2. County of Volusia  Department of Public Protection Division of

3. Administrative Responsibilities Ordinance - Certificate of Public Convenience and Necessity (COPCN) - Closest unit emergency medical response System analysis EMS Trust Fund Liaison to agencies (county and municipal) Partnerships (contingency and pilot programs)

4. Response Times Definition. What defines a response time? Industry standards. 4 minutes? 8 minutes? From where did these times evolve? Measure. What’s the most transparent formula for illustrating response times? Do response times affect patient outcome?

5. Anatomy of a Response 0:45 4:00 5:45 0:45 6:30 Time: Elapsed time: 0:30 1:15 0:30 1:45 Recognition: delay between initial illness or injury and activation of EMS system (45 seconds). Reaction time: difference in time between receipt of alarm and ’wheels moving’ on apparatus (30 seconds). Processing time: difference between notification of field units and receipt of call information by the communications center (30 seconds). Vertical response time: difference between arriving at the patient’s side and ‘wheels stop’ at the location (45 seconds). Response time: difference between ‘wheels stop’ at the location of the event and ’wheels start’ at the beginning of the response (4 minutes). 1 2 35 4

6. Clinical Responsibilities Medical oversight of field & communications staff (401.265, Florida Statutes) - Prehospital standing medical orders - Quality assurance - Access to legend devices, prescription medications, & controlled substances - Contingency emergency medical transport Credentialing and education

7. Challenges facing EMS Existing health care - Customary reimbursement (Medicare, Medicaid, etc.) - Revenue (FY 09-10 uncollectibles, $16 million) Impact of Patient Protection and Affordable Care Act - “EMS agencies lose money responding to calls from the publicly insured.” – N AT ’ L C TR FOR P OLICY A NALYSIS - Value-based - No one really knows. Better utilization of resources - Increased efficiency without loss of effectiveness (Emergency Medical Dispatch) - Lost unit hours (e.g., bed delays, diversion) Public expectation

8. Challenges facing EMS - continued Determining an affordable, sustainable, and outcome-driven model (i.e., optimal service)

9. Questions?