Friday, September 10, 2010

Ambulance Response Times

Well, the Special Committee on Emergency Services turned out to be quite the little show on Thursday. It was going along pretty quietly--councilpersons Sharp, Curls, Ford and Riley in attendance along with Fire Chief Smokey Dyer and others--until Ed Ford had some things to add.

Ford represents the area of KC north of the Missouri River, where there have been some concerns about response times for ambulances. It seems that only 72% of the time is an ambulance making it onto the scene of an emergency call within 9 minutes. Mr. Ford had some issues for Chief Dyer.

The two of them went at it pretty strongly for a good period of time. Mr. Ford pressing the issue, and Chief Dyer denying that it was a real problem.

It was pretty plain by the end of the morning that the chief does not see this as a problem to solve. The chief goes back to three points: 1. He wants to concentrate on "patient outcomes" and not just response time as a measure of EMS effectiveness. 2. He does not see the problem being solved by using more personnel or going back to posting at non-FD sites. 3. He does see it as strictly a political issue, and feels "caught in the middle." 4. He thinks it is not worth spending more money except maybe to move a northland firehouse.

I understand where the chief is coming from in some ways, but appearing to shrug off the concerns of the Northland councilman was a very bad move for public relations. In addition, the only reason he is not hearing it about Southland response times is that John Sharp of District 6 is a champion of this dumb idea of merging MAST into the FD. And finally, response times have to be part of evaluation of performance, because in the true emergency (yes, there aren't that many of them, but each one counts for the patient!), time really does count.

Now, with regard to the numbers, I managed to obtain the figures from an assistant chief, who said, oh they are available on the website. I says, I looked and couldn't find. He took my email address and said he'd send the url. Any bets on whether or not I'll actually get an email with the web url?

Here, after the jump are photos of the actual documents. You should be able to read them after clicking on them to make them bigger.

photos of (top) Chief Smokey Dyer and (bottom) Councilman Ed Ford by The Observer

The August Response times and other reports of KCFD activity. Click on image to make big; use the back button to return here.

One month in the life of the Kansas City Fire Department.

Interesting motto.

Data for ambulance response times. ARD1 North; ARD2 Central; ARD3 East; ARD4 South

All calls in ARD1, the Northland. My lines are to make clear the 10 minute and 11 minute mark.


Anonymous said...

John Sharp always said MAST figures were fudged. While I wasn't in favor of the merger, perhaps we're getting true figures now.

The Observer said...

This indeed was brought up at the meeting. It was later brought up that the Fire Department had been able to get ahold of raw MAST data for these response times. If my recollection serves me right, the indication was that MAST was doing just a little bit better in the northland.

To me, the figures should be as pure as possible. No fudging.

Thanks for visiting and for the comment.

The Observer

Anonymous said...

I don't get this obsession over an arbitrary time. Is 9 minutes worse than 10? 10 worse than 12? We should be easily able to see if people who get an ambulance in 4 minutes do better than those getting one in 12 minutes. But to my knowledge, no study has ever found any difference.

The reason we have these times was to keep the people in charge of the system accountable. Back when EPI ran MAST, and later when MAST ran the system the city created these times to keep the managers of the system accountable. Without a response time requirement, it would be possible for a for-profit company to run the system as a bare bones outfit by understaffing it. So the city put these times in place to make sure that who ever was running the system didn't play any games.

We don't have a third party company doing it anymore, so this emphasis on response times is misguided. What we should be doing is not taking the straw man argument of response times but instead looking at things like cardiac arrest save rates. That is what matters.

If you could get an ambulance to your house in 4 minutes, but got horrible quality of care, what's the point vs having one arrive in 10 minutes to provide exceptional care.

Response times are easy to remedy. You just throw ambulances into the system. Quality of care is not easy to fix because it means hiring good people who care. If you have ever tried to hire good people, you realize how difficult this is.

Care is a better long term goal because that's what matters. Are the crews professional, delivering good care? That's the difficult part.

I really believe that Smokey is sincere in people delivering good care. I have heard from people that he really does look into citizen comments from taxpayers either good or bad.

If you want to follow the performance of the KCFD nee MAST system, get the cardiac arrest save rates from the health department and follow those over a 12 month period. That will show you what has changed, either good or bad. That metric encompasses not only ambulance response times, but the times of the first-in fire crew, the quality of care, and the ability of the whole department to work together. It is a real-world outcomes based benchmark and what we should be looking at.

The Observer said...

Anon 7:49 PM
What a good considered comment. I really like when commenters put their thinking caps on and some thought into their work.

One thing I did not mention in the post (the meeting is really best taken in via video because there was a lot packed in a short time), is that I felt Chief Dyer's passion for patient care. I do believe that he really wants to do this EMS thing right. In some ways, I found Ed Ford to be angling politically, especially in his comments to the press afterwards.

As was noted, the 9 minute response time goal is rather arbitrary, picked when EMS and prehospital care was still a pretty new venture. It was studied in conjunction with cardiac arrest specifically. So it is a bit arbitrary in its origin. I believe it is only one component in successful patient outcomes, but it is an important one. However, I could say that I don't want to spend extra money or put personnel out on the street who don't get enough practice to be good medics for a gain of 30 seconds.

Finally, I do believe in something that is important to outcomes, and was just touched on in the meeting is the work of bystanders. Every successful code blue (I'm an RN) I have ever seen has been successful due to prompt initiation of CPR at the time the victim went down. Especially with the "yuck" factor of mouth to mouth resuscitation removed, we need to train folks in the metro in compressions properly applied and the use of AEDs.

I will look into the Health Dept stats. They would make good partners with the others.

Thanks for commenting! The Observer