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Lee County (Fla.) EMS System Profile

Within seconds of a patient encounter, your sixth sense as a field provider tells you whether the patient is going to need to be transported or not. A few vitals signs and an assessment later, and this notion is confirmed or contradicted -- more often than not, your gut was right.

At Lee County, Fla., we're taking this notion and employing a practice of "Movement with Purpose" to manage not only on scene times but each time interval within a call to achieve the "perfect call." At the center of this initiative is the collection and review of all data.

For example, the 2007 Consortium U.S. Metropolitan Municipalities' EMS Medical Directors position statements recommend that for calls meeting trauma criteria, an ambulance will be en route to a trauma center within nine minutes, 59 seconds after arriving at the scene. To better understand our system performance in meeting this recommendation, we opted to dig deeper into all time intervals. Using the electronic patient care reporting system from ImageTrend, we now review time intervals to understand what did and did not occur during a trauma case and find ways to be more efficient on scene.

The time needed to perform an initial assessment, treatments and procedures will vary, but to what degree is it entirely situational? The practice of "load and go" suggests that there's very little time that expires on scene. Barring barriers to patient care, with few exceptions, every patient should be afforded short scene times whether they are a trauma patient or have a stubbed toe. Through retrospective review, quality improvement officials can establish milestones within on scene times for a variety of patient types, including trauma, patient refusal, dead at scene, as well as the many other situations encountered.

Movement with Purpose is a principle for looking at the efficiencies of our processes to arrive on scene, render appropriate care and transport or not transport as needed. The practice is not asking field providers to rush what they're currently doing, but to determine whether it needs to be done at all, whether it can be done en route or on scene, or how can it be done with greater efficiency. Movement with Purpose is about responding and treating a patient's condition efficiently, so that the crew can be available for the next emergency call.

Our findings have fueled the practice of "Movement with Purpose" within Lee County, and now field providers are most efficient on scene when patient acuity is highest. Quality managers believe that through retrospective call review, the right procedures, benchmarks and strategies will normalize events and achieve the perfect call, regardless of the acuity of the patient. And we couldn't take this leap forward without a robust data collection and reporting tool.

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