Since October 2021, low-acuity 911 EMS calls in Charlotte have a 60-minute response time goal, typically without a medical first response, under MEDIC’s Sierra protocol.
Here’s a link to a December 13, 2022 video of the briefing that MEDIC’s Executive Director, Medical Director, the Chief of the Charlotte Fire Department, and the physician Chair of the MEDIC Board provided to the Mecklenburg County Board of Commissioners, all supporting the expansion of the Sierra protocol to a 90-minute response time goal to enhance further medical first response for critical patients, and drastically improve response safety.
13 months of Sierra protocol data provided to the County Board you’ll see in the video includes:
- 12,901 low-acuity 911 calls fell in the 60-minute response goal.
- 65% of the patients were transported to the hospital.
- < 1% were transported with lights and siren.
- 0% negative impact on patient outcomes.
The expansion of the Sierra protocol from a 60-minute response time to 90-minutes will reduce MEDIC’s lights and siren response from 76% of 911 calls to 19% and reduce medical first response lights and siren use from 99% of calls to 49% of calls.
In a conversation with MEDIC’s Executive Director last week, he shared that to date, over 20,000 911 calls have fallen into the current 60-minute response goal under the Sierra protocol, and they have only received 3 complaints about the response time.
Many EMS systems are doing similar re-design, based on actual agency patient care and dispatch data, as a way to deliver a maximum response to the highest acuity calls to try and improve patient outcomes, and improve overall response safety.
One example is the Colorado Springs Fire Department, who implemented a tiered response program that sends ‘community medicine’ units only to low acuity 911 calls. CSFD’s program is receiving a national innovation award from the Congressional Fire Services Institute (CFSI) on May 23rd in Washington, DC.
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Some 911 calls could soon get a slower response from MEDIC crews in Charlotte
By Danielle Chemtob
April 13, 2023
https://charlotte.axios.com/326121/medic-is-changing-how-it-responds-to-911-calls/
Starting Monday, if you dial 911, in many cases it might take emergency personnel longer to respond to your call than it has in the past.
What’s happening: MEDIC is a not-for-profit agency funded in part by the county that provides emergency medical services in the area. The agency says it will start responding slower to calls that are not life-threatening as a way to preserve resources for the sickest patients.
Driving the news: More than three-quarters of calls are dispatched with a rapid response time and lights and sirens, but only 5% are determined to be life-threatening when emergency workers arrive, per the agency’s data.
“Our response to our calls versus our outcomes are misaligned,” John Peterson, MEDIC’s executive director, tells Axios. “And what we need to do is we need to better use our resources so that we can protect our sickest patients.”
Why it matters: The COVID-19 pandemic put a strain on emergency medical services in Mecklenburg County and elsewhere, and agencies are still understaffed. But Charlotte’s population is growing, leading to more 911 calls and a greater need for service.
Yes, but: Some firefighters have criticized the policy, saying it could put a greater burden on fire and police departments.
Tom Brewer, president of the Charlotte Fire Fighters Association, says firefighters are already waiting longer — anywhere from 45 minutes to an hour — for EMS to arrive after responding to calls. That takes away fire resources from other calls and increases burnout among firefighters, he says.
Brewer says he’s aware of numerous instances where patients got in the back of police cars or firefighters went with people to the hospital because they were tired of waiting for an ambulance.
“It’s the worst day of your life: if you’re calling 911, you want someone to get there, you expect service,” he says.
The big picture: Just under half of 450 EMS agencies in the U.S. [responding to a national survey] have lengthened response times since 2019, according to a survey from the National Association of Emergency Medical Technicians (NAEMT). The association supports MEDIC’s changes.
The study found that costs for EMS rose, including for supplies and wages.
What they’re saying: Peterson says personnel is not the reason for the policy change, but it does help them be more flexible to respond to calls in the face of issues like staffing shortages.
MEDIC, Peterson says, has 60 vacancies for frontline-facing employees, the lowest number the agency has had in over a year.
Last year, the county funded a program with CPCC that covers the costs of a student’s tuition, books and fees, plus pays a $17 per hour stipend, for an EMS training program. The students agree to work for MEDIC for a minimum of one year after graduation.
MEDIC’s new policy also involves using lights and sirens less frequently due to the risk of accidents.
Responding with lights and sirens increases the chance of a crash by 50%, per NAEMT data.
“The ambulance that never gets to the scene can’t help you,” Matt Zavadsky, an at-large director for the association, tells Axios.
The other side: Cornelius Fire chief Guerry Barbee said at a Town Board meeting that he was worried that not using lights and sirens would significantly lengthen response times, especially during rush hour or in accessing remote areas, Cornelius Today reports.
In February, the Davidson Board of Commissioners adopted a resolution that it sent to MEDIC expressing concern about the policy and requesting adjustments.
Lights and sirens only save an average of two or three minutes in travel time, according to Peterson, which he says doesn’t have an impact on the vast majority of patients.
Peterson says most of the calls that will have slower response times won’t require a response from the fire department. If police or firefighters arrive on the scene of an emergency, MEDIC will respond right away.
How it works: When you call 911, you can ask for police, fire, or MEDIC to help. The [MEDIC] call taker has medical training and uses a worldwide standard protocol to determine whether a situation is life-threatening, per Peterson.
Mayor Pro Tem Braxton Winston, who is also wary of the changes, wonders whether there’s a better way to respond to the greater need for emergency services as the city expands. He noted that some cities have a combined fire and EMS agency.
“There’s no doubt that emergency service resources are stressed,” Winston says. “That’s why you know, I question … do we have … the right MEDIC and ambulatory first response model?”
