Owner system

In for money

By Jay Fitch, PhD, Fitch & Associates

Clinically sophisticated, fast, inexpensive: choose two!

This was the wisdom coined by EMS pioneer Jack Stout in the early 1980’s. The logic of course is that a great and fast EMS system won’t be the cheapest. Likewise, if the system is cheap, it may be fast, but the quality may be lacking. The underlying theory is that when budget is a concern, you can’t have it all and compromises have to be made.

Communities are trying to answer the question of what they want from their systems and what they are willing to pay.

Communities are trying to answer the question of what they want from their systems and what they are willing to pay.

Contemporary thinking is that while everyone thinks their urgency is ultra-time-sensitive, clinical evidence tells us that is not necessarily the case. Few calls are truly urgent and as call intake, prioritization and telemedicine improvements are made, more systems will further tailor response time requirements to clinical needs. From a community perspective, reasonable response times are necessary, but the days of requiring all patients to receive advanced life support transport within 8 minutes are almost a thing of the past. Communities have determined that the costs are simply too high.

Fully deployed systems may be faster and cheaper than a fully static station-based deployment approach, but there are other impacts in terms of caregiver satisfaction and fatigue that also need to be considered. By striving to reduce costs, some systems have increased productivity to the point that the department cannot retain highly experienced staff. And that can impact the level of clinical sophistication of the service.


Watch for more:

Watch for more:

On Demand: Fatigue in EMS – Measuring the Prevalence and Effectiveness of Fatigue Management Initiatives

Learn about the results of the recent EMS1 survey on provider fatigue, as well as ongoing research on fatigue and strategies to prevent and manage it


Developing meaningful quality and accountability processes and using learning management systems that make training available anytime and anywhere are key investments that EMS systems should make. When budgets are tight, systems that reduce quality improvement efforts, training, and supervision are shortsighted, and these decisions ultimately impact the clinical levels the service can achieve.

The pandemic has put a strain on our people as well as the operational and financial processes of the system. Many organizations have had to make uncomfortable compromises to survive. Communities are trying to answer the question of what they want from their systems and what they are willing to pay. Jack Stout was right that a balance of all three factors is necessary for a sustainable EMS system. The landmark articles he wrote on system design more than 40 years ago are still relevant today.

About the Author

Jay Fitch, PhD, is a founding partner of EMS/Public Safety Fitch & Associates. Caregiver, director, consultant and author, his work in public safety spans nearly 50 years. He can be contacted at [email protected]