Management Insights

Best practices in EMS management are highlighted at the 2008 Pinnacle EMS Leadership and Management Conference.

     New leaders—and those wishing to become or remain more effective—largely have to figure things out as they go, drawing liberal helpings of wisdom and guidance from those around them who have traveled similar roads.

     There are, however, a growing number of resources dedicated to assisting them. Among these is the annual Pinnacle EMS Leadership and Management Conference, presented each year by Fitch & Associates. The 2008 show featured a variety of seminars and presentations over five days in San Diego. Three of these offerings—looking at novel ways to reduce response times, obstacles to making improvements in response times and quality, and technologies that will impact the future of healthcare delivery—receive follow-up treatments here, in hopes that their insights can benefit a wider audience. Next year's Pinnacle show will be August 3–7 in St. Petersburg, FL. For more, see

A Few Seconds Off the Top: Dispatch vs. Response Time

     Many EMS providers work in systems that strive to get to calls in under nine minutes. The 8:59 response time standard, while not universal in EMS, is widely employed in urban systems and backed with the authority of NFPA standard 1710, which requires eight-minute ALS response to 90% of incidents. (The additional 59 seconds represents time for call processing.)

     The first problem with that, and with most response-time matters, is that not everyone measures things the same way. Do you start your clock from 9-1-1 pickup, from wheels rolling, or from some point in between? The NFPA excludes call-processing time from its standard, so the second problem is that if you're including it—i.e., starting the clock from call pickup—8:59 really may be leaving you just 4½ minutes of actual travel time. The rest, work done by veteran EMS author/consultant Jay Fitch illustrated, can be consumed by the call-taking and dispatch process.

     Each component of this process eats time virtually invisibly. It takes time for a PSAP to answer a call and transfer it to EMS, Fitch noted. An EMS answering point must pick up the call and gather pertinent facts. The call must be transferred to a dispatcher, along with location information, then assigned to a crew. Finally, responding personnel have to get on the road.

     Looking at this sequence, the question of how to reduce response times becomes much more interesting. Your best opportunities for time savings may, in fact, come during the dispatch process.

     "I'd say it's the single most controllable time element you have in your system," says Guillermo Fuentes, a consultant with Fitch & Associates and veteran of EMS systems in Montreal and Niagara Falls, Ontario. "Dispatch centers have evolved over time. Originally people had a notion that a call would come in and an ambulance would go out. Now things have evolved, and we want more from our dispatch centers. These new requirements are where you start seeing real lost time."

     Correspondingly, though, the industry is also beginning to see some fresh approaches for trimming those component intervals. One, being utilized in places like Niagara Falls, Ontario, and Pinellas County, Fla., involves separating dispatching by task instead of by zone.

     For these SSM systems, it works like this: One dispatcher essentially handles only deployment—having units positioned, based on past volumes, where they're likely to be needed. A second independently dispatches crews to calls, and a third manages destination decisions.

     Niagara's system is set up, as calls are triaged, to automatically identify the crew most likely to be dispatched to each and put them on alert. Once the initial call-taker forwards a call to the first, primary dispatcher, that dispatcher can either formally assign that preselected unit or override the computer's choice and send another.

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