The Road to Perdition

     This column, which appears occasionally, focuses on issues of rural and frontier EMS.

     "Let's see - should I focus my energy on getting the ambulance out the door with two people in a reasonable amount of time, or on collecting business and patient care data?"

     Each day the leaders of rural ambulance services face an overwhelming number of challenges. These challenges range from recruitment and retention to a lack of financial resources. A compounding factor is that many such leaders are themselves volunteers. Besides working full-time outside the ambulance service and having a full-time commitment to family, rural ambulance leaders contribute countless hours ensuring their services are compliant with local, regional and state regulations. Then supplies need ordering, call schedules need filling, and continuing medical education needs coordination, among other unending requirements. With such imposing problems, limited time and an overwhelming number of things to do, data collection is often at the bottom of these leaders' to-do lists, if it's even there at all. But ironically, data may be the solution to many of their challenges.

Data Helps Meet Needs
     Three of the most important customers of rural ambulance service leaders have specific needs. Patients want three things from their ambulance services: timely response, friendly service and reasonable cost. Meeting two of the patients' needs requires data; the other requires another of the leader's customers: great staff. Great ambulance staff want efficiency, and efficiency demands automation. Funders want to know community impact, and demonstrating impact requires information.

     Ignore these customers, and you've chosen a road to perdition.

     Data and automation empower leaders, allowing them to satisfy customers by making better decisions faster. Demonstrating the difference you make can lead to increased financial resources and decrease the time required to manage day-to-day operations. One way data helps the leader make better decisions quicker is by providing evidence-based information he or she can rely on instead of experience or gut instinct. Automation can make that data more easily available.

     Taking the time to enter accurate run information into your state NEMSIS system can have a big payoff. Consider the need to justify an increase in your operating subsidy. Passion is often the tool used in communicating with local commissioners. Sometimes it is effective, sometimes not. Imagine demonstrating leadership by showing the potential funders how what you do affects the community. Simply providing a set of routine reports on your activity can be a major boost. Many state NEMSIS systems are capable of producing "canned" reports on basic aspects of service. What's more, the same report card you provide the city council can also be a motivator for staff improvement.

     Every day decisions need to be made, from things as simple as how many of a certain item to carry or stock to whether to add a new treatment or procedure. In both examples, data can drive the decision. By considering the frequency data for a certain procedure, like giving oxygen by nonrebreather mask, a service could confidently stock its shelves with sufficient supplies. Similarly, reviewing the data on a certain provider impression could inform a decision on whether the added cost of a new treatment or procedure could be supported based on demand.

     Data is also critical in day-to-day operations. Imagine developing a budget with information on your daily, weekly and monthly run volume, or what type of supplies you used and how often you used them. How helpful might it be when recruiting new personnel if you knew when the busiest time for calls is, or how many calls are 9-1-1 and how long the average call lasts? As you develop your yearly CE calendar, would you prefer training on areas you found in the data to represent your highest number of calls, or the same items you train on year after year?

     Data is the information that allows us to understand the what, when, where and how of the challenges facing our organizations. It's the leadership tool that allows us to maximize our time, make right decisions the first time and move organizations forward. Data is the critical link for rural ambulance service leaders to lead their organizations with the limited time and resources available to them.

Choose the Right Road
     Leaders should embrace NEMSIS and become part of the solution at the state level. When seeking electronic patient care record systems, try to find one that is friendly and flexible in the way staff inputs data and in the information outputs you can use locally. If your run volume is small, consider seeking grants through your state EMS or rural health office for an electronic system, or do Web entry into your state's NEMSIS system.

Gary Wingrove is responsible for strategic affairs at Mayo Clinic Medical Transport in Rochester, MN, and chairs the rural EMS issue group for the National Rural Health Association and the advisory board of the Rural Domestic Preparedness Consortium.

Aarron Reinert, NREMT-P, BA, is executive director for Lakes Region EMS, a rural ambulance service in Minnesota that covers a 450-square-mile service area.

EMS EXPO Gary Wingrove is a featured speaker at EMS EXPO, October 15-17, in Las Vegas, NV. For more information, visit www.emsexpo2008.com.