Proposal Will Give Okla. EMSA Extra Minutes to Respond to Serious Calls

Aug. 27-- EMSA ambulances would have two more minutes to arrive at the most serious medical calls under a proposed new contract for paramedic service, records show.

The Emergency Medical Services Authority is including an allowable response time of 10 minutes and 59 seconds for priority one calls in its request for proposals as part of a new paramedic contract. The current maximum response time for priority one, or life threatening, calls is 8 minutes, 59 seconds.

EMSA's contractor, Paramedics Plus, must respond to 90 percent of priority one calls within that time frame or face fines. EMSA's five-year contract with Paramedics Plus expires Oct. 31, 2013.

The Medical Control Board recommended the change, based on studies showing little benefit to shorter response times.

EMSA is a government agency that supervises a contractor providing medical service for more than 1 million people in Tulsa, Oklahoma City and surrounding cities. Residents of those cities pay a fee on their utility bills designed to cover out-of-pocket costs for ambulance service.

The 11-physician Medical Control Board establishes medical standards of care for first responders working for EMSA and fire departments that make up the EMS system for Tulsa, Oklahoma City and surrounding areas.

"We didn't dictate the need to change the response time," said EMSA spokeswoman Kelli Bruer. "The Medical Control Board, after researching the issue, came back with that recommendation. It is a clinical change they are recommending based on evidence-based medical outcomes."

The response time is measured from the time a call comes into the dispatch center until the ambulance arrives, Bruer said.

If adopted in the new contract next year, the 10-minute, 59-second response time for priority one calls would be longer than response times in four out of five peer cities and equal to that of a fifth city. Those emergency medical systems are based in Tyler, Texas; Fort Worth; Pinellas County (Tampa), Fla.; Fort Wayne, Ind.; and Charlotte, N.C. They have response times ranging from Tyler's 8:59 to Charlotte's 10:59.

"As with many clinical changes, EMSA often leads the nation for a service its size," Bruer said. "We expect other cities to also be evaluating their response times as well, if they haven't already."

At the suggestion of EMSA trustee Clay Bird, the request for proposals will also seek bids on a 8:59 response time.

The contract to provide paramedic service for EMSA is a lucrative one. EMSA paid Paramedics Plus more than $208 million during the current five-year contract, records show.

EMSA board members heard a presentation from CEO Steve Williamson about the response time issue during their monthly board meeting last week. Williamson pointed to a recent study by the Department of Emergency Medicine at the University of Oklahoma's School of Community Medicine in Tulsa. EMSA commissioned the study, which was published last year.

The study reviewed numerous scientific studies on response times. It concludes that "EMS system response times may not be a significant factor in improving clinical outcomes from acute illness or injury."

The review of studies found some types of emergencies -- including cardiac arrest, choking and allergy-induced shock -- may benefit from very short response times.

Dr. Jeffrey Goodloe, an EMSA board member and medical director of the Medical Control Board, served as an editor on the study. Goodloe is an associate professor of emergency medicine at the OU School of Community Medicine.

Goodloe said that because the Tulsa Fire Department responds to priority one calls, a longer response time would not pose a risk to patients in EMSA's service area. All fire department vehicles are equipped with defibrillators, a device that delivers a dose of electric energy to the heart during cardiac arrest.

Goodloe said there is a risk to shorter response times from ambulances being involved in accidents en route. He said there is little available data, however, on such accidents.

"There is a real concern in emergency medical services and public safety in general about the unnecessary risk that is created by artificially low response times and use of lights and sirens when they don't have beneficial impact," Goodloe said. "We would never recommend curbing the use of lights and sirens or lengthening the allowable response time if it came at a clinical detriment to the patient. We always want the benefit to outweigh the risk."

Response times

Here are maximum allowable priority one response times of EMS systems in selected peer cities that EMSA uses for various comparisons. Based on data contained in a recent study by OU, EMSA is proposing to lengthen the allowable response time to 10:59 on priority one, or life-threatening calls. Its current priority one response time is 8:59, though its average time for such calls is actually less than six minutes, according to spokeswoman Kelli Bruer.

Tulsa: 8:59 (proposed time 10:59)

Tyler, Texas: 8:59

Fort Worth: 9:00

Pinellas County (Tampa) Fla.: 10:00

Fort Wayne, Ind.: 8:30

Charlotte, N.C.: 10:59

Source: EMSA

Ziva Branstetter 918-581-8306

ziva.branstetter@tulsaworld.com

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