The Old and the New; Richmond Ambulance Authority

The Old and the New;

Richmond Ambulance Authority embraces needed changes in the provision of EMS services.

By Alan E Perry

Why I checked them out

I was intrigued by the Richmond Ambulance Authority (RAA) web presence which is very active in promoting the organization, its providers and EMS public education.  All subjects I like to see EMS systems promote, both for their own well-being and the good of the communities they serve. The web site (http://www.raaems.org/) is well organized and the organization very open about their operations. They pursue a high level of efficiency and hold themselves to high standards for response time and unit utilization using system status management. My interest was such that I inquired about part-time employment to get an inside view of the system, that is still on hold, but I was able to do a ride-along on Medic 483 to see how it all came together on the street. This document is merely my impression of the service based on my own opinions and experiences.

Their unique environment

In March of 1991 the Virginia General Assembly created the Richmond Ambulance Authority for the purpose of providing the City of Richmond with the framework to build a high quality and innovative EMS system. It has been successful; the RAA is accredited by the National Commission on Accreditation of Ambulance Services (CAAS). Their dispatch center is accredited by the National Academy of Emergency Dispatch (NAED), and is one of only eleven EMS systems in the country to possess both. Those of you familiar with these organizations know that obtaining these qualifications is no small task. This illustrates the level of support and singularity of purpose the organization possesses. With this mandate they have developed an entire EMS system focused on efficiency, integration of technology, evidence based treatment protocols and logical operational policies that serve as a model for the provision of EMS anywhere. Richmond has a permanent population of around 200,000 which swells to up to a million on any given work day, their call volume is approximately 60,000 annually.

What seems to work

As an EMS provider I appreciate the seamless functionality of good quality communications and dispatch systems. RAA has its own dispatch center, uses both radio and wireless GPS to locate, dispatch and map units route to calls, units can respond and mark on scene by the push of a button keeping radio channels clear of unnecessary traffic. The GPS system keeps track of all units and facilitates the dispatch of the closest appropriate unit for a call. Software in the dispatch center is predictive of call locations and volume based on historic data allowing units to be stationed in relative proximity to the next expected call keeping response times below 9 minutes. All 911 response units have at least one paramedic on them. All trucks are equipped with power stretchers. Reports are completed on highly functional ePCR software which links wirelessly with their Zoll monitors. Unit inventory is maintained through a sealed bin system, if a bin is opened it is replaced with a new sealed bin, in this way unit inventories are always complete and standardized. RAA appears to have an excellent working relationship with the facilities they serve, the EMS report/break rooms at all facilities are clean and inviting, have well stocked snack boxes and a wide variety of beverages in the refrigerators to keep the providers sustained during their 12-16 hour shifts. RAA has an excellent working relationship with the Richmond Fire Department. Their single facility on Hermitage road houses the administrative offices, dispatch center, training center, supply and equipment warehouse and Ambulance maintenance shop.

Some of the same old problems

Some of the problems remaining are the same that are found in just about every EMS system. There are a large number of non-emergency and nuisance calls, the Police hand off some questionable psychiatric patients, and every call is dispatched as a priority one call until proven otherwise. As a former EMS system manager and Field Officer the issues with unsecured equipment and the general cleanliness of the units and equipment still concern me. Employees suffer from inequality in pay across public safety disciplines frequently working second jobs to make ends meet.

What I would do to improve the system

RAA has an excellent public education and marketing program already in place, this program can be used to address the appropriate use of the 911 system to the general public to reduce the burden of unsubstantiated calls. Build up the value of your employees and attempt to get the compensation more in line with other public safety personnel. The facilities at RAA are already equipped for decon of contaminated equipment, it may be useful to put each unit through a decon process weekly to include thorough cleaning of the box, the cab and all of the equipment on it. Make the VAOEMS regulations part of the training process for all employees to get better compliance with requirements for securing equipment and hygiene. Permit scheduled breaks for crews to eat a meal without having to do so in the cab of the truck, perhaps permitting them to rotate through stations at local ER’s to accomplish this will not disturb the deployment model too much.

Conclusion

RAA has established itself as a proactive, competent and capable resource for the citizens and visitors of Richmond. It is, in my opinion, a shining example of what an EMS system should strive for. RAA has embraced many of the suggestions put forth ten years ago in the EMS Agenda for the Future, an accomplishment for them and an unheeded warning to most other EMS systems in the State and Nation. RAA should be cautious, you can never rest when you are on top, you must take advantage of the position to keep pushing forward. The same CQI process used to evaluate patient care needs to be applied to the entire system. Continued success will require improving operational and patient care efficiency, increasing the value to the community and the providers and building the trust and respect of the public and your employees through continued integrity in your actions.