Trend and Analysis
This measure has a slight decline over the past several years. The agency has shifted emphasis to advanced life support performance as these incidents are more likely to be clinically time sensitive. Some gains in ALS performance have come at the expense of BLS performance.
The balancing factors for response time performance and reliability are (a) efficient production of resources, (b) effective deployment of those resources and (c) managing demand for services. The agency improved production through an improved staffing model (introduced February 2018) to ensure that at least two units are available in each station staffed by career personnel. This doubles the probability that a request for service can be answered by the closest station and resulted in a 6% cumulative improvement in the communities that benefitted from additional staffing. The agency intends to maintain this staffing model as the effective standard staffing as it demonstrates the greatest return on investment.
Lost or wasted production capacity is a component in this metric. The greatest loss of unit hours produced lies in the amount of time an EMS unit spends transferring a patient to a healthcare facility. This dynamic impacts basic life support units more than advanced life support as the clinical needs of the patients are less time sensitive. The agency established a benchmark of 30 minutes to execute a safe and effective handoff of the patient to our clinical partners in the facility, though healthcare facilities do not include the quick release of EMS units as part of their service mandates. To manage this concern, the agency monitors these times across the region to ensure transportation decision making by the EMS providers in the field is adequately informed and balances the clinical needs of the patient and the needs of the system to quickly return units to service. Currently, the hospital cycle time for the previous year is an average of 57 minutes. With a cycle time benchmark at 30 minutes to allow for a proper patient handoff, the system is “losing” 27 minutes per transport. The agency effectively loses 2.7 units per year to cycle time delays at healthcare facilities.