King County's Medic One/EMS system structure and organization

King County, WAshignton

Demographics of the System

King County, Washington

Service Area

Population Density

Economic Indicators from Census Data

Structural Attributes of the EMS System

Geographic Scope

Standard Setting and Enforcement

Division of Functions

Market Allocation

Failure to Perform -- Consequences

Business Structure

Management Level

Demographics of the System

King County, Washington

King County, Washington is the most populace county in the state of Washington as well as in the top 15 most populated counties in the United States (13th). The county has a total land area of 2,307 square miles with slight over eight percent of this area being water (United States Census Bureau, 2015). The area is known for being a center for liberal politics and Seattle is one of the most liberal cities in the country and has elected socialist councilmembers, gay mayors, endorsed the "War on Christmas," has strongly supported environmental movements, and is among the top five cities with the fewest cars; however, although Seattle and King County are often associated with liberalism in its politics and its policies, some argue that there are still many strong conservative elements despite its strong progressive tendencies (Anderstone, 2014). King County was actually renamed in 2005 to honor Dr. Martin Luther King Jr. as opposed to the original founder who also shared the last name King.

Population

King County, Washington, has a population of just over two million people based on an 2014 estimate of population that is derived from an extrapolation of the official U.S. Census Bureau report that was conducted in 2010; in 2010 the population figure was noted as 1,931,256 (United States Census Bureau, 2015). The population growth in the county has been estimated at roughly eleven percent which also occurred during a period of flat job growth and indicates a rate of growth that is not based on the county's economic performance and job opportunities (King County, 2013). The 20th century ushered in a period of rapid population growth and industrialization in the region.

Service Area

The Emergency Medical Services (EMS) Division of Public Health - Seattle & King County represents a complex network of different responders and providers. The network is organized under a Medic One/EMS system that provides coordination and standardization efforts within the system. For example, there is standardized EMT training, continuing education, dispatcher training and code standardization, and even data collection provided by the Medic one organization. Whenever anyone has a medical emergency and dials 9-1-1, they are utilizing a system called Medic One/EMS, which aims to enhance survival rates and abate disability from emergencies that take place outside of the hospital in the county through the provision of effective and high-quality patient care prior to entering clinical and hospital settings. In order to achieve this, the Division abides by a medical paradigm that integrates a philosophy predicated on collaborative decision-making, and the devising and cultivation of seminal, groundbreaking strategic initiatives that respond to the importunity for services and stimulate the efficacy of the system. As such, all programs in the EMS Division are devised to amplify these endeavors and are cultivated vis-a-vis potent partnerships with other important regional EMS agencies in addition to avant-garde leadership and administration within the emergency medical field. (Public Health - Seattle & King County, 2015, pp. 6-7).

Population Density

The area within King County is geographically diverse with points that are at sea level as well as many points of high altitude; the same can be said about its human population with a significant amount of area being highly-dense in population and urbanized, while other areas being mostly rural with a low population density (Vance-Sherman, 2015). Seattle, the regions urban center, is one of the most population dense cities in the United States. "Of the 366 "Metropolitan Statistical Areas" the Census Bureau tabulated, in the 2010 census Seattle-Tacoma-Bellevue came 24th in population-weighted density at 4721.6 people per square mile, although it's 15th in overall population at 3.4m people" (Duke, 2012). However, the city is rapidly becoming denser with further population growth and much of this density is increasing through diversity.

Figure 1 - Seattle's Diversity (King County Council, 2013)

Economic Indicators from Census Data

The region can be categorized by a wage and income rate that was significantly higher than the country's average and there were also far fewer people living in poverty relative to state and national averages (Vance-Sherman, 2015). Seattle's progressive government was one of the first in the country to institute a significantly higher minimum wage ($15 dollars an hour). The program has so far been argued to be a success.

Within the time period between January 2014 and December 2014, the business owners within Seattle and Takoma and their customers have been absorbing the price of paying employees minimum wage, or $15 an hour. In addition, unemployment diminished by over 15%, thereby falling from 6.3% TO 5.2%. Surprisingly, people have the agency to increase the minimum wage at an exponential rate with regards to increments in addition to elevating employment rates concurrently. (Worstall, 2015).

The fact that King County is largely progressive and also a strong economy has had major implications for public services include the county's Emergency Management System (EMS).

Structural Attributes of the EMS System

Geographic Scope

The Medic One/EMS system in King County covers the full range of the county's boundaries and in some cases actually extends beyond these boundaries as it coordinates with neighboring systems. According to Vance-Sherman (2015) the regional context can be described as:

The Medic One/EMS system in King County covers the full range of the county's boundaries and in some cases actually extends beyond these boundaries as it coordinates with neighboring systems. According to Vance-Sherman (2015) the regional context can be described as a county with borders that are located between Puget sound on the west side and the Cascade Range on the east, which is King's County. King County is perceived as a very diverse cultural and geographical region, as its elevation levels oscillate, "with points at sea level and a high point of nearly 8,000 feet"(Vance-Sherman, 2015 ). King's County also contains a diverse and vast array of human geographies because of how densely populated it is in urban spaces along the coast of Puget Sound, in rural communities that are located at the southeast and in alienated towns in the Cascade foothills. Interesting, only 39 cities and towns are identified in King's County. (Vance-Sherman, 2015).

Market Allocation

The Medic One/EMS system retains a degree of distinction with regards to how it is funded primarily attributable tao the elevated rates of economic development in the regions in addition to the leadership of political progressives. The Medic One/EMS system is validated and strengthened by various levy funds that result in the provided services less valuable but not immune from the boom and busts of the economy and a system that has preserved its monetary homeostasis and futility despite the onset of the an debilitating economic recession (Public Health-Seattle and King County, N.d., pp. 10-11).

In 2012, a levy was proposed and passed for a rate of 33.5 cents/$1,000 ad valorem (AV) or property tax, which translated into the average homeowner having to pay an estimated $107 annually beginning in 2014 if he or she wants to have instant access to emergency care 24 hours a day, 7 days a week throughout King County (Public Health -- Seattle and King County, 2013, pp. 8-9). This annually fee is $3 less than homeowners on average paid in 2008 for identical services. EMS systems have continued to shore up its financial and operation inefficiencies, which has enabled it to provide high-quality EMS services at an affordable price (Public Health -- Seattle and King County, 2013, pp. 8-9). Comment by a: Define.

Figure 2 - King County Levy Financial Breakdown (Pubic Health - Seattle and King County, 2013)

Failure to Perform -- Consequences

The Medic One/EMS system is responsible for managing the entire King County EMS system and this organization has gained its funding from the levy instituted with the county's property tax. The system must be accountable to the public and continue to provide high standards of service that also creates value financially by operating efficiently and effectively in terms of resource usage and funding levels. If the system was unable to create a strong value proposition for public oversight, the consequences would include the public losing confidence in the system and not approving future levies. Comment by a: Not sure it is unique to have a tax subsidy. If you believe it is, please explain why.

Business Structure

The business structure for the Medic One/EMS system is a complex network of various organizations and providers. The Medic One/EMS System in King County is distinctive from other systems in that it (a) is medically based, (b) is regional, and (c) uses tiered out-of-hospital response (Public Health - Seattle & King County, 2015, p. 6). The Medic One/EMS system is the centralized unit that provides universal access to everyone in the county, manages the dispatcher triage protocols, and organizes BLS, ALS, and transport to the hospitals.

Management Level

The Medic One/EMS system's management is specialized relative to the organizational role within the system and there specific objectives. The leadership for the Medic One/EMS centralized coordinating role is the highest level of management in the system and has roles that focus on quality and efficiency in the system.

The leadership of the Medical Program Director ensures the success and the ongoing medical quality improvement of the EMS system. Mickey Eisenberg, MD, PhD, opted to take on this important role for more than a decade. His obligations included devising and implementing protocols, validating and overseeing the efficacy of EMT pedagogy and promoting ways to improve medical education, thereby approbating any and all medical education for EMT technicians when needed (Public Health - Seattle & King County, 2015, pp. 6-7).

Furthermore, on a high level, management is also assisted by advanced system metrics that allow leaders to continually evaluate performance standards in terms of quality and efficiency metrics and even conduct simulations to ensure that all objectives are being met. The EMS division has adopted a mantra of "measure and improve" and the system and its performance are constantly being monitored for potential areas of improvement (Public Health - Seattle & King County, 2015, p. 17).

Figure 3 - Example of a Medical Quality Improvement Study in King County (Public Health - Seattle & King County, 2015, p. 17)

Although the management function and related metrics are well-defined on a high-level, the EMS system must also measure performance and meet management objectives on a regional and tactical level. Regional Strategic Initiatives for the system address issues such as (Public Health - Seattle & King County, 2015, p. 9):

Uniform training of EMTs and dispatchers

Regional medical control and quality improvement

Injury prevention programs

Regional data collection and analysis

Regional planning for the EMS system

Financial/administrative management

The "measure and improve mantra" has been integrated to each level of management in the Medic One/EMS system and serves as a foundation for evidence-based management of the entire system to ensure that it provides quality and efficiency to the residents of Seattle and King County, Washington.