If you think it’s all about response times, you have missed the point.
November 19, 2015
So much media discussion about ambulance services seemed focused on response times. Indeed, every year the media awaits the annual Australian Council of Ambulance Authority’s report that, among other things, compares each state’s ambulance service’s response times to each other.
I have never really understood why this comparison occurs. Is there any true competition between ambulance services to achieve the lowest (ie: fastest) response times? No. Not really. While there may be a level of light, friendly rivalry between them about who is faster this year, any national (or international!) comparison between services is both unfair and completely irrelevant.
That is partly because percentile-based average ambulance response time reporting is an artificial method of gauging ambulance effectiveness. Yet, for all intents and purposes, the way response times are reported does imply one service is doing better than another. Occasionally, this can even feed into budgetary decision making. (Do you really think the state Minister of Health of the “slowest” responding ambulance service is unconcerned with their state being the slowest to respond to emergencies? Of course not. The public outcry will force them to improve ambulance responsiveness.)
People in the industry understand that is it not really all about rapid responsiveness. The industry is continuing to confront indicators that are significantly harder to quantify, such as responsive deployment arrangements, transportation of patients and appropriately trained pre-hospital clinical staff delivering quality clinical care.
Certainly, there are some situations where response times are vitally important, such as time to defibrillation. However, even this vitally critical intervention is somewhat less important for ambulance now than, say, even 10 years ago. Why? Well, AEDs (Public Access Defibrillator programs) and CPR mean there is a greater ability for a member of the public to deliver that initial shock in significantly less time than waiting for an ambulance to arrive. No defib available means a timely ambulance response becomes more critical.
In the vast majority of cases, research suggests that ambulance response times have little or no bearing on the majority of clinical outcomes. In 2015, the Victorian Government Auditor General undertook a review of all Emergency Service Response Times in that state. In the report, Auditor General announced they could find no significant clinical or operational evidence- or even “clear rationale”- to support established response time targets. While I am surprised by the extreme strength of this claim, it does make me wonder why we still report against these straw-man constructs and have not yet developed a better reporting metric.
I am not suggesting that response times are irrelevant. However, if you think measuring ambulance service effectiveness against response times is the best approach, you have missed the point. It is about appropriate resource deployment, effectively trained staff and patient transportation. Oh, and patient care.
Craig has more than 25 years experience in health and emergency medical operational management, emergency planning, health service delivery and service redevelopment. His book “Time to Respond- leadership, management and operational effectiveness in the pre-hospital field” comes out in December 2015.
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