US Response Times?

[theotherphil]

Hi there, after reading a post in the UK forums from a US medic critisising the response times of the UK Ambulance services, I thought I'd ask how things are done in the US? It'd be nice to compare and contrast the differences.

Here in the UK, the government fund the NHS and as such, is free to set targets as it sees fit. Firstly, we have 3 main categories of incident:

• Category A - Life threatening conditions where rapid intervention may positively influence the eventual outcome of the patient.

• Category B - Patients whose condition is serious but not life threatening.

• Category C - Patients whose condition is neither serious or life threatening.

EMERGENCY RESPONSE STANDARDS (ORCON)

The response standards are very much linked to the severity of patients’ conditions and specify that: -

• 75% of all life threatening emergency incidents (Category A) to be responded to within 8 minutes.

• 95% of Category B incidents to be responded to within 19 minutes.

• 95% of Category C incidents to be responded to within 60 minutes.

In addition to this, there is a 3 minute activation time (time from emergency call being made, to getting a vehicle moving) which needs to be met in 95% of cases. This 3 min activation time is included in the response time.....eg, if it takes 3 minutes to take the call and assign it to a vehicle, the crew then have to reach the scene of a Cat A call in 5 minutes to hit the required 8 min response. Fast response units (single manned Paramedic cars or bikes) can be used for Cat A incidents and they must be backed up by a regular ambulance within 19 minutes in 95% of cases.

As you can see, these are quite strict targets to meet especially when you consider the type of terrain in the UK.....rural and urban with a lot of traffic most times.

Is there any sort of standards in place in the US with regards to response times? Are they nationally agreed targets or local to individual states? Who monitors adherence to the standards and what happens if they are not met?

Many thanks!

[croaker260]

Well, there are no nationally mandated standards, or even state standards, or even local standards ...except what is mandated by contractualo terms with performamnce based contracts.

That said there are GOALS.

The most commmon goal is to have ALS with in 8 minutes and BLS within 4 minutes for a cardiac arrest, wich is the recomendation ofthe American Heart Assos. and is far from a national regulation in any snese of the word.

Several organizations have pushed for more relaistic and comprehensive standards, such as response times for calls that are non cardiac arrest, non ALS and complete BS., but also considering areas with low population density and such.

The problem is that there are too many competing interest ijnthe US to allow such standards to be adopted...the Unions, the provates,anmd everyone who doenst want another eye looking over their shoulder (even if they neeed it) speaks out. Then there are the "what if" crowd who want a medic on every street courner with in 4 minutes or less on every fire engine crowd...

Does that help at all?

Bottom line there are quite a few individuals and small groups who have some very neat ideas on this subject...but a lot of highly funded assholes who want to see the idea die.

[AZCEP]

I will echo croaker's sentiment.

In Arizona, each transporting provider is issued a Certificate of Necessity. This basically says that a given entity can provide service to a given level with available resources. It also outlines response times based on the size of the geographic area that a service has to cover.

Some of the response areas are 3-4 hours across, so telling a provider that they have to have ALS/BLS on scene in 8 minutes would be entirely unrealistic. Most have guidlines based on percentages and times to respond like already mentioned.

[theotherphil]

That's great guys, thanks! Obviously it's easier to enforce a national standard when the size of the UK will fit into one of your states :wink:

Over here, people make a big deal of a "postcode lottery".....they believe that you should have the same access to NHS resources no matter where you live. Waiting for 30mins + for an Ambulance doesn't go down too well, as was highlighted in the thread I mentioned in the first post. It is considered a failure if we reach a Cat A call in 9 minutes and the patient lives but a success if we reach a Cat A call in 7 minutes and the patient dies :shock:....it's all about targets nowadays with management not being bothered about patient care.

Many thanks!

[scott33]

It’s true we are not forced to make any call is any particular time scale. We drive as quickly as we feel we need to, though obviously dilly-dallying will not go down too well. As far as goals go, I have heard "under 9" for our more life threatening calls, but it's not enforced and I have not seen it in writing. PD are often on scene with the AED for arrests in no time, and work in a similar role to the UK FR

Different calls will necessitate different responses, and although we run hot to almost all our calls, common sense should prevail (not always the case sadly)

I have never liked the idea of ORCON, and would be surprised if any UK road staff did. It just screams of "accident waiting to happen". Perhaps the money used to design, implement, staff, and monitor such a system, would have been better spent on having a couple more satellite ambulance stations in the more remote areas, which are failing their ORCON targets.

That's what the the poor figures would tell me, not "Oh you have to drive faster" ...Probably implemented by some pen-pusher who has never stepped foot in an ambulance

As far as driving and response goes, we have the guidelines, you have the protocols...sux doesn't it?

[Niftymedi911]

In Lee county, FL the county adopted national standards but customized them more. We have no set BLS or ALS response. We respond to all calls 10-18 (L&S). We respond reguardless of c/c and priority. But as of Jan 07 we will be implementing medical prioiry dispatching into the system to allow units respond to BLS calls 18X. (non-L&S). We have 8 minutes from the time the call is recieved to the time on scene. Our agency records what are called out-of-chute times which is how long it take you to go enroute. We have units placed with fire department stations throughout the county so we have no system status. Which I really dont mind system status sucks. Anyway, we have to respond to the call after our tones drop and alerts the station within 1 minute during the day and 2 minutes during the night. We cover over 1,100 miles within our county so we dont always met the guidelines though. We meet the 8 min deadline 86% of the time out of 74,000 calls last year. We meet the deadline by 96% if the response was 9 mins long.

[theotherphil]

I have never liked the idea of ORCON, and would be surprised if any UK road staff did. It just screams of "accident waiting to happen". Perhaps the money used to design, implement, staff, and monitor such a system, would have been better spent on having a couple more satellite ambulance stations in the more remote areas, which are failing their ORCON targets.

Yes, I agree. In remote places, first responder schemes are usually in place and sometimes in co-operation with the Fire Service. Where I work, we do have sattelite Stations and roadside standby points where crews standyby based on predictive analysis software in the control room.

That's what the the poor figures would tell me, not "Oh you have to drive faster" ...Probably implemented by some pen-pusher who has never stepped foot in an ambulance

As far as driving and response goes, we have the guidelines, you have the protocols...sux doesn't it?

Lol, we haven't had protocols over here for a long time....they expect us to rely on common sense (dodgy at best ). Although we have these times to meet, it is supposed to be done by ensuring adequate vehicles are available in strategic points to respond to an incident in a given area.....not by driving accross the county at break neck speeds. When fully manned, the system works beautifully. If shifts aren't covered then we don't have the blanket coverage needed to reliably meet the targets. The onus of responsibility to meet the targets is on management having sufficient vehicles on the road. We certainly don't put ourselves at risk to meet a government time....far better us arrive in one piece than not at all.

[croaker260]

That's great guys, thanks! Obviously it's easier to enforce a national standard when the size of the UK will fit into one of your states :wink:

One other thig to consider, something even us Yanks often forget..is that the idea of a "national" anything is not popular politically. In fact it wasnt until after the civil war in the mid 1800's that people in the US even BEGAN to think of themselves as somethign other than Kentuckians, Idahoians, or New Yorkers. In fact, this regional idenidity still persist to this day.

I know, we certainly have come a long way from those days in terms of federalism...but the principle still holds. Instead of national health care we have regional medicare/medicaid insurance with no national health system...instead of a national Highway construction we have the DOT giving money to the states to administer it for them...and instead of a FEDERALY mandated national standard for EMS, we have national recomendations that the states can chose to comply or not comply with.

The main way the Federal Goverment "enforces" anything is by tying compliance with reimbursement and federal monies, very seldom by mandate. Look at HIPAA, only enforced if you want to receve medicare monies. If you dont recieve medicare monies, then HIPAA doent apply from a legal point of view.

[paramedicmike]

and instead of a FEDERALY mandated national standard for EMS, we have national recomendations that the states can chose to comply or not comply with.

And therein lies our problems.

-be safe

[vs-eh?]

In Lee county, FL the county adopted national standards but customized them more. We have no set BLS or ALS response. We respond to all calls 10-18 (L&S). We respond reguardless of c/c and priority.

I 100% disagree with that philosophy. I also believe you said in another post that fire responds on every call.

Utterly ridiculous. A tremendous waste of resources, and in my opinion in gives the public a false impression of EMS in general. Sorry peeps we don't need to rush to that back pain or nose-bleed L+S with 5-6 people on scene. People SHOULD have to wait at times, and maybe when they see that it is just a fancy cab ride to the hospital they may think to call about similar again.