High Performance EMS: System Design, Metrics, and Outcomes

The Five D's of EMS Planning

The five D's that Emergency Medical Services (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—financial stability, for example. Some systems also exclude certain members of a community based on factors such as patient refusal or provider refusal of services (Dean, 2004).

The High Performance EMS Model and Public Utility Foundation

The High Performance EMS (HPEMS) model can address many issues in system response and the quality of care that the system is likely to generate for the local community. The HPEMS system is based on the Public Utility Model (PUM), and a range of metrics have been developed to measure system performance since its introduction and the first study of the Kansas City, MO, system in 1997 (Overton, 2002).

One of the most important factors in system design is strategic development—and more specifically, strategic planning. Having a set of metrics to assist system design can provide a model and a baseline that help stakeholders identify needs, risks, and other critical components. The public utility model is essentially a natural monopoly tasked with protecting the public's health in times of need. This model operates with limited or no competition and should make patient health its highest priority, while also being subject to public oversight (Dean, 2004). Having a metric system in place can help ensure these outcomes for all patients regardless of their ability to pay; since it is a monopoly, patients cannot call another provider (Stout, 1985).

Human and Organizational Factors in System Design

System design may not always be the most decisive factor in ensuring patient outcomes, and many additional 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 apparently no one had the foresight to anticipate (The Grand Jury, 2004). The region linked its dispatch system between the two organizations, and in the wake of the merger there were cultural conflicts, allegations of rampant harassment, and even on-the-job drug and substance abuse. This case illustrates that even with the best-designed system imaginable, EMS planners must also account for the human factors inherent in organizational culture.

Conclusion

It is likely that King County's achievements could not have been met without the early work of the public utility model, which provided a foundation for future metric development in EMS. System design, strategic planning, and accountability metrics are all essential tools—but as the San Francisco case demonstrates, organizational culture and human factors must be addressed with equal rigor for any EMS system to fulfill its mission.

References

Dean, S. (2004). Public utility model EMS. EMS, 87–91.

Overton, J. (2002). High performance EMS: Market study 2002. North American Association of Public Utility Models, 1–91.

Public Health – Seattle & King County. (2015). 2014 annual report. Seattle: King County Council.

Stout, J. (1985). Public utility model revisited. JEMS, 71–74.

The Grand Jury. (2004). The merger of emergency medical services and the San Francisco Fire Department: Match made in heaven or shotgun wedding? Report for the City and County of San Francisco, 1–31.