New plan uses ambulances wisely.

Byline: David Lindberg and Jeff Clawson For The Register-Guard

"Every emergency medical services system is either designed for the benefit of the patients it serves, or is designed primarily for the convenience of itself and its member organizations."

- American Ambulance Association, Ambulance Contracting Guide

In our opinion, the Eugene Fire and Emergency Medical Services Department has crafted an EMS deployment strategy to meet the needs of the patients it serves. Following a comprehensive planning process, the department last year modified its EMS deployment plan in ways that improve the level of service to the community. The changes, initiated on Aug. 1, 2002, were designed to more effectively match the appropriate response resources to the specific demand for services.

Careful analysis found predictable patterns in when medical emergencies occur. This helped Eugene's managers to determine how to best deploy EMS resources to provide services as quickly and efficiently as possible to the entire service area. This is particularly vital to the timely delivery of paramedic-level advanced life support services.

The new operational plan, which features the upgraded deployment of ambulances, is complemented by two associated strategies: the use of telephone triage protocols in the Central Lane 911 Communications Center to quickly and accurately determine the severity of callers' emergencies, and the use of fire engines staffed with paramedics to deliver faster, more reliable first-response advanced life support services to patients with life-threatening emergencies.

Before this new service model was implemented, ambulances in Eugene were not supplied and positioned to adequately meet demands. Eugene units were frequently understaffed during times of peak activity. This often resulted in response times that exceeded the desired limit, and ambulances from the Springfield Fire and Life Safety Department were often asked to come into Eugene to help.

For Eugene residents, the new strategies mean that Eugene Fire and EMS is now able to effectively handle the demands of the community in a more reliable and efficient manner, without regularly requiring other jurisdictions to devote their resources to meet Eugene's needs.

For Springfield residents, it means that their fire department can now concentrate on getting its ambulances back into Springfield after they have transported patients to Sacred Heart Medical Center in Eugene.

Under the old response protocol, the closest available ambulance anywhere in central Lane County would respond to a call, regardless of the severity of a patient's condition. Consider the following scenario under that protocol:

A Springfield ambulance headed home after delivering a patient to Sacred Heart happens to be the closest unit to a low-severity call for service in Eugene. Under prior policies, the Springfield ambulance would respond, even though the telephone triage determined that the patient was not suffering from a life-threatening, time-critical condition.

Since Springfield staffs only three paramedic ambulances, diverting one of them to Eugene would decrease Springfield's paramedic response capacity by fully one-third - and that's only if both other ambulances were still available for calls. Because Springfield has fewer ambulances than Eugene, it is more vulnerable to any such decreases. Responding into another jurisdiction only increases this risk.

This is not to say that one jurisdiction would never cross the line into the other to provide service. Indeed, existing mutual aid agreements provide that either may request assistance from the other, and that assistance will be provided if resources are available. A strong partnership between neighboring ambulance service providers is an essential safeguard to ensure that transport will always be available when needed.

Eugene is to be congratulated for accepting the challenges presented to all ambulance providers in this country by the rapidly changing health care environment and for focusing on viable solutions to maintaining these vital public safety resources. Their work in developing new response strategies and models to more effectively meet the needs of Eugene in a more efficient and sustainable manner, while also allowing Springfield to better serve its own community, truly shows foresight and vision.

David Lindberg is president and CEO of HealthAnalytics LLC of Mesa, Ariz., a national EMS, fire and 911 consulting and information services firm. Jeff Clawson of Salt Lake City is CEO and medical director of research and standards for Medical Priority Consultants Inc. Both worked as a consultants in developing the Eugene Fire and EMS Department's staffing and response system.