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County of Volusia  Department of Public Protection

Division of. Emergency. Medical. Administration. County of Volusia  Department of Public Protection. Administrative Responsibilities. Ordinance Certificate of Public Convenience and Necessity (COPCN) Closest unit emergency medical response System analysis EMS Trust Fund

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County of Volusia  Department of Public Protection

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  1. Division of Emergency Medical Administration County of Volusia Department of Public Protection

  2. Administrative Responsibilities • Ordinance • Certificate of Public Convenienceand Necessity (COPCN) • Closest unit emergency medicalresponse • System analysis • EMS Trust Fund • Liaison to agencies (county and municipal) • Partnerships (contingency and pilot programs)

  3. Response Times • Definition. What defines a response time? • Industry standards. 4 minutes? 8 minutes? From where did these times evolve? • Measure. What’s the most transparent formula for illustrating response times? • Do response times affect patientoutcome?

  4. Anatomy of a Response 1 3 5 Reaction time: difference in time between receipt of alarm and ’wheels moving’ on apparatus (30 seconds). Recognition: delay between initial illness or injury and activation of EMS system (45 seconds). Vertical response time: difference between arriving at the patient’s side and ‘wheels stop’ at the location (45 seconds). 4 2 Time: 0:45 4:00 0:45 0:30 0:30 Elapsed time: 0:45 5:45 6:30 1:15 1:45 Response time: difference between ‘wheels stop’ at the location of the event and ’wheels start’ at the beginning of the response (4 minutes). Processing time: difference between notification of field units and receipt of call information by the communications center (30 seconds).

  5. Clinical Responsibilities • Medical oversight of field & communications staff (401.265, Florida Statutes) • Prehospital standing medical orders • Quality assurance • Access to legend devices, prescription medications, & controlled substances • Contingency emergency medical transport • Credentialing andeducation

  6. Challenges facing EMS • Existing health care • Customary reimbursement (Medicare, Medicaid, etc.) • Revenue (FY 09-10 uncollectibles, $16 million) • Impact of Patient Protection and Affordable Care Act • “EMS agencies lose money responding to calls from the publicly insured.” – Nat’l Ctr for Policy Analysis • Value-based • No one really knows. • Better utilization of resources • Increased efficiency without loss of effectiveness (Emergency Medical Dispatch) • Lost unit hours (e.g., bed delays, diversion) • Public expectation

  7. Challenges facing EMS - continued • Determining an affordable, sustainable, and outcome-driven model (i.e., optimal service)

  8. Questions?

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