EMS and ambulance Response Time Stand...

EMS and ambulance Response Time Standards

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Mike Mulligan

Charlestown, MA

#1 Sep 15, 2010
EMS and ambulance Response Time Standards

“Most of these communities have established standards of eight minutes or less 90% of the time for ALS service. Some municipalities, especially in California, have even moved response time standards to 12 or 15 minutes for private EMS providers 90% of the time, but these are usually coordinated with ALS first response.”

“On all EMS calls, the NFPA 1710 standard establishes a turnout time of one minute, and four minutes or less for the arrival of a unit with first responder or higher level capability at an emergency medical incident. This objective should be met 90% of the time.”

“If a fire department provides ALS services, the standard recommends arrival of an ALS company within an eight-minute response time to 90% of incidents. This does not preclude the four-minute initial response.”
Mike Mulligan

Charlestown, MA

#2 Sep 15, 2010
Brattleboro must have a pretty good EMS response time as they got a separate fire service ems system?
Mike Mulligan

Charlestown, MA

#3 Sep 15, 2010
http://www.emsresponder.com/print/EMS-Magazin... $2255

EMS Response Time Standards

Manager's Corner

Posted: July 8th, 2008 05:26 PM GMT-05:00
After receiving an e-mail asking whether there is a federal law requiring an agency to be on scene within so many minutes, I realized there is some confusion about response time standards.


NFPA Standard

One of the key EMS benchmarks for municipal and career fire departments is the National Fire Protection Association's (NFPA) 1710 (Standard for the Organization and Deployment of Fire Suppression Operations, Emergency Medical Operations, and Special Operations to the Public by Career Fire Departments).

The NFPA 1710 standard is based upon a combination of accepted practices and more than 30 years of study, research, testing and validation. Members of the 1710 committee that developed the standard include representatives from various fire agencies and the International Association of City/County Managers (ICMA).

On all EMS calls, the NFPA 1710 standard establishes a turnout time of one minute, and four minutes or less for the arrival of a unit with first responder or higher level capability at an emergency medical incident. This objective should be met 90% of the time.

If a fire department provides ALS services, the standard recommends arrival of an ALS company within an eight-minute response time to 90% of incidents. This does not preclude the four-minute initial response.

The standard recommends that a "fire department's emergency medical response capability includes personnel, equipment, and resources to deploy at the first responder level with automated external defibrillator (AED) or higher treatment level." The standard also recommends that all firefighters who respond to medical emergencies be trained at a minimum to the first responder/AED level.
Mike Mulligan

Charlestown, MA

#4 Sep 15, 2010
Another requirement in the standard is that all personnel dispatched to an ALS emergency should include a minimum of two people trained at the EMT-P level and two people trained at the EMT level-all arriving within the established times.
Paramedics can come from different agencies.
Fire departments can have established automatic mutual aid or mutual aid agreements to meet many of the requirements of the standard.

It is clear response time standards are a vital part of the mission of any EMS agency. Key to the mission are the level of service provided and the time required to deliver that service.


First, there is no federal law regarding response times, and, after doing thorough research, I cannot find any state laws that pertain to response times. There are some contractual agreements between EMS providers and political subdivisions that stipulate response times, and some political subdivisions enter and ratify these contractual agreements into ordinances. But most of the contractual agreements or ordinances are directed toward private EMS providers. Most of these communities have established standards of eight minutes or less 90% of the time for ALS service. Some municipalities, especially in California, have even moved response time standards to 12 or 15 minutes for private EMS providers 90% of the time, but these are usually coordinated with ALS first response.
Mike Mulligan

Charlestown, MA

#5 Sep 15, 2010
What really drives response time philosophy is consensus standards. Consensus standards are developed by specific industries to set forth widely accepted benchmarks for things such as response times. This is an attempt by the EMS industry to self-regulate by establishing minimal operating performance or safety standards.

Liability Issues
In most cases, compliance with consensus standards is voluntary. Regardless of whether compliance is voluntary or mandatory, EMS agencies must consider the impact of "voluntary" standards on private litigation. In some states, a department may be liable for negligent performance. Even in states that protect EMS personnel under an immunity statute, most state laws do not protect personnel or their agencies for grossly negligent acts. Essentially, gross negligence involves the violation of a standard with willful intent that results in injury or loss to some individual or organization. In establishing the standard for EMS agencies, the courts frequently look to the "voluntary" standards issued by various organizations. Although "voluntary" in name, these standards can become, in effect, the legally enforceable standard of care or operation for EMS agencies and their personnel. Accordingly, EMS agencies should pay close attention to applicable standards.

Cardiac Care

One standard that affects EMS deals with cardiac arrest. This is one of the most relevant standards affecting response times.

Most adults who can be saved from cardiac arrest are in ventricular fibrillation (VF) or pulseless ventricular tachycardia. Electrical defibrillation with ALS intervention provides the single most important therapy for the treatment of these patients. Resuscitation science, therefore, places great emphasis on early defibrillation and ALS intervention. The greatest chances of survival result when the interval between the start of VF and the delivery of defibrillation is as brief as possible. The Advanced Life Support Working Group of the International Liaison Committee on Resuscitation (ILCOR) for the American Heart Association recommends that resuscitation personnel be authorized, trained, equipped and directed to operate a defibrillator and provide ALS intervention if their professional responsibilities require them to respond to persons in cardiac arrest.

The American Heart Association's scientific position is that brain death and permanent death start to occur in 4–6 minutes after someone experiences cardiac arrest. Cardiac arrest can be reversible if treated within a few minutes with an electric shock and ALS intervention to restore a normal heartbeat. Verifying this standard are studies showing that a victim's chances of survival are reduced by 7%–10% with every minute that passes without defibrillation and advanced life support intervention. Few attempts at resuscitation succeed after 10 minutes.
Mike Mulligan

Charlestown, MA

#6 Sep 15, 2010
The implication was, I was waiting for a ambulance for 45 minutes to 1 hour?
mike mulligan

Charlestown, MA

#7 Sep 17, 2010
Talk about a infinitely deep black hole, where once going in you never are allowed to come out again...it is talking to the NH Dept of safety EMS bureau about ambulance response times. The state don’t even have any indicators of quality around ambulance service...response times to them is not relevant to health care outcomes.

As a group of people, I have never seen state employees hate government as much as the employees of the state of NH.

I asked the guy in the quality research bureau...so how is ambulance response times doing broadly in my area around Hinsdale. I get something like I’ll have to run that by our legal department before I can tell you. It will take me a month or so before we can aggregatethe data.

Seems the local hospital quality assurance board or something oversees the quality of ambulance service in our area.

A local newspaper isn’t going to have the time or money to investigate this.

I just asked a basic question, is ambulance service quality increasing, staying the same or declining in our area. Basically it is unregulated.

I will tell you right off the bat, remember “altruism abuse”...the idea that most ambulance service is voluntary means the public has no expectations of ambulance quality because everyone just volunteers.

Just think about it, with all our reported issues with volunteer fire departments staffing.

mike mulligan

Charlestown, MA

#8 Sep 17, 2010
There is no national or state ambulance response times.

The ambulance and EMS crew...they should be in a large organizations with career opportunities and in good wages and benefits...and wrapped around in comprehensive health care standards and responsibilities.

That is the only way we assure our own health care outcomes!
mike mulligan

Charlestown, MA

#9 Sep 17, 2010
So let me get this straight, you are in a car accident with your chest caved in and internal organs damaged...you are in excruciating pain, maybe your children are in excruciating pain, everyone is terrified of dying...but it doesn’t matter to the ambulance service if they get to the scene of the accident within ten minutes or one hour.
mike mulligan

Charlestown, MA

#10 Sep 17, 2010
You know what I am sickened by...the talk of the NH state people overseeing EMS licensing...the idea I get out of them that response time doesn’t matter. It is a protective human reaction to all the death and suffering they experienced...as a coping mechanism response time doesn’t matter.

This is the system I am in and I have no control over it, I am doing the best that is possible considering what I am seeing, this is how I have to cope with the situations I see. That is actually a healthy coping system so you can stray in the game.

There was lots of talk about what the towns can afford.

But who is in there fighting for faster ambulance times?
mike mulligan

Charlestown, MA

#11 Sep 17, 2010
What I have learned so far, what I would tell the tourist coming into rural Vermont and New Hampshire from higher population zone, cites and metropolitan area...you are coming to the ambulance response times of the third world and your health is severely threatened if you get into a accident.
mike mulligan

Charlestown, MA

#12 Sep 17, 2010
Could one state use that against another state...tourism competition...say Massachusetts has a highly regulated ambulance system thus we are safe. NH believes in freestator or libertarian values, you going to bleed to death on the highways because ambulance service isn’t regulated.
mike mulligan

Charlestown, MA

#13 Sep 17, 2010
When a San Jose resident calls 911 with a medical problem, an AMR ambulance and a San Jose Fire Department vehicle are dispatched virtually simultaneously, Lynch said. Either unit could show up first depending on the origin of their dispatch, traffic and other factors.

Ambulances also practice "posting," which means they are spread across the county based on a history of where problems exist, such as heavy traffic at rush hour. Posting allows ambulances to be dispatched from the locations that make the most sense in terms of history and geography.
mike mulligan

Charlestown, MA

#14 Sep 17, 2010
According to Rescue’s documents...they got the call at 20:26 and they were on the scene on my accident at 20:41... that is perfectly acceptable to me. They came with full lights and sirens.

But it is strange the stated time is exactly 15 minutes. I would have felt better if it like 17, 18 or 21 minutes...not some rounded number like 15 minutes.

They depart the scene at 2100, they arrive at the hospital at 2115, in service at 21:15, in quarters at 2130...I hate these rounded numbers....
mike mulligan

Charlestown, MA

#15 Sep 17, 2010
So I get from Rescue, say if the call came in from Hinsdale through a cell phone contract purchased in Vermont. The 911 call could have gone up to the Keene Mutual aid call center, it might have gone up the Montpelier 911 call center...there the operators typically have to go through a lengthy questionnaire from the caller. Conceivably it could have gone to Keene 911 Mutual air, to the Montpelier 911 dispatch, to the Brattleboro fire station central dispatch, then by radio dispatch to Rescue.

It is interesting, when the Brattleboro fire call center dispatches a ambulance to Hinsdale, the Hinsdale police get a heads up and the police department has got a set of policies mandating a police response, a bike accident being one of them...from what I am told the police came rather quickly to the scene.

Did the dispatch centers eat up a half and hour?

Both me and my biking buddy had relatively minor injuries...but it looks like the ambulance only had one emt person in it and they took away two patients?

But I find no unsafety in this case.
mike mulligan

Charlestown, MA

#16 Dec 6, 2010
http://www.topix.com/forum/source/brattleboro...

Beginning on message #14 Sep 17, 2010
jason

Huntsville, AL

#17 Oct 27, 2013
Is there a national standard time for how how long an ambulance should be at the ER to drop off a patient and be back in service?
ECT

Newton Center, MA

#18 Oct 27, 2013
But can EMS do ECT ?
They do have those defibrillator machines which jump-start the heart with a jolt of juice- those put to ewe're temples would give ewe a treatment like the ECT gives...

The Cure Is In The Current
http://www.bible.ca/psychiatry/psychiatry-his...

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Pumpkins from hell

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Mike Mulligan

Brattleboro, VT

#19 Oct 28, 2013
I was in la la la with a concussion and brain contusion. I couldn’t remember where I lived.
I woke up in a smock and no underwear on...well I was conscious, but my camera was in the “not recording mode”.

I really don't think a defibrillator has enought juice to do the job
Mike Mulligan

Brattleboro, VT

#20 Oct 28, 2013
What I learned:
There is a chain 911 response centers with cell phones in Hinsdale...to Montpelier or something, then to the Keene response center. The Vermont center collects the information, repeats it to Keene...they then send it to the police or ambulance center. I am troubled by this chain.

I don’t think the EMTs have a secure enough jobs with decent pay and a career...they don’t have the power to challenge the system.

I think volunteerism is bs and it is a threat to your health...

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