Transcript Ambulance Response Times

Ambulance Response
Times
Tim Meyer, Director
North Dakota Department of Health
Division of EMS and Trauma
December 2, 2008
North Dakota Ambulance
Services
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139 ground ambulance services
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5 air ambulance services
ALS services do 72% of all calls in ND.
Over 3,400 EMS workers in ND
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120 BLS, 19 ALS
88% are volunteers
Average age is 42; 17% are over 65
What Are the Costs of EMS?
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It costs between $250,000 and $300,000 per year
for each ambulance service (estimated at $40m
to $50m per year statewide).
Labor.
 Vehicle expenses; depreciation, fuel, maintenance.
 Medical supplies.
 Personnel training.
 Building/facilities.
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Who Pays for EMS?
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$2.8m in local taxes on behalf of EMS.
$1.25m state staffing grant (625k per year).
$1.24m state training grant (620k per year).
Volunteer labor (est. $17m to $21m per year).
Third party payors: Medicare, Medicaid, Blue
Cross Blue Shield, etc. (est. $23m to $33m per
year).
Data Collection
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Data regarding each ambulance call must be
submitted to the Department (NDAC 33-1101.2-10(5)).
Web-based system called SOAR (Statewide
Online Ambulance Reporting).
Our dataset matches national requirements.
In 2007 we received data from over 57,000
ambulance calls.
Response Time Data
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We collect the following times:
911 call time.
 Time notified by dispatch.
 Time enroute.
 Arrive scene time.
 Depart scene time.
 Arrive at facility time.
 Time available for next call.
 Time back in quarters.
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Response Times Data Problems
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Subjective – self reporting.
Probable errors:
Frontier counties have an average response time of
over 55 minutes (DOT FY 2007).
 Multiple entries of over 1.5 days.
 Not uniformly using a 3rd party (dispatch) to record
times.
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Services are not reporting all calls to us.
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Cancelled runs, no transports, stand-bys, DOA, etc.
Who Cares?
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National push for public reporting of health
quality data:
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Health plans - 1998
End stage renal disease facilities - 2001
Nursing homes - 2002
Home health - 2003
Hospitals - April 2005
Clinics – forthcoming
EMS – within next 5 years
Quality and Pay for Performance
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2005 – 2007 hospital Medicare payment updates
(periodic increases) tied to quality; “Pay for
Performance”.
Ambulance services will be reimbursed in this
manner in the future.
Response times will be a quality indicator for
ambulance services.
 2007 Legislature requires us to establish response
time standards for ambulance services.
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What if We Do Nothing?
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Aging workforce will eventually = less
volunteers.
Failing to meet basic quality indicators will =
less payment to ambulance services.
Less funds will = less ambulance services.
Less ambulance services will = longer response
times for the public and more burden on
remaining ambulance services.
Our Plan
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Encourage EMS system development.
Improve the quality of the EMS delivery system.
Assist ambulance services in establishing their own
quality assurance processes.
 Monitor patient care benchmarks.
 Establish response time standards.
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Educate EMS providers to improve communications with
dispatch.
Give the public the best possible emergency
care.
What can PSAPs do?
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PSAPs are the gate keeper of response time data
– Objective Third Party.
Is it possible to get an export file on a monthly
basis?
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911 call time, time notified by dispatch, time
enroute, arrive scene time, depart scene time, arrive
at facility time, time available for next call, and time
back in quarters.
Continued
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The Health Department would do all QA
activity.
We will work to improve the communications of
EMS agencies.
Questions????
Tim Meyer, Director
Division of EMS and Trauma
North Dakota Dept. of Health
600 E. Blvd. Ave., Dept. 301
Bismarck, ND 58505-0200
701-328-2388
[email protected]
ndhealth.gov/ems
Lindsey Narloch, Research Analyst
Division of EMS and Trauma
North Dakota Dept. of Health
600 E. Blvd. Ave., Dept. 301
Bismarck, ND 58505-0200
701-328-2388
[email protected]
ndhealth.gov/ems