Tri-State Ambulance 2011 Community Report

Transcription

1 Tri-State Ambulance 2011 Community Report Clinical Performance and Accomplishments Cardiac Arrest Survival Rate According to national data published in 2005 by the American Heart Association, 5.4 percent of all patients who suffer a sudden cardiac arrest in the non-hospital setting survive to be discharged from the hospital(1). Tri-State Ambulance, along with area first responders and citizens, achieved an impressive 13.8 percent discharged normal rate in 2011 for all treated cardiac arrests in the Tri-State Ambulance service area, more than twice the national average in this category! A recent comprehensive study of Emergency Medical Services (EMS) system performance for cardiac arrests involved a number of U.S. cities (see graphic). This study looked at patients who were discharged from a hospital after suffering a cardiac arrest in which the event was witnessed and the victim was in a shockable heart rhythm (where a defibrillator could be used). The study showed a wide range of performance throughout the nation and placed King County, Wash. and Rochester, Minn. as the leaders. Although the communities where Tri-State provides ambulance service were not involved in this study, measuring with the same criteria, the Tri-State Ambulance service area achieved an impressive 45 percent of cardiac arrest victims who survived to be discharged from a hospital in This quality measure has remained consistent with a five-year average of percent. Superior medical care by Gundersen Lutheran, Mayo Clinic Health System La Crosse and Vernon Memorial medical centers as well as early CPR and defibrillation by area first responder agencies also contributed to achieving this outcome. The Gundersen Lutheran/Tri-State Ambulance Emergency Medical Dispatch Center also played a large role by instructing sixty-three 911 callers in providing lifesaving medical care, such as CPR, prior to EMS arrival. In addition, carefully controlling the number of paramedics in the system has enabled the average Tri-State paramedic to treat 3.6 cardiac arrests annually; nearly twice the national average (2). This high utilization rate helps produce our impressive cardiac arrest survival rate and places our system among the best in the nation. Advanced Airway Proficiency One of the most critical skills performed by paramedics is advanced airway placement. Advanced airways can include endotracheal intubation, the technique of placing a breathing tube into the trachea (windpipe) of a patient who is not breathing or is breathing inadequately. In 2011, Tri-State paramedics were able to successfully intubate patients 85 percent of the time. In those cases where endotracheal intubation wasn t successful, another type of advanced airway was used allowing Tri-State paramedics to arrive at area medical centers with advanced airways 95 percent of the time.

2 Electronic Patient Care Reporting and Tracking Tri-State Ambulance continues to record and track all patient-related data on notebook computers in our ambulances. Electronic information assures accurate patient records and allows Tri-State Ambulance s medical director and quality assurance team to provide real-time quality assurance reviews of our paramedics. This system also facilitates accurate retrospective data analysis of all patient care done by our medical professionals. By continuously analyzing patient data, we are able to constantly improve our delivery model. In 2011, Tri-State Ambulance further advanced its patient related technology by becoming 100 percent paperless. Tri- State was able to do this by developing a method of where our paramedics and EMTs can scan any paper document into digital format and attach it to an individual patient s medical record. The future of electronic data reporting and patient information gathering looks promising. Tri-State Ambulance has the electronic infrastructure in place to support upcoming information technology initiatives by the federal government and partner medical centers. Innovative Cardiac Alert Protocol Working with both Gundersen Lutheran and Mayo Clinic Health System La Crosse, Tri-State Ambulance and our medical director continue to use our Cardiac Alert protocol which allows paramedics in the field to activate the hospital cardiac catheterization teams prior to the patient arriving at the hospital. This early activation significantly reduces the time between when a patient s heart attack is diagnosed and the time the patient receives definitive intervention at the receiving hospital. With heart attack patients, every minute is crucial to survival and long-term heart health. In 2009, Tri-State Ambulance added the ability for our paramedics to electronically transmit a patient s diagnostic EKG directly to cardiologists and emergency room physicians via . This technology has drastically reduced the number of critical minutes it takes to admit a heart attack patient to a cardiac catheterization lab where the blocked blood vessels are again opened. Specialty Care Services and Training Level In addition to our high clinical performance and skill utilization, Tri-State Ambulance continues to embrace and implement the latest industry lifesaving procedures, medication and services. Tri-State Ambulance, in conjunction with Gundersen Lutheran, offers critical care interfacility transports from smaller hospitals back to Gundersen Lutheran or Mayo Clinic Health System La Crosse. This service uses critical care-trained paramedics and nurses to create a mobile intensive care ambulance. Nearly half of Tri- State s paramedics are trained to this critical care level. These are the same paramedics who respond to 911 calls in the La Crosse area while not on transfers. Because of this high level of certification, La Crosse area residents are cared for by some of the nation s highest trained critical care paramedics.

3 Operational Accomplishments Strategic Deployment of Ambulances Tri-State Ambulance continues to deploy ambulances strategically throughout the region by using System Status Management which stages or posts ambulances in and around the La Crosse area based on historical and projected ambulance demand. This type of ambulance deployment works to maximize the availability of ambulances and offers quick response times to the patients who need it. In 2010, Tri-State Ambulance took deployment one step further by changing the focus from our own response time performance to the response time performance of the entire system. Even though we know that it s relatively simple to place ambulances in areas of high call demand (like downtown La Crosse) and achieve short response times, this practice may not be in the best interest of the patients we serve. For example, we know that patients who experience cardiac arrest, typically our most time-sensitive response type, require a trained responder with an automated external defibrillator (AED) to provide treatment within 5-6 minutes of collapse or their chances of survival decrease by 10 percent for every additional minute. In response, we have chosen to strategically place ambulances in areas around the greater La Crosse area to fill the gaps where first responder agencies are unable to respond in the 5-6 minute window. In addition, we track cardiac arrests and take into consideration any trends in occurrence times and locations. This practice has increased our overall response times slightly, but it is the right thing to do. Ultimately, it makes little sense to park an ambulance near a fire station when we know that the first 5-10 minutes of most ambulance responses require only basic life support treatment already offered by all areas first responder groups. Peak Load Staffing An analysis of historical ambulance data shows when and where Tri-State Ambulance has typically experienced the highest number of ambulance requests for life-threatening situations. Using trends gathered from this analysis, Tri- State is able to staff efficiently and effectively while still bettering response time requirements. A simple example, and one of the most obvious, is to consider that there are 50 percent less ambulance responses after midnight as compared to a typical day. It makes little sense to have the same number of on-duty staff at 3 a.m. as required at 3 p.m.

4 Axis Title 7.00 Tuesday 16 Week Sept-Dec Ambulance Supply Max Peak Average Second Peak Peak Averages Blended Demand Tuesday Example of daily staffing levels compared to run volumes Response Peak Probability 6.25% 12.50% 6.25% 6.25% 12.50% 18.75% 6.25% 12.50% 18.75% 6.25% 6.25% 12.50% 12.50% 6.25% 12.50% 6.25% 12.50% 6.25% 6.25% 6.25% 12.50% 12.50% 12.50% 18.75% Second Peak Probability 31.25% 43.75% 25.00% 31.25% 18.75% 25.00% 18.75% 37.50% 31.25% 6.25% 6.25% 31.25% 6.25% 6.25% 25.00% 12.50% 12.50% 6.25% 6.25% 12.50% 43.75% 68.75% 25.00% 43.75% Contractual Compliance La Crosse County Second Peak or Higher Prob % 56.25% 31.25% 37.50% 31.25% 43.75% 25.00% 50.00% 50.00% 12.50% 12.50% 43.75% 18.75% 12.50% 37.50% 18.75% 25.00% 12.50% 12.50% 18.75% 56.25% 81.25% 37.50% 62.50% Supply (Ambulances) Peak All Peak Count (how many) In the latter part of 2009, La Crosse County formed an EMS Commission made up of elected and appointed officials from various municipalities, villages, and townships. The purpose of the EMS Commission is to work toward regulation and oversight of ambulance services within La Crosse County. Through a collaborative effort between Tri-State Ambulance, commission members and local public safety officials, a comprehensive ambulance contract was finalized and the language unanimously approved. 2nd Peak nd Peak Count Total Avg All Average Peak 1 & Blended Demand - 20wk In the second half of 2010, the members of the commission were asked to bring the contract back to their local governing bodies for approval. Although the contract for ambulance service has not yet been adopted by all towns and municipalities, and is therefore not enforceable, Tri-State Ambulance has continued to meet and exceed the criteria set forth. One of the most prominent topics of the contract is the response time of ambulances. Below are Tri- State s 2011 La Crosse County emergency response time compliance results. Times are measured from the time an ambulance is dispatched until arrival at a scene. Zone 1: The City of La Crosse Monthly reporting 100 percent compliance all months 96 percent of 2,854 lights-and-sirens responses at scene in fewer than 9 minutes (90 percent required) 56 percent at scene in fewer than 5 minutes (50 th percentile) Zone 2: The City of Onalaska, Town of Shelby and Town of Campbell Monthly reporting 100 percent compliance all months 93 percent of 1,135 lights-and-sirens responses at scene in fewer than 11 minutes (90 percent required) 56 percent at scene in fewer than 7 minutes (50 th percentile) Zone 3: Villages of Holmen and West Salem, Towns of Medary and Onalaska Quarterly reporting 100 percent compliance all quarters 92 percent of 675 lights-and-sirens responses at scene in fewer than 16 minutes (90 percent required) 57 percent at scene in fewer than 10 minutes (50 th percentile) Zone 4: Towns of Barre, Farmington, Greenfield, Hamilton, Holland and Washington (Note: The Village of Bangor, Village of Rockland, Town of Bangor and Town of Burns have agreements with other ambulance services and, therefore, are not included) No contractual requirement Annual reporting 95 percent of 195 lights-and-sirens responses at scene in fewer than 25 minutes 52 percent at scene in fewer than 13 minutes (50 th percentile required)

5 Regional Operations and Communications Center In the latter part of 2009 Tri-State Ambulance began searching for a larger facility to accommodate its growth over the past decade. In September of 2011, Tri-State Ambulance, in conjunction with Gundersen Lutheran, purchased a recently renovated 23,400 square foot facility in La Crosse. Plans for the building will be to house not only Tri-State s administrative offices and ambulance deployment facility, but also the Gundersen Lutheran/Tri-State Ambulance Medical Communications Center. This shared space makes great economic sense and allows for future growth of both organizations while sharing property costs. The increased size of the new building has allowed Tri-State to adopt a number of internal processes which will create greater efficiency and significantly aid in reducing operating costs. These include: Expansion of the Tri-State Ambulance training department to offer numerous educational opportunities to not only emergency medical service providers but also community members. Courses such as CPR, First Aid, Emergency Medical Technician, First Responder and incident command training will be just a few of the planned courses to be offered. The addition of a full-time fleet servicing center will provide servicing and maintenance to the more than 40 fleet vehicles operated by Tri-State Ambulance and Tri-State Regional Ambulance. In addition, the fleet department will be contracted with other ambulance services to perform their servicing and maintenance. Consolidated central supply of medical supplies and equipment for disbursement to outlying Tri-State Ambulance locations. Shared facilities and resources for the Gundersen Lutheran Medical Communications Center. The new facility was renovated and Tri-State Ambulance operations began in the early part of Technology Vehicle Area Computer Networks Tri-State Ambulances are all equipped with On-Board Mobile Gateway computers that use high-speed wireless data to communicate with our state-of-the-art dispatch center. These sophisticated on-board computers transmit GPS information to our dispatch center which automatically informs our dispatchers which ambulance to send to the scene of the 911 call based on geographic distance. In addition, our on-board computers give our paramedics access to medical protocols, medication interaction resources, traffic and weather information. Driver Safety and Vehicle Monitoring Tri-State installed its first ambulance black box driver safety monitoring system in This system helps employees ensure that they are driving safely and that patients receive the most comfortable ride possible. In addition, vehicle electronic sensors are monitored so vehicles can be pulled off of the roadway prior to major mechanical problems or failures. Tri-State has seen a significant reduction in maintenance costs since installing these monitors. These black boxes are being installed in all future Tri-State ambulances.

6 Radio Interoperability In the latter part of 2009 and early 2010, Tri-State Ambulance was awarded a $110,000, (20 percent match) grant from the federal government to purchase radio equipment. Since Tri-State responds to emergencies in Wisconsin, Minnesota and Iowa, and has relationships with more than 40 different agencies, it is imperative that Tri-State is able to communicate across numerous radio wave boundaries. The new digital multi-band equipment is capable of communicating with all agencies. In addition to new equipment, Tri-State has been able to lease space on a newly constructed tower high above Lake Onalaska and the Mississippi River. This tower serves as Tri-State s primary transmit-and-receive frequency and has increased the range dramatically since beginning operations in Safer Ambulances Fleet Conversion In the winter of 2011, Tri-State Ambulance took delivery of two new ambulances as part of a four year comprehensive safer ambulances fleet replacement plan. Not only are the new ambulances marked with highly visible lighting and reflective striping, but they are designed to offer both patients and staff a safer, smoother and more secure ambulance ride. The slightly smaller size and switch from diesel motors to gasoline has made our fleet percent less expensive to purchase and 30 to 40 percent less costly to maintain and service. In addition to the higher visibility ambulances, all paramedics and EMTs now have high-visibility outerwear that will help protect them while working dangerous scenes. Emergency Medical Dispatch With the assistance of Tri-State Ambulance, the Gundersen Lutheran Medical Communications Center continues to provide emergency medical dispatch (EMD) services to anyone who calls 911 in La Crosse County, parts of Winona County and Jackson County. EMD is an internationally approved, locally authorized protocol for providing pre-arrival medical instructions to callers for emergency medical services. The protocol also teaches certified emergency medical dispatchers how to determine the proper mode in which the ambulance should respond based on the patient s medical condition. These two parts of EMD help assure that the patient receives medical treatment as soon as the call is placed for an ambulance. It also keeps the community and other drivers safe by appropriately reducing the occurrence of ambulances responding with lights and sirens to non-emergency calls. In 2011, EMD was crucial in the following areas: 149 cardiac or respiratory arrest victims with CPR instructions given when needed 23 labor-and-delivery requests with step-by-step instructions while awaiting an ambulance 436 Chest pain patients where symptoms were deemed as heart related

7 7,687 total requests triaged around the Seven Rivers Region through EMD Fiscal Accomplishments Funding As a non-profit healthcare organization, Tri-State Ambulance provides paramedic, advanced life support service with no taxpayer subsidies. This is impressive considering that across America the majority of 911 ambulance providers receive a tax-funded subsidy. Government-run ambulance services often see as much as 75 percent of their budget as taxpayer supported. The past few years have been financially challenging to the ambulance industry and healthcare in general. Lower insurance reimbursement and higher numbers of uninsured have left countless ambulance providers asking for increased subsidies from their towns or counties. Due to Tri-State s decreased revenue and lower reimbursement, numerous adjustments to its operations have been made without reducing service. Interestingly, Tri-State has actually been able to improve response time performance while at the same time maintaining expenses. Because the service area is large, it provides just enough business for Tri-State to continue to offer excellent service without the need for financial subsidies. This is a very fine balance that would be upset if any changes in coverage area or population were to occur. Keep in mind that a Tri-State Ambulance can respond to calls in La Crosse, La Crescent, Holmen, Nodine, Onalaska, West Salem, Genoa, Coon Valley and Viroqua in the same day very quickly. This regional delivery system creates significant economic efficiency and helps maintain clinical proficiency by giving our paramedics a high call volume throughout the region. Community Service Accomplishments Nation s First AED Loaner Program In the latter part of 2009 and early 2010, Tri-State Ambulance, with assistance from the local chapter of the Sudden Cardiac Arrest Association, received national attention for the creation of an AED (automated external defibrillator) loaner program. The new AED Loaner Program allows the general public to borrow an AED for group events within the Tri-State service area. In 2011, there were seventeen different occasions and 147 total days where an AED was signed out to a community member or group marked another first as one of the Loaner AEDs was used to successfully shock and revive a person suffering from a cardiac arrest at a local fair. This program was created to aid in the treatment and survival of sudden cardiac arrest victims. Contact Tri-State Ambulance for more information or to reserve an AED for an event.

8 Freedom Honor Flight Medical Team 2011 marked the fourth consecutive year where Tri-State Ambulance has donated a contingency of paramedics to assist veterans on a trip to Washington D.C. to view war memorials. The Freedom Honor Flight program in the La Crosse area has been hugely successful and Tri-State is honored to take part. In 2010, Tri-State s involvment with Freedom Honor Flight was featured in an article written for the Journal of Emergency Medical Services (6). Tri- State sent paramedics on two flights in 2011 to make a total of eight flights in four years. Donated Community Service Responses In 2011, Tri-State Ambulance donated services to more than 500 requests from local agencies and patients. This included more than 300 assistance calls where patients were assisted but not injured, greater than 100 public event standbys or safety seminars, 91 combined standbys for area fire or police departments. In addition, during 2011, Tri State Ambulance donated more than 300 hours of ambulance and bike medic team standby service to events such as Oktoberfest, Riverfest, the 3rd Street Aid Station, Applefest, the American Heart Association s Heart Walk, numerous YMCA marathons and triathlons, and frequent community gatherings. A great example of the value of having Tri-State Ambulance personnel stand by at these events was the revival of a cardiac arrest victim along the Maple Leaf parade route in The Tri-State bike team was on scene in less than one minute and immediately defibrillated a middle-aged patient who was later discharged from a local hospital. Donated event coverage in 2011 amounted to greater than $120,000 worth of services given to our local community. United Way Tri State Ambulance ran its first ever United Way Campaign as a Pacesetter for This tradition continues and employee pledges have increased every year. Tri-State Ambulance is proud to be able to contribute to the United Way. Total 2011 contributions were over $3,400. Contact Information Tri-State Ambulance, Inc. 235 Causeway Blvd La Crosse, WI (608) Tri-State Ambulance is a wholly owned subsidiary of Gundersen Lutheran

9 References 1. American Heart Association; Circulation. 2005; 112: IV-1 IV-5 2. Academy of Emergency Medicine, May 2006, Vol. 13, No. 5, Suppl.1 3. Wang HE, Yearly DM. Out-of-hospital endotracheal intubation where are we? Annals of Emergency Medicine 2006; 47: Journal of Emergency Medical Services, Feb 2007, 200 City Survey 5. Journal of Emergency Medical Services, Feb 2010, 200 City Survey 6. Journal of Emergency Medical Services, Online