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System Status Management and Destination Selection
Providing ambulance services is a complicated process. System Status Management is an EMS term that means balancing the number of ambulances requested with the number of non-emergency transports from local facilities while maintaining ambulance availability to respond to emergencies for the best possible EMS response. This allocation of scarce EMS resources is a complex dance that requires cooperation between citizens, dispatch, management, and ambulance personnel.
Following is a discussion of challenges related to Simpson County’s EMS System Status Management.
Covington County Hospital Ambulance Service (CCHAS) supports a patient’s right to self-determine their desired transport location. However, there are constraints based on EMS system status management. CCHAS provides three ambulances 24/7 to Simpson County. Simpson County has a mean monthly call volume of approximately 400. That is approximately 13 ambulance calls a day and 4.3 calls/day/ambulance. Each call lasts approximately 3.5 hours (2.5-hours travel, 0.5-hour treatment, 0.5-hour reparation). Three ambulances will meet the needs of Simpson County with careful system status management.
Many people request ambulance transportation to out-of-the-county facilities. If there are enough EMS vehicles and personnel (resources), this is not a problem, but this situation rarely exists. Fortunately, most ambulance requests are not life-threatening after initial stabilization and do not require a higher level of care than can be provided by local facilities. For example, in October 2022, there were 461 ambulance requests; only 15 of those calls resulted in emergency transport from the scene to the hospital.
CCHAS endeavors to always keep one ambulance in Simpson County to provide 911 coverage to the citizens of Simpson County. When the other two Simpson ambulances are out of the county on transports, the third unit must remain in the county. Patients experiencing conditions that can be stabilized locally will be transported to a local facility in this event. After treatment at a local facility, the patient can be transferred to a higher level of care.
Level one and two facilities are experiencing staff shortages which inhibits a timely transfer of care from the ambulance to the receiving facility. As a result, ambulance personnel cannot wait excessive lengths of time to transfer the patient from the stretcher to the hospital. There are reports of 8-12 hour waits for hospitals to accept an ambulance patient. This takes an ambulance out of service for the duration of the transportation/transfer time. Additionally, it denies Simpson County citizens ambulance coverage, especially when the patient’s condition could be treated at the local facilities.
Understandably, most people want to be transported to the facility where their doctor has admitting privileges. The patient will not see their personal doctor if transported to a level one or level two facility. Instead, they will see the emergency room provider with instructions to follow up with their private physician.
All patients that qualify for a systems-of-care (active myocardial infarction-heart attack, cerebral vascular accident-stroke, OB/Neonate, Alpha/bravo trauma, orthopedics, surgery) will be transported to a level one or two facility regardless of system status management.
Patients that require more than one healthcare provider to manage their conditions in the back of an ambulance will have to be transported locally to stabilize the patient. An example would be cardiac arrest. After stabilization at a local facility, the patient can be transferred by ambulance to a higher level of care.
Prioritizing ambulance requests is important when multiple ambulance requests are received simultaneously. This situation occurs frequently. Ambulance requests from patients in the community are prioritized over patients located in a healthcare facility. Patients in a swing bed unit, emergency room, acute care facility, doctor’s office, clinic, or nursing home are seen after out-of-facility patients are addressed. Occasionally scheduled transports are delayed or canceled secondary to increased 911 call volume. While this is inconvenient, emergency calls are always the priority.
CCHAS Simpson County endeavors to provide each patient with the best care possible at their desired facility while keeping the entire county mission in mind. CCHAS makes every effort to accommodate the wishes of the patient. However, this is not always possible based on the number of ambulance requests, the severity of calls, and available resources. This methodology is standard EMS system status management and is used successfully throughout the country.
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