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Creating an EMS Safety Net

stout

If you call up FirstWatch.net, you will see a dramatic opening on its website: “Bioterrorism. Epidemics. Crime Patterns. Operational Vulnerabilities. For any kind of threat, earlier detection means earlier action. Know first with FirstWatch.”

No, FirstWatch isn’t the latest movie starring Bruce Willis. Rather, it’s the state-of-the-art, real-time early warning system and company run by President Todd Stout. The system could more closely be called a virtual EMS supervisor, a term coined by his colleague, Bruce Evans, the deputy chief of Upper Pine River Fire Protection District in Colorado.

“I built this system originally in 1998 to monitor EMS dispatch data in Kansas City,” says Stout. “We watched for statistically significant increases in certain kinds of calls, which could indicate signs and symptoms of a bioterrorist event.”

Almost 15 years later, the FirstWatch system has come a long way. The system today is a high-tech data mining and monitoring marvel, tracking EMS call activity for 118 agencies, or consortiums of agency sites, across the nation.

“We track almost 300 different agencies and get about 40,000 new public safety incidents a day, mostly EMS, into our data centers,” says Stout. “That’s one record every two seconds, but we get each of those records many times because we are polling those calls throughout the life of the call.”

The system electronically monitors and reports on everything from patient care performance, ambulance and vehicle breakdowns, pediatric drownings, even accidents in traffic traveling to and from large-scale special events like concerts, sporting events, and other entertainment events. They are all tracked and recorded in real time.

Building a Network
FirstWatch looks for user-defined criteria or geographic clusters that pinpoint statistically significant increases. If found, the system sends out an alert to the company’s dashboard and then alerts EMS providers about the situation. In essence, FirstWatch is an EMS safety net.

“In the old days, dispatch and supervisors were less busy and had more time to listen to the radio and pay attention to what was going on,” says Stout. “Now everyone is just pushed so hard, resources are cut, and they end up in a spot where there is no reasonable way for humans to keep up. These are easy things for a computer to do, so it relieves the burden on humans.”

Take, for instance, the Richmond Ambulance Authority. On certain days, EMS dispatch within the city noticed spikes in calls with people experiencing respiratory problems, and the agencies needed to find a correlation in order to stay ahead of the curve. FirstWatch helped them track the calls and ultimately determine the culprit: changes in temperature of 30 degrees warmer or colder. “When there is that fairly big change in temperature, EMS knew they were going to get slammed with respiratory calls within the next several hours or days,” Stout says. “Once they figured that out, they started stocking extra oxygen supplies on those days.”

Or take the Tulsa, Okla., ice storm are few years ago, when dispatch calls spiked for carbon monoxide poisonings. When Stout’s FirstWatch team did a recalculation of the calls over a two-week period, something that’s easy for the system to do, they discovered that most of the calls were coming from predominantly Hispanic parts of the city. Further investigation revealed that the ice storm knocked out power, and people were trying to keep warm using barbecues and generators inside their home.

“They were killing themselves with carbon monoxide,” says Stout. EMS contacted the press and radio stations about the situation, and they asked residents to take barbecues and generators out of their homes and garages. That action precipitated a rapid decline in carbon monoxide calls. “We put all of that together in an hour with the information that was coming in from the EMS dispatch stations,” Stout says.

FirstWatch & the President
One of the more “exotic” parts of the FirstWatch system is its ability to draw a “geo fence” around a particular area that will, in essence, strip out routine EMS calls and focus on specific “triggers” that may be related to an event in the area. For instance, FirstWatch was deployed recently in Honolulu, Hawaii, at a conference attended by President Barack Obama. FirstWatch was used to draw two geo fences, one around the area of possible protestors and one around the area where attendees were staying.

“We set up the geo fences,” says Stout, “and then our customers watched everything in those fences a little closer. We pulled out other routine EMS calls and watched for bomb threats, fights, assaults and gastrointestinal problems that might indicate food poisoning situations.”

The geo fences can be used for tracking data in a geographical area, such as following parade routes in New Orleans during Mardi Gras, but they are also used to track clusters occurring anywhere within a predefined area and time frame. So, for instance, if the data reveals a geographical cluster of seizures within a close time frame, FirstWatch sends out an alert that something is amiss.

“That’s not normal because seizures are not contagious,” Stout says. “Something is causing them. So we can look for x number of seizure calls in number of miles within a certain time period. We can pick the wheat from the chaff and see what’s going on.”

Forging Partnerships
Currently, Stout and FirstWatch are partnering with Sabina Braithwaite, MD, MPH, and Sedgwick County EMS in Wichita, Kan., to take their monitoring beyond response time and performance improvement. For several months, medics have been capturing the hospital’s medical record identification numbers for patient billing and follow-up purposes.

“Now that we have all that data, we can tie every call they take and every patient they respond to, from dispatch, to what the medic found, to the patient’s condition at emergency room discharge, into the hospital or out into the world,” says Stout. “From a research perspective, that opens up a constantly changing batch of information that people typically had to manually tie together. How much healthcare improvement can be done from that?”

Stout’s goal is to eventually standardize all the data so that it can be analyzed and reported in meaningful ways. “We’ve been doing this for more than a decade, and none of that standardization exists,” he says. “We now have this structured framework, a system, and a process to grab that data, bring it in and analyze it.” This, in turn, will help FirstWatch provide a better data-capturing platform for his customers. “I can’t guess what a customer’s needs are from a data perspective; I don’t know what their medical directors are after, and I don’t know exactly what their challenges are,” he says. “Our business model is to put our system in place and then work with the agency to give them what they need.”

Customer Appeal
Stout is quick to point out that his customers’ needs drive the way data is captured, measured and reported. “They don’t need me to come in and say you have to capture the data this way to make it work,” he says. “We approach it from the perspective of best practices shared, and we show them what other geographic regions do in monitoring and reporting data.”

Beyond just collecting data for monitoring and reporting purposes, Stout sees the real value of the FirstWatch system in its ability to improve clinical quality. If prehospital providers can use the data to link their own performance to better patient care, so much the better.

“If I’m a medic, and I know if I do ‘X,’ it does this, and I do ‘Y,’ it does that, and somebody tells me that right after I do it, then it will stick in my head, and I will do a better job,” he says. “This will help us know about patients. We’re going to know what’s happening with them, and I’m going to be able to make improvements in my skills and approach to make patient care better.”

The real-time monitoring—and feedback—lies at the heart of the success of FirstWatch. Stout stresses that prehospital providers want to do good work, and they want to do the right thing. Real-time data reveals real-time problems, and real-time solutions. Quickly sharing that feedback can mean tightening efficiencies, resulting in real cost and life savings.

“We can take the burden off of prehospital dispatch and field providers and help make their jobs easier,” he says. “Let the computer do what the computer does really well, and let’s save the humans for things that it takes human brains to do. I know how EMS people function and think for the most part, and our team can take good care of them.”
 

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