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ing the orders to be delivered by midweek (based on knowledge of delivery lag times). After the supplies are received, a midweek order is also placed. High-Performance Logistics Using a sealed-bin speed-loading system eliminates ambulances being over- or understocked and allows for consistency on each ambulance. Sealed bins are loaded by logistics staff by commodity or treatment (identified by logistics and vehicle-stocking standard operating procedures). Stores are heat-sealed into packs and placed on every ambulance in the same position, providing a uniformity that makes spot-checking easy. From an accountability perspective, as stock is taken from the storage area and sealed into bins, it is clas- sified as used and the par level adjusted, which in turn cues reorder. For the binning system to be successful, there has to be a level of trust between logistics and field personnel. Field personnel need to be confident that when they open their bins, everything that is supposed to be there is in fact there. The binning system is most successful when staff are dedicated to stocking the bins. The sealed-bin system allows for the logistics department to successfully manage just-in-time stock control measures. Personnel dedicated to binning have the greatest knowledge about how fast supplies are used. Their knowledge of how quickly supplies move allows for accurate orders to be placed when in a nonautomated stock control system. Leveraging External Relationships It is important for EMS agencies to have strong working relationships with their local hospitals. Ask if it's possible to rotate equipment through and/or have a one-for-one stock exchange. For example, if a nonrebreather, ECG pads and IV lock set are used on a patient, could those supplies be replaced on patient handover? Sign an agreement so both parties understand what is expected. There may also be a requirement to have a one-for-one stock exchange with first response agencies. If they use a nonrebreather, the transporting agency will give them a nonrebreather because it can then be replaced at the hospital. This allows the first response agency to maintain its bag and readiness. Logistics staff serve a crucial role in ensuring smooth opera- tions. RAA logistics staff not only clean and stock ambulances so they are ready for field crews, they also visit area hospitals and pick up equipment left by field crews after patent handovers. This equipment is brought back to logistics and cleaned prior to being placed back in service. This helps improve hospital turnaround times—crews aren't tied up cleaning equipment. Each ambulance is deep-cleaned monthly. All bins are removed from the ambulance and replaced with fresh ones. Cabinets are emptied and wiped down. Floors are scrubbed with a heavy-duty cleaner. Logistics staff can also be used for lifting assistance, which avoids the need to take another ambulance or first response fire apparatus out of service. Stores equal cash on the shelf. A just-in-time supply system keeps stock moving at the appropriate rate of both affordability and consumption. EMSWORLD.com | OCTOBER 2015 27 For More Information Circle 23 on Reader Service Card ABOUT THE AUTHORS Elizabeth Papelino, NRP, is the logistics and production manager for the Richmond Ambulance Authority. She holds a Master of Science in Health Sciences degree concentrating on Emergency Services Management from the George Washington University in Washington, DC, and a Bachelor of Applied Studies concentrating on Emergency Services Management from the University of Richmond. She has more than 12 years of public safety experience. Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the U.S. in 2008 to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served for 20 years in prehospital leadership and command roles. A JUST-IN-TIME SUPPLY SYSTEM KEEPS STOCK MOVING AT THE APPROPRIATE RATE OF BOTH AFFORDABILITY & CONSUMPTION.