Re: Are Your First Responders Running Too Many Calls?

[Guest guest]

Just for the record, the numbers in the first bullet don't work out. 1.25% of

2900 calls would be 36 + calls. One call in 2900 is slightly over 0.034%.

Still not very many, though. . .

wrote:

Has anyone else seen the details of the Toronto EMS research presented

at

NAEMSP annual meeting January 12th?

All I have found so far is review article in the February edition of EMS

Insider but they are saying Chief Alan Craig received a standing ovation and

proclaimed as absolutely elegant for his presentation and some interesting

conclusions are being made from his research of over 250,000 calls such as:

* Only 1.25% or 1 in 2,900 calls resulted in an opportunity for

critical FFR intervention prior to ambulance arrival.

* Realizing that in his urban system 50% of the calls ambulances

reaches the scene before a FFR unit.

* But if this model had been used, emergent FFR responses would have

been decreased by 82% in his system.

* Should FFR be done by vehicles other than large fire apparatus?

Excellent work and appears to me to just be the beginning into some very

interesting areas of research that could impact system design worldwide.

Jim<

[Guest guest]

This is the full abstract:

IMPROVING THE SPECIFICITY OF URBAN FIREFIGHTER " FIRST RESPONSE " BY MODELING

THE PROBABILITY OF CRITICAL INTERVENTION BEFORE EMS ARRIVAL Alan M. Craig,

Rick Verbeek,

Schwartz. Toronto EMS, Toronto, Ontario, Canada

Objective: To derive a method to test the specificity of urban firefighter

" first response " by modeling the probability of firefighter critical

intervention before EMS paramedic arrival in an EMS system using the Medical

Priority Dispatch System (MPDS). Background: Many fire departments dispatch

defibrillator-equipped nonparamedic resources to selected EMS calls

intending to deliver time-sensitive interventions prior to EMS paramedic

arrival. Truly critical cases are rare (<1%), and " hot " responses by

Firefighter First Responders (FFRs) are associated with risk to responders

and the public. Furthermore, EMS paramedics often arrive before FFRs.

Methods: Patient records 182,635 from an urban EMS system over 16 months

were reviewed to establish the cumulative rate of defibrillation, CPR, or

critically ill/injured patients for each MPDS determinant. A generalized

multiplier model was developed, which predicts the probability of FFR

critical intervention for various rates of firefighter arrival before EMS.

MPDS determinants with more than 1% probability of FFR intervention before

EMS arrival were designated as warranting " hot " response. Determinants with

a probability of intervention between 0.4% and 1% were redesignated as

nonemergency ( " cold " ) responses to provide on-scene assistance to

paramedics.

Where the probability of intervention was less than 0.4%, firefighter

response was considered futile.

Results: In the study community, firefighters are " firston-scene " in 50% of

calls. This model would have reduced annual FFR " hot " responses by 76% (from

62,900 to 15,300) by restricting " lights-and-siren " response to MPDS

determinants with a probability of critical intervention before EMS arrival

of greater than 1%. 36,500 responses were downgraded to safer nonemergency

runs, and 11,100 responses were eliminated as medically futile. The

specificity of FFR response was improved from 75.2% (95% CI: 75.0%-75.4%) to

94.3% (95% CI: 94.3%-94.4%). The model produced a threefold improvement in

positive predictive value from 3.2% to 9.5%, with the negative predictive

value increasing from 99.7% to 99.9%. Modeling higher rates of FFR

" First-on-Scene " increased calls designated as " hot " responses but rapidly

degraded specificity (if 1% cutoff for " hot " response is maintained).

Conclusions: This model improves the specificity of firefighter response to

EMS calls and should be validated prospectively.

From: texasems-l [mailto:texasems-l ] On

Behalf Of STEVE BOWMAN

Sent: Monday, February 12, 2007 1:32 PM

To: texasems-l

Subject: Re: Are Your First Responders Running Too Many Calls?

Just for the record, the numbers in the first bullet don't work out. 1.25%

of 2900 calls would be 36 + calls. One call in 2900 is slightly over 0.034%.

Still not very many, though. . .

<jimmnn@... <mailto:jimmnn%40comcast.net> > wrote:

Has anyone else seen the details of the Toronto EMS research presented at

NAEMSP annual meeting January 12th?

All I have found so far is review article in the February edition of EMS

Insider but they are saying Chief Alan Craig received a standing ovation and

proclaimed as absolutely elegant for his presentation and some interesting

conclusions are being made from his research of over 250,000 calls such as:

* Only 1.25% or 1 in 2,900 calls resulted in an opportunity for

critical FFR intervention prior to ambulance arrival.

* Realizing that in his urban system 50% of the calls ambulances

reaches the scene before a FFR unit.

* But if this model had been used, emergent FFR responses would have

been decreased by 82% in his system.

* Should FFR be done by vehicles other than large fire apparatus?

Excellent work and appears to me to just be the beginning into some very

interesting areas of research that could impact system design worldwide.

Jim<

[Guest guest]

Does this mean that FRs should give up or limit responding....I think

not. Maybe the word 'FIRST' and mind set in " First Responder' needs to

be changed to 'Co-Responder'. More hands on deck during any call is

going to benefit the patient. Even if they arrive after the ambulance,

a five man crew is better than a 2 man crew. Maybe the next study needs

to look at time and patient care efficiency variables in relation to the

overall number of responders.

-MH

>>> STEVE BOWMAN 2/12/2007 1:32 pm >>>

Just for the record, the numbers in the first bullet don't work out.

1.25% of 2900 calls would be 36 + calls. One call in 2900 is slightly

over 0.034%.

Still not very many, though. . .

wrote:

Has anyone else seen the details of the Toronto EMS research

presented at

NAEMSP annual meeting January 12th?

All I have found so far is review article in the February edition of

EMS

Insider but they are saying Chief Alan Craig received a standing

ovation and

proclaimed as absolutely elegant for his presentation and some

interesting

conclusions are being made from his research of over 250,000 calls such

as:

* Only 1.25% or 1 in 2,900 calls resulted in an opportunity for

critical FFR intervention prior to ambulance arrival.

* Realizing that in his urban system 50% of the calls ambulances

reaches the scene before a FFR unit.

* But if this model had been used, emergent FFR responses would have

been decreased by 82% in his system.

* Should FFR be done by vehicles other than large fire apparatus?

Excellent work and appears to me to just be the beginning into some

very

interesting areas of research that could impact system design

worldwide.

Jim<

[Guest guest]

I echo Mike and also ask this: What evidence exists that " MPDS

determinants " have any factual validity whatsoever? If this study is based on

MPDS

determinants, and those determinants cannot be proven to have anything more than

statistical validity, then the whole study is flawed, isn't it?

Is MPDS any better than System Status Management at predicting anything about

a call? Or is MPDS just another scheme to make money by selling snake oil

in a bottle labeled " valid data? "

Also, I might add, if FFR is unneeded, then how are fire departments going to

justify keeping all those guys and gals on the payroll just to sit around the

station and wait for the occasional fire call to come in? Why do they need

all those big red vehicles? In fact, what good are fire officers? There are

way too many of them, aren't there? And they make very high salaries. Take

away the administrative duties associated with the first response system, and

you could easily get by with 1/2 or maybe even 1/4 the current number of fire

officers. After all, how often are you working more than one major fire

incident at a time?

Without EMS first response duties, most fire services would have only maybe

15-20% of the calls they now respond to. Hey, Mr. Mayor, Mr. City Manager,

Ms. City Council President, you're spending way, way too much money on the fire

service. They're not needed. You can save millions by closing 80% of the

fire stations, selling 80% of the equipment, and laying off 80% of the

firefighters. Get rid of all those high priced fire officers, and you can cut

your

city's budget substantially and LOWER TAXES.

Now, have I got a deal for YOU! Close the fire department and put out a

Request for Proposal (RFP) for a private service to take over the fire duties.

Private business can do anything better than government and at substantial

savings. Go for the lowest bidder!

And, while we're at it, think about putting the PD out for bid also. Brinks

security or Blackwater would surely be interested. Just think about what

police officers make and what security guards make. The savings could be

dramatic.

I think we may be onto something here.

Maybe the Firefighter/Trash Removal Technician model isn't so far fetched

after all.

Skeptics want to know.

Gene Gandy

>

> Does this mean that FRs should give up or limit responding..Does this

> not. Maybe the word 'FIRST' and mind set in " First Responder' needs to

> be changed to 'Co-Responder' be changed to 'Co-Responder'<wbr>. Mor

> going to benefit the patient. Even if they arrive after the ambulance,

> a five man crew is better than a 2 man crew. Maybe the next study needs

> to look at time and patient care efficiency variables in relation to the

> overall number of responders.

>

> -MH

>

> >>> STEVE BOWMAN 2/12/2007 1:32 pm >>>

> Just for the record, the numbers in the first bullet don't work out.

> 1.25% of 2900 calls would be 36 + calls. One call in 2900 is slightly

> over 0.034%.

>

> Still not very many, though. . .

>

> wrote:

> Has anyone else seen the details of the Toronto EMS research

> presented at

> NAEMSP annual meeting January 12th?

>

> All I have found so far is review article in the February edition of

> EMS

> Insider but they are saying Chief Alan Craig received a standing

> ovation and

> proclaimed as absolutely elegant for his presentation and some

> interesting

> conclusions are being made from his research of over 250,000 calls such

> as:

>

> * Only 1.25% or 1 in 2,900 calls resulted in an opportunity for

> critical FFR intervention prior to ambulance arrival.

> * Realizing that in his urban system 50% of the calls ambulances

> reaches the scene before a FFR unit.

> * But if this model had been used, emergent FFR responses would have

> been decreased by 82% in his system.

> * Should FFR be done by vehicles other than large fire apparatus?

>

> Excellent work and appears to me to just be the beginning into some

> very

> interesting areas of research that could impact system design

> worldwide.

>

> Jim<

>

>

[Guest guest]

> And, while we're at it, think about putting the PD out for bid

> also. Brinks

> security or Blackwater would surely be interested. Just think

> about what

> police officers make and what security guards make. The savings

> could be

> dramatic.

So would the theatrics...

But, to echo Gene, if we're willing to allow private EMS to assume a

public safety role, why not allow private fire and private police? I

think I could argue that police are a " state " function, but I can see

Gene's point.

Why not take the Carol Strayhorn approach and if you can find it in

the yellow pages, government shouldn't be doing it - they should be

buying it?

Mike