Standing Orders by Smartphone
Today around 35% of Americans own smartphones, and that number increases by around 5% a year. With the youthful workforce and expanding purview of EMS, it only makes sense to harness the devices for our practice. The Tucson Fire Department has thus devised an app to distribute administrative orders and otherwise facilitate the care of its personnel.
The app is quick, intuitive and easy to navigate, Tucson Fire Department Medical Director Terry Valenzuela, MD, MPH, told this year’s EMS State of the Sciences Conference. It offers guidance on patient assessment, standard ALS and BLS care, triage and transport, special populations, refusals, treat-and-release, field terminations and more.
For an EMS user, information has to be quick and organized. Accordingly, the Tucson app, which works on all mobile devices, starts simple, with key concepts and a search box that filters as you type. Dropdowns and links narrow general content to specific, with scrollable details and color-coded guidance (blue for BLS assessment thresholds, red for ALS). Department leaders can change and update content in real time as protocols and practice evolve.
Other key functions of the app include hyperlinks to important references and one-button calling. The benefits have included simpler processes, better consistency and less time on the radio. Medical control can also review aggregate usage of the app and look for trends that can be addressed in CE.
Mining Data From Hospitals
If your system wants to look at patient outcome data, you have a leg up in Texas, where state law explicitly lets hospitals share that for EMS quality purposes. Ft. Worth’s MedStar is making the most of it, aggressively mining data from various facilities in its community so as to better understand and care for its patients.
Uses for the data include quality improvement, staffing, supplying and examining hospital issues like nursing home transfers, medical director Jeff Beeson, DO, told the EMS State of the Sciences Conference in February. With the care of key life-critical patients like those with STEMIs, it’s allowed discrete consideration of crucial interval times—e.g., call to dispatch, on-scene to EKG, recognition to cath lab activation—essential to reducing overall door-to-balloon times. MedStar is getting similar feedback for victims of stroke, sepsis and trauma.
All the data-busting helps the hospitals too—for instance, leading to earlier discharges of nursing home patients to prevent after-hours bouncebacks.
More Equitable Workload
Almost everywhere, call volumes are rising and providers are ever more taxed. Worried that some crews were bearing more brunt of this than others, EMS leaders in Cincinnati wanted to distribute things more equitably.
The Cincinnati Fire Department answers 54,000 calls a year with 12 ambulances. Previously, these were tiered into eight BLS rigs, each staffed by two EMTs, and four ALS rescues, all staffed with two paramedics. Measuring their workload wasn’t a precise undertaking, but leaders ultimately concluded the BLS rigs, representing 67% of their transport resources, were responding to 80% of the EMS call volume. The ALS units, 33% of department resources, were answering 20%. The CFD subsequently reconfigured its EMS into a single tier, with 12 EMT/paramedic-staffed ambulances.
To gauge the impact of that move, leaders vetted call data for 45 days following the change through a control chart process. They found only single upper and lower outliers: All city medic units were running between 8.2–12.2 calls a day except Medic 18, which was running just 5.4, and Medic 12, which was running 13.9.
The solution to that was to relocate and rechristen Medic 18, which left its airport location and became Medic 21in the city’s Camp Washington area. Medic 21 subsequently averaged 9.3 runs a day, and helped cut Medic 12’s rate to 11.6. Systemwide, in the period studied after the change, no unit averaged more than 11.6 calls a day.