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Untitled document

Advanced Life Support Pilot Project
Final Report

Narrative

The following information is being provided as a final report of findings and recommendations of the
Advanced Life Support (ALS) Pilot Project. The data provided in this report covers a period commencing June 18, 2004 and concluding on December 31, 2004. An interim report was produced and published on November 23, 2004. This document is an extension of that information and provides a total summary of data collected in table form. Also provided is a medical review of data and patient Five ALS providers took part in the pilot project: Fitch-Rona EMS, Town of Madison Fire Department/EMS, City of Madison Fire Department/EMS, City of Middleton EMS, and Sun Prairie EMS. Sun Prairie EMS began providing paramedic service to their community as of August 9, 2004 and began participating in the pilot project on November 8, 2004 after meeting the requirements for participation set forth by the Steering Subcommittee. This subcommittee consists of representatives of Dane County EMS, Fire Fighter Union Local 311, the Public Safety Communications Center, and one representative from each of the participating ALS providers. A Memorandum of Understanding was developed by the participating agencies and signed by their governing bodies. This document provided the guiding principles for the pilot. It specified that the closest available municipal ALS ambulance would provide ALS care within Dane County. In addition, BLS service providers would receive the closest available ALS ambulance on those calls determined by the Medical Priority Dispatch System (MPDS) to be categorized under the currently adopted list of automatic aid codes or when requested by a BLS provider. The Medical Priority Dispatch System was fully implemented into the Public Safety Communications Center on February 18, 2002. The system is intended to assess each 911 call medically to allow allocation of the proper level and speed of EMS care while identifying pertinent safety and clinical information for EMS responders. It also identifies certain life threatening conditions that require full resource allocation while providing life saving instructions to callers. The first automatic dispatch of ALS began on February 1, 2003 with the first dispatch of the closest ALS unit commenced on June 18,
An additional charge of the steering subcommittee was to study and submit recommendations for the
consolidation of medical direction and collaboration among all ALS providers. To that end, an ad hoc subcommittee was formed to study the possibility of medical direction consolidation. The subcommittee will explore potential ways in which this proposal might be accomplished. There are numerous positive reasons in support of this consolidation initiative. The committee will continue to dialogue on this issue with the understanding that resolution will take time. The ALS Pilot Steering Subcommittee concept worked very well. It provided an avenue by which participating providers could share concerns and request revisions. The subcommittee met monthly U:\ems\SHARED\ALS Final Report 052605.doc Data Collection
A Data Collection Subcommittee was formed. They were tasked to review and analyze data on a biweekly basis. The committee had nine members with representation from each of the following constituencies: Firefighters Union Local 311, Dane County BLS providers, Dane County EMS, the Public Safety Communications Center, and a representative from each of the five participating ALS The Data Collection Subcommittee has met numerous times during the pilot period. Since the commencement of the pilot 533 calls for ALS service have been made. 187 of those calls were a result of Automatic Aid or Closest ALS responses as determined by the Medical Priority Dispatch System, and 142 were manual requests for ALS by Basic Life Support services.
The following tables of information show a summary of all calls handled by the ALS
providers outside of their primary response jurisdiction.
Call Volume Summary for Responses Into Other EMS Districts
By Each ALS Provider
Participating ALS Agency Mutual Auto BLS Closest Specific Dispatch Total Number
Aid Request
Request Discrepancies
Fitch-Rona EMS
City of Madison FD/EMS
City of Middleton EMS
Sun Prairie EMS
Town of Madison FD/EMS
The following definitions are provided for clarification: Mutual Aid Request – No ambulances were available in the requesting jurisdiction
ALS Intercept (Automatic Aid) – Simultaneous dispatch of an ALS unit with a BLS unit based
on the list of high-level Priority Dispatch codes ALS Intercept (General Request from BLS Services) – Response with a BLS ambulance from
another jurisdiction after the BLS unit has requested ALS support Closest ALS Unit – Responding ALS unit was closer than an ALS unit from the other
Dispatch Discrepancies – Typically, situations where the incident took place near a
jurisdictional border and the official location was changed to reflect the proper municipality after the ALS unit from the neighboring jurisdiction arrived on scene Specific Request for ALS – Situations not covered by any of the above examples

Medical Priority Dispatch System – A standardized commercial training program for 911 call
takers with scripted questions and instructions which allows them to: Consistently and accurately interrogate 911 callers to determine the exact problem and Identify and provide instructions regarding on-scene safety items. Allocate the proper level of EMS response and care. Give medically sound post-dispatch instructions and life-saving pre-arrival instructions to Provide accurate information to EMS responders. U:\ems\SHARED\ALS Final Report 052605.doc List of Predetermined Automatic Aid Codes and ALS Call Activity
Code Description
Ineffective Breathing – Cardiac or respiratory arrest Chest Pain – Severe respiratory distress Heart Problem - Severe respiratory distress Stabbing/Gun Shot – Unconscious or arrest Interfacility Transfer - Suspected cardiac/respiratory arrest Total Delta
Code Description
Ineffective Breathing (Allergic Reaction) Ineffective Breathing (Breathing Problems) Cardiac or Respiratory Arrest (Not Breathing) Cardiac or Respiratory Arrest (Breathing Uncertain) Cardiac or Respiratory Arrest (Strangulation) Cardiac or Respiratory Arrest (Suffocation) Cardiac or Respiratory Arrest (Underwater) Ineffective Breathing (Electrocution/Lightening) Ineffective Breathing (Unconscious/Fainting) Total Echo
Prior to the inception of the ALS Pilot Project, the above list of high priority call types was established in which 911 dispatchers were to send the closest available ALS ambulance. This chart illustrates the frequency that ALS ambulances were dispatched to each of the specific high priority call types. This data can be used to evaluate the ways in which ALS resources are being used and if this list of codes U:\ems\SHARED\ALS Final Report 052605.doc Reasons For ALS Support and/or Mutual Aid Received by All Providers
District Receiving ALS Services
Specific
Dispatch
Request Discrepancy Total
Belleville EMS
Blooming Grove, Burke, Maple
Bluff EMS
Brooklyn EMS
Cambridge Area EMS
Cross Plains Area EMS
Deer-Grove EMS
De Forest FD/EMS
District 1 EMS
Fitch-Rona EMS
City of Madison FD/EMS
Marshall EMS
McFarland EMS
Middleton EMS
Monona FD/EMS
Mount Horeb FD/EMS
New Glarus EMS
Oregon Area FD/EMS
Sauk Prairie EMS
Shorewood Hills EMS
Stoughton Area EMS
Sun Prairie EMS
Town of Madison FD/EMS
Waunakee Area EMS
*Albany EMS
*Arena EMS
*Arlington EMS
*Barneveld EMS
*Blanchardville EMS
*Curtis Ambulance (Edgerton)
*Curtis Ambulance (Madison)
*Evansville EMS
*Heartline-Medix EMS
(Columbus)
*Lake Mills EMS
*Lodi Area EMS
*Plain EMS
*Poynette-Dekorra EMS
*Ryan Brothers Ambulance
*Spring Green EMS
*Waterloo EMS
* Indicates an Out-of-County or Private EMS Provider. The definitions shown on page 2 should be used when reviewing this U:\ems\SHARED\ALS Final Report 052605.doc ALS Support and/or Mutual Aid Supplied by Each ALS Provider
ALS Agency Providing Services
District Receiving ALS Services
Belleville EMS
Blooming Grove, Burke, Maple Bluff EMS
Brooklyn EMS
Cambridge Area EMS
Cross Plains Area EMS
Deer-Grove EMS
De Forest FD/EMS
District 1 EMS
Fitch-Rona EMS
City of Madison FD/EMS
Marshall EMS
McFarland EMS
Middleton EMS
Monona FD/EMS
Mount Horeb FD/EMS
New Glarus EMS
Oregon Area FD/EMS
Sauk Prairie EMS
Shorewood Hills EMS
Stoughton Area EMS
Sun Prairie EMS
Town of Madison FD/EMS
Waunakee Area EMS
*Albany EMS
*Arena EMS
*Arlington EMS
*Barneveld EMS
*Blanchardville EMS
*Curtis Ambulance (Edgerton)
*Curtis Ambulance (Madison)
*Evansville EMS
*Heartline-Medix EMS (Columbus)
*Lake Mills EMS
*Lodi Area EMS
*Plain EMS
*Poynette-Dekorra EMS
*Ryan Brothers Ambulance
*Spring Green EMS
*Waterloo EMS
This table illustrates the number of times that each of the participating ALS providers supplied ALS support or mutual aid responses in support of another EMS district. As expected, this data reveals the relationships and interactions between all EMS providers and helps to define the regiona

Source: http://www.co.dane.wi.us/emergency/ems/pdf/als_final_report.pdf

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