Re: Response Time

[Guest guest]

Well stated Bob. Unfortunately, in this world today, everything is politically

cost effective, regardless of the system. I have to say though, in cities where

both FD and EMS services divide up the city and respond, with a great map system

in place, that the competition between the two makes for great response times. I

don't agree with cities that limit their 911 calls to one service, when there

are multiple services out there ready to respond. There is nothing wrong with

more than one service responding to a call, especially if a service happens to

have an ambulance in the vicinity of the call at the time of the call. The

service who arrives first, starts rendering care, whether it be basic or ACLS,

then the major service for the city can take over upon arrival. EMS and FD

services for a city, must work together, whether it improves the survival of the

patient or not. The point is to render care as quickly and efficiently as

possible, as long as SOMEONE gets to the scene and initiates care. The word MINE

and YOURS shouldn't exits in the EMS vocabulary, just OURS, because we're all in

it together for the same reason; taking care of people and structures. If I

respond to a call and find a lay person with an AED rendering care, I'm

THANKFUL. If EMS systems would get back to the basics, then everyone involved

would be better off.

Response Time

It is intuitive that shorter response times result in improved survival.

But, how response time standards are promulgated is largely a factor of

politics and cost, rather than empirically derived clinical evidence.

The National Fire Protection Association (NFPA) standard 1710 defines

response time criteria for fire and EMS, which also includes minimum

fire company staffing requirements. The national League of Cities,

International City/County Management Association, U.S. Conference of

Mayors and National Association of Counties openly opposed this standard

on the basis that the standard would require an increase of 30,000 (11%)

firefighters nationwide; it would force cities and counties to shift tax

revenues from fire prevention to fire suppression, thereby effectively

increasing the overall risk to firefighters in the suppression role;

and, the NFPA provided no evidence that the standard's staffing

requirements would achieve the standard's response time criteria. In

this example, response times serve as the entree to labor costs and

staffing issues - and are only loosely linked (if at all) to patient

outcomes.

The second example is that of the fractile response time devotee's. RFP

writers (consultants), municipalities and private EMS contractors use

response times to determine overall system costs, measure provider

efficiency and impose regulatory enforcement. Rarely are these response

time standards ever linked to patient outcomes.

RFP writers create a menu from which contracting municipalities select

the most affordable response time standard. As the response time

standards increase, the corresponding system costs decrease. Thus,

response times are an expression of cost, rather than the result of EMS

efficacy or outcome determinations. That's the reason why response time

standards are all over the place: 7:59, 8:59, 9:59, 10:59, 11:59, etc. @

90%.

I resist the notion that today's method of calculating response time

reliability (X minutes and seconds @ 90%) is more precise than

calculating average response time for ALL outbound emergency responses.

The 10% buffer provided by today's method is a " fudge factor " exemption

that under an average response time method would far exceed the actual

number of excessive response times.

Furthermore, contractor's who use today's method are incented (if not

predisposed) to lower the response classification level of as many calls

as possible in order to lessen their regulatory exposure and burden

(monetary penalties). All-inclusive response time averaging would

eliminate this practice entirely. Besides, since no one is linking

response times to outcomes - what difference does it make anyway?

Response times are determined by politics and cost, but are " sold " to

the consuming public as objective scientific derivations. Such is not

the case. Since cardiac arrest is the most commonly cited basis for

response times, which medical group (if any) has gotten it right? If you

ask the CPR/ECC/ACLS crowd you better deliver a shock within 4-6 minutes

- from onset. In systems where there is no first responder

defibrillation capability that can meet this criterion, does it really

matter (then) how long it takes to respond?

Despite the existence of the Utstein model, this group (along with EMS)

still measures success in terms of ROSC and hospital admission. These

patients are considered to be " saves " , despite the fact that > 50% of

said " saves " will die in hospital of recurrent cardiac arrest or severe

neurological damage. Long term survival for those discharged alive is

expressed in terms of months - not years or decades. And, at what cost?

The other medical group, which I believe has greater credibility is the

CNS (brain) resuscitation researchers - Safar, Blaine White, Norm

Abramson, etc. In their world, EMS response times are expressed in terms

of neurological outcomes, rather than ROSC or hospital admissions. Their

work is focused on measuring and predicting neurological survival on the

belief that restarting the heart has no merit in the presence of a dead

brain - quite different from the CPR/ECC/ACLS bunch. Blaine White once

told me, " If I suffer a cardiac arrest, all I want the EMS personnel to

do is pack my head in ice and haul ass for the hospital! "

Having said all of this, it's evident to me that EMS response times (as

we know them) are determined by political fiat, cost considerations and

organizational imperatives. Objectively derived and scientifically

irrefutable evidence for EMS response times are yet to be established,

and are dependent solely on the availability of funding for

comprehensive and long term EMS research. Until then - pick a number ...

any number.

Bob Kellow

[Guest guest]

bravo, bravo, bravo, bravo

when anyone can show any measure that accurately shows that EMS works, i

will be very interested in seeing it.

john

Atwell Rasmussen, Ph.D., REMTP

Lieutenant, Education and Training

Greenville County EMS

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Response Time

It is intuitive that shorter response times result in improved survival.

But, how response time standards are promulgated is largely a factor of

politics and cost, rather than empirically derived clinical evidence.

The National Fire Protection Association (NFPA) standard 1710 defines

response time criteria for fire and EMS, which also includes minimum

fire company staffing requirements. The national League of Cities,

International City/County Management Association, U.S. Conference of

Mayors and National Association of Counties openly opposed this standard

on the basis that the standard would require an increase of 30,000 (11%)

firefighters nationwide; it would force cities and counties to shift tax

revenues from fire prevention to fire suppression, thereby effectively

increasing the overall risk to firefighters in the suppression role;

and, the NFPA provided no evidence that the standard's staffing

requirements would achieve the standard's response time criteria. In

this example, response times serve as the entree to labor costs and

staffing issues - and are only loosely linked (if at all) to patient

outcomes.

The second example is that of the fractile response time devotee's. RFP

writers (consultants), municipalities and private EMS contractors use

response times to determine overall system costs, measure provider

efficiency and impose regulatory enforcement. Rarely are these response

time standards ever linked to patient outcomes.

RFP writers create a menu from which contracting municipalities select

the most affordable response time standard. As the response time

standards increase, the corresponding system costs decrease. Thus,

response times are an expression of cost, rather than the result of EMS

efficacy or outcome determinations. That's the reason why response time

standards are all over the place: 7:59, 8:59, 9:59, 10:59, 11:59, etc. @

90%.

I resist the notion that today's method of calculating response time

reliability (X minutes and seconds @ 90%) is more precise than

calculating average response time for ALL outbound emergency responses.

The 10% buffer provided by today's method is a " fudge factor " exemption

that under an average response time method would far exceed the actual

number of excessive response times.

Furthermore, contractor's who use today's method are incented (if not

predisposed) to lower the response classification level of as many calls

as possible in order to lessen their regulatory exposure and burden

(monetary penalties). All-inclusive response time averaging would

eliminate this practice entirely. Besides, since no one is linking

response times to outcomes - what difference does it make anyway?

Response times are determined by politics and cost, but are " sold " to

the consuming public as objective scientific derivations. Such is not

the case. Since cardiac arrest is the most commonly cited basis for

response times, which medical group (if any) has gotten it right? If you

ask the CPR/ECC/ACLS crowd you better deliver a shock within 4-6 minutes

- from onset. In systems where there is no first responder

defibrillation capability that can meet this criterion, does it really

matter (then) how long it takes to respond?

Despite the existence of the Utstein model, this group (along with EMS)

still measures success in terms of ROSC and hospital admission. These

patients are considered to be " saves " , despite the fact that > 50% of

said " saves " will die in hospital of recurrent cardiac arrest or severe

neurological damage. Long term survival for those discharged alive is

expressed in terms of months - not years or decades. And, at what cost?

The other medical group, which I believe has greater credibility is the

CNS (brain) resuscitation researchers - Safar, Blaine White, Norm

Abramson, etc. In their world, EMS response times are expressed in terms

of neurological outcomes, rather than ROSC or hospital admissions. Their

work is focused on measuring and predicting neurological survival on the

belief that restarting the heart has no merit in the presence of a dead

brain - quite different from the CPR/ECC/ACLS bunch. Blaine White once

told me, " If I suffer a cardiac arrest, all I want the EMS personnel to

do is pack my head in ice and haul ass for the hospital! "

Having said all of this, it's evident to me that EMS response times (as

we know them) are determined by political fiat, cost considerations and

organizational imperatives. Objectively derived and scientifically

irrefutable evidence for EMS response times are yet to be established,

and are dependent solely on the availability of funding for

comprehensive and long term EMS research. Until then - pick a number ...

any number.

Bob Kellow

[Guest guest]

ssm

Response Time

It is intuitive that shorter response times result in improved survival.

But, how response time standards are promulgated is largely a factor of

politics and cost, rather than empirically derived clinical evidence.

The National Fire Protection Association (NFPA) standard 1710 defines

response time criteria for fire and EMS, which also includes minimum

fire company staffing requirements. The national League of Cities,

International City/County Management Association, U.S. Conference of

Mayors and National Association of Counties openly opposed this standard

on the basis that the standard would require an increase of 30,000 (11%)

firefighters nationwide; it would force cities and counties to shift tax

revenues from fire prevention to fire suppression, thereby effectively

increasing the overall risk to firefighters in the suppression role;

and, the NFPA provided no evidence that the standard's staffing

requirements would achieve the standard's response time criteria. In

this example, response times serve as the entree to labor costs and

staffing issues - and are only loosely linked (if at all) to patient

outcomes.

The second example is that of the fractile response time devotee's. RFP

writers (consultants), municipalities and private EMS contractors use

response times to determine overall system costs, measure provider

efficiency and impose regulatory enforcement. Rarely are these response

time standards ever linked to patient outcomes.

RFP writers create a menu from which contracting municipalities select

the most affordable response time standard. As the response time

standards increase, the corresponding system costs decrease. Thus,

response times are an expression of cost, rather than the result of EMS

efficacy or outcome determinations. That's the reason why response time

standards are all over the place: 7:59, 8:59, 9:59, 10:59, 11:59, etc. @

90%.

I resist the notion that today's method of calculating response time

reliability (X minutes and seconds @ 90%) is more precise than

calculating average response time for ALL outbound emergency responses.

The 10% buffer provided by today's method is a " fudge factor " exemption

that under an average response time method would far exceed the actual

number of excessive response times.

Furthermore, contractor's who use today's method are incented (if not

predisposed) to lower the response classification level of as many calls

as possible in order to lessen their regulatory exposure and burden

(monetary penalties). All-inclusive response time averaging would

eliminate this practice entirely. Besides, since no one is linking

response times to outcomes - what difference does it make anyway?

Response times are determined by politics and cost, but are " sold " to

the consuming public as objective scientific derivations. Such is not

the case. Since cardiac arrest is the most commonly cited basis for

response times, which medical group (if any) has gotten it right? If you

ask the CPR/ECC/ACLS crowd you better deliver a shock within 4-6 minutes

- from onset. In systems where there is no first responder

defibrillation capability that can meet this criterion, does it really

matter (then) how long it takes to respond?

Despite the existence of the Utstein model, this group (along with EMS)

still measures success in terms of ROSC and hospital admission. These

patients are considered to be " saves " , despite the fact that > 50% of

said " saves " will die in hospital of recurrent cardiac arrest or severe

neurological damage. Long term survival for those discharged alive is

expressed in terms of months - not years or decades. And, at what cost?

The other medical group, which I believe has greater credibility is the

CNS (brain) resuscitation researchers - Safar, Blaine White, Norm

Abramson, etc. In their world, EMS response times are expressed in terms

of neurological outcomes, rather than ROSC or hospital admissions. Their

work is focused on measuring and predicting neurological survival on the

belief that restarting the heart has no merit in the presence of a dead

brain - quite different from the CPR/ECC/ACLS bunch. Blaine White once

told me, " If I suffer a cardiac arrest, all I want the EMS personnel to

do is pack my head in ice and haul ass for the hospital! "

Having said all of this, it's evident to me that EMS response times (as

we know them) are determined by political fiat, cost considerations and

organizational imperatives. Objectively derived and scientifically

irrefutable evidence for EMS response times are yet to be established,

and are dependent solely on the availability of funding for

comprehensive and long term EMS research. Until then - pick a number ...

any number.

Bob Kellow

[Guest guest]

There is nothing on that web page it is blank.

Silsbee EMS

114 hwy 96 south

Silsbee, Tx 77656

Response Time

>

>

> It is intuitive that shorter response times result in improved survival.

> But, how response time standards are promulgated is largely a factor of

> politics and cost, rather than empirically derived clinical evidence.

>

> The National Fire Protection Association (NFPA) standard 1710 defines

> response time criteria for fire and EMS, which also includes minimum

> fire company staffing requirements. The national League of Cities,

> International City/County Management Association, U.S. Conference of

> Mayors and National Association of Counties openly opposed this standard

> on the basis that the standard would require an increase of 30,000 (11%)

> firefighters nationwide; it would force cities and counties to shift tax

> revenues from fire prevention to fire suppression, thereby effectively

> increasing the overall risk to firefighters in the suppression role;

> and, the NFPA provided no evidence that the standard's staffing

> requirements would achieve the standard's response time criteria. In

> this example, response times serve as the entree to labor costs and

> staffing issues - and are only loosely linked (if at all) to patient

> outcomes.

>

> The second example is that of the fractile response time devotee's. RFP

> writers (consultants), municipalities and private EMS contractors use

> response times to determine overall system costs, measure provider

> efficiency and impose regulatory enforcement. Rarely are these response

> time standards ever linked to patient outcomes.

>

> RFP writers create a menu from which contracting municipalities select

> the most affordable response time standard. As the response time

> standards increase, the corresponding system costs decrease. Thus,

> response times are an expression of cost, rather than the result of EMS

> efficacy or outcome determinations. That's the reason why response time

> standards are all over the place: 7:59, 8:59, 9:59, 10:59, 11:59, etc. @

> 90%.

>

> I resist the notion that today's method of calculating response time

> reliability (X minutes and seconds @ 90%) is more precise than

> calculating average response time for ALL outbound emergency responses.

> The 10% buffer provided by today's method is a " fudge factor " exemption

> that under an average response time method would far exceed the actual

> number of excessive response times.

>

> Furthermore, contractor's who use today's method are incented (if not

> predisposed) to lower the response classification level of as many calls

> as possible in order to lessen their regulatory exposure and burden

> (monetary penalties). All-inclusive response time averaging would

> eliminate this practice entirely. Besides, since no one is linking

> response times to outcomes - what difference does it make anyway?

>

> Response times are determined by politics and cost, but are " sold " to

> the consuming public as objective scientific derivations. Such is not

> the case. Since cardiac arrest is the most commonly cited basis for

> response times, which medical group (if any) has gotten it right? If you

> ask the CPR/ECC/ACLS crowd you better deliver a shock within 4-6 minutes

> - from onset. In systems where there is no first responder

> defibrillation capability that can meet this criterion, does it really

> matter (then) how long it takes to respond?

>

> Despite the existence of the Utstein model, this group (along with EMS)

> still measures success in terms of ROSC and hospital admission. These

> patients are considered to be " saves " , despite the fact that > 50% of

> said " saves " will die in hospital of recurrent cardiac arrest or severe

> neurological damage. Long term survival for those discharged alive is

> expressed in terms of months - not years or decades. And, at what cost?

>

> The other medical group, which I believe has greater credibility is the

> CNS (brain) resuscitation researchers - Safar, Blaine White, Norm

> Abramson, etc. In their world, EMS response times are expressed in terms

> of neurological outcomes, rather than ROSC or hospital admissions. Their

> work is focused on measuring and predicting neurological survival on the

> belief that restarting the heart has no merit in the presence of a dead

> brain - quite different from the CPR/ECC/ACLS bunch. Blaine White once

> told me, " If I suffer a cardiac arrest, all I want the EMS personnel to

> do is pack my head in ice and haul ass for the hospital! "

>

> Having said all of this, it's evident to me that EMS response times (as

> we know them) are determined by political fiat, cost considerations and

> organizational imperatives. Objectively derived and scientifically

> irrefutable evidence for EMS response times are yet to be established,

> and are dependent solely on the availability of funding for

> comprehensive and long term EMS research. Until then - pick a number ...

> any number.

>

> Bob Kellow

>

>

>

>

[Guest guest]

Bob -

With regards to NFPA 1700/1710, I believe you are mistaking the staffing

question with the response time question. There is a great staffing

study from Dallas FD (and applied studies in Thunder Bay, Ontario, CA)

that demonstrate that a 4-person engine crew is x% more efficient than a

3-person engine crew.

This efficiency principle works to effectively decrease both the initial

response requirements and the length of time units are out-of-service at

an incident. This then decreases the required amount of units

" required " by a system for various " activity levels " (simultaneous

number of working incidents). While this doesn't directly affect

response time to any given incident, it indirectly affects it by leaving

more companies in service - using only 3 engines per box instead of 4

leaves that fourth on in service for a call, etc. Additionally, it

provides for a higher level of safety per incident by having the

necessary personnel arriving quicker (in the above example, they arrive

on the first three apparatus instead of the first four, decreasing the

net response time for all units end-to-end).

This is also the reason that Miami FD (NOT Metro-Dade) assigns a

Lieutenant/officer to each Rescue (Ambulance/MICU) as a third person -

the extra officer provides them demonstrably better numbers for unit

efficiency, especially for returning first-responsing crews to service

at full crew strength earlier.

Mike

Response Time

The National Fire Protection Association (NFPA) standard 1710 defines

response time criteria for fire and EMS, which also includes minimum

fire company staffing requirements. The national League of Cities,

International City/County Management Association, U.S. Conference of

Mayors and National Association of Counties openly opposed this standard

on the basis that the standard would require an increase of 30,000 (11%)

firefighters nationwide; it would force cities and counties to shift tax

revenues from fire prevention to fire suppression, thereby effectively

increasing the overall risk to firefighters in the suppression role;

and, the NFPA provided no evidence that the standard's staffing

requirements would achieve the standard's response time criteria. In

this example, response times serve as the entree to labor costs and

staffing issues - and are only loosely linked (if at all) to patient

outcomes.

[Guest guest]

Earlier, DENISE GALZA said:

" The word MINE and YOURS shouldn't exits in the EMS vocabulary, just

OURS, because we're all in it together for the same reason; taking care

of people and structures. "

Unfortunately, , this isn't true. Some companies are in it for

the money (*regardless* of their dedication to their patients,

communities, etc.). If they don't make a profit, they go out of

business, PERIOD.

Compare this to a public service/public utility model in which EMS, like

other city services (Fire, Police, Streets, Libraries, etc), is a

cost-controlled loss (designed to operate in the red). We're *not* all

in it for the same reason.

Mike

[Guest guest]

My point is regardless of how much money your service makes, for rich or poor,

whatever the case may be, does that dictate your treatment both medically and

personally of a patient in the field? Do you treat a drunk that you've picked up

numerous times with the same professionalism as you would picking up a VIP?

Money does not dictate the way one performs his job, if they are a true

professional. Many times I've seen indigent and drunk patients treated

indignantly by EMS people; whether we approve of them or not, is not within our

scope of practice: it's the level of care we give to them that counts. I rest

may case.

RE: Response Time

Earlier, DENISE GALZA said:

" The word MINE and YOURS shouldn't exits in the EMS vocabulary, just

OURS, because we're all in it together for the same reason; taking care

of people and structures. "

Unfortunately, , this isn't true. Some companies are in it for

the money (*regardless* of their dedication to their patients,

communities, etc.). If they don't make a profit, they go out of

business, PERIOD.

Compare this to a public service/public utility model in which EMS, like

other city services (Fire, Police, Streets, Libraries, etc), is a

cost-controlled loss (designed to operate in the red). We're *not* all

in it for the same reason.

Mike

[Guest guest]

The system what we use startes from the time the call was recieved until the

unit goes on scene. We have the usual 8:59 response time 80% of the time.

This is for a MICU-911 service

[Guest guest]

On-scene times are easy to fudge and frequently are. If it's done by voice

communication, it's usually done as you're approaching the scene. You want

to get that out of the way so you can concentrate of parking your hearse, er

ambulance, in the right place, trying to see whether or not there are any

crazies hiding in the bushes, whether or not you're going to be run over by a

Dallas driver, and so forth.

If it's done by computer button, it depends on when somebody remembered to

push it.

The only true way to determine on-scene time is to have a GPS that reports

when the truck goes into park. Even then, that doesn't tell you when actual

patient contact was made. I suppose there would have to be a personal GPS

system that would be activated in some way when you actually made patient

contact. Or maybe just assigning a Geek to follow each crew and monitor

their times. But then that would assume that the Geek was awake and alert

and remembered to push the buttons hisself.

How silly does this get? Worse.

A lawyer's trick is to ask the driver of the amlance to describe in detail

the actions taken, from the moment the call is received to the end, and

estimate how long each action required. For instance, " Where were you when

you received the call? " " In the station. " " No, I mean, exactly WHERE in the

station were you? " " Hmmm, in the squad room watching TV. " " How many steps

was that to the ambulance? "

" I don't know, maybe 20. " How many seconds did it take you to get up out of

the chair and walk to the ambulance? " " I don't know, maybe 30. " " OK, then

what did you do? " " Well, we drove to the scene. " " NO, NO, NO, I mean what

did you do when you got to the truck? Did you open the door and get in? "

" Well, of course. " " OK, then what did you do? " " Well I started the

engine. " How long did that take? Is it a diesel? Did it take a few seconds

to get it to start? " " Yes, it's a diesel. " " Describe the procedure for

starting the diesel engine. " (Deponent describes.) " How many seconds did

that take? " " Oh, maybe 30 seconds. " " OK, was the door to the bay up or down

at that time? " " I don't remember. " " OK, then what did you do? " " Well we

drove to the scene. " " Excuse me. I don't mean to be difficult, but what

I'm trying to learn here is the exact sequence of actions you took, so would

you please tell me whether you left the station immediately, or did you,

perhaps, sit there for a few seconds while you looked the address up on a

map? " " Well, we might have had to look it up. " " Good. How long do you

think that would have taken? " " Maybe 30 seconds. " " Good. You're doing

well. Now how many blocks was it from your station to the house where Mr.

Strangleman was found? " " Well, I don't remember exactly. " " Well, if I

showed you a map of the city could you trace your route? " " Yes I probably

could. "

" Fine, you've outlined 46 blocks on the map. Now how fast were you

driving? " " Well, probably about 45-50 miles per hour. " " I see. At that

speed how long did it take you to cover a block? " " I don't know. " " Well, to

the best of your memory? " " Maybe 20 seconds. "

Now this goes on and on, and the lawyer is asking for time estimates for each

and every action and maneuver and writing them down. When this part is over,

s/he will go on to another issue and cover it. Then, s/he'll go to the PCR

and point to the box where it says " Dispatch time " or whatever. She'll ask

the witness to explain what that means. She'll do this for each block where

times are entered. Then she'll go back and spring the times estimated by the

witness on him and say, " But, you testified earlier that it took you a total

of 4 minutes and 30 seconds to get out of the driveway and into the street

after starting the truck, raising the door, and looking up the address on the

map. Is that what you testified to? " " Yes. " " And you estimated that it

took you about 20 seconds to cover each of the 46 blocks from your station to

the scene? " " Yes, that's what I said. " " So, if you'll bear with me here,

would you take this calculator and put in 46? Fine, now multiply that times

20. Great, and what do you get? " " 920. " " So that's 920 seconds, right? "

" Right. " " Now, there's 60 seconds in a minute, so would you divide 920 by

60 for the jury? " " Let's see, OK, it's 15.33333. " " So that would be 15 and

1/3 minutes, wouldn't it? " " I guess so. "

" So if you add 4 minutes and 30 seconds to 15 minutes and 20 seconds, you get

19 minutes and 50 seconds, don't you? " " I guess so. " " So that means that it

took you almost 20 minutes to get to your call by your estimates. " " Well, I

could be off. " " I certainly understand that, but on your patient care report

form it has 'time enroute' as 8 minutes and 47 seconds. Isn't that correct? "

" Yes. " " So there's a discrepancy between your recollection of how long it

took you to get there and what you wrote on your documentation, isn't there. "

" Well, it's been a long time. " " Of course it has, and your memory is not

good about the call is it? " " Not too good, no. " " But would you agree with

me that there's quite a difference between 8 minutes and 47 seconds and 20

minutes? " " Well, I don't remember.... " OBJECTION: NON-RESPONSIVE. " Is

there or is there not a fairly large difference between 8 minutes and 47

seconds and 20 minutes when you're making an emergency ambulance response? "

" I guess you'd have to say there is. " " So the information written on your

patient care/response form and what you remember are very different? "

Now, ladies and gentlemen. Can you see where this might go?

First of all, it's been shown that the witness's memory of the event is not

good.

So the stage is set for when the witness claims to remember something that's

REALLY relevant that wasn't documented.

Second it's been shown that there's a large difference between the times

estimated and the times written down. Now the doubt has been sowed as to the

reliability of both the witness's memory and the numbers on the run sheet.

The careful and well prepared attorney will pick away and pick away at the

witness, smiling all the while and thanking him for his responses, while

inflicting the death of a thousand cuts. Cases seldom have a " If the glove

don't fit, you must acquit. " Rather they whittle away little by little at a

witness's credibility and plant doubt in the minds of the jury that he's

telling the whole truth.

Each and every part of the treatment will be asked about in minute detail,

and compared with the written documentation, and so forth.

So be careful about your response times. Be able to back them up with a

policy and, if possible tapes. Don't allow yourself to be made to speculate.

Gene Gandy

[Guest guest]

I believe this is why Austin/ County has a policy that a unit may

not mark itself " responding/enroute " until the wheels on the truck are

moving. It's probably also why Dallas requires both a push of a button

on the MDT as well as a verbal acknowledgement of response including

address via radio.

Mike

Re: Response Time

<snip>

So be careful about your response times. Be able to back them up with a

policy and, if possible tapes. Don't allow yourself to be made to

speculate.

Gene Gandy