5 Ds and Hpems

¶ … HPEMS Processes The five D's that EMS planners need to address can be thought of as death, disability, discomfort, destitution, and dissatisfaction. The goal of a high performance EMS process is to mitigate potential damages in each of these categories to the highest extent possible. There are many different strategies that can be used to create relevant metrics and guide a system's design. Most people assume that patient care is the highest priority among all EMS systems, however this is not necessarily always the case (Dean, 2004).

Some systems, whether intentionally or not, may favor other metrics over patient care such as financial stability for example. Some system exclude certain members of a community based on certain factors such as patient refusal or provider refusal for services (Dean, 2004). The high performance EMS (HPEMS) model can address many issues in the response and the quality of care that the system is likely to generate for the local community.

The HPEMS system is based off the public utility model (PUM) and there have been a range of metrics to measure system performance since its introduction and first study of the Kansas City, MO, system in 1997 (Overton, 2002). One of the most important factors relative to system design can come from strategic development and more specifically strategic planning. Having a set of metrics to assist system design and the strategic design can provide a model and a baseline that can help stakeholders to identify needs and risks among other critical components.

The public utility model is essentially a natural monopoly tasked to protect the public's health in times of need; this model has limited, or no, competition and should make patient health the highest priority as well as be subjected to oversight (Dean, 2004). Having a metric system in place can provide a means to ensuring these outcomes for all patients regardless of their ability to pay; since it is a monopoly, patients cannot call another provider (Stout, 1985).

System design may not always be the most relevant factor to ensuring patient outcomes however and many more influences must be considered. For example, in one case study, a merger of the Department of Public Health (DPH) and the San Francisco Fire Department (SFFD) resulted in a cultural clash that no one apparently had the foresight to suspect (The Grand Jury, 2004).

The region linked its dispatch system between the two organizations and in the wake of the merger there were cultural clashes, allegations of rampant harassment, and even drug and substance abuse that occurred on the job -- thus even with the best designed system imaginable, EMS planners must also consider the human factors that are inherent in organizational culture. The Emergency Medical Services Division of King County has several well-designed metric systems that contribute to its overall effectiveness.

The county has implemented a tiered response system for example to free resources and establish economic efficiencies (Public Health - Seattle & King County, 2015). This system is being closely monitored to ensure that patient outcomes are not sacrificed for the benefit of other metrics. Many other metrics have also been refined in this system as well. The EMS team in King County serves nearly two million people in the local area and states that they provide lifesaving services on average.