Interesting comments from the fire chief, and another example of the need for EMS and community leaders to implement evidence-based system design changes in EMS systems, such as:
- Effective, quality assured, medical director approved Emergency Medical Dispatch (EMD) to prioritize EMS requests based on acuity.
- Dispatch processes to navigate calls that can be effectively dispositioned from the PSAP, without sending an ambulance.
- Lengthening response times to low-acuity calls to maintain readiness/availability of resources to reduce response times for the 5-10% of high acuity calls.
- The use of a tiered deployment strategy (BLS and ALS units), as well as potentially single-resource Community Health units to respond to low-acuity EMS calls that have a low propensity for requiring transport to an ED.
- Stopping the ability for hospitals to violate EMTALA rules and rob community EMS resources by EMS agencies allowing hospitals to hold EMS crews at the hospitals..
5-7% of the patients EMS responds to require Potentially Life-Saving Interventions, and studies have shown that cardiac arrest patients have better outcomes if the time from time of call to CPR initiation is within 4 minutes, yet few EMS systems are designed to meet this goal, or track or report this important metric.
Effective community education is key to implementing these evidence-based system changes. View a recent webinar on "Expectations vs. Reality" with physician EMS leaders here: https://aimhi.mobi/ondemand/13420011
Download a summary document of evidence-based patient outcome research and joint position statements on issues like response times, ALS utilization and performance metrics , with links to the source studies here: References-Resources on Response Times - All ALS and EMS Performance Measures Updated 5-1-25.pdf
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A study finds long EMS response times in DeKalb. What are the reasons?
By Michael Doudna, WSB-TV
April 29, 2025
https://www.wsbtv.com/news/local/dekalb-county/study-finds-long-ems-response-times-dekalb-what-are-reasons/EVT4J3H5EJAQ3PW4Z7FAUPTHLQ/
DEKALB COUNTY, Ga. — When you call 911, you expect a quick response. In Dekalb County, a study found that EMS response times could be more than 20 minutes.
The recommended standard nationally for basic life support is usually between four and eight minutes.
The county conducted an EMS feasibility study, looking at five years of data between 2019-2023.
The study found that AMR, the county contractor, responded to EMS calls at 23 minutes in the 90th percentile. Dekalb County Fire was more than 10 minutes.
The study found the main problem was resources. Dekalb County Fire Chief Darnell Fullum told Channel 2’s Michael Doudna that he agreed resources were part of the problem.
Around 80 percent of the time an EMT crew was on the clock, they were on an emergency call. That means the system’s resiliency is impacted.
“That means there are fewer resources available for that next call that comes in,” Fullum said.
“Those 911 calls don’t stop, but they keep coming in and they keep stacking up,” said Chad Black, Chairman of the Georgia EMS Association.
Black says that lack of resources exacerbates issues from tiring out workers to putting them out of position.
He says EMT crews should be on a call about 50 percent of the time they are on the clock. That allows for enough resources to be on standby when those top-priority calls come in.
The study estimated it would cost Dekalb County between $12 to 16 million to get resources to around that level and have response times of eight to 12 minutes in the 90th percentile.
“More investment is needed ... but it’s not just money,” Fullum said.
According to Fullum, around 80 percent of 911 calls are not life-and-death emergencies. In nearly half of cases, an ambulance responds to end with no one being transported.
“There are calls we don’t need to be going to,” Fullum said.
“We need to educate the public on what is an emergency and what is not,” Black said.
Channel 2 did a ride along with DeKalb County EMTs Kentrick Wade, Brittney Witherby and fire Capt. Jason Daniels.
The first call came in just after 10 a.m., of a person feeling faint. The ambulance arrived five minutes later. Wade and Witherby rushed in and then came out with an empty stretcher.
“They felt like they were fine and didn’t need our services,” Witherby said.
“It happens more than you think,” Wade said.
The second call happened on our way back from the first one. The call came in about an accident with injuries after a hit-and-run near Spaghetti Junction.
It took 23 minutes to find the accident. When they arrived, the victim decided he wanted to get checked out at the hospital. That led to around a half-hour drive to Grady and then waiting at the hospital.
“The amount of time a patient will spend in an ambulance on our stretcher is the same as if they would go to the hospital and wait in a waiting room,” Witherby said.
Those waits, known as “wall times” can add up. The study found in the 90th percentile, Dekalb EMTs were spending more than 80 minutes at major metro hospitals. During that time, they are stuck, unable to go to new calls.
“You hear calls come through all the time on our walkie, whether it is a cardiac arrest or a breathing problem right down the street,” Witherby said. “While we have someone in our care at the hospital, we aren’t able to go on any other calls, regardless of what the priority is.”
DeKalb says they receive too many emergency calls that do not need an ambulance, hurting the availability of resources.
“Help us to make sure those resources are available. Know when to call 911, know when 911 might not be your best solution,” Fullum said. “That means changing sometimes the expectations. That means educating the public on when that ambulance needs to get there right away.”
The report found that except for cases like strokes and heart attacks, longer ambulance response times do not have a large impact on survivability.
Fullum says to reduce response times to the most important calls, the public’s help is needed to use limited resources.
He also pointed to services like nurse navigators, which do not take up EMS ambulances and instead divert some 911 calls to nurses, who can also provide a rideshare voucher to get someone to the hospital.
Dekalb County claims that after investing more than $4 million in the EMS system, response times are down, especially for top-priority calls, sitting around 8:43 on average.
Channel 2 did request to interview the Dekalb County CEO about future investment and the study’s recommendations, but repeated attempts were rebuffed.