One would imagine that in the world of Emergency Medical Services, the goal would be to respond as quickly and efficiently as possible to all emergencies in order to achieve the greatest possible outcomes for the patient. In many cases this is true. However, there’s a dirty little secret used by EMS agencies that few are familiar with. It’s called system status management (SSM). The idea behind SSM is that calls are tracked over a certain period of time to determine the probability of an occurrence in a certain region during certain times. Such information is then analyzed to determine staffing levels and posting locations for ambulances. While, theoretically this is a great idea, there are major obstacles that SSM has not been able to overcome. The first issue is that system status management leaves rural areas largely uncovered. The second major issue is that SSM does not account for the probability of a MCI (mass casualty incident). There is a saying in EMS that on most days X number of ambulances is too many, while on others, 100 is not enough. The goal of SSM however, is to minimize the number of ambulances to maximize profitability.
In addition to determining adequate staffing levels, SSM has been used to analyze profit potential. This occurs primarily in private, non-government based agencies. Statistically, the shorter agency response times result in less profit is being earned due to a decrease in the utilization hours of the crews. For that reason, a response time goal of (typically) 90% has been set in those systems. In other words, the EMS agency wants to miss the response time goals 9-10% of the time in order to maximize profits while still meeting its contractual obligations. Therefore, the data gathered to determine the best strategic positioning of the ambulances is also used to determine how staffing can be minimized in such a manner as to maximize profits at the expense of the patient. The end result is a system that is constantly taxed. This means that EMS crews that are overworked, unable to take breaks, and eventually burn out and quit. In one agency I worked for there was a turnover rate of 300% for employees and a 100% turnover rate on supervisors while I was employed there.
One of the major reasons I chose to pursue my MBA was to learn more about business so that I could be of benefit to an industry I love. As an industry EMS is plagued with issues that can be fixed but are seemingly ignored for the most part. First, there is no continuity in EMS. There are public (city/county) agencies, fire-based EMS agencies, hospital-based agencies, private for profit agencies, not for profit agencies, and volunteer agencies. There are 8, 10, 12, 14, 16, and 24-hour systems. There is no tax base for EMS due to our ability to bill insurances and collect Medicare/Medicaid funding which results in EMS relying on the government to determine our compensation. EMS is obligated by law to transport and care for all patients regardless of their ability to pay which results in many EMS agencies working for free multiple times throughout the day (remember, we can’t levy taxes for our services unlike fire and law enforcement). And lastly, most people are unaware of the capacity EMS personnel have to perform life-saving medical interventions. Although I have a national license, have been licensed in 6 states, a 2-year and 4-year degree, a MBA, and yet, I am often called an ambulance driver rather than a Paramedic. We have a huge public relations problem that no one seems interested in addressing.
I know the issues facing EMS are huge but I’m afraid that if someone doesn’t step up and take the lead, this highly necessary service will end up in a floundering heap of government regulations while providing sub-standard care due to an overburdened system. My goal is to take the available information regarding EMS, compounded with my education, to help build a better EMS system nationwide. This will require analyzing data and probabilities to support the decisions that will allow Paramedics and EMT’s to best serve their communities while achieving a better work/life balance for the EMS crews. However, this is not a battle that can be fought alone.
EMS needs people with the courage to step up and lead.
