July 17, 2012
ENCINITAS, CA—Emergency response in Pima County, AZ, improved significantly since the Northwest Fire Rescue District deployed FirstWatch Real-Time Situational Awareness System, which allows for close monitoring of each step in 9-1-1 call processing and fire/EMS response.
A few years ago, Northwest Fire Rescue District, which serves a population of about 110,000 in Marana, AZ, and in unincorporated areas outside of Tucson, was seeking reaccreditation from the Center for Public Safety Excellence. To be accredited, fire and EMS agencies have to meet rigorous standards in multiple areas of performance.
The fire rescue district faced several hurdles: 9-1-1 call processing times were not meeting national standards. In addition, fire district officials saw room for improvement in firefighter response, including how fast they were getting geared up and leaving the station and how quickly they were initiating treatment on scene, especially in life and death situations such as cardiac arrest.
To address those issues, the fire district applied for and received a $50,000 Assistance to Firefighters Grant (FIRE Act) from the U.S. Department of Homeland Security to deploy FirstWatch, an Internet-based real-time data monitoring and surveillance system that could be integrated with the district’s Fire Records System. (The grant covered 80% of the cost; the district covered 20%.)
Phase one of Northwest Fire’s operations quality improvement initiative began in September 2011. According to national standards, ambulances should be dispatched within 60 seconds of a call coming in to a 9-1-1 communications center, in 90% of cases. However, the emergency dispatch center the district contracts with was meeting that standard only 17% of the time.
Using FirstWatch, Northwest Fire District officials began monitoring each call in near real-time to determine precisely how long it took to dispatch a fire truck, and acted quickly when calls took too long. The result: dispatchers are now meeting the standard more than 50% of the time, and trending upward. “We needed something that was in real-time, so we could react to trends and make decisions when it would make a difference,” says Northwest Fire Rescue District Communications Coordinator Jim Long. “FirstWatch helped us tremendously, and was also instrumental in helping us get reaccredited in January. It’s a good watchdog that shows us at any given moment exactly what's happening in the communications center and to what extent we’re making a difference in improving patient outcomes,” Long says.
Phase two of the quality improvement initiative involved using FirstWatch to closely monitor all aspects of firefighters’ performance. That included measuring how long it took them to leave the station after being dispatched to an emergency; how long it took to arrive on scene; and how long it took to get the fire truck back into service so that it was ready to answer another call, a sign of operational efficiency.
Phase three, which is ongoing, involves using FirstWatch to mine electronic patient care reports, seeking out areas for improvement. One such measurement is how long it takes firefighters to use a 12-lead EKG, which diagnoses STEMI, the most serious type of heart attack. Diagnosing STEMI before the patient arrives at the hospital enables hospital staff to be ready to deliver prompt treatment upon arrival. Other measurements include whether a bystander started CPR in cases of cardiac arrest, whether an automated external defibrillator (AED) was used, and whether firefighters started hypothermia in the field, believed to be key contributors to whether or not patients survive.