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August 8, 2011

Texas fire chief: New dispatch policy improves care

Editor's note: Otto Drozd III is chief of the El Paso Fire Department.

By Otto Drozd III
El Paso Times

EL PASO, Texas — Last year, the El Paso Fire Department revised its ambulance transport policy in order to have ambulances available for the most critical calls. It is important that the community understand how this is improving patient care.

The EPFD has a responsibility to constantly look for efficiencies that will provide equal or greater services, while not overburdening the taxpayer. The Transport Policy and Patient Triage programs were designed specifically to enhance those abilities.

The EPFD responds to over 73,000 calls annually, 80 percent being medical responses. An evaluation concluded that the standing policy of allowing patients to choose transport to any hospital resulted in elongated transport times causing ambulances to be out of service for calls within their primary response area.

Of approximately 30,000 transports, 43 percent are Basic Life Support calls (non-emergency transports). As a result, constant backup was necessary from other parts of the city.

Additionally, first-response fire engines were impacted (reducing their availability). For this reason, a policy of "catchment" transports was initiated in 2010.

The Catchment Transport policy identifies hospitals for each ambulance within the city that have the fastest travel and turnaround time. This allows the ambulance to return to its assigned response area sooner. Four to five hospitals within closest proximity, and with the most efficient turnaround times, become the "catchment" hospitals for the city's ambulances.

In February, the Priority Dispatch call triaging system was implemented; this system matches the response to the need.

The combination of these two new policies has resulted in a more-efficient response. The Fire Department's goal is to have its limited number of "emergency" ambulances immediately available to treat those patients with a critical need for Advanced Life Support (paramedic ambulances).

The community will find that it will no longer get a firetruck and an ambulance on every call. Only the most critical calls will continue to get that level of response. For most calls, a response of trained emergency medical technicians or paramedics will be sent to provide evaluation, initial care, and to determine transport requirements.

Critical patients will always be transported to the "closest appropriate facility" for stabilization. Less-emergent patients will be transported to the hospital of their choice by a city ambulance in the unit's catchment area. If the patient is requesting to be transported to a hospital outside the catchment area, and they are a stable, non-critical patient, a private ambulance will be called to complete the transport.

While awaiting the arrival of an ambulance, trained EMTs will continue to provide reassessments and appropriate treatment. In short, stable non-emergency patients can continue to be transported to the hospital of their choice, either by city ambulance (in catchment) or a private ambulance service (out of catchment).

The results have been positive, with unit availability increasing while response times have decreased (citywide). Previously, it was common for the city to have less than three units available for city coverage. Average response times have decreased by 5 percent, paramedic response times in less than eight minutes have increased from 76 percent to 80 percent of the time, the average response times for private ambulances have dropped by 10 percent and hospital performance has increased.

Workflows have changed, resulting in a reduction in the time it takes for the patient to be transferred to the hospital from the ambulance, many times to less than 10 minutes.

It is important to remember that the Fire Department will continue to review the effects of these policies.

The Northeast and West sides of the city remain areas of concern given the lack of nearby hospital facilities and promise to continue presenting challenges to unit availability.

Our citizens are experiencing positive results in the pre-hospital and hospital setting. The changes seek to uphold EPFD's commitment to providing the best care possible to our community in their time of need.

Copyright 2011 El Paso Times, a MediaNews Group Newspaper
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