This content features bonus materials for the March JEMS feature article, "Effectiveness & Financial Benefits of Speed Loading" by Johnathan D. Washko, BS-EMSA, NREMT-P, AEMD
Images courtesy Jonathan Washko, Harry Loud & Rick Rod
Emergency Medical Services Authority (EMSA): Oklahoma City & Tulsa
Annual Responses: 91,200
Total FT & PT Employees: 344
Service Area: Urban, Suburban
Fleet Size: 51
Deployment Centers: 1
EMSA Packaging Station
The inventory of supplies is maintained more efficiently as are costs for maintaining the proper inventory. An added benefit is that supplies are in the same location every shift, making them readily accessible to all crews.
EMSA Packaging Station
Jim Jordan, Support Services Manager, for EMSA’s Eastern Oklahoma Division wrote the following regarding its speed loading program:
EMSA has found that the most efficient and cost-effective method for them so far is to have the units stocked and ready for service when the shift begins. This reduces the amount of time the crew spends at the base at the beginning of shift and increases the amount of time crew is available for requests for service. It also addresses other issues, including consistency of stock on the unit and reduction of items forgotten to be restocked.
EMSA Packaging Station
In Tulsa, we have established the support services department for speed loading. As a unit arrives at the end of shift, it is turned over to an individual or a team of support services assistants, who immediately begin preparing the unit for return to service. Each unit has numbered plastic bins of various sizes within its cabinets. For example, cabinet “6” may have a total of three different bins labeled 6a, 6b, and 6c.
When bin 6a has its protective cover opened or unsealed, it is removed and replaced by another 6a bin already stocked and sealed. The other bins in cabinet 6 still sealed are left untouched. It takes only minutes to remove all the bins that are unsealed and replace them with newly stocked and sealed bins.
Jersey City Medical Center EMS (JCMCEMS)
Annual Responses: 91,336
Total FT & PT Employees: 226
Service Area: Urban
Fleet Size: 40
Deployment Centers: 2
Deployment Type: Tiered ALS/BLS, High Performance
Sarah DeGeorge, JCMC EMS Technical Coordinator and Gerald Drasheff, JCMC EMS Supervisor shared these experiences:
Sarah DeGeorge says, “As part of Jersey City Medical Center (JCMC) EMS’s quest for best practices, I had the opportunity to see a bin system first hand while visiting a large EMS organization in the southern United States. I witnessed first-hand how a systematic approach to re-stocking vehicles was able to reduce man-hours and save costs. The challenge was to figure out how this could be implemented in a large urban EMS system with over 140 years of tradition already in place. In addition, we had to account for a variety of cabinet configurations and the unique and varied supply needs present in a tiered EMS system.”
The bins are color coded according to cabinet configuration and level of care (ALS vs. BLS). Changes were then made to the ambulance purchasing process to ensure that all future ambulances came with a standard cabinet configuration.
Drasheff says, “The initial effort that it takes to organize, set up, and maintain the bins is a wise investment. It saves a considerable amount of time when checking, re-stocking and setting up ambulances. Before the bins it would take two to three hours to completely set up an ambulance. We can now set up a truck in about an hour.”
What JCMC EMS found was that every employee had a different “safety” item. DeGeorge says, “By the end of the week, there were enough OB kits to run an MCI at a maternity clinic, more gloves then you could go through in a year and the cabinets were so cluttered that you would have to empty half of the cabinet to find any one particular item. There was no organization or standard cabinet setup. On calls were seconds truly count, this could be problematic.”
North Shore – LIJ Center for EMS, NYC & Long Island, N.Y.
Annual Responses: 119,000 Total FT & PT Employees: 600 Service Area: Urban, Suburban Fleet Size: 100 Deployment Centers: 6 Deployment Type: FDNY EMS 9-1-1 program - Tiered ALS/BLS in static deployment model, Core Division (Long Island) all ALS with High Performance deployment www.northshorelij/NSLIJ/CEMS
North Shore Vehicles
“Our approach is slightly different that others as we have challenges completely centralizing our operations because of New York City traffic, contractual obligations and our agencies vast geography."
North Shore Vehicles
We employ speed loaders, but have moved a majority of the technicians, distribution and manufacturing points from a warehouse, into multi-function, mobile support units, capable of handling almost every supply or minor vehicle maintenance need, from ALS and BLS supply re-stocking, repackaging and resealing, to jump starting a vehicle, to towing a vehicle if stuck in snow to swapping out a malfunctioning stretcher or stair chair, to plowing snow, to replacing light bulbs, wiper blades and windshield washer fluid to rescuing someone from an area inaccessible by an ambulance (all the units are heavy duty 4x4’s)."
North Shore Vehicles
"We use these vehicles and approach to combat out of service time and it works and works well!”
Regional Emergency Medical Services Authority (REMSA) Reno, Nev.
Annual Responses: 55,000
Total FT & PT Employees: 330
Service Area: Urban, Suburban, Rural
Fleet Size: 62 Vehicles, 3 Helicopters
Deployment Centers: 1
Deployment Type: All ALS, High Performance
REMSA Re-stocking Station
Valarie Popovich, current REMSA Communications Supervisor and former Supply and Logistics Manager responsible for installing REMSA’s existing Speed Loader program shares her experiences:
“Prior to the introduction of our speed loader program back in 2007, the average vehicle turn-a-round time for our supply technicians to restock, wash and sterilize an ambulance was well over an hour. Our fleet was not standardized and different ambulances had supplies and equipment in different places and the reliability of the system was not as good as it could have been.”
Life EMS, Kalamazoo, Mich.
Annual Responses: 21,000 Total FT & PT Employees: 54 Service Area: Suburban, Rural Fleet Size: 13 Deployment Centers: 1 www.lifeems.com
Kraig Dodge, vice president of Operations, and Brian Scribner, Director of Operations, explain one of their operations that use the Speed Loader concept. "Life EMS has positions in our urban operations that we call “readi medics.”
We found that “readi medics” were taking excessively long to complete rig checks. Our unit check sheet was excessively complicated and our units had excessive overstock of supplies on board (paramedics are known to horde supplies), so completing a check sheet could take 45-60 minutes on average. We also were having a problem with losing important items such as gas cards, hospital access cards, and portable radios.
Readi medics are support personnel who actually do the rig checks and rig re-stocking. Their job is to have each rig completely prepped and ready for deployment so when the medic crew arrives, they can simply get into their unit and deploy into the system. We use basic EMTs as “readi medics” so they can also be used on the ambulance if we need the added staffing depth during high call volume periods."
Life EMS Bins
Before the speed loader program, Life EMS spent approximately $5600 to fully stock a unit (not including heart monitor, of course). After the speed loader program, we spend approximately $4000 per unit. We then planned the speed loader bins based on the new inventory list.
Sunstar Paramedics (Pinellas County, Fla.)
Annual Responses: 181,000 Total FT & PT Employees: 558 Fleet Size: 74 Deployment Centers: 3 Deployment Type: All ALS, High Performance www.sunstarems.com
San Diego Fire-Rescue Department & Rural Metro
San Diego Fire-Rescue Department and Rural Metro of San Diego, formally the partnered organization San Diego Medical Services Enterprise, who now provides Emergency Medical Services to the City of San Diego and surrounding areas, speed loading was born primarily as a method of inventory control.
The first version of the Bin System was developed using large PVC (plastic) containers that contained specific items, generally related, such as Airway supplies, Trauma supplies, Oxygen supplies and so on. The containers were sealed with a plastic security clip.
The first version of the Bin System was developed using large PVC (plastic) containers that contained specific items, generally related, such as Airway supplies, Trauma supplies, Oxygen supplies and so on.
The containers were sealed with a plastic security clip. Interestingly, it was decided to gather trusted staff members with appropriate support vehicles to be simultaneously deployed to each and every fire station/ambulance post to recover all medical supplies and equipment stored within.
Saving on Supplies
With the return of the excess supplies to the central supply warehouse after the initial deployment, it was found that close to 3.2 million dollars in supplies and equipment was returned and accounted for. Obviously, this resulted in the agency’s ability to upgrade and modernize its fleet with new equipment and supplies.
All supplies and equipment was inventoried, removed from the stations/posts and returned to the central supply warehouse. At the same time, the various new containers (bins) were deployed to each station/post.
When the daily rounds driver visited each station, any bin that was found to have been opened would simply be replaced with a new bin and the used bin would be returned to the central supply warehouse and inventoried, restocked, resealed, and made ready for redeployment.
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