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Comprehensive Assessment of Emergency Medical Services 66 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, theoretically, 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 toolkits" based on actual samples of an individual EMS system's call data. The Center, in Interval # Calls Average 90% Turnout Time Travel Time 3,517 3,445 0:00:55 0:08:31 0:02:00 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. EMS Operations and Medical personnel familiar with EMS operations that were queried indicated that travel distance; i.e. travel time, as well as the number and rate of admissions to the emergency rooms of the destination hospitals are have - ing an impact these times. Note: Preliminary numbers from the first quarter of 2012 indicate that the total average event duration times have again increased by several minutes. Figure 16 Total Average Event Duration 2007 -2011 0:48:58 ------------- - - - - - -- ------i------,-- 0:47:44 0:47:53 0:47:31 -------- ------ - - - - - - -- *---- ---- - - - -- ------ ----- - -- - - - - -� j 0:46:05 --- --- ------ - - - - -- '------- ------ '-- - - - -'- -- -- � ------ L------ '-- - - -- ' 0:44:38 - --- - --- ---- -------- ------- r----- --- --- - ---- ---- r------ r------ --- -- - - - � 0:43:12 ------ `- ----- ---- -- -- '-- ----- ;--- --- ----- ------- `------ ---- --- -- - - - - -' 0:41:52 ' 0:41:46 0.41:21 _` -- - - -- - - -- - -- -r- -- r------ 1------ _1 ------- r--- ---- r------ -- -- - - -� i I __ 0.40.19 - -- - - -- --------------- �-- --- --- ----------------------- -- -- � - --- � - -- 0:38:53 '-- - ' i - - i- -=— -- I I 0:37:26 2007 2008 2009 2010 2011 6 American College of Emergency Physicians; Principals of EMS systems; 2006 Solutions for Local Government, Inc. 22