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System Status Management

Discussion in 'Pre-Hospital [ EMS ]' started by DSM, Mar 14, 2004.

  1. DSM

    DSM
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    ....don't you just hate it??? Who has to do this? And who doesn't. When I first got into EMS....we never posted...We stayed on our station until we got a call and that was it...Now we work 12 hour shifts and sit in the ambulance all day. God help you if you don't like your partner:(
     
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  2. southerndoc

    southerndoc life is good
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    I really like the term Community Ambulancing, as used by the Montgomery County Hospital District.

    I gotta admit, that's very creative. I like it, I like it!
     
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  3. InfiniumEtAl

    InfiniumEtAl Member
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    Around 6 years ago, when I began working in EMS we always went back to the station (Private ambulance(s) in Chicago), recently though we have only been allowed to return to the station on sunday shifts even when we have nothing to do. In Champaign we always returned to the station, and in Israel we also returned to the station. I also know that in NY city it is always mandatory to return to the hospital you are assigned to (although they almost never get the chance to return before another call comes in.)
     
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  4. Apollyon

    Apollyon Screw the GST
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    When Rural/Metro bought us out way back when (9 years ago), they brought in SSM. It was a double-edged sword, depending where the posts were. In Amherst NY, there was stuff there. In Niagara Falls, you were sitting in the parking lot of a deserted K-Mart.

    I second you on the partner, though. It's like I always said, though - if you like your partner, every patient can be 400lbs or dead 3 days, and you don't mind. If you don't like your partner, you can be in service at your house, not take any calls, and STILL have a bad day.
     
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  5. 12R34Y

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    I hate system status!

    I also think that it is bogus..........the nature of an EMERGENCY is that it is unexpected.......one cannot say that there are more calls here v.s. there or blah blah blah.

    they have these sophisticated statistics, but bottom line......emergencies can happen any time at any place.

    My service had what we called "move-ups" . We were usually at our fixed station (firehouse, or lone quarters) and when 2 or more adjacent ambulance districts were left open a unit was called to go on a "move up" to cover the open districts until somebody cleared the hospital.

    much better than true system status management!

    later
     
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  6. Tas

    Tas Senior Member
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    You guys are probably going to hate me, but I'm going to "somewhat" stick up for system status management and give you the point of view of the people that post you (in other words, yes, I'm a dispatcher...)

    It does work, when the whole point is to cut down a response time as much as possible, having trucks out in the community near areas that either 1) have a higher statistical probabability of an emergency or 2) are locations in which there is fast access to mulitple areas DOES cut down on response times. True, not for everyone, but it is significant... Isn't this what you would want for your family/friends? To have an ambulance in a position for the fastest response time possible, given that emergencies CAN happen at any time at any place?


    Now, that being said in support of SSM, I want to say this. I live by the philosophy that it's MY job to protect MY trucks and MY medics. That includes from burnout and boredom. I know the places in my area of responsibility that have things for medics to do while waiting on a call and I try my best to rotate crews through those areas or at the very LEAST try to limit the amount of time MY guys sit in "deserted Kmart parking lots".

    If your dispatchers don't rotate you, this might very well be something to suggest to the boss. (The max time I allow a truck to sit in a dead spot is 1 hour if I can help it and the max time at a place where there is "something to do" is about 2 hours. I rotate them "home" so they can eat and rest for a few minutes.)
     
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  7. InfiniumEtAl

    InfiniumEtAl Member
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    I hated the shuffle. I always ruined my sleep. :sleep:

    I agree with you on the access routes, but I disagree with SSM that's simply by neighborhood. It blows when you can't go somwhere simply because it's only a few blocks out of your "area".
     
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  8. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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    There is an interesting article from 1998 which demonstrated that EMS personnel who are confined to ambulances in an SSM-like deployment scheme suffered a higher rate of back pain and injuries.

    Morneau, PM, "The Effects of Stand-bys and Roaming on Paramedics: The seated Posture and Vehicular Vibrations," University of Ottawa School of Human Kinetics, 1998.

    - H
     
  9. FoughtFyr

    FoughtFyr SDN Lifetime Donor
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  10. OP
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    DSM

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    I know the reasoning behind SSM but I agree it is so confining to sit in an ambulance for 12 hours. God only knows why those things are so uncomfortable. The newer ones seem to sacrifice space up front for more space in the back. They were never designed to live in. Even a patrol car for policemen has more room than the front of an ambulance. I guess that is why I hate SSM so much. And I am a short person. I don't know how you guys with long legs can stand it.
     
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  11. Apollyon

    Apollyon Screw the GST
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    In the passenger seat (or, the driver's seat, for that matter), as long as you lock your door, you can get somewhat comfortable.

    As you experienced folks know, someone opening the door when you are sleeping on it is a shocking experience, to say the least.

    It's true about having something to do, though. At the one posting in Amherst, NY, I used to call in to a local radio station and talk on the air all the time (we were in the parking lot of a hotel, and the pay phones were unlimited talk for 25 cents, and they didn't give us the 'bum-rush' out of there - nice bathrooms, too!). At the one the was "the middle" (when you were the last car), there was a 7-11 with THE most wide-ranging soda fountain I'd ever seen...I would get the 'rainbow' in the "Double Gulp" - the 'bladder buster', the 'super tanker' - the baddest of the bad of sodas...64 ounces of love! Most I ever had in one day was 3 Double Gulps and a quart of won-ton soup.
     
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  12. 12R34Y

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    I still don't like SSM at all.........regardless of what dispatchers say.

    For example, in KC they pull ALL of there rigs out of the south side to go downtown..........well there may be several emergency calls in the south that night (emergencies being as UNPREDICTABLE as they are) and guess what.........super long response times.

    I just think you should spread your rigs out and let the cards fall where they may.

    just my opinion.

    later
     
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  13. Tas

    Tas Senior Member
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    out of curiosity, what amt of time do you mean when you say super-long?

    As a dispatcher, I *do* spread my trucks out to reduce response times to ALL parts of my city. I'm very happy with the response times we get (although we only service probably 100k people).

    I did have 1 bad response time last night, but two trucks in the same area were both called at the same time to do full arrest and when the 3rd call came in just moments later (of course...) had to pull a truck from WAYYY out to make the run....

    oh well, best laid plans of mice and men....
     
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  14. 12R34Y

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    Super long response time as defined by that particular service is anything greater than 10 minutes i believe.

    SSM works fine for 100K people. I didn't know that is what you were referring to, but in a city of over 1,000,000 it sucks.

    spreading your rigs out makes sense.......that's why there are stations spread out everywhere where units should sit unless a bunch of adjacent units are out.

    The problem with SSM in some big cities is that they play the statistics game way tooooo much.

    they will literally pull ALL of the units out of certain areas and this is BAD!

    just opinions here.

    later
     
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  15. Tas

    Tas Senior Member
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    actually, I *DO* know what you mean about pulling rigs all over the place...

    One of our dispatchers always looks like shes playing chess with the trucks, CONSTANTLY. Unfortunatly, shes in a position such that I would be unable to change anything. Whats worse, shes an EMT that used to work "outside". Seems like she'd realize what shes doing. But this is her fault, not really SSM.

    I guess what it boils down to, just like there are good medics and bad medics, there are dispatchers who care about their guys and dispatchers that don't.

    Although, unless there is more than 1 truck to a station (sure hope there is...) it would seem to me like SSM would work better and better the larger the population you served...of course, I would never believe removing trucks entirely from an area would be an appropriate thing to do...have you ever approached your boss with concerns over leaving an area entirely open?

    If this is truly your concern (btw, don't approach them with arguements against SSM, trust me, they've heard them before - if they were going to stop using it, they would've) but if leaving an area uncovered is truly your concern, explain your reasons that DESPITE the statistics you feel a truck should be posted in a specific area. They *should* listen to you (we hope :) )
     
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  16. 12R34Y

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    i'm not actively employed anymore do to being in medschool.

    I know SSM is here to stay i just don't like trying to "predict" unpredictable events.

    thanks for the discussion though

    later
     
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  17. niko327

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    Nobody returns to their base hospital in New York City until it's time to go home. You are supposed to sit on your 10-89 which is the code that you are stationed at your assigned cross street location which is usually never at a hospital. This is true whether you work for FDNY EMS or a 911 Hospital based ambulance. That TV show on NBC called Third Watch portrays the paramedics returning to fire stations or precincts between calls, once again pure fantasy. I know it sucks but unfortunately it's reality. "Show this unit 10-89 central, 89" Ahhh the memories.......
     
  18. trauma_junky

    trauma_junky 12 step pre-med rehab
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    Our system is overly aggresive with maintaing the system. It is based on nothing but speculation. I am in the middle of compiling info on response time vs, fuel spent in moving trucks. So far the numbers don't support system status BS.
     
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  19. ronnie

    ronnie New Member

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  20. flighterdoc

    flighterdoc Rocket Scientist
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  21. Karlh

    Karlh New Member

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    I appreciate the strong feelings about SSM from a medic's viewpoint. While SSM is most often associated with EMS, every business uses the principles of it. The goal is to match supply with demand as best as possible. Can you imagine the cost of an airline ticket is they didn't keep these issues in mind. For that matter why is Southwest's more cost effective than American?

    The problem in our industry is what I like to call system status mismangement. Keeps costs down profits up by playing games is done far too often. Many services are like dealing with used car dealers. They simply can't be trusted.

    Our community took an aggressive stance on back injuries long before (1990) the Canadian study was done. Effective training and monitoring reduced back injuried by over 90%. Most of it was making employees feel accountable. Frankly it struck me that a lot of the complaints were, at best, dramatisized.

    While it me be true that EMS stands for Earn Money Sleeping, there are cheaper ways that some communites can provide the same level of service. Don't the community leaders have an obligation to provide that value to the residents?
     
  22. Mavrick

    Mavrick Junior Member

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    Here we try to get back to station. It doesn't always happen because control usually send us out to either another emergency, an immediate or urgent removal. Personally I dont fancy the idea of sitting out there waiting for something to happen. Like some of you say, if you dont get on with your partner it could be a nightmare. There is only so much conversation you can have!
    In the south of the city we have six stations in a 20 mile radius and there are about nine ambulances on duty at any one time. I guess it makes sence for us to go back to the station as we are never that far away from it! Wish I hadn't said that........I'm bound to get sent somewhere stupid this afternoon :eek:
     
  23. y8sc

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    Does anybody have anything good to say about it? It has been around down there for a while. (EMS Managers and dispatchers opinion does not count) Our Management in Hamilton Ontario (Canada) wants to implement it. Our management has pulled the wool over our City Councils eyes on how much of a savings this is going to be and good for the public.
    Im having a hard time finding many articles and studies that negate this other than the University of Ottawa study about back injuries.
    Any ideas?
     
  24. greytmedic

    greytmedic Faster than you
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  25. pseudoknot

    Physician PhD Faculty Lifetime Donor Verified Account 10+ Year Member

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    SSM is one of the worst of the many bad ideas that have become ubiquitous in EMS. It is based on no real evidence and is ostensibly a way to manage response times (which haven't been shown to be clinically important). It's really just a great way to save money and run down morale.

    Note the correlation between fire departments, strong unions, great morale, and no SSM.
     
  26. MedicFL

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    This thread is like 5 years old!!! But SSM SUCKS!!!!
     
  27. greytmedic

    greytmedic Faster than you
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    It just goes to show you that something that sucked five years ago still sucks! :D
     
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  28. leviathan

    leviathan Drinking from the hydrant
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    Meh...I don't mind it. Normally we are allowed to stay in quarters if there are no calls going on. If a nearby station is suddenly swamped and busy with calls, we will get called out to either cross cover midway between both stations (if our own station is down to just our car), or at the other station quarters (if we have adequate coverage in our own area). Usually you're only there for max 20-30 minutes until the local cars are freed up.
     
  29. MedicFL

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    Having a station is not SSM. SSM is where trucks are placed on street corners, with no station and are moved around to fill posting locations. You are constantly moving units around chasing calls. What you are describing is a normal station based system where unit have to move up for coverage which happens but is no SSM..
     
  30. jkelly2

    jkelly2 Huge member
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    Not true! System status management is simply preparing the system for the next call. . . every system has a system status plan, be it "ambulances will clear the hospital and return to the station with the same number" or a more complex deployment strategy based on geographic and temporal demand patterns. I recommend Jack Stout's "System status management: The fact is, it's everywhere" article from the April 1989 issue of JEMS. The article will dispell misperceptions of SSM and help you identify whether your plan is set up for success or doomed to failure.

    Among them, that ambulances should rove about town and change posts frequently. Ambulances don't scare off heart attacks like police cars scare off criminals, so it is not good SSM to put extra wear and tear and increase fuel costs having ambulances patrol. Also, a good system status plan intends to balance response time reliability with financial responsibility. Shifting units around too often is expensive.

    Another misperception: ambulances sit on street corners and in parking lots. Early in the development of a plan, ambulances may sit out on a street corner and change posts frequently, but as the plan is refined and response time obligations are met, the system may look into buying or renting some sort of housing in locations that correspond with oft-occupied posting locations.

    A manager can take bits and pieces of effective SSM techniques, throw it together, and call it SSM. But in that case, it might as well be system status mismanagement.
     
  31. emedpa

    emedpa GlobalDoc
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    I used to work as a ventura county, ca medic.
    we did a modified ssm with primary stations but frequent postings to other parts of the county to cover holes in coverage when other units were out. it is a very large county so often we were an hr+ away from our primary station. what really sucked was when 1 unit went out on a bs transfer out of county at odark30 and every other unit had to post over 1 station or between 2 stations for several hrs. some postings were actual buildings with beds, others were street corners or parking lots at the corner of x and y. we also did mutual aid in parts of northern la county and covered their areas when all of their units were out on calls.
     
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  32. leviathan

    leviathan Drinking from the hydrant
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    Like I said, we do sit at street corners quite often. It's definitely not done for 12 hours, though!
     

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