As call volumes rise and calls become ever-more complex, EMS and fire-rescue agencies more often work together to provide patient care. This is especially true for Sunstar Paramedics, the ambulance provider for Pinellas County, Fla.
Sunstar operates in a dual-response system with 18 fire agencies in the county. This model has been effective for providing rapid and high-quality care to the county’s nearly one million residents and 5–7 million visitors a year.
While the dual-response approach has many benefits, it can also create challenges when separate agencies work closely together. Pinellas public-safety leaders recognized one of these challenges—locating needed supplies from other responders’ bags when on scene—as the local fire departments and Sunstar worked together on calls.
Evaluating a Change
Sunstar Paramedics and each of the 18 fire agencies previously designed and stocked their own response bags. And because they often used each other’s supplies on scene, finding necessary materials could sometimes hinder the fastest possible care.
For example, response bags could be different colors for different organizations. So a red bag could be for trauma for one fire department and for airways for Sunstar Paramedics. This forced crews to interrupt care to ask where things were in other agencies’ bags.
After recognizing it as a challenge, the Pinellas County EMS and Fire Administration began to evaluate the possibility of creating uniform response bags for use by all first responders in the system. But this systemwide change could not be implemented overnight.
Leaders began to hold discussions around the benefits and downsides of uniform bags through surveying county paramedics and EMTs. Their consensus was that not only would uniform bags save time, they would also reduce the possibility of mistakes.
As more agencies weighed in, the benefits added up, and the county decided to move forward with the process of creating uniform bags. When it did, previous design flaws were taken into account.
Designing the New Bags
The county started the process of designing new response bags with an original set of gear from the manufacturer, StatPacks. Then it customized the bags with input from Sunstar and each of the fire agencies.
The county is mandated to have certain supplies on ambulances to comply with state regulations, but there was room to improve in more ways than just the supplies in the bag.
An important adjustment was improving the bags’ ergonomics. The new bags were designed to be carried on the crew member’s back, shoulder, or side. They were made to be agile so as to not hinder responders on scene.
Leaders decided on three new color-coded response bags: the airway bag was green, the trauma bag was red, and the medical bag was blue. The bright colors are not typical in EMS, but they are highly visible when walking into a call and help crews rapidly identify the bags.
Determining the location of supplies within the bags was a collaborative decision too. The planning process started with the required list of items, then teams from Sunstar and Pinellas County evaluated supplies in the current bags. In total, 120–150 individual items and supplies were placed in each response bag.
The teams worked together to determine the best bag placement for each item. They wanted to design the bags based on call levels. For example, items used for low-acuity calls or used more frequently were placed in the outside pockets. For high-acuity patient needs, crews would delve into the center compartments for more critical items and medications.
For those more critical and expensive items, they also evaluated how constrained materials would be, if they would be hard to reach on a call, and where items would be most protected. With the previous response bags, some items were often damaged because of their placement.
After all the items were placed, the county brought in representatives from the fire agencies and Sunstar Paramedics to test the layout for functionality and recommend adjustments.
Implementing the New Bags
Once the response bags were fully designed and approved, the agencies received demo units. Employees were trained on the new setup over a month’s time through online continuing medical education courses with the Pinellas County medical director.
Crews were also provided with cheat sheets, pictorials, and other training materials to show where items were located within the bags, how to use the bags, and how to restock them. In addition to the initial training, Sunstar Paramedics field training officers demonstrated the new bags at all hubs and locations.
While training took place, Pinellas County and Sunstar Paramedics began to work on implementation and quality assurance. Approximately 1,200 bags needed to be packed with supplies and checked for quality before delivery to their agencies.
Around 10–15 Sunstar employees—mainly vehicle supply technicians, EMTs, and paramedics—and Pinellas County employees sorted and packed the bags over a week. They created an assembly line-style setup with defined roles for each person and inventory lists for each bag.
Before items were packed a supervision team inspected all supplies and discarded damaged materials, including new supplies that were not shipped correctly or tubing crushed during shipment. A Sunstar Paramedics supervisor and Pinellas County EMS representative conducted final visual inspections of each response bag to make sure they met standards.
After the bags were filled and finalized, they had to be delivered to all 18 fire agencies—which all needed to receive them on the same day. Sunstar Paramedics worked with the county to plan the allotment and routing and organized trucks and delivery times for each agency.
All the agencies received the response bags and placed them in ambulances and on fire apparatus. The response from all the agencies was overwhelmingly positive.
While the ambulance crews were excited to use the new response bags, they were also encouraged to provide feedback on adding items. Sunstar Paramedics and the fire agencies collected feedback on potential changes and evaluated which recommendations to provide to Pinellas County for consideration, as no changes can be made without the county’s approval.
Since the response bags are standardized, any change is a full system change. When a change is made, notification is added to the online CME. The Pinellas County medical director also sends a notice to employees that they have to review the one-page document to learn about the change, and the employee is required to submit an acknowledgement regarding the change.
Today the new response bags are highly praised and utilized by the entire EMS system in Pinellas County. They are also used at training sites, countywide coordinated CMEs, and education sites, which helps further develop the relationships between all agencies in the EMS system.
Pinellas County and its residents benefit from this close-knit EMS system, with oversight and input from the Pinellas County EMS and Fire Administration. Because of this oversight, Pinellas County is continuously looking for ways to advance the system. The response bags have been one of many updates to improve the system and overall patient care.
John Peterson, MS, MBA, EMT-P, is chief operating officer for Sunstar Paramedics in Pinellas County, Fla., where he oversees the organization’s daily operations and 725 local employees, as well as president of the Florida Ambulance Association.