Great coversations last week. Now that we have laid the foundation of EMS Systems, more of the asks are exploring what is new or different in our post pandemic world of unscheduled out-of-hospital care.
This Week’s asks:
- Is there a newer video showing telecommunicator providing dispatcher CPR, using a tiered response protocol, to replace the 2018 Pitt County NC example?
- Is there research looking at the impact of non-transport paramedic units (chase cars or paramedic-capable fire companies) on patient outcomes? Not looking at community paramedics.
- Have other EMS agencies altered their response time goals using the same process that the Mecklenburg (NC) EMS Agency used?
You can respond in the comments or email michaelward@isu.edu
Background to this week’s lectures
Between 1999 and 2024 a core course in the Master’s of Emergency Health Services (EHS) at the University of Maryland Baltimore County (UMBC) was “EHS 640: High Performance EMS.” Stephen Dean was an early adopter of Jack Stout’s Public Utility Model for Pinellas County, Florida, and wrote the original course while a visiting professor at UMBC and obtaining his Ph.D.
Kurt Kruperman and Jon Washko, both adjunct faculty members at UMBC’s EHS, updated the course in 2010. Kruperman was getting his Ph.D. They obtained support from the American Ambulance Association, digitizing EMS Structured for Quality: Best Practices in Designing, Managing and Contracting for Emergency Ambulance Service to use as the textbook. Wasko provided ambulance deployment and financial exercises.
In 2021, while working on my Ph.D., I updated the course. Unfortunately, the same post-pandemic economic forces that dismantled some high-performance public utility ambulance services also impacted EHS. We needed to go where the students and the funded research were. EHS morphed into the Department of Emergency and Disaster Health Systems (EDHS). EHS 640 is gone.
Many metrics from the Stout public utility model, such as unit hour utilization, dynamic ambulance deployment, and response time performance measurement, are embedded into the best practices of emergency service systems. Both lectures this week reflect the work I did for the 2021 EHS 640 course and my Ph.D.
6: What is “High-Performance EMS”?
The EMS 3300 lecture follows the origin story of economist Jack Stout starting as a Systems Analyst with the Arkansas Health Systems Foundation (one of the five 1972 Department of Health, Education, and Welfare EMS funded demonstration projects), to research fellow at the University of Oklahoma’s Center for Economic and Management Research – where the Public Utility Model (PUM) was developed.
The 1980s witnessed the creation of nine Public Utility Model EMS Systems, starting with Kansas City. The high-performance EMS (HP-EMS) body of knowledge comes from the dozens of Stout articles published in the trade magazine Journal of Emergency Medical Services from 1983-1989. Stout’s The Fourth Party organization became the focus for all HP-EMS development and advocacy.
We describe the six elements of HP-EMS as articulated by Jack Stout and Jerry Overton in 2002, and compare/contrast with the 2025 Academy of International Mobile Healthcare Integration (AIMHi) “High Performance System Design.”
We review three elements challenging the public utility model:
- Increased expenses and labor costs while reimbursements decline
- Inconsistent or negligent ambulance authority oversight
- Political pressure from fire department
Wrap up by evaluating how well Bengalcare Mobile Health aligns with the AIMHi HP-EMS System Design.
Required readings/viewings:
Richmond Ambulance Authority (2022) RAA-High Performance EMS. (2:18 minutes)
Stout, J. (1985a). Public Utility Model Revisited: Part 1: Origins. Journal of Emergency Medical Services (February), 55-58, 62-63. http://emsmuseum.org/wp-content/uploads/2021/05/Public-Utility-Model-Revisited-Part-1-_-Origins-55-58-62-63-1985-02-JEMS.pdf
Stout, J. (1985b). Public Utility Model Revisited: Part 2: 10 Essential Features. Journal of Emergency Medical Services (March) 71 – 74. http://emsmuseum.org/wp-content/uploads/2021/04/Public-Utility-Model-Revisited_Part-2-10-Essential-Features_1985-March-71-74-JEMS.pdf
Stout, J. (1985c). Public Utility Model Revisited: Part 3. Journal of Emergency Medical Services (May) 58-64. http://emsmuseum.org/wp-content/uploads/2021/04/Tulsa-Public-Utility-Model-Revisited-Part-3_1985-May-58-64-JEMS.pdf
Dean, S. (2004) Public Utility Model EMS. EMS World. 33(3) 87-91.
Bledsoe, B. (2003 December) EMS Myth #8: Public Utility Models are the most efficient model for providing prehospital care. EMS World.
Redlener, M., Buckler, D. G., Sondheim, S. E., Yeturu, S. K., Loo, G. T., Munjal, K. G., … Crowe, R. P. (2024). A National Assessment of EMS Performance at the Response and Agency Level. Prehospital Emergency Care, 1–8. https://doi.org/10.1080/10903127.2023.2283886
Multnomah County Ombudsman (2024 May) “County has longstanding contractual authority to hold AMR accountable, and needs to comply with code.”
7: Clinically Significant Response Time
The 3300 lecture guides students through a 9-1-1 call, explaining how the Clawson Medical Priority Dispatch system operates. Also discuss the APCO model.
Introduce students to the Seattle/King County Medic One program. Describe the 1979 “Project Restart” study of cardiac arrest survival in King County – 604 cardiac arrests between April 1976 to August 1977. Show how the results of this peer-reviewed research is the source of the 7:59 minute response time goal for a paramedic ambulance.
Describe how Seattle/King County and Rochester, Minnesota, achieved significant cardiac arrest patient survival. Share more recent peer-reviewed analysis of patient outcomes after out-of-hospital paramedic intervention. Show how Detroit went from a cardiac arrest survival rate of zero (1 survivor a year) to an Utstein survival rate of 25% in 2024, including a 39.5% rate when the patient received bystander CPR or AED use.
Review the June 2024 American Ambulance Association presentation “EMS Transformed: Delivering High-Performance, High-Value EMS in Mecklenburg.”
Small Group Activity to report out at next LIVE session: What Should Be An Appropriate Ambulance Response Time for BengalCare Mobile Health?
Required readings/viewings
Pitt County NC (2018) reenactment of 9-1-1 cardiac arrest call (4:37 minutes)
Eisenberg, M., et al. (1979) Paramedic Programs and Out-of-Hospital Cardiac Arrest. American Journal of Public Health 69(1) 30-38
First hour of the American Ambulance Association June 2024 presentation “EMS Transformed: Delivering High-Performance, High-Value EMS in Mecklenburg.”
Featured picture: Figure 3 from Eisenberg, M., et al. (1979) Paramedic Programs and Out-of-Hospital Cardiac Arrest. American Journal of Public Health 69(1) 30-38