KSN Investigates: EMS response times

(KSN photo / file)

WICHITA, Kansas – A KSN investigation into operations at Sedgwick County EMS, particularly concerning ambulance response times and performance, has revealed concerning information about how the department has been forced to operate with limited funds.

Our investigation detected numerous challenges with limited resources at Sedgwick County EMS. KSN News delved deeper into the situation, revealing that with more calls coming in, putting a greater demand on EMS, there is an alarming trend that could impact citizens the next time they call 911.

Sedgwick County EMS: Call Volume on the Rise

The call volume at Sedgwick County EMS has increased at a rate of about three to four percent each year. Meaning, the number of emergency calls EMS responds to is on the rise.

Through our investigation, KSN News has learned that the trend of increasing calls has forced emergency officials to get creative with how they respond to emergencies in the county.

Scott Hadley, Director, Sedgwick County EMS.
Scott Hadley, Director, Sedgwick County EMS.

“…There’s been a steady increase month to month in our call volume, over the previous time frame in the previous year,” said Scott Hadley, the Director of Sedgwick County EMS.

Hadley said administration at EMS looks at the data to try to understand why certain trends, like an increase in call volume, are occurring.

When every second counts in an emergency situation, whether it be ‘life or death,’ the track record matters… and Sedgwick County EMS tracks these records.

“On the surface, it may be very simple. You call 911, an ambulance comes and it takes me to the hospital,” said Director of Sedgwick Co. EMS, Scott Hadley. “But, there’s a lot that goes on to make that happen and to make it happen in the most effective and efficient manner.”

KSN’s Brittany Glas dug into the data below, investigating whether the way EMS operates in Sedgwick County, could be adding to your wait.

Sedgwick County EMS: Data Explained

According to the Sedgwick County EMS webpage, EMS “responds to an average of 155 requests for service per day and more than 56,000 responses per year.

Since January 2011, when officials with Sedgwick County EMS began producing monthly performance reports, SCEMS has been committed to providing transparent information about their operations to the Sedgwick County Commission and the public, alike. Of the trends tracked, response times and call volume data is incredibly important to operations for the Division of Public Safety.

Sedgwick County has set, defined times / time limits for what it considers “On Time Responses.” These apply to all three areas across the county, as outlined by their area and population. They are:

  1. Urban areas: 8:59
  2. Suburban areas: 10:59
  3. Rural areas: 15:59
Click to view EMS reports
Click to view EMS monthly reports

Sedgwick County EMS sets its own standard that it should meet these response times, 90 percent of the time, for calls in Urban, Suburban, and Rural portions of the county. EMS gives itself a monthly “report card” of sorts, documenting how often they met those response time goals.

Concerning their own 90 percent goal, Sedgwick County EMS is not meeting that goal most months. They are, however, getting very close to that 90 percent target.

  • Emergency calls in Urban Sedgwick County: 98% of the time, the monthly 90% goal is met.
    According to their monthly response reports, Sedgwick County EMS meets the standard 93 percent of the time, on average, in Urban areas.
  • Emergency calls in Suburban Sedgwick County: 15% of the time, the monthly 90% goal is met.
    While Suburban calls are the worst in terms of meeting the agency’s 90 percent goal, they are responding to individual emergencies on time, about 84 percent of the time, on average. This is just below the 90 percent target.
  • Emergency calls in Rural Sedgwick County: 28% of the time, the monthly 90% goal is met.
    Performance for Rural calls come in second when considering how often it meets the agency’s 90 percent goal, they are responding to individual emergencies on time, about 87 percent of the time, on average. This is just below the 90 percent target.

Sedgwick County EMS has set the standard, and by their own admission, they are not meeting their own standard for emergency calls in Rural and Suburban Sedgwick County.

“The numbers have reflected, especially in the Suburban and Rural areas, we’re not as reliable as we once were, several years ago,” said Hadley.

To reiterate, however, each month, they do come extremely close, but their monthly performance reports reveal that SCEMS is usually below the cut off of 90 percent. Therefore, not meeting the standard, monthly.

KSN News sat down with the head of EMS in Sedgwick County to address the performance reports.

“We’re not as reliable as we once were over the years,” said Scott Hadley, Director, Sedgwick County EMS.

“We measure that to see ‘how are we doing?’ from the time the caller calls 911, until we arrive at the Emergency Department,” said Hadley.

This, he says, is only one span of time that EMS measures on every call the department takes.

Annual-Volume
Sedgwick County EMS & Wichita Fire / Sedgwick County Fire Departments: Emergency Operations

In Sedgwick County, every time 911 is called for a medical emergency situation, the call is sent to both Sedgwick County EMS and fire, either the Wichita Fire Department, or Sedgwick County Fire Department.

“They’re dispatched at the same time our units are dispatched,” said Major Russ Trower, a division leader for Medic 1 for Sedgwick Co. EMS.

For calls that are especially demanding, like ‘Subject Not Breathing’ calls, two fire units are sent to respond.

In cases like this, Maj. Trower said, “a lot of manpower helps us out.”

More often than not, as discovered through our KSN Investigation, an ambulance won’t be the first to respond to an emergency in the county.

Who will? It’s likely, firefighters will.

“In a lot of the cases, that is true,” said Scott Hadley. “…where they [firefighters] will get there first and everybody starts out with the basic assessment.”

Scott Hadley told KSN News that the entities work together, in a combined effort, to handle emergency calls.

Hadley says that on the majority of higher acuity calls, the fire departments respond, as well.

“We can all work as a team together to provide care to that patient,” said Hadley.

This collaboration is possible, in large part, because of the first-response capability most firefighters have now. Most firefighters, Hadley says, are trained Emergency Medical Technicians, or EMTs.

According to the Sedgwick Co. website, an Emergency Medical Technician (EMT) is “a basic-level, pre-hospital health care provider.”

EMTs reportedly perform basic life support skills, including:

  • Taking vital signs
  • Patient assessment
  • Administration of oxygen
  • Airway management
  • Cardio-Pulmonary Resuscitation (CPR)
  • External semi-automatic defibrillation
  • Blood glucose monitoring
  • Splinting
  • Wound care

The collaboration has been in place for some time, Hadley says, but the groups’ “Pit Crew” has been in place since August 2012. That is when the organizations came together to train together in a choreographed effort.

“We operate under one umbrella. We all have the same protocols depending on your level of certification,” said Hadley.

Even though firefighters are now equipped with many of the same tools paramedics have, the Wichita Fire Department cannot transport patients to area hospitals.

When firefighters respond, they significantly cut down the wait time for patients.

We saw this first-hand in the two days KSN spent riding along with EMS crews across the Wichita area.

KSN's Brittany Glas rode along with Sedgwick County paramedics to learn more about how the county operates in emergency medical situations.
KSN’s Brittany Glas rode along with Sedgwick County paramedics to learn more about how the county operates in emergency medical situations.

In one six hour period, inside an ambulance and alongside paramedics, each of the ten 911 calls we went out on, Wichita firefighters responded to the emergency scene before we did.

“[Fire] can first respond, get to the scene of the call, usually give us a triage, and start some basic life support until we arrive, and then we, [EMS], take over the patient care,” explained Major Russ Trower, a division leader for Medic 1 for Sedgwick Co. EMS.

So, why is fire beating EMS to the scene?

To answer the question simply…

“They have a lot more stations around the city,” said Hadley.

Sedgwick County EMS: Geographic Locations, Stations / Posts

Fire departments in our area, the city’s Wichita Fire Department and Sedgwick County Fire Departments, both operate under a “Static” type of deployment model. The departments utilize a “Grid System” in order to respond to calls.

Meaning, there are a lot more stations, physical posts, which maintain ambulances and ambulance crews.

The Wichita Fire Department alone has 21 brick and mortar building stations.

The Sedgwick County Fire Department has nine stations located strategically throughout the county.

Together, in all, firefighters in the Wichita and surrounding areas work out of 30 total brick and mortar stations that are scattered around the area. Each station has a designated coverage area in which to respond to fires and/or emergencies.

Sedgwick County EMS / Fire Department Stations
Sedgwick County EMS / Fire Department Stations

For example, given the locations of each of the 30 fire departments in our area, if a fire were to break out near Market and Eighth Street in downtown Wichita, Fire Station 1 would respond because that station is the closest to the scene of that reported fire.

These 30 stations are aside from the larger number of fire stations that could be considered across Sedgwick County, when including cities other than Wichita that have their own fire departments, as well.

These would include the Derby Fire Department, Mulvane Emergency Services, Valley Center Fire Department, Colwich Fire Department, Cheney Fire Department, Clearwater Fire Department, Mount Hope Fire Department, and the Viola Volunteer Fire Department.

Sedgwick County Fire Department stations have designated “Response Areas” which include the following locations:

Wichita Fire Department also has designated “Response Areas” at these locations:

For Sedgwick County EMS, there are only 15 brick and mortar locations to cover the same geographical area, leading EMS to operate more like Uber… The closest ambulance goes to the higher priority call.

“We have to balance the need, the demand, with the geography,” said Hadley. “So, we try to do both the best we can with what resources we have available.”

Hadley admits, “It’s tough.”

How does EMS tackle the challenge?

“We send the closest unit to the next call, and sometimes, that may be farther than others, or sometimes, it may be very close,” explained Hadley.

Sedgwick County EMS stations are located at the addresses listed below:

Ambulances are constantly on the go. Crews, basically, hoping they will be close to the next call that comes in.

Scott Hadley says EMS is not “statically deployed,” like the fire departments in the area.

“Our system is very fluid and dynamic,” said Hadley. “Even though the crew and the ambulance may start at a certain post during the day, at a certain location, it’s very fluid throughout any given day.”

Sedgwick County does its best to predict where emergency calls will be. Officials track two years of historical data – where and when calls have come in – in a particular area, during a specific time of the day. EMS utilizes innovative technology to view the historical demand through a program that both administration and EMS crews have access to from their computers.

“There’s no system that can predict where the next call is going to be…”

— Scott Hadley, Director, Sedgwick Co. EMS

From these historical trends, SCEMS positions their ambulances in the places they think will be closest to the next emergency call. Then a real-time tracking system knows where each in-service ambulance is located, sending the closest ambulance to the highest-priority call.

“If it’s getting busier in one area of the county, we’re constantly shifting resources to cover other areas so that we do respond in a timely manner to a caller who needs our help,” explained Hadley.

Where SCEMS deploys and then moves its resources around the county is intended to meet and match emergency demand, Hadley says.

Considering this type of “mobile operation” though, leaves gaps in the service. When one ambulance must relocate in order to cover a serious call, it leaves a hole behind in its original location.

“There’s no system that can predict where the next call is going to be,” said Hadley. “But, based on historical demand patterns, we can certainly understand that, and [gauge] the probability of certain areas of a call are more than other areas.”

It is possible that such “holes” created through physical, geographical coverage gaps, can lead to longer response times.

KSN took these concerns about county residents’ safety in emergency situations straight to county leaders.

Could these gaps produce unwanted and unnecessary delays in wait times?

“They’ll be taken care of with existing resources,” said Chairman Sedgwick Co. Commissioner Richard Ranzau, who represents the 4th District.

Sedgwick County EMS: Repeated Requests for Resources

Sedgwick County Commissioner Richard Ranzau
Sedgwick County Commissioner Richard Ranzau

“We’re still going to meet our response time goals,” said Commissioner Ranzau.

Ranzau continued:

“In general, yeah, EMS stations are important, yes, but the fact that we didn’t build this one right now is not anything to be concerned about,” he said.

Commissioner Ranzau referred to the denial of funds, as requested, to build an EMS station in Northeast Sedgwick County.

In the last year, SCEMS, as deemed necessary by EMS administration officials like Director Scott Hadley, requested two more EMS stations to physically fill in those coverage holes.

The two EMS stations had been said to be necessary to be built to serve “growing populations in those areas.”

However, this request was not funded in its entirety.

In fact, the proposed 2016 budget, released on July 20 by the Sedgwick County Commission, included about $8 million dollars in cuts.

The county infrastructure took a $16 million hit with that proposed budget, part of which had included not building two EMS stations. Doing that would have cut about $2.5 million, as shown below.

Northeast EMS post: $1,114,354

Southeast EMS post: $1,395,829

See story | ‘New Sedgwick Co. EMS stations likely put on hold in 2016’

“Of course, we have a finite and limited number of resources that we have to manage each and every day, which is sometimes challenging,” said Hadley. “Some days are busier than other days.”

EMS Station Request in Southeast Sedgwick County – Funded

By the time the final budget was approved and passed, commissioners did move forward with approving the funding for one EMS station in the Southeast portion of Sedgwick County.

See story | ‘Sedgwick County Commission to fund southeast EMS post’

The commission denied funds for a Northeast EMS station.

EMS Director, Scott Hadley, explained why SCEMS submitted a plan for a Southeast post. This portion of the county is getting busier.

“We know Derby’s getting busier. The call volume’s going up, [so is] Haysville’s call volume,” he said.

The approval to build this station is a “win-win” for the whole community, emergency officials told KSN.

“You [will] definitely have ambulances closer to calls more of the time,” said Maj. Russ Trower. “This [will] save trucks from leaving Derby to come up here to help fill Wichita, or trucks leaving Wichita to come down here to help fill Derby or Haysville.”

EMS Station Request in Northeast Sedgwick County – Denied Funding

Because commissioners denied funds for a Northeast EMS station in Sedgwick County, SCEMS will likely continue to operate as a type of mobile service, especially in this area.

Sedgwick County Commissioner Dave Unruh
Sedgwick County Commissioner Dave Unruh

Commissioner Dave Unruh, who represents this area of the county in the 1st District, told KSN News that this station is needed and it makes sense to build it.

“With more investment in that area, we would have clearly better response times,” Commissioner Unruh explained.

Commissioner Unruh says that it is only a matter of time before this way of operating could end in tragedy.

“Long-term, this is where the growth is,” he said. “This is what we need. Let’s plan for it. Here’s the time. Let’s move on it.”

Despite the funding challenges Sedgwick Co. EMS faces, Scott Hadley stressed that he believes county citizens are safe.

“Citizens can be reassured that we’re doing everything we can to provide quality services to them,” said Hadley. “We know that we’re not going to get everything that we ask for every budget cycle. There’s a lot of expense… But, with that said, we’re going to come and ask for what we need. We’re going to have data to support what we need.”

Then, Hadley says, the decision is left up to the county’s governing body.

Sedgwick County & City of Wichita: A Mutual Agreement

The city of Wichita and Sedgwick County have operated under some form of mutual agreement since 1975 when the county became the governing body over 911 emergency calls. The most recent agreement was established once again, and then updated to take effect on January 1, 2004.

That agreement lasted five years and has been automatically renewed on an annual basis. That is, so long as both the city and the county agree to renew the agreement and are not opposed to doing so.

KSN reached out to city leaders to find out if they are frustrated that Wichita’s resources are being used to provide emergency response assistance alongside Sedgwick Co. EMS.

None of the city leaders we spoke with were concerned because of the nature of EMS’s duties and responsibilities.

Average Response Times Across the Region: A Comparative Analysis

EMS operations can vary significantly from state-to-state. For most metro or urban areas however, response time goals around 9 minutes is relatively standard nationwide.

Omaha, Nebraska and Oklahoma City / Tulsa, Oklahoma use different standards and classifications for response times than the Sedgwick County EMS so it is difficult to make a direct comparison.

Oklahoma Emergency Medical Services Authority, or EMSA, states that in Oklahoma City, Edmond and Tulsa, the targeted response time (90% target) for areas they consider “metro” is 10 minutes, 59 seconds (10:59), which was increased on November 1, 2013 from 8 minutes, 59 seconds. For “suburbs”, the targeted 90% response time is 11 minutes, 59 seconds (11:59).

According to EMSA’s website, the response time increased because,

“Based on best practices of evidence-based medicine, and at the recommendation of the Medical Control Board and the ambulance provider selection committee, EMSA is increasing emergency response times for 911 calls. Scientific data has proven a quicker response time does not guarantee survival, but rather CPR administered at the time of the 911 call provides the life-sustaining care in those early minutes of an emergency. The reason for the increased response time is to increase the safety for medics and the general public when medics respond to 911 calls.” 

In Nebraska, the majority of EMS services are operated under various fire department agencies across the state. In Omaha, Emergency Medical Services is coordinated by the Bureau Chief of the Omaha Fire Department. Unlike most states across the U.S., the state of Nebraska monitors EMS performance through NEMSIS, the National EMS Information System.

Read more about EMS in Nebraska by visiting the Nebraska EMS Homepage.

Accreditation

In Kansas, Sedgwick County EMS is the only ambulance service that is CAAS accredited. To view a national map from the Commission on Accreditation of Ambulance Services, CAAS, and the services with this accreditation, click here. 

A portion of the process required to receive and establish this accreditation includes an external review of the EMS organization. SCEMS is one of fewer than 200 accredited services of this kind across the U.S.

SCEMS received accreditation in 2010, 2013, and will receive the accreditation again in 2016. All ambulance systems are eligible for the three-year accreditation including private, public, fire department and hospital-based operations.

For supplemental information about how SCEMS operates, visit their website, http://www.sedgwickcounty.org/ems/. 

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