongoing dia- logue with their communities. Agencies need to com- municate what quality is in EMS and how it can be obtained. Programs that can lead to better outcomes include a robust first responder system utilizing cur- rent police and fire resources; public education on how to identify strokes and heart attacks and when to call 9-1-1; and community-wide education and buy-in to develop a public-access CPR and AED program. Greg Mears, MD, Medical Director, ZOLL Systems of care evaluate the outcomes of patients with time-dependent illnesses and injuries from first healthcare provider contact through definitive care. As a result, EMS is challenged to provide a timely response to a subset of patients that is small com- pared to the overall number of EMS responses. EMS should continue to build systems to quickly identify and ensure timely lifesaving care for cardiac arrest, trauma, STEMI, stroke and acute airway compro- mise. Other EMS responses can be managed using time intervals that are acceptable to the EMS system's community and customer expectations. 48 JUNE 2015 | EMSWORLD.com