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Reduction in unavailable-for-response episodes in a private emergency medical services agency

Brian L. Risavi, DO, MS, FACEP, FAAEM, Saad Mahmood, DO, Kevin Andryc, DO, John Libonati, EMT-P, Mark A. Terrell, EdD


Objective: Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/ benefit analysis.

Design: The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes. This identified clusters of unavailable-for-response episodes for which incremental staffing changes were implemented. Internal audit of cost/revenues was recorded.

Setting: Midsized private EMS agency in Northwest Pennsylvania.

Subjects/participants: EMS Responders/Agency calls.

Interventions: Temporally precise increases in staffing during critical time periods/unavailable-for-response episodes.

Main outcome measure(s): Reduction in unavailable-for-response episodes, cost effectiveness.

Results: Evaluating 23,833 EMS responses that occurred during the study period, staffing changes resulted in a 93 percent average reduction and 100 percent maximum reduction in unavailable-for-response episodes and were cost effective, based on evaluation of cost versus revenue, in this EMS agency.

Conclusions: Identification of opportunities for system staffing improvement in a midsized EMS agency demonstrated feasibility and usability of mapping temporal patterns of unavailable-for-response episodes to substantially reduce the number of unavailable-for-response episodes and was cost effective.


EMS, quality improvement, response

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