1. Ambulance Response Times Tim Meyer, Director North Dakota Department of Health Division of EMS and Trauma December 2, 2008

2. North Dakota Ambulance Services 139 ground ambulance services 139 ground ambulance services 120 BLS, 19 ALS 120 BLS, 19 ALS 5 air ambulance services 5 air ambulance services ALS services do 72% of all calls in ND. ALS services do 72% of all calls in ND. Over 3,400 EMS workers in ND Over 3,400 EMS workers in ND 88% are volunteers 88% are volunteers Average age is 42; 17% are over 65 Average age is 42; 17% are over 65

3. What Are the Costs of EMS? It costs between $250,000 and $300,000 per year for each ambulance service (estimated at $40m to $50m per year statewide). It costs between $250,000 and $300,000 per year for each ambulance service (estimated at $40m to $50m per year statewide). Labor. Labor. Vehicle expenses; depreciation, fuel, maintenance. Vehicle expenses; depreciation, fuel, maintenance. Medical supplies. Medical supplies. Personnel training. Personnel training. Building/facilities. Building/facilities.

4. Who Pays for EMS? $2.8m in local taxes on behalf of EMS. $2.8m in local taxes on behalf of EMS. $1.25m state staffing grant (625k per year). $1.25m state staffing grant (625k per year). $1.24m state training grant (620k per year). $1.24m state training grant (620k per year). Volunteer labor (est. $17m to $21m per year). Volunteer labor (est. $17m to $21m per year). Third party payors: Medicare, Medicaid, Blue Cross Blue Shield, etc. (est. $23m to $33m per year). Third party payors: Medicare, Medicaid, Blue Cross Blue Shield, etc. (est. $23m to $33m per year).

6. Data Collection Data regarding each ambulance call must be submitted to the Department (NDAC 33-11- 01.2-10(5)). Data regarding each ambulance call must be submitted to the Department (NDAC 33-11- 01.2-10(5)). Web-based system called SOAR (Statewide Online Ambulance Reporting). Web-based system called SOAR (Statewide Online Ambulance Reporting). Our dataset matches national requirements. Our dataset matches national requirements. In 2007 we received data from over 57,000 ambulance calls. In 2007 we received data from over 57,000 ambulance calls.

7. Response Time Data We collect the following times: We collect the following times: 911 call time. 911 call time. Time notified by dispatch. Time notified by dispatch. Time enroute. Time enroute. Arrive scene time. Arrive scene time. Depart scene time. Depart scene time. Arrive at facility time. Arrive at facility time. Time available for next call. Time available for next call. Time back in quarters. Time back in quarters.

8. Response Times Data Problems Subjective – self reporting. Subjective – self reporting. Probable errors: Probable errors: Frontier counties have an average response time of over 55 minutes (DOT FY 2007). Frontier counties have an average response time of over 55 minutes (DOT FY 2007). Multiple entries of over 1.5 days. Multiple entries of over 1.5 days. Not uniformly using a 3 rd party (dispatch) to record times. Not uniformly using a 3 rd party (dispatch) to record times. Services are not reporting all calls to us. Services are not reporting all calls to us. Cancelled runs, no transports, stand-bys, DOA, etc. Cancelled runs, no transports, stand-bys, DOA, etc.

9. Who Cares? National push for public reporting of health quality data: National push for public reporting of health quality data: Health plans - 1998 Health plans - 1998 End stage renal disease facilities - 2001 End stage renal disease facilities - 2001 Nursing homes - 2002 Nursing homes - 2002 Home health - 2003 Home health - 2003 Hospitals - April 2005 Hospitals - April 2005 Clinics – forthcoming Clinics – forthcoming EMS – within next 5 years EMS – within next 5 years

10. Quality and Pay for Performance 2005 – 2007 hospital Medicare payment updates (periodic increases) tied to quality; “Pay for Performance”. 2005 – 2007 hospital Medicare payment updates (periodic increases) tied to quality; “Pay for Performance”. Ambulance services will be reimbursed in this manner in the future. Ambulance services will be reimbursed in this manner in the future. Response times will be a quality indicator for ambulance services. Response times will be a quality indicator for ambulance services. 2007 Legislature requires us to establish response time standards for ambulance services. 2007 Legislature requires us to establish response time standards for ambulance services.

11. What if We Do Nothing? Aging workforce will eventually = less volunteers. Aging workforce will eventually = less volunteers. Failing to meet basic quality indicators will = less payment to ambulance services. Failing to meet basic quality indicators will = less payment to ambulance services. Less funds will = less ambulance services. Less funds will = less ambulance services. Less ambulance services will = longer response times for the public and more burden on remaining ambulance services. Less ambulance services will = longer response times for the public and more burden on remaining ambulance services.

12. Our Plan Encourage EMS system development. Encourage EMS system development. Improve the quality of the EMS delivery system. Improve the quality of the EMS delivery system. Assist ambulance services in establishing their own quality assurance processes. Assist ambulance services in establishing their own quality assurance processes. Monitor patient care benchmarks. Monitor patient care benchmarks. Establish response time standards. Establish response time standards. Educate EMS providers to improve communications with dispatch. Educate EMS providers to improve communications with dispatch. Give the public the best possible emergency care. Give the public the best possible emergency care.

13. What can PSAPs do? PSAPs are the gate keeper of response time data – Objective Third Party. PSAPs are the gate keeper of response time data – Objective Third Party. Is it possible to get an export file on a monthly basis? Is it possible to get an export file on a monthly basis? 911 call time, time notified by dispatch, time enroute, arrive scene time, depart scene time, arrive at facility time, time available for next call, and time back in quarters. 911 call time, time notified by dispatch, time enroute, arrive scene time, depart scene time, arrive at facility time, time available for next call, and time back in quarters.

14. Continued The Health Department would do all QA activity. The Health Department would do all QA activity. We will work to improve the communications of EMS agencies. We will work to improve the communications of EMS agencies.

15. Questions???? Tim Meyer, Director Division of EMS and Trauma North Dakota Dept. of Health 600 E. Blvd. Ave., Dept. 301 Bismarck, ND 58505-0200 701-328-2388tmmeyer@nd.govndhealth.gov/ems Lindsey Narloch, Research Analyst Division of EMS and Trauma North Dakota Dept. of Health 600 E. Blvd. Ave., Dept. 301 Bismarck, ND 58505-0200 701-328-2388 lindseybnarloch@nd.gov ndhealth.gov/ems