King County, WAshignton Emergency Medical Service (EMS)

"Measure and improve" is the motto that drives King County EMS

Demographics of the System

King County, Washington - Overview

Service Area

Population Density

Economic Indicators from Census Data

Structural Attributes of the EMS System

Geographic Scope

Standard Setting and Enforcement

Division of Functions

Market Allocation

Failure to Perform -- Consequences

Business Structure

Management Level

King County EMS System Outputs

Prevention and Early Dectection

Bystander Action and System Access

911 Call Taking

First Response Dispatch and Services

Ambulance Services

Receiving Facility Interface

Medical Oversight

HallMarks of HPEMS

Accountability

Independent Oversight

Accounting of Service Costs

System Features that Ensure Economic Efficiency

System Features that Ensure Long-Term High Performance

King County EMS Performance Measures

Clinical Level 22

REsponse Time STandard 22

Cost Per Transport 25

Cost Per Unit Hour 25

Unit Hour Utilization 26

System Cost Per-Capita 26

Subsidy Per-Captia 26

Conclusion 27

References 29

Appendix 32

Demographics of the System

King County, Washington - Overview

King County, Washington is the most populace county in the state of Washington as well as in the top 15 most populated counties in the United States (13th). The county has a total land area of 2,307 square miles with slight over eight percent of this area being water (United States Census Bureau, 2015). The area is known for being a center for liberal politics and Seattle is one of the most liberal cities in the country and has elected socialist councilmembers, gay mayors, endorsed the "War on Christmas," has strongly supported environmental movements, and is among the top five cities with the fewest cars; however, although Seattle and King County are often associated with liberalism in its politics and its policies, some argue that there are still many strong conservative elements despite its strong progressive tendencies (Anderstone, 2014). King County was actually renamed in 2005 to honor Dr. Martin Luther King Jr. as opposed to the original founder who also shared the last name King.

Population

King County, Washington, has a population of just over two million people based on an 2014 estimate of population that is derived from an extrapolation of the official U.S. Census Bureau report that was conducted in 2010; in 2010 the population figure was noted as 1,931,256 (United States Census Bureau, 2015). The population growth in the county has been estimated at roughly eleven percent which also occurred during a period of flat job growth and indicates a rate of growth that is not based on the county's economic performance and job opportunities (King County, 2013). The 20th century ushered in a period of rapid population growth and industrialization in the region.

Service Area

The Emergency Medical Services (EMS) Division of Public Health - Seattle & King County represents a complex network of different responders and providers. The network is organized under a Medic One/EMS system that provides coordination and standardization efforts within the system. For example, there is standardized EMT training, continuing education, dispatcher training and code standardization, and even data collection provided by the Medic One organization.

Anytime you call *** in King County for a medical emergency, you are using the Medic One/EMS system and the Medic One system in King County is dedicated to increasing survival and reducing disability from out-of-hospital emergencies in the county by providing the highest quality patient care in the pre-hospital setting (Pubic Health - Seattle and King County, 2013, p. 6). In order to meet the county's objectives, the Division adheres to a medical model of integrated regional with the Medic One/EMS services, which includes a philosophy of cooperative decision making, and the development of innovative strategic initiatives that address the demand for services while also trying to build recourse efficiencies in the system. All of the EMS Division programs have been designed to enhance these efforts through strong partnerships with other regional EMS agencies as well as utilizing strong leadership to further these objectives (Public Health - Seattle & King County, 2015, pp. 6-7).

Population Density

The area within King County is geographically diverse with points that are at sea level as well as many points of high altitude; the same can be said about its human population with a significant amount of area being highly-dense in population and urbanized, while other areas being mostly rural with a low population density (Vance-Sherman, 2015). Seattle, the regions urban center, is one of the most population dense cities in the United States. Of the 366 "Metropolitan Statistical Areas" the Census Bureau tabulated, in the 2010 census Seattle-Tacoma-Bellevue came 24th in...

However, the city is rapidly becoming denser with further population growth and much of this density is increasing through diversity.
Figure 1 - Seattle's DiversityInvalid source specified.

Economic Indicators from Census Data

The region can be categorized by a wage and income rate that was significantly higher than the country's average and there were also far fewer people living in poverty relative to state and national averages (Vance-Sherman, 2015). Seattle's progressive government was one of the first in the country to institute a significantly higher minimum wage ($15 dollars an hour). The program has so far been argued to be a success. Furthermore, the results of some studies have indicated that the unemployment rate has decreased after the minimum wage increase. In one period between January and December of 2014, business owners (and their customers) unemployment decreased 17.46%, falling from 6.3% to 5.2% (Worstall, 2015). The fact that King County is largely progressive and also a strong economy has had major implications for public services include the county's Emergency Management System (EMS).

Structural Attributes of the EMS System

Geographic Scope

The Medic One/EMS system in King County covers the full range of the county's boundaries and in some cases actually extends beyond these boundaries as it coordinates with neighboring systems. According to Vance-Sherman (2015) the regional context can be described as:

"King County's current boundaries situate it between Puget Sound to the west and the crest line of the Cascade Range to the east. It borders Snohomish County to the north and Pierce County to the south. King County is very geographically diverse, with points at sea level and a high point of nearly 8,000 feet. The human geography of King County is also diverse; characterized by high-density urbanization along the shores of Puget Sound, suburban communities to the east of Lake Washington, rural communities to the southeast and remote towns in the Cascade foothills. There are 39 towns and cities located in King County (Vance-Sherman, 2015)."

Standard Setting and Enforcement

The Medic One/EMS system is the central organization that plays a central collaborative role in King County. This organization operates based on partnerships that are built on regional, collaborative, cross-jurisdictional coordination -- while each provider operates individually, the care provided to the patient operates within a "seamless" system (Public Health - Seattle and King County, N.d., p. 4). It is this continuum of consistent, standardized medical care and collaboration between 30 fire departments, six paramedic agencies, five EMS dispatch centers, 20 hospitals, the University of Washington, and the citizens throughout King County that allows the system to excel in pre-hospital emergency care. The Medic One/EMS system is also responsible for medical training which is provided on a regional basis to ensure no matter the location within King County the medical triage and delivery is the same (Public Health - Seattle and King County, N.d., p. 4).

Division of Functions

The Medic One/EMS system operates on a tiered system model that enlists a Basic Life Support (BLS) as the standard operating procedure. Most incidents are responded to with BLS services and the ALS services are reserved for the incidents that the dispatchers deem as medically necessary. This reserves the more limited regional resource of an ALS unit (known locally as a medic unit) for the serious or life-threatening injuries and illnesses (Public Health - Seattle and King County, N.d., p. 11)."

The dispatch centers are trained to specifically code calls and prioritize the response based on this system to maximize the efficiency of the resources available in the system. The Medic One/EMS manages the full out-of-hospital continuum of care throughout the entire county through its partnership with 30 fire departments, six paramedic agencies, five EMS dispatch centers, 20 hospitals, the University of Washington, and the citizens throughout King County.

There are five major components that are included in the Medic One/EMS system in King County that include:

1. Universal access

2. Dispatcher triage

3. Basic Life Support Services

4. Advanced Life Support Services

5. Transportation to a Hospital

Market Allocation

The Medic One/EMS system has a fairly unique funding structure that is only possible because of the regions high economic development and politically progressive leadership. Medic One/EMS is supported by levy funds that make the services it provides less vulnerable, though not immune, to fluctuations in the economy and this system has maintained financial viability and stability, even throughout the economic recession, due to a sustained focus on operational and financial efficiencies (Public Health - Seattle and King County, N.d., pp. 10-11).

In 2012 the proposed levy (which was passed) called for a levy rate of 33.5 cents/$1,000 AV means that the average homeowner will pay approximately $107 a year in 2014 for highly trained medical personnel to arrive within minutes of an emergency, any time of…