Public Utility Model

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Public Utility Model ("PUM") EMS is an ambulance system in which the community retains public control of the ambulance system's capital assets and accounts receivable through direct, accountable daily oversight. It then subcontracts the day-to-day operations to an outside ambulance service provider. Roughly 5% of all EMS agencies in the United States are Public Utility Model EMS systems.

A Public Utility Model EMS system is designed where the government not only regulates and oversees system performance, but the ambulance service provider (contractor) is held accountable to meet or exceed performance requirements. This can include termination of the provider contract and even fines being imposed. In Public Utility Model EMS system design, the government is a "purchaser" of First Responder paramedic, and paramedic ambulance transport services through a competitive (bidding) process insuring that the most cost-effective provision of EMS services is guaranteed.

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[edit] Examples

For example, in Fort Worth, Texas, the 9-1-1 public utility model is known as "MedStar". However, the contractor up until 2005 was Rural/Metro. In Richmond, Virginia, the 9-1-1 public utility model is called the "Richmond Ambulance Authority". Recently, the Richmond Ambulance Authority terminated its contract with American Medical Response and is self-operated. American Medical Response replaced a previous contractor many years ago who lost its bid to provide services under contract to the authority.

Examples of public utility model EMS systems currently operating in the United States include:

[edit] Distinguishing Characteristics

Public Utility Model EMS systems have certain characteristics which make it different from other emergency medical services delivery models. They are:

[edit] Oversight

There must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. These are usually boards made up of stakeholders in an EMS system (citizens, elected/appointed government officials, physicians, paramedics, nurses, financial gurus, and even consumer advocates)

[edit] Patient Care

High quality patient care is the number one focus of a public utility model EMS service. Continuous quality improvement is paramount, and every aspect of the EMS delivery process is examined and re-examined exhaustively in a never-ending cycle.

[edit] Performance-based contracts

Services are provided by contractors who are under "performance-based" agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. There are performance benchmarks established for dispatchers, unit response times

[edit] Financial control

Financial controls must be in place where the public utlity model oversight authority controls all EMS system funding. A public utility model is designed to be funded through the collection of user fees and not reliance on tax money. While some systems struggle with reimbursement issues, the fact remains that a substantial portion of PUM operating revenues are derived from user fees not tax subsidy.

[edit] Response Level

Advanced Life Support (ALS) resources are sent to all calls - there may be a tiered response with a local fire department providing BLS first response via and engine or truck company, but the level of transporting care is always ALS and ALWAYS at the paramedic level.

Purists will argue, with merit, that a true PUM must encompass all five of these hallmarks. However, many existing PUM operations are a hybrid of a simple third-service EMS organization utilizing one or more of the above listed characteristics in an effort to provide the best advanced life support patient care possible.

[edit] History

Around 1983 Jack Stout proposed System Status Management (definition below) in the Denver City and County EMS system. Soon after, he proposed, or was instrumental in developing Public Utility Models, EMS Performance Contracts, and helped design the very first Computer Aided Dispatch (CAD) system, specific to EMS needs. This gave communities the ability to monitor and measure the performance of their EMS providers (spurring continuous quality improvement and accountability). From this the response time standards were developed that most PUM's use.

[edit] SSM

System Status Management (SSM) is the most widely accepted method for managing ambulance/EMS resources in the PUM and third service government environment. SSM has two dominant components:

[edit] Dynamic Deployment

Ambulances are geographically deployed based on projected demand by the time of day and day of week by using historic demand data. This model responds to the fact that as populations move from home to work and back, geographic demand patterns vary. Using SSM, ambulances do not respond from fixed stations, but are "posted" to street corners on an hour to hour basis. The "posts" are selected to provide the best response times for the projected demand at that time of day.

[edit] Peak Demand Staffing

Shift schedules are designed to provide the number of ambulances needed for the time of day and day of week projected demand. Consequently, in a typical PUM EMS provider system, ambulances typically begin duty every hour from 5:00 a.m. until noon and then the numbers start declining about 5:00 p.m. until midnight. Shift lengths are typically 8, 9, 10, 11, 12 and 24 hours in a large and busy system.

SSM enables a public utility model EMS contractor to match resources to demand more accurately than using a more traditional 'static' model of fixed staffing and fixed stations for all hours of the day and days of the week.

[edit] References

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Fitch, Joseph J.; Prehospital Care Administration ISBN# 0-8151-3391-X "Public utility model EMS." Emerg Med Serv. 2004 Mar;33(3):87-91 (Dean S.) University of Maryland, Baltimore County, Emergency Health Services Department, USA. PMID: 15055076