EMS Response Time Standards

After receiving an e-mail asking whether there is a federal law requiring an agency to be on scene within so many minutes, I realized there is some confusion about response time standards.

First, there is no federal law regarding response times, and, after doing thorough research, I cannot find any state laws that pertain to response times. There are some contractual agreements between EMS providers and political subdivisions that stipulate response times, and some political subdivisions enter and ratify these contractual agreements into ordinances. But most of the contractual agreements or ordinances are directed toward private EMS providers. Most of these communities have established standards of eight minutes or less 90% of the time for ALS service. Some municipalities, especially in California, have even moved response time standards to 12 or 15 minutes for private EMS providers 90% of the time, but these are usually coordinated with ALS first response.

What really drives response time philosophy is consensus standards. Consensus standards are developed by specific industries to set forth widely accepted benchmarks for things such as response times. This is an attempt by the EMS industry to self-regulate by establishing minimal operating performance or safety standards.

Liability Issues

In most cases, compliance with consensus standards is voluntary. Regardless of whether compliance is voluntary or mandatory, EMS agencies must consider the impact of "voluntary" standards on private litigation. In some states, a department may be liable for negligent performance. Even in states that protect EMS personnel under an immunity statute, most state laws do not protect personnel or their agencies for grossly negligent acts. Essentially, gross negligence involves the violation of a standard with willful intent that results in injury or loss to some individual or organization. In establishing the standard for EMS agencies, the courts frequently look to the "voluntary" standards issued by various organizations. Although "voluntary" in name, these standards can become, in effect, the legally enforceable standard of care or operation for EMS agencies and their personnel. Accordingly, EMS agencies should pay close attention to applicable standards.

Cardiac Care

One standard that affects EMS deals with cardiac arrest. This is one of the most relevant standards affecting response times.

Most adults who can be saved from cardiac arrest are in ventricular fibrillation (VF) or pulseless ventricular tachycardia. Electrical defibrillation with ALS intervention provides the single most important therapy for the treatment of these patients. Resuscitation science, therefore, places great emphasis on early defibrillation and ALS intervention. The greatest chances of survival result when the interval between the start of VF and the delivery of defibrillation is as brief as possible. The Advanced Life Support Working Group of the International Liaison Committee on Resuscitation (ILCOR) for the American Heart Association recommends that resuscitation personnel be authorized, trained, equipped and directed to operate a defibrillator and provide ALS intervention if their professional responsibilities require them to respond to persons in cardiac arrest.

The American Heart Association's scientific position is that brain death and permanent death start to occur in 4–6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversible if treated within a few minutes with an electric shock and ALS intervention to restore a normal heartbeat. Verifying this standard are studies showing that a victim's chances of survival are reduced by 7%–10% with every minute that passes without defibrillation and advanced life support intervention. Few attempts at resuscitation succeed after 10 minutes.

NFPA Standard

One of the key EMS benchmarks for municipal and career fire departments is the National Fire Protection Association's (NFPA) 1710 (Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments).

The NFPA 1710 standard is based upon a combination of accepted practices and more than 30 years of study, research, testing and validation. Members of the 1710 committee that developed the standard include representatives from various fire agencies and the International Association of City/County Managers (ICMA).

On all EMS calls, the NFPA 1710 standard establishes a turnout time of one minute, and four minutes or less for the arrival of a unit with first responder or higher level capability at an emergency medical incident. This objective should be met 90% of the time.

If a fire department provides ALS services, the standard recommends arrival of an ALS company within an eight-minute response time to 90% of incidents. This does not preclude the four-minute initial response.

The standard recommends that a "fire department's emergency medical response capability includes personnel, equipment, and resources to deploy at the first responder level with automated external defibrillator (AED) or higher treatment level." The standard also recommends that all firefighters who respond to medical emergencies be trained at a minimum to the first responder/AED level.

Another requirement in the standard is that all personnel dispatched to an ALS emergency should include a minimum of two people trained at the EMT-P level and two people trained at the EMT level-all arriving within the established times. Paramedics can come from different agencies.

Fire departments can have established automatic mutual aid or mutual aid agreements to meet many of the requirements of the standard.

It is clear response time standards are a vital part of the mission of any EMS agency. Key to the mission are the level of service provided and the time required to deliver that service.

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