Cardiac & Resuscitation, Patient Care

Foundation Provides Millions to Improve Response Times

The Duke Endowment (TDE), a private foundation, has contributed $1.6 million to a cooperative EMS Performance Improvement Toolkit Project to help„North Carolina counties improve their„EMS system response times. The grants, awarded through the North Carolina Office of EMS, will help 26 N.C. counties implement emergency medical dispatch programs, enhance existing EMD programs and implement policies that require benchmarks for important„EMS response-time intervals.

TDE also awarded $841,148 to„South Carolina to implement an„EMS data system. That system will provide organizations in that state access to the EMS performance improvement toolkits currently available for use only in„North Carolina.


The EMS Performance Improvement Toolkit Project is a collaboration by NCOEMS, TCE and the EMS Performance Improvement„Center housed within the Department of Emergency Medicine at the„University of„North Carolina at„Chapel Hill. The project began in late 2004, funded by a three-year grant to NCOEMS from TDE. NCOEMS subcontracted with the EMSPIC to develop and implement six Web-based„EMS performance-enhancement toolkits. (Check out “North Carolina Project Will Aid EMS Systems Nationwide,” December 2004„EMS„Insider, for more on this project.)

A toolkit works like “TurboTax,” using collected data to create a Web-based reporting package. Each toolkit includes a series of reports analyzing important aspects of an„EMS event.

“The goal of this project was to apply knowledge, data and experience to evaluate and improve„EMS service delivery, personnel performance and clinical care,” said North Carolina EMS Medical Director Greg Mears, MD, executive director of EMSPIC and co-investigator for the National EMS Information System.

The current„EMS toolkits focus on EMS System Response, Acute Trauma Care, EMS Cardiac Arrest Care, Acute Pediatric Care, Acute Cardiac (STEMI) Care and State EMS System Design. Funding from the Centers for Disease Control and Prevention has allowed completion of an additional toolkit on Acute Stroke Care.

The 2008 EMS Toolkit Grant Program focuses on key„EMS performance indicators in the EMS System Response Toolkit.

“We identified areas each agency could improve on,” Mears said.

“Each EMS system was given a challenge to optimize their response times as much as possible using technical assistance provided by the EMS toolkit and by NCOEMS and the EMSPIC,” said Cindy Raisor, RN,„EMS performance improvement coordinator for NCOEMS. “Many„EMS systems were unable to make all the recommended changes due to a lack of financial resources.” Those systems were invited to apply for grants to address those unmet needs.

Based on their EMS System Response Toolkit results,„EMS systems could apply for grants to either implement an EMD program or to upgrade an existing EMD program focusing on computerized performance-improvement equipment and resources.

The 26 counties that received the grants are also required to develop and implement„EMS system response-time policies on:

  • Dispatch center times;
  • EMS wheels-rolling times;
  • Emergency department turnaround times;
  • EMS vehicle maintenance; and
  • EMS data completion and submission.

“As part of the contract, they must write policies that fit their system, but we provide the template,” Mears said.

On Nov. 30, the NCOEMS announced 26 awards ranging from $31,000 to $154,277. Although the program has only $1.6 million for the grant program for 2008, 59„EMS systems had submitted applications, requesting $2.8 million in funding.

South Carolina grant

TDE also is providing more than $800,000 to the Division of EMS and Trauma of the South Carolina Department of Health and Environmental Control. “In the first year, they awarded $333,074 for the implementation of the S.C. EMS data system within 10„EMS systems,” said South Carolina EMS and Trauma Director Alonzo Smith. Another $508,074 from TDE for the second year of the project will implement the data system statewide.

According to Smith and„Mears,„South Carolina will use„North Carolina_s Prehospital Medical Information System for collecting data. EMSPIC developed, implemented and maintains PreMIS using funds obtained by NCOEMS. The use of the PreMIS system will allow„South Carolina to access and use the EMS Performance Improvement Toolkits from„North Carolina.

According to Mears, TDE and the„North Carolina and South Carolina EMS offices intend to fund local EMS agencies in both states on the basis of each of the six„EMS toolkit_s performance indicators. “The goal is to work with„EMS agencies to optimize performance on each toolkit topic,” he said. “Grant funds would be made available by TDE to local„EMS agencies based on their identified performance needs. This program could provide millions of dollars of resources to North and„South Carolina over the next 10 years.”

What this means to you

EMS systems nationwide can download the “mock toolkits” on EMS Acute Stroke Care and on EMS Acute Cardiac Care posted on the EMSPIC Web site. Each EMS toolkit contains 30 to 50 reports generated from data collected using the NEMSIS dataset, and allows each EMS system to both see its results and to compare itself with similar-sized„EMS systems (by population or square miles) and to the state average. Each EMS toolkit also recommends up to 30 operational changes (or interventions) an„EMS system could make that could result in improvements.„

TDE’s mission restricts its funding to North and„South Carolina, but, “There are hundreds of endowments and foundations across the country, and many are willing to fund„EMS initiatives,” Raisor noted.

“But you must describe and quantify the problem and the reason funds are needed and show that the proposed change would make a difference. This is one of the many benefits that a comprehensive„EMS data system can bring,” she said.

According to Mears, “The key is to get everyone onto a NEMSIS-based EMS data system that holds information on every„EMS event in their state.”

For more information, visit„

EMS„Interventions that Improve STEMI Patient Outcomes

According to the„EMS„Performance„Improvement„Center, large clinical trials have found that the following„EMS interventions improve patient outcomes:

  • A timely 12-lead ECG to promptly identify an ST-elevation myocardial infarction;
  • Aspirin administration;
  • Minimum„EMS scene times (ideally, 15 minutes or less); and
  • Transport (with early notification of impending STEMI patient arrival) to a hospital capable of performing percutaneous coronary intervention, or if PCI is not available, capable of administering thrombolytics.

EMS„Interventions that Improve Stroke-Patient Outcomes

According to the„EMS„Performance„Improvement„Center, large clinical trials have found that these five„EMS interventions improve the outcomes of acute stroke patients:

  • Quick determination and documentation of symptom-onset time;
  • Prompt recognition of the stroke via use of a validated stroke screen;
  • Blood glucose test to screen for hypoglycemia;
  • Minimum„EMS scene times (10 minutes or less); and
  • Transport (with pre-arrival notification) to a stroke center, or if a stroke center isn_t available, to a hospital capable of administering thrombolytics.