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Bright Lights, Big City: Fire-Based EMS
A decade ago it was accurate to consider large non-fire ems 9-1-1 services as the best examples of high performance systems, utilizing innovation and technology to improve both patient outcomes and system efficiency. Fire-based systems were struggling with unfilled paramedic positions, shot-gun mergers, and unsophisticated administrators.
Wake County (NC), SunStar (FL), EMSA (OK), MAST (MO), and Richmond continue to provide excellence. Some large fire-based systems are also raising the bar.
HOUSTON HAS SOLUTIONS
Houston Fire Department was one of the first large fire departments to integrate GPS into their dispatching algorithm. (2001 paper HERE) The computer determined the distances of available units, rolling a fire company only if a transport unit would take too long. It was one of the first geo data-driven tiered dispatch systems.
Houston had early success with Automatic Crash Notification systems, building upon the geo data-based, computer aided dispatch system. (2004 presentation HERE)
FIRE BASED EMS: 2001 - now
A January 2002 Tri-Data report resulted in establishing two-paramedic non-transport squad vehicles and a mix of ALS and BLS ambulances. (Huge TriData report HERE). HFD makes about 400 transports a day.
Houston is one of the sites for the Resuscitation Outcomes Consortium (earlier blog HERE and Houston description HERE).
STRATEGIES TO REDUCE NON-EMERGENCY USE OF 911
Houston is trying various programs to reduce the workload generated by people who call for EMS and do not need out-of-hospital care. Doctor David Persse, City of Houston EMS Physician Director, spoke about Houston’s efforts in telemedicine, emergency ambulance routing and ems tiered deployment at EMS Today.
The presentation was rich in detail, providing real-world examples of what worked and what did not work in a huge and complex ems service. If you were not at EMS Today in Baltimore, you can catch a similar presentation at the IAFC Fire-Rescue Med conference in Las Vegas.
Big-city EMS continues to be faced with problems of overutilization, misutilization and new utilizations of prehospital emergency care. Dr. Persse will describe several aggressive tactics Houston has employed to try to further refine the art of being maximally efficient with EMS resources, including the use of telehealth nursing, emergency ambulance routing and tiered deployment with paramedic squads, as well as high-tech research. Tuesday, May 5 at 3:30 pm
Registration information HERE
Wake County (NC), SunStar (FL), EMSA (OK), MAST (MO), and Richmond continue to provide excellence. Some large fire-based systems are also raising the bar.
HOUSTON HAS SOLUTIONS
Houston Fire Department was one of the first large fire departments to integrate GPS into their dispatching algorithm. (2001 paper HERE) The computer determined the distances of available units, rolling a fire company only if a transport unit would take too long. It was one of the first geo data-driven tiered dispatch systems.
Houston had early success with Automatic Crash Notification systems, building upon the geo data-based, computer aided dispatch system. (2004 presentation HERE)
FIRE BASED EMS: 2001 - now
A January 2002 Tri-Data report resulted in establishing two-paramedic non-transport squad vehicles and a mix of ALS and BLS ambulances. (Huge TriData report HERE). HFD makes about 400 transports a day.
Houston is one of the sites for the Resuscitation Outcomes Consortium (earlier blog HERE and Houston description HERE).
STRATEGIES TO REDUCE NON-EMERGENCY USE OF 911
Houston is trying various programs to reduce the workload generated by people who call for EMS and do not need out-of-hospital care. Doctor David Persse, City of Houston EMS Physician Director, spoke about Houston’s efforts in telemedicine, emergency ambulance routing and ems tiered deployment at EMS Today.
The presentation was rich in detail, providing real-world examples of what worked and what did not work in a huge and complex ems service. If you were not at EMS Today in Baltimore, you can catch a similar presentation at the IAFC Fire-Rescue Med conference in Las Vegas.
Big-city EMS continues to be faced with problems of overutilization, misutilization and new utilizations of prehospital emergency care. Dr. Persse will describe several aggressive tactics Houston has employed to try to further refine the art of being maximally efficient with EMS resources, including the use of telehealth nursing, emergency ambulance routing and tiered deployment with paramedic squads, as well as high-tech research. Tuesday, May 5 at 3:30 pm
Registration information HERE
Add a Comment
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Comment by Mike Ward on March 31, 2009 at 3:26pm
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JEMSconnect detailed profile on Houston
http://www.jems.com/news_and_articles/columns/Travis/houston_at_a_g...
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Comment by Jason Koontz on March 30, 2009 at 3:58pm
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Mike, We had that system in Tacoma, WA. We calle dit "divert status". If used correctly it evens patients out over the local hospitals, and sends the right patients to the right hospitals. problem is, teh hospitals tended to abuse it. When they needed a break, or felt like they were getting too many patients brought in by ambulances that "didn't need care", i.e. the drunk homeless guy thats cold and too lazy to walk to the shelter, a 32 year old woman with chronic back pain thats been bothering her for 3 weeks and wants a shot, things like that, they close to incoming ambulances. The problem is now that hospital, who's just tired of not-sick patients, but happens to have one of the only cath labs, refuses to accept incoming ambulances, and I'm inbound with an active MI. I have to divert to a different hospital, who may or may not have the ability to do something about the MI, vs being able to get them the proper care required. Its a great system, but like you said, I think it needs to be reserved for smaller communities.
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They are trying a couple of things ..
Over-the-phone nurse triage
Physician phone assistance when on scene (destination issues)
A cool and real-time program to track how crowded the EDs are based on the number of ambulances at the ED, whether the patient is still on the stretcher and the cumulative time the crews are waiting at the hospital. (THAT can work in a smaller community)
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Comment by Art "ChiefReason" Goodrich on March 29, 2009 at 4:33pm
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Mike:
So, if I understand it, there is a pre-use "triage" to determine level of care/response that is done over the phone in Houston?
Or is there the idea to get the public less dependent on EMS for outside the hospital care?
Third; how will this find its way to smaller communities, if at all?
Good reading.
TCSS.
Art
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