Identifying Opportunities For Improving Emergency Care

Cindy Raisor, RN, is helping emergency medical services agencies in South Carolina improve their performance through the use of a centralized data system.

To improve the quality of care patients receive in crisis situations, The Duke Endowment granted more than $5.5 million between 2004 and 2007 to help strengthen emergency medical services in North Carolina and South Carolina.

Challenge

Emergency medical services providers are counted on to save lives. They offer urgent medical care in crisis situations, often while transporting patients to hospitals for definitive care. People experiencing non-life threatening illness or injury also depend on timely and efficient care for first aid. In North Carolina and South Carolina, as in the rest of the country, EMS providers serve six primary functions in pre-hospital care: detection, reporting, response, on-scene care, care in transit and transfer to definitive care. Providers also play an integral role in disasters, and they serve as on-the-ground resources in identifying public health threats.

Disparities in Level of Emergency Care and Response Times

Each year, 540 EMS agencies in North Carolina respond to more than 1.2 million events, while 250 agencies in South Carolina respond to more than 600,000 events. Because emergency medical care is provided by a variety of individuals and agencies, both public and private, the level of care can vary greatly, even within communities. Baseline data gathered through North Carolina's comprehensive EMS information system revealed clear disparities in care provided and the importance of improving EMS response times. Before this initiative, South Carolina did not have a standard, centralized system for recording or comparing EMS event data.

The disparities in North Carolina included:

• An average 116 percent difference between the response times of top ten and bottom ten performing counties, correlating to a 27 percent increase in injury fatality rates for the low performers
• Increased mortality rates for other emergent conditions such as stroke and cardiac arrest for EMS programs with slower response times
• 20 percent slower response times in counties with higher injury fatality rates
• 11.3 percent slower response times in counties with higher cardiovascular disease rates
• 22 percent higher injury fatality rate and 10 percent higher cardiovascular disease mortality rate in counties that have not optimized their EMS response times
• Slower response times in counties with no Emergency Medical Dispatch (EMD) system and those who had not implemented standard policies and procedures for all providers

While response times are just one measure, they can help establish acceptable operating performance or safety standards for emergency medical service providers — and they can highlight how critical timely and efficient emergency medical services are. In some situations, a swift and proficient response can mean the difference between life and death. For example, in cardiac arrest, a victim's chances of survival are reduced 7 percent to 10 percent for every minute that passes without defibrillation and advanced life support intervention, according to an article from EMS Responder.com.

Response

To help reduce disparities in care, The Duke Endowment supported four projects in North Carolina and South Carolina aimed at improving the performance of emergency medical services providers.

North Carolina Statewide Database System

The Endowment granted $899,250 to the North Carolina Office of Emergency Medical Services to develop a statewide database system. The system includes three components:

• Pre-Hospital Medical Information System (PreMIS), which provides data entry and reporting capability.
• Credentialing Information System (CIS), a database used to monitor and provide credentials to EMS personnel, ambulances and agencies.
• EMS Performance Toolkit Project, custom web-based reports running off the state database. The toolkits analyze individual EMS providers' performance and generate recommendations for improvement.

North Carolina Emergency Medical Dispatch Programs and Standard Policies

Baseline data showed that high-performing EMS systems shared two key characteristics: fully operational Emergency Medical Dispatch systems and standardized policies and procedures across all EMS providers within the system. To help EMS systems improve their performance, the Endowment granted $2.4 million for EMS systems in North Carolina to implement or upgrade EMD systems and to implement standard policies.

North Carolina Response Times

The Endowment granted $1.6 million to help EMS providers in 26 counties improve their response times.

South Carolina Statewide Database System

The Endowment granted $650,000 to the South Carolina Officer of Emergency Medical Services to implement the EMS database system (PreMIS, CIS and EMS toolkits) developed and piloted by the North Carolina Office of Emergency Medical Services.

Participating Sites

North Carolina

• North Carolina Office of EMS, Raleigh
• EMS Performance Improvement Center (Department of Emergency Medicine at the University of North Carolina at Chapel Hill)
• All EMS systems statewide

South Carolina

• South Carolina Department of Health and Environmental Control, Division of EMS and Trauma, Columbia
• All EMS systems statewide

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