HomeMy WebLinkAboutIR 010 (4) INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 23-010
To the Mayor and Members of the City Council January 24, 2023
Page 1 of 3
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SUBJECT: UPDATE ON MEDSTAR EMS RESPONSE PLANNING
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The purpose of this informal report is to provide an update on the Metropolitan Area EMS Authority
("MedStar") reprioritization and response planning process, and to provide an overview of
upcoming efforts that lead to a more patient-centric service model and will be recommended to
Mayor and Council for review and approval during FY23.
Citygate Report
The Citygate Fire and EMS Staffing and Operational review offered recommendations that will lead
to more patient-centric care, specifically:
1 . Task MedStar and the Fire Department to continue dispatch reprioritization efforts that
reduce the number of non-life-threatening complaints categorized as Priority 1 calls, so the
system can focus on getting the right resources to the most critical calls in the fastest time
possible.
2. The City Council should adopt updated, clearly measurable response time goals for the
Department based on best practices starting with the 9-1-1 call receipt in Police dispatch.
The Council needs to require regular reporting to provide accountability for the Department
to meet its goals. The goals identified in Recommendation #1 are consistent with both
national best practices and the risks to be protected in Fort Worth. Measurement and
planning, as Fort Worth continues to evolve, will be necessary for the Department to meet
these goals.
Project Background
The Restated and Amended Interlocal Agreement between the City of Fort Worth and the 14 cities
in the MedStar system establishes a system performance committee that recommends system-
level response time and clinical standards for adoption by MedStar's Board of Directors. To obtain
a diverse cross section of the community, the members of the System Performance Committee
("The Committee") include leadership from several of the member cities' first response agencies
including Fort Worth Fire Department, Fort Worth City Manager's Office including David Cooke and
Valerie Washington, Bill Masterton, Chief Operating Officer of JPS Hospital, Jessica Rangel,
Executive Vice President of Health Systems with University of North Texas Health Science Center,
and operational and clinical representatives from MedStar's executive team and Office of the
Medical Director staff. The Committee has been working to best determine which EMS callers
have the most critical need for the fastest response. This effort to identify and focus on high priority
calls was recognized and recommended by the Citygate report as a needed initiative. Likewise,
the Committee has been tasked with incorporating the other Citygate recommendations into its'
discussion and work product. The ultimate goal is to deliver a more patient-centric, data-driven,
EMS resource deployment plan.
The Process
The Committee is taking a phased approach to changing the EMS deployment model.
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 23-010
To the Mayor and Members of the City Council January 24, 2023
Page 2 of 3
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SUBJECT: UPDATE ON MEDSTAR EMS RESPONSE PLANNING
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Phase 1 : Agree on a more patient-centric, data-driven, methodology to prioritize and objectively
match the acuity of 911 caller's medical complaint with the most appropriate resources and get
them to the patient in the most appropriate amount of time. The goal is to get the right resources,
to the right patient, at the right time. This goal recognizes that it isn't feasible, or necessary, to
respond with maximal resources in the shortest possible time for every 911 call regardless of
patient acuity.
Phase 2: Develop response time goals for each response priority based on clinical science,
financial discussions, and response modeling.
Phase 3: Develop and execute an implementation plan to meet these response time goals.
Phase 4: Monitor the changes, on an ongoing basis, and make adjustments as needed.
Phase 1
The objective of phase 1 is to get the right resources to the right patients at the right time. Data
shows that the sickest patients, those with cardiac or respiratory arrest, need the most resources
in the shortest amount of time possible. This, combined with ongoing efforts such as
telecommunicator guided CPR, bystander CPR and AED utilization, will give these patients the
best opportunity for survival.
The methodology the Committee recommends utilizes three years of patient care data from patient
care reports, combined with the emergency medical dispatch ("EMD") response determinant
assigned to each 911 call. The methodology looks at four criteria: presence of cardiac or respiratory
arrest or continuous seizures, unstable vital signs, the use of potentially life-saving medical
interventions, and whether lights and sirens were used to transport the patient to the hospital.
Additionally, calls for motor vehicle collisions ("MVCs") were considered with recognition that crash
scenes are inherently dangerous environments for patients and first responders. The 911 calls
were placed into eight (8) priorities from most acute to least acute.
Utilizing this data-driven approach to prioritizing emergency calls from the actual MAEMSA system,
will help assure that the sickest patients are given the highest priority, receiving the appropriate
resources in the shortest amount of time, while allowing a more tailored response for the needs of
patients in other priorities.
Barring any technical barriers, we anticipate implementing this methodology February 1 , 2023. A
chart showing the call breakdown for each priority is below.
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS
INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 23-010
To the Mayor and Members of the City Council January 24, 2023
Page 3 of 3
xA.
SUBJECT: UPDATE ON MEDSTAR EMS RESPONSE PLANNING
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Larger Avg
Proposed % of Incidents/
Hot/Cold Proposed Priority Incidents Incidents Day
P5 -ALS Cold 156,399 41.97% 142.7
P6 -ALS IFT Cold - Emergency
P7 -ALS Cold 36,342 9.75% 33.2
Cold Responses P8 - BLS Cold 20,987 5.63% 19.1
P9 - ALS IFT Cold - Non-Emergency
P1 0 - BLS IFT Cold - Non-Emer enc
Group Subtotal. Cold Responses 1 213,7281 57.36% 195.0
Grand Total: All Responses 372,627 100.00% 340.0
1:ALS=Advanced Life Support.BLS=Basic Life Support.Hot=Lights&Siren response. Cold=No Lights&Siren response
Next Steps:
We anticipate a fully developed proposal for the remaining priorities to be included in budget
discussions for next fiscal year. MedStar has purchased advanced modeling software that will be
deployable in April to aid in making data-driven decisions that maximize potential for improvement
in patient outcome. There are already several budget meetings scheduled with City and MedStar
leadership to discuss the options and potential financial needs. However, that does not mean no
action is being taken in the meantime. In addition to implementing Phase 1 on February 1 , 2023,
MedStar is increasing resources in anticipation of changing response models.
For questions regarding this report, please contact Ken Simpson at ksimpson(a)-medstar911.org,
Dr. Jeff Jarvis at liarvis _medstar911.org, Valerie Washington at
Valerie.Washington(a)_fortworthtexas.gov, or Fire Chief James Davis at
iim.davis(c�fortworthtexas.gov.
David Cooke
City Manager
ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS