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Comprehensive Assessment of Emergency Medical Services 23 DRAFT REPORT and 911/Communications Center Operations Study Historically response times have been the most readily measured performance indicator for EMS and that measurement has been the "average". This method however results in highlighting the problem of inequity of service because, by definition, 50% of the patients experienced response times longer than average. To ensure more equitable service to all areas of the community; i.e. County; fractile response time measurement was introduced and is now commonly used by EMS systems throughout the Country.6 Figure 15 Average vs.Fractile Time Intervals The previously referenced NCOEMS Performance Improvement Center runs periodic "performance Interval #calls ! Average 90 toolkits" based on actual samples of an Turnout Time 3,517 0:00:55 0:02:00 individual EMS system's call data. The Center, in Travel Time 3,445 0:08:31 0:15:00 addition to "average" times also runs the calculations based on the 90%fractile suggested by NFPA for Fire and EMS systems. The Orange County EMS calls identified in this table (Figure 15) were selected from 2011 call data and run for average and 90%fractile times for both Turn-Out Time and Travel Time. Of course, analysis of the average and 90% fractile times identified do little more than prove the point already stated; 50 % of the patients experienced response times that took longer than the "average". This will continue to be the case until the paradigm is changed which, in this case, will be the performance standard regarding response time(s) and the manner by which these response times are measured and assessed. Total Event Duration The total event duration is the time from the initial announcement of the call (dispatch) for service to the time the EMS Unit that responded to that dispatch is back in service and available to take another call. While the Turn-Out Time and Travel Time are the first two time intervals of consequence in this regard, the time on scene with the patient, transport time to the appropriate medical facility, and time at the medical facility until release, are significant as well. Cumulatively they combine to result in the total event duration time. Figure 16 EMS Operations and Medical Total Average Event Duration personnel familiar with EMS 2007-2011 operations that were queried 0:48:58 0:47,,s3 0:4744 indicated that travel distance; 0:47:31 i.e. travel time as well as the number and rate of admissions 0:4 :0 to the emergency rooms of the 8;94:38 destination hospitals are 0:45: impacting these times. 0;43:12 ..._ 0.41:'52 :41:46 0:41:21 Note: Preliminary numbers from the first quarter of 2012 0111:40:1 . .... indicate that total average 8; :53 event duration times have again increased by several minutes. 0:37: 200 2008 2409 2010; 2011 ,mmm, mmmmm mmmmm mmmmm mmmmm mmmmm mmmm mmmm mmmm mmmmmmm;� 6 American College of Emergency Physicians;Principals of EMS Systems;2006 Solutions for Local Government,Inc. 21