EMS Performance Improvement Toolkits

The EMS Performance Improvement Centerwww.EMSPIC.org

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Access 911

First Responder

EMS Response

Dispatch

Emergency Department

Specialty Care Transport

Specialty Center

Rehabilitation

Prevention/ Education

Event/Recognition

The EMS Stroke Care ToolkitCenters for Disease Control and Prevention (CDC)$250,000 for one year

The EMS Toolkit ProjectThe Duke EndowmentPhase I

$300,000 annually 2004-2007

Phase II

What is an EMS Toolkit?Detailed ReportEvaluates an EMS specific topic

Patient CareService DeliveryPersonnel Performance

Benchmarking with state and similar systemsRecommendations for improvementContinuous use

Six Sigma meets Public Health

EMSSystem

ResponseToolkitReports

IdentifyIntervention

ImplementIntervention

AnalyzedAnd

TrendResults

The SimplicityWeb-BasedNHTSA Version 2.2.1 DatasetPossibly Additional Data ElementsNo Prior Performance Improvement Knowledge Required“TurboTax” ImplementationVisual Reporting MethodologiesMassive Technical Assistance

The PerceptionIts NOT:

JudgmentalNegativeDegradingDifficult

It IS:EasyUsefulHelpfulEducationalEnablingPositiveWorthwhile

What is an Intervention

Customized direction provided within each EMS Toolkit based on an individual EMS System’s results.Approximately 25 to 30 interventions or recommendations per EMS ToolkitEach EMS System is encouraged to choose 1 or 2 for implementation within their SystemRinse and Repeat

The Toolkits

Year 1Local EMS System ResponseState EMS System Design and Performance

Year 2Cardiac Arrest CareTrauma Care

Year 3 Pediatric CareAcute Cardiac CareStroke Care (CDC funded)

A Match Made in Heaven

Money from Duke EndowmentEMS Toolkits from OEMSEMS Systems Use EMS ToolkitsDuke Endowment money to EMS Systems to address EMS Toolkit identified issues.

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EMS Toolkit Phase II Project

Funded by The Duke Endowment$1,600,000 to EMS Systems based on the EMS System Response ToolkitContinued funding to EMSPIC and OEMSRinse and repeat (7 to 10 years)

Request for Application to fund South Carolina

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EMS System Response Time

Toolkit

EMS System Response Toolkit

Data Completion RateEMS Response TimesEMS Unit AvailabilityEMS Transport TimeEMS Total Call TimeEMS Call Center TimeMiscellaneous Factors

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Record Selection

EMSResponse

Times

Intervention 10Calls per Day of Week and Time of Day

The purpose of this intervention is to provide instruction on how to evaluate EMS event numbers by analyzing the number of calls by the day of the week and the time of the day. Information obtained from this analysis can be used to create improved EMS System Response plans which can improve EMS System Response Time.

Each EMS Event typically requires an EMS unit to provide service delivery and care. If the number of EMS events outnumber the number of EMS vehicles which are staffed and in service at any point in time, the EMS Systems Response Time will increase.

By receiving this intervention, the EMS System Response Toolkit determined that there were at least 5 times where the number of EMS events (averaged for the day of the week and hour of the day) equaled or exceeded the number of staffed EMS units in service during that same time.

Recommended Plan of Action

Implement a plan which will increase the number of EMS units during times when the number of EMS events are likely to be greater than the number of available EMS units. This could be done by one of the following methods:

Bring in additional peak time EMS units during hours where EMS events exceed normal staffing patterns.

Change the EMS unit staffing pattern to place more EMS units in service during high volume times. For example, move an EMS unit which is normally in service during nighttime hours into service during daytime hours.

Consider changing personnel staffing hours from 24 to 12 hour shifts to allow more shifts (and EMS units) to be in service during peak hours.

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Community Demographics

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Fatal Injury Rates

EMS Systems by 90% Fractal Total EMS Response Time

EMS System Total 90% Fractal EMS Response Time(mm:ss)

Injury Fatality Rate(deaths/100,000 Pop)

Top 10 Average 14:00 62.4

Bottom 10 Average 35:12 75.0

There is a 21:12 (151%) difference between the top 10 and bottom 10 There is a 20% increase in the injury fatality rate The average EMS System Total Response Time for North Carolina is 21:40 (mm:ss).

EMS Response Toolkit

FindingsData Completion and Accuracy IssuesLong Wheels Rolling Times Unit AvailabilityLong Transport DistancesCall Center TimesFirst Responder CoverageVehicle Maintenance PlanQuality Management ProgramDemographic Trends

North Carolina EMD

AlamanceAlexander

Alleghany

Anson

Ashe

Avery

Beaufort

Bertie

Bladen

Brunswick

Buncombe

Burke

Cabarrus

Caldwell

Camden

Carteret

Caswell

CatawbaChatham

Cherokee

Chowan

Clay

Cleveland

Columbus

Craven

Cumberland

Currituck

DareDavidson

Davie

Duplin

Durham

Edgecombe

Forsyth Franklin

Gaston

Gates

Graham

Granville

Greene

Guilford

Halifax

Harnett

Haywood

Henderson

Hertford

Hoke

Hyde

Iredell

Jackson

Johnston

Jones

Lee

Lenoir

Lincoln

Mcdowell

Macon

MadisonMartin

Mecklenburg

Mitchell

Montgomery Moore

Nash

New Hanover

Northampton

Onslow

Orange

Pamlico

Pasquotank

Pender

Perquimans

Person

Pitt

Polk

Randolph

Richmond

Robeson

Rockingham

Rowan

Rutherford

Sampson

Scotland

Stanly

StokesSurry

Swain

Transylvania

Tyrrell

Union

VanceWarren

Washington

Watauga

Wayne

Wilkes

Wilson

Yadkin

YanceyWake

COUNTIES WITH EMD PROGRAMS

68 Counties have approved EMD Centers 2 Counties are pending approval

COUNTIES WITHOUT EMD PROGRAMS

PENDING APPROVAL

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EMS Acute Trauma Care

Toolkit

EMS Trauma Care ToolkitEMS System CharacteristicsData QualityCounty Injury StatisticsEMS System CapabilityEMS System PerformanceEMS Personnel PerformanceEMS Patient OutcomesEMS Injury Prevention

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Record Selection Criteria

Injury Statistics

Skills Performed

Measurement Quiz 1

Medic # Success Rate

001 50%002 50%

Attempts

10

2

Injury Prevention

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EMS Cardiac Arrest

Toolkit

EMS Cardiac Arrest ToolkitEMS Cardiac Arrest OverviewData QualityCounty CV Disease/Patient StatisticsEMS System CapabilityEMS System PerformanceEMS Personnel PerformanceEMS Patient OutcomesEMS Education and Community Outreach

Cardiac Arrest Etiology

Arrest Location Type

Utstein Template

Community Outreach

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EMS Acute Cardiac Care

(STEMI)Toolkit

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EMS Acute Cardiac Care Toolkit

EMS Acute Cardiac Care OverviewData QualityCounty CV Disease/Patient StatisticsEMS System CapabilityEMS System PerformanceEMS Personnel PerformanceEMS Patient OutcomesEMS Education and Community Outreach

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Overview

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Patient Selection

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County Statistics

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System Capabilities

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System Performance

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Personnel Performance

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Outcomes

Number needed to Treat = 15

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Community Education/Prevention

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EMS Acute Stroke Care

Toolkit

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EMS Acute Stroke Care Toolkit

EMS Acute Cardiac Care OverviewData QualityCounty CV Disease/Patient StatisticsEMS System CapabilityEMS System PerformanceEMS Personnel PerformanceEMS Patient OutcomesEMS Education and Community Outreach

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Patient Selection

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Patient Demographics

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System Capabilities

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Personnel Performance

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Outcomes

Number needed to Treat = 12

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EMS Acute Pediatric Care

Toolkit

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Pediatric Hot Issues

Airway ManagementCirculatory SupportPain ManagementSpecial NeedsEducation and Prevention

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Patient Selection

In Summary

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Questions ?