What Strategies is Kansas City Using to Effectively Provide Emergency Medical Services?

The objective related to emergency medical services is: Evaluate and identify areas of opportunity in the emergency response delivery system to ensure the best possible patient outcomes. Below are the strategies from the current Citywide Business Plan that the City is pursuing that relate to this objective. These strategies provide insight into the departments that are involved and the actions that are being taken.

a.       Measure the impact and effectiveness of the Kansas City Assessment and Triage Center (KC-ATC). (Office of the City Manager)
b.      Implement the Ground Emergency Medical Transportation (GEMT) program that provides supplemental reimbursement for ambulance services to Missouri HealthNet participants. (Fire)
c.       Provide an ongoing series of courses on CPR and other life-saving techniques throughout the City in order to improve the cardiac survival rate. (Fire)
d.      Develop initiatives to reduce the number of chronic users of emergency response services. (Emergency Medical Director)

Advanced Life Support (ALS) Response Time by Ambulance Response District

In addition to the looking at the aggregate response time as shown in the above ALS response chart, the City monitors response times within the four ambulance response districts.

ALS Response Time by Ambulance District

Response time is measured as the percent of advanced life support responses to life-threatening emergencies that happen within 9 minutes. Response times for each of the four ambulance response Districts (ARDs) are below; a map is shown to the right that delineates the borders of the ARDs. ALS response times are calculated over a three month period, so the chart shows a three-month rolling average. Since pumper trucks with ALS capability (paramedic-trained staff and medicine) began being deployed, response times have improved in several districts.

Patient Outcomes

Although a rapid response to life-threatening emergencies is an important component of emergency medical operations, the ultimate desired outcome is the survival and well-being of the patient. While there are many factors involved in this outcome beyond the EMS response, it is important that the EMS staff administer the correct medical protocols in an effective way. One measurement of patient outcomes that is tracked across cities and communities is the return of spontaneous circulation after a cardiac event (also called ROSC). Signs of ROSC include breathing/coughing/movement and pulse/blood pressure. ROSC is more likely to occur after a cardiac arrest with a "shockable" rhythm such as ventricular fibrillation (v-fib) or ventricular tachycardia (v-tach). The measurement below shows the percent of cardiac arrest patients with v-fib or v-tach rhythm that experience ROSC after EMS response. The city's target for this measure is 30%, was consistently met in Fiscal Year 2014 but not in Fiscal Year 2015.

Resident Satisfaction

The resident survey has two questions about the city's emergency medical services - one about the overall quality, and another about how quickly emergency medical personnel responds in an emergency, which was recently added to the survey. Both questions have had sustained high levels of satisfaction over the past several years.

Ratings by Users

The resident survey asks a number of "experiential" questions in order to assess how often citizens are using different city services; among these questions is "have you used the ambulance service?" According to the survey, in most years approximately 10-15% of residents report that they have used the ambulance. As the analysis below shows, residents who have used the ambulance service are more likely to be very satisfied than non-users with both quality and timeliness.

KCStat Schedule

All Council priorities, including those in the area of Public Safety, are discussed at KCStat Meetings, which are public meetings held at City Hall and moderated by the Mayor and City Manager. Anyone from the public may attend, or follow the discussion via Twitter (#kcstat). Videos of KCStat meetings and meeting documents are archived online and can be accessed at kcmo.gov/kcstat/. A list of past and future KCStat meetings for Public Safety is also available on that page.