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North Dakota EMS

Systems Model
Mark Weber
Tyrone Johnson
North Dakota EMS Systems Model
North Dakota EMS Systems Model

> What is an EMS System?


> What is the purpose of planning EMS
systems?
> What we need to do.
do

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North Dakota EMS Systems Model

> What is an EMS System?


> A system that assures reasonable access to
emergency healthcare.
> A coordinated effort of response to a call for
help utilizing all resources.

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North Dakota EMS Systems Model

> What is an EMS System?


> Getting help to the patient as soon as possible.
CPR trained (AED), First Aid, First Responder
(citizen, law personnel, fire and EMS)
> Effective Communications.
Coordinated response (professional dispatch,
automatic dispatch of resources)
The right resources (Ambulance,
Ambulance, Fire, Law, extrication,
water rescue, utility, etc.)

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North Dakota EMS Systems Model

> What is an EMS System?


> Tiered response
First Responders (well equipped/trained)
Quick Response Units (well equipped/trained)
Rescue/Extrication
Substation Ambulance Services
BLS Ambulance Services

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North Dakota EMS Systems Model

> What is an EMS System?


> Tiered response
ALS Ambulance Services
Air Services
Level 4, 5 Trauma/Medical Centers
Level 2, 3 Trauma/Medical Centers
Transport to tertiary Specialty Centers
(Burn, Pediatric, Amputation)

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North Dakota EMS Systems Model

> What is the purpose of planning EMS


systems?
> Vision: What will EMS look like in 20 years
> How many Ambulance Services will survive?
> Do we need 140? maybe, maybe not.
> We will need access to emergency healthcare in
every community

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North Dakota EMS Systems Model

> What is the purpose of planning EMS


systems?
> Vision: What will EMS look like in 20 years
We will not have enough volunteers
Things will look different
Someone needs to facilitate the change
> We cannot let ambulance services just close their doors, it
must be a coordinated transition.

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North Dakota EMS Systems Model

> What we need to do.


Define what reasonable EMS is.is
Assist all EMS services

Identify Critical Ambulance Services


Build a foundation of ALS Services
Develop a consistent funding source.
North Dakota EMS Systems Model

> What we need to do.


Define what reasonable EMS is.
> Defined by DEMS
> EMS agencies be dispatched directly by a public safety
answering point (P SAP) by radio or pager.
> EMS agencies have scheduled personnel on call at all
times.
> When there is a fragmented response by EMTs there is
direct communications between EMTs and other crew.

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North Dakota EMS Systems Model

> What we need to do.


Define what reasonable EMS is.
> Defined by DEMS
> Automatic ALS dispatch for;
> Major trauma requiring transport to a designated trauma
center. > Cardiac chest pain or acute myocardial infarction.
> Cardiac arrest.
> Severe respiratory distress or respiratory arrest.
> Utilization of ALS Air care

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North Dakota EMS Systems Model

> What we need to do.


Define what reasonable EMS is.
> Defined by DEMS
> Cities with a hospital must have an ambulance service.
> Cities with a population of at least 1,000 that are more than
15 miles from another city of 1,000 must have an
ambulance
> Cities with a population of 500 to 999 and that are fewer
than 25 miles from an ambulance must have an EMS
agency.
> 20 minute response time on all major highways

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North Dakota EMS Systems Model

> What we need to do.


> Define what reasonable EMS is.
> Defined by DEMS
> Urban ambulance services must have a response time
standard of arriving on scene in fewer than nine minutes 90
percent of the time.
> Rural and transportation corridor ambulance services must
have an enroute time of 10 minutes or less 90 percent of
the time and an overall response time of less than 20
minutes 90 percent of the time.

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North Dakota EMS Systems Model

> What we need to do.


> Define what reasonable EMS is.
> Defined by DEMS
> Frontier ambulance services must have an enroute time of
10 minutes or less 90 percent of the time and an overall
response time of less than 30 minutes 90 percent of the
time.

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North Dakota EMS Systems Model

> What we need to do.


Assist all EMS services
> Leadership programs
> Medical Oversight/Quality patient care
> Recruitment and retention programs
> Help them improve their system (create value)
> Provide high quality, low cost Education
> Educate the public to the importance of EMS
> Accept the fact that we will need to help the most rural areas
> Work on the rural/frontier attitude about loosing
services

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North Dakota EMS Systems Model

> What we need to do.


Assist all EMS services
> Work on competiveness between services
> Develop efficient /coordinated systems to continue service
when communities cannot operate a 24/7 service.
> We cannot let the closing of one service close another.
> Work toward competency based education rather than the
required 72hrs of continuing education.

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North Dakota EMS Systems Model

> What we need to do.


Identify Critical Ambulance Services (Access Critical)
> Ambulance services that are critical to ND EMS.
> Services that need to be here in 20 years (reasonable EMS)
> Facilitate and fund continued services
> Whose responsibility is it to fund EMS
> Offer an analysis of service
An evaluation of their current system and recommendations
for improvement.

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North Dakota EMS Systems Model

> What we need to do.


Identify Critical Ambulance Services (Access Critical)
> Offer leadership training
> Develop medical oversight program, to help keep competent
providers. (this may help with education requirements)
> Develop & Facilitate Recruitment and Retention programs.
> We need to accept the fact that there is going to be depopulation
in the rural areas.

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North Dakota EMS Systems Model

> What we need to do.


Build a foundation of BLS/ALS Services (larger communities)
> Used as the local resource for Advanced level care and other
resources. (transfers and intercepts with BLS services)
> Help them with
> Transition from BLS to ALS
> Leadership
> Recruitment and Retention
> Reimbursement
> Working to develop a system

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North Dakota EMS Systems Model

> What we need to do.


Build a foundation of BLS/ALS Services (larger communities)
> Help them with
> Offer an analysis of service
> An evaluation of their current system and recommendations for
improvement.
> Funding (Whose responsibility is it to fund EMS)
> Local, County, State
> Funding for mandatory intercepts
> Communications

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North Dakota EMS Systems Model

> What we need to do.


Develop a consistent funding source.
> Local:
> Services must operate as a business (reimbursement, fiscal
responsibility) > Buy in from the community.
> State:
> Medicaid reimbursement
> Public service funds, Statewide funding
> Federal:
> Medicare reimbursement levels

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North Dakota EMS Systems Model

> What we need:


> Funding
> For Access Critical Ambulance Services
> To help keep them open with staff
> To provide Reasonable EMS

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North Dakota EMS Systems Model

> What we need:


> Funding
NDEMSA
> Keep the process moving forward
> Leadership training
> Recruitment and Retention program
> EMS Open forum meetings
> EMS awareness
> Facilitate analysis of troubled systems

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North Dakota EMS Systems Model

> What we need:


> Funding
DEMS
> Education (specifically to bring services together and
train) > Trauma (PHTLS classes)
> Pediatrics (PEPP classes)
> EMS initial classes
> EMS refresher classes
> Medical
Oversight/Q.I.

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North Dakota EMS Systems Model

Vision:

Reasonable EMS coverage

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North Dakota EMS Systems Model

> Vision:
> This is not going to be a one size fits all solution.

> Ambulance Services are closing, we need a system in


place to assure reasonable EMS for all communities.

> We need to identify the access critical services that need


to be here in 20 years.

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North Dakota EMS Systems Model

Questions

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