County of Volusia Department of Public Protection

Division of

Administrative Responsibilities

• Ordinance- Certificate of Public Convenience

and Necessity (COPCN)- Closest unit emergency medical

response• System analysis• EMS Trust Fund• Liaison to agencies (county and municipal)• Partnerships (contingency and pilot

programs)

Response Times• Definition. What defines a response time?• Industry standards. 4 minutes? 8

minutes? From where did these times evolve?

• Measure. What’s the most transparent formula for illustrating response times?

• Do response times affect patientoutcome?

Anatomy of a Response

0:45 0:45

4:005:45

0:456:30

Time:Elapsed time:

0:30 1:15

0:30 1:45

Recognition: delay between initial illness or injury and activation of EMS system (45 seconds).

Reaction time: difference in time between receipt of alarm and ’wheels moving’ on apparatus (30 seconds).

Processing time: difference between notification of field units and receipt of call information by the communications center (30 seconds).

Vertical response time: difference between arriving at the patient’s side and ‘wheels stop’ at the location (45 seconds).

Response time: difference between ‘wheels stop’ at the location of the event and ’wheels start’ at the beginning of the response (4 minutes).

1

2

3 5

4

Clinical Responsibilities• Medical oversight of field &

communications staff (401.265, Florida Statutes)- Prehospital standing medical orders- Quality assurance- Access to legend devices, prescription

medications, & controlled substances- Contingency emergency medical transport

• Credentialing andeducation

Challenges facing EMS• Existing health care

- Customary reimbursement (Medicare, Medicaid, etc.)

- Revenue (FY 09-10 uncollectibles, $16 million)• Impact of Patient Protection and

Affordable Care Act- “EMS agencies lose money responding to calls

from the publicly insured.” – NAT’L CTR FOR POLICY ANALYSIS

- Value-based- No one really knows.

• Better utilization of resources- Increased efficiency without loss of effectiveness

(Emergency Medical Dispatch)- Lost unit hours (e.g., bed delays, diversion)

• Public expectation

Challenges facing EMS - continued

• Determining an affordable, sustainable, and outcome-driven model (i.e., optimal service)

Questions?