Improving Ambulance Response

Improving Ambulance Response

The Anne Arundel County Fire Dept. announced that implementing Joanna's recommendation
slashed dispatch times in half


The most important job of a local government is to keep its citizens safe.  When your spouse has a heart attack or your child is choking, you need to know that well-trained paramedics will be there to help as quickly as possible.

Unfortunately, Anne Arundel County is not meeting national standards for ambulance response times.  According to the National Fire Protection Association (NFPA), a first responder should arrive within six minutes of a 911 call 90% of the time.  In Anne Arundel County, an analysis of the 14,439 ambulance calls during the 4th quarter of 2010 found that a first responder arrived within six minutes only 21% of the time, and it took 12.5 minutes (more than twice the six minute standard) to cover 90% of all calls.

For most calls, whether the ambulance arrives in 6 minutes or 12.5 minutes doesn’t make that much of a difference.  However, for life-threatening emergencies such as cardiac arrest, survival rates decrease by 7%-10% for every one-minute delay in starting CPR and defibrillation.

Our hardworking firefighters, both career and volunteer, are doing everything in their power to arrive quickly.  However, there appear to be several things we could improve about the processes the Fire Department follows.  Of these, dispatching ambulances (i.e., ordering a fire house to send an ambulance to a location) more quickly offers the best option of immediately improving our ambulance response times.  

The NFPA standard states that an ambulance should be dispatched within 60 seconds of a 911 call 90% of the time and within 90 seconds 99% of the time.  In Anne Arundel County, only 3% of our calls are dispatched within 60 seconds and 13% within 90 seconds.  It takes 134 seconds (2¼ minutes) on average to dispatch an ambulance and many of our calls last much longer before a dispatch order is given.  We often use more than half of the six minutes the ambulance has to arrive on scene asking questions on the phone!

This is a serious problem that potentially affects every resident of our county.  Eventually we need to upgrade our 911 call processing center so that all operators are trained to handle police, fire, and medical calls, saving the current 19-second delay between when the police answer the call and the call is transferred to a fire department call-taker.  Only one other county in the state uses such an inefficient system.  

But even without this change, we should be able to shave one to two minutes off our ambulance dispatch times by ordering an ambulance on its way as soon as the call-taker has verified location information and the type of emergency.  While the dispatcher is doing this, the call-taker would remain on the phone providing assistance and collecting more detailed information which could be shared with the medical team once they are en route if necessary.  This simple change would improve safety at no cost.      

While on the phone, call-takers gather information to determine whether to send an Advanced Life Support (ALS) ambulance or a Basic Life Support (BLS) ambulance.  However, there’s no reason to take several minutes making this decision.  Experienced call-takers typically have enough information to judge what type of ambulance is necessary within 45 seconds.  In addition, the county only has 6 staffed BLS ambulances compared to 26 staffed ALS ambulances, and we send an ALS ambulance on 82% of all calls anyway.    

Dispatching ambulances within 60 seconds is a reasonable objective we should set for ourselves.  A recent analysis of 14 fire departments across the country found that they were dispatching within 60 seconds 80% of the time.  Howard County, which uses the same call-taking system as we do, takes an average of 60 seconds to dispatch their ambulances.

Just as in the business world, every government agency should be continually analyzing their performance and implementing cost-effective improvements such as this.  I encourage the Fire Department to dispatch ambulances earlier in the 911 call and to search for other means to improve our ambulance response times.  


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