As communities fight for emergency resources, budgets, and access to first responder performance data, it is becoming essential for fire departments and other first responder agencies to develop appropriate processes to not only develop accurate data, but to extract and share that data as appropriate. Part One of our series on the gathering of data defined a few of the issues that fire departments face.
The trick for any agency to demonstrate accurate data is accurate data acquisition. While this may seem both obvious and simple to comprehend, in reality, it is a constantly moving target. Consider the time it takes for a fire company to arrive on scene at an incident. The basic parameter could be from the time the call is received until the unit arrives on scene. But, how do you track that?
When is the call received? That may be the easiest, as phone records are precise. But by whom? If you dial 911 from a land line, you may get directly to your city’s emergency dispatch center for fire. How about a mobile phone call from a crowded freeway. That call may get received by the highway patrol or state police, and from there, it will be transferred to the fire dispatch center. How much time is used to make that transfer? Even if it’s 20 seconds, that time may not be included in one type of report and included in another, resulting in what may be perceived to be “inaccurate” reporting. So, a good tracking system must include the option of including calls that are transferred from one agency to another.
Time to dispatch is another random figure to evaluate. The burden to assign resources to an emergency falls on the dispatcher. often forgotten is the role of the caller and the situation. In cities that dispatch fire units to non-EMS calls only, things are simpler. Where is the fire? What type of fire is it? What is your address? That type of information can be captured in less than a minute and with good training and appropriate software, emergency units will be notified in a fairly consistent manner.
Add EMS into the mix, however, and all bets are off, especially in a larger city (+500,000 residents). The time it takes to evaluate a medical emergency takes additional seconds or even minutes before resources are assigned. The simple answer would be to “Quick Start” (QS) a resource based on the same criteria as fire – Who needs help? What is the problem? What is your address? And once the initial unit is en route, the dispatcher can continue to question the caller and work to assist them prior to resources arriving. This format is expensive. It means ambulances and/or fire engines will be en route in emergency without knowing the exact issue they’re facing. It also pulls that resource out of service when further evaluation of the call might have resulted in a different resource being used.
Most dispatch centers have a protocol to go thru prior to sending EMS units to a medical emergency. The first is determining what the emergency is. That may take time. If the caller is panic stricken, or unable to communicate clearly, the dispatcher needs to determine if he/she can tell where the caller is. Often, notably with a mobile phone, that isn’t possible right away. Next, the dispatcher needs to determine the condition of the patient. In an automobile accident, it’s pretty easy to know that specific types of resources need to be assigned. If the patient is suffering a medical emergency, getting the proper information from the caller can be more complex. And for those individuals who call 911 continually, determining IF a real emergency is taking place also adds time to setting up the proper assignment and dispatching it.
The answer is to implement simple time-based software management into computer aided dispatch systems that permit a dispatcher to add “ticks” to the timeline, based on what is taking place. Some of those ticks should be automatic – when the call is answered, when the type of emergency is determined, and when a dispatch is sent. Others require the “human touch,” including the interview process, ongoing telephone direction and/or assistance while responders are en route, etc.
The challenge is that the more information you gather, the more you need to evaluate in order to extract the proper data to result in proper response management. Equal to that is the basis, or “standard” to be applied. Our opinion is that the standard should not be a national “average,” but one that is based on the size of the community served, and the number of resources available.
A town with 10,000 residents and 15 fire stations should be given a response standard specific to that mix of people and responders. A city with four million people and 106 fire stations needs to be tracked based on that combination of people and emergency resources. It may be important to add a third element: geography. As two simple examples, Los Angeles includes 470 square miles, four million people, and 106 fire stations. New York City is a fraction of the size, with 49.2 square miles of land, but with more than eight million people (double Los Angeles). FDNY operates from 218 fire houses, with 33 additional EMS stations. But add the 30% non-profit hospital EMS response component, along with New York’s use of dedicated Paramedic/EMT professionals, and the dispatch matrix is no longer something that can be matched to another department. Doing so is just false math.
A key to the overall issue of response times is to determine what is best for your town or city. How long should it take for resources to get to people in need or emergency situations? What resources are available? How do you get them there?
Once that criteria has been established, then you can begin to determine what tools are needed to help you monitor and manage response times effectively. Our next article on response times will take a look at Automatic Vehicle Location, or AVL.