By Miles Shuper

On March 1, Tulare County’s emergency ambulance response went state-of-the-art. The latest technology keeps track of the whereabouts of every ambulance in the county and when an ambulance is called, now the closest one available is the one that responds. That means faster, smarter response–when every second counts.

Tulare County’s new ambulance response plan tracks each request for service from beginning to end and ensures closest-unit response. The eight private, public, and volunteer ambulance services, referred to as the Ambulance Provider Association of Tulare County, work together to operate the countywide system using uniform standards, fees, and the state-of-the-art dispatch system.

Officials say the public will probably only notice subtle changes as a result of the behind-the-scenes shift to the new system. However, the smarter resource distribution and quicker responses will pay major dividends for the 110 to 130 ambulance calls occurring in the county each day.

Choreographing Response
The heart of the new system is in the Tulare County Consolidated Ambulance Dispatch Center (TCCAD), where a new Computer Aided Dispatch (CAD) system not only monitors ambulance resources in the county, but also shifts coverage whenever an ambulance is dispatched to a call for service.

The CAD system is like an air traffic control panel for the dispatchers to manage the movement of available ambulances. The software programs within the CAD system use stored response data collected on previous calls to predict where an emergency is most likely to occur. The system then identifies areas that require coverage, while also noting which ambulance will be the closest to a specific address. “It is a fascinating and state-of-the-art system,” says Paul Main of American Ambulance, one of the central coordinators of the new consolidated system.

He adds that the countywide display screen is in constant motion, ever adjusting to calls and using past call information to plot the potential for service, based on a detailed list of factors.

Split-Second Decisions
Anna Smith, a veteran emergency services and law enforcement dispatcher who oversees the dispatch center in downtown Tulare, says the new software is amazing. When each second of travel time is essential, dispatchers have every piece of information needed to make split-second decisions through the CAD system.

The system constantly evaluates data variables and even movement of ambulances to determine locations most likely to need coverage.
Some of the data points being evaluated include time of day, day of the week, call frequency patterns, weather, and road conditions.

After dispatchers receive a request, the information is transmitted to the responding ambulance personnel across their radios and pager. They can see the details of the call and the address, and even map the route to the address with a sophisticated system of hardware and software inside the ambulance. This information is intended to reduce time spent on the radio with the dispatch center, and to reduce response times.

Complex Standards
Having as much information in front of dispatchers and responding personnel is critical to decreasing response times to all requests for service. All ambulances in Tulare County must meet response standards for metropolitan, rural, and wilderness areas. Metropolitan areas have one standard for response time; rural and wilderness each have their own, but each ambulance in the county must meet the standard that applies to the call the team is on. If they fail to meet these standards, the ambulance companies are fined.

These fees are paid to Tulare County and the money, in turn, goes to help the emergency medical services system in Tulare County. This is a common practice in most areas of California, explained Dan Lynch, administrator for the Central California Emergency Medical Services Agency, which oversees Fresno, Madera, Tulare, and Kings County ambulance services.

Main, who like Lynch has been impressed with the cooperation and diligence shown by those who make up the alliance, says the most important thing is having the best response of resources “without worry as to stepping on boundary lines.”

More Changes
Main stresses that changes are forthcoming in a variety of other approaches. The ambulance association is planning an ambulance service training academy, expected to start in June, that will give new EMTs an opportunity to get required hands-on training that will help them get jobs within the county or elsewhere. This is similar to how the fire or police academy is offered in the community. As another advantage to working together, the ambulance services now have cooperative buying power that helps each service become more cost efficient, he said.

These changes started in Tulare County a few years ago. In 2003, Tulare County became part of the region of counties that use the Central California Emergency Medical Services Agency (CCEMSA) for ambulance oversight. In 2007, Tulare County officially became a “paramedic county” meaning all valley-floor emergency response crews were staffed to the advanced life support-paramedic level.

That was a milestone for the county, but it still needed to modify its ambulance service, as the system used a dated delivery model. The system did not address the service areas that were left uncovered while ambulances were already on assigned calls, or the inconsistent response time requirements throughout the county. To begin hunting for solutions, Tulare County Supervisors, emergency service officials, and others asked for solutions to the problem and find a way to provide the best, most effective, and efficient system possible.

Dan Lynch said there was no doubt that Tulare County’s system of nine providers (including the city of Dinuba Fire Department, which operates under a separate contract, but works with the eight providers to deliver services within the county) simply could not ensure the closest ambulance always responded to an incident. Ambulance companies’ operating areas generally precluded them from crossing boundaries, so there appeared to be too many service gaps.

County Supervisors considered the options, including Lynch’s strong suggestion that the county seek a contract with a single provider—which would have to meet stringent performance standards including response times, billings, and other rules.

The Supervisors also heard the suggestion from the ambulance services. The ambulance services acknowledged and confirmed that the system needed to be improved and even revamped, and they suggested they could work together as one group, with the county and the EMS agency, to deliver the system the supervisors were looking for.

The County Supervisors were reluctant to put the providers out of business, and they agreed to investigate forming a joint powers agreement among the eight providers, who could work together for a better system. Such a system would set and stringently enforce higher performance standards.

Working Together
Lynch has high praise for the way Tulare County’s new system has come together and sees a major improvement in efficiency, uniformity, and cooperation throughout the county. He says cooperation among the previously independent providers who now operate under a single contract is evident and the sense of unity was clear as the consolidation took shape.

Having a uniform system has a number of advantages. It not only ensures that the closest ambulance is sent to the scene, but sets standards of service and training requirements, creates opportunities for better cost efficiency as well as uniformity in equipment, collective supply purchases, system redundancy, and numerous other benefits, Main points out. Especially valuable, Main says, is that having the existing companies provide services, keeps personnel on the job who know their geographical territories so everyone benefits. “It truly is a ‘win-win’ situation for everyone in Tulare County.”

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