A Look at El Campo EMS’s New Lights & Sirens Policy

The City of El Campo EMS recently initiated a new policy in which its ambulances will not go with lights and sirens on every call.

Click here to view El Campo’s EMS priority determination document:

Click here to view El Campo’s decision tree document:

TEMSA recently sat down with Garret Bubela, El Campo’s EMS director, and Anthony Scopel, El Campo’s clinical captain, to discuss the policy.

TEMSA: How did you determine to move forward with a new policy that eliminates lights and sirens on every call?

Garret Bubela: We had been wanting to reduce our lights and sirens use for many years as we all know how driving with lights and sirens increase the risk of crashes.  Our biggest hurdle has always been our dispatch system. We are a city EMS department that is dispatched by our city police department. Since they are housed in the police department, they primarily focused on police dispatching. EMS and volunteer fire are added entities they dispatch for. The dispatchers not only perform call-taking and dispatching duties but also many other administrative tasks for the police department. Many times, there is only one dispatcher on-duty who manages all of these tasks. This had concerned previous police administration in that they didn’t want to add additional duties on their dispatchers by having them become EMD certified and lengthen the amount of time spent on the phone asking questions.  While we didn’t agree with their assessment of the situation, there was little we could do about it.  We also tried to explore outsourcing our EMS dispatching, but the city did not wish to pursue those options since they were already paying in-house dispatchers. 

The first step in actually moving forward with this process this year came with the release of the Joint Statement on Lights and Siren Vehicle Operations on Emergency Medical Services (EMS) Response, which was endorsed by 13 well-known organizations. I forwarded that over to our police chief, and we scheduled a meeting to begin a discussion on how we could accomplish this.  A meeting was held between key EMS and police staff, and we all agreed that this warranted exploring.

TEMSA: What went into the process to determine your new policy?

Anthony Scopel: We first began this process by speaking with our dispatch supervisor. She advised that the dispatchers were already asking questions of callers, but that information was not being relayed to us. With this in mind, we needed a series of easy-to-answer questions that a lay person could answer quickly without having to be instructed and would be standardized by our dispatch center.

I began by looking at the last two years’ worth of call data to analyze where we could decrease our lights and sirens responses without delaying response time to critical patients. In the analysis, I looked at the frequency of refusals versus transports and then broke that down into emergency traffic transports and non-emergency transports.

Of the more than 5,000 calls reviewed, only 277 (5.04 percent) resulted in a transport emergency traffic to the ER. Of that 5.04 percent, 27 patients were transported to a landing zone for transfer to air medical crews, 51 patients were in cardiac arrest prior to EMS arrival, and only 34 had skills above an IV and Oxygen administration performed prior to or during transport.

Within the data, it was very clear what patient complaints identified in the reports caused us to transport emergency traffic or required paramedic-level skills for stabilization of the patient. Calls with complaints of altered mental status, hemorrhage, chest pain, shortness of breath and cardiac arrhythmia were the most common calls that required paramedic-level care. Of the calls identified, I researched established EMD questions to identify the best questions that could be asked to get quick responses from the caller by a dispatcher with no medical training or background.

The questions developed were based on the data that I identified as our most commonly run calls that required a higher level of care. To make it easy to quickly determine a priority versus non-priority response the questions must all be answered in one way to create a non-emergency response. The backup to the system is that either the dispatcher or the crew can upgrade the response at their discretion based on the information they have and their experience.

Garret Bubela: The next step was to get approval from all necessary parties.  We started with our medical director, who was fully on board with the change. She had been to a medical director conference in recent years where this topic was discussed and understood the need for change. 

We then brought the policy to our city manager and city attorney to get their buy-in since they would need to give their approval from the political and legal standpoints. They also approved it without any reservations. 

From there, we circled back around to the dispatch supervisor to make sure there weren’t any other concerns and have now reached the point where we are ready for deployment.

TEMSA: How will you evaluate the effectiveness/impact of your new policy?

Anthony Scopel: To monitor the effectiveness of the system, our PCR software ESO has several built-in measures that apply perfectly to the situation. The first is the ability to look at response times over a predetermined period of time. By looking at the data our current average response time for the past 6 months is 7:29. The average response time for the previous year was 8:01. We will be evaluating our response time for the first 15 and 30 days to identify any major changes to these times. Monitoring of our response times will also be conducted at 30-day intervals for the first six months to identify patterns. In addition to response times, we also can look at the Safe Use of Lights and Sirens During Response to Scene report. This report will help us track the decrease in lights and sirens responses at the same intervals we will monitor response times. An ad hoc report was created to monitor the crew and dispatchers upgrading of calls when the response priority should have been a non-emergency response. We hope to eliminate abuse by crew and dispatchers who are still resistant to this policy change in the first 30 days after the policy goes into effect. This same report looks at the transport priority of patients to identify patients that we responded non-emergency to that required transport emergency traffic or via air medical helicopter to the ER.

Our goal is to decrease lights and sirens response to non-emergency 911 calls by 30 to 35 percent in the first six months. Preliminary data in the first 12 days of program rollout has shown a reduction of lights and sirens use by 55 percent. 

An additional goal is to keep response times under nine minutes in the urban setting and 14 minutes in the rural setting, which, depending on what studies are reviewed, fits within the EMS average national response times. The goal is to get the unit out the door quickly. If questions are not asked and answered in a timely fashion the crew will initiate the response emergency traffic, the unit can then be downgraded after the information is obtained by the dispatcher.

Our goal is not to downgrade all calls, but instead, to decrease responses to lift assist only, staging calls, calls to nursing facilities for lab value issues, and sick person calls where only mild symptoms are reported. We look for this policy to identify calls of a similar nature we have identified as being non-emergent in nature where transport has consistently resulted in either a refusal for service, canceled before arrival, or non-emergency transport to the ER.

TEMSA: What has been the response from the community so far?

Garret Bubela: The program rolled out on July 1, so we started the process of educating the public earlier this summer. We took multiple public awareness steps prior to its launch.  One of the steps was a short presentation at a City Council meeting, where we outlined the history, statistics and the need for change.  We gave a brief overview of the new policy which was well received.  We understood that city council members are in a position where they could get questions from their constituents, and we wanted them to be prepared to respond. 

The same week we presented to City Council, we deployed a PSA in our local newspaper that covered all of the same material.  We referenced many of the stats, the reason for the change, and a brief overview of the policy. Our goal was to get out in front of the public and educate them on why we are making the change.  The week after the article was published, I was approached by a community member who was grateful for the article and stated it explained the situation well and helped them understand. 

It is important in our marketing to show that our response will not change in those calls where time may be of the essence. We are also not changing our expectations on how fast our crews get out of the station as every call will still be deemed an “emergency” (but may not warrant a lights and sirens response). We have developed a one-page informational flyer to hand to patients and family on-scene who may not be happy with our response. We included a direct number to EMS administration to address their concerns.  Lastly, we have a short script by every phone in the station that gives our crews some data to provide to the public that may call if the administration isn’t available at the time.

TEMSA: Have other EMS agencies reached out to you about your new policy to help them determine their own?

Garret Bubela: At this time, our policy is pretty new and hasn’t gotten out there too much.  Anyone is more than welcome to reach out to us, and we are willing to share the process we are doing.