title: Reduction in unavailable-for-response episodes in a private emergency medical services agency.
abstract: OBJECTIVE
  Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/benefit analysis.
  
  
  METHODS
  The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes. This identified clusters of unavailable-for-response episodes for which incremental staffing changes were implemented. Internal audit of cost/revenues was recorded.
  
  
  METHODS
  Midsized private EMS agency in Northwest Pennsylvania.
  
  
  METHODS
  EMS Responders/Agency calls.
  
  
  METHODS
  Temporally precise increases in staffing during critical time periods/unavailable-for-response episodes.
  
  
  METHODS
  Reduction in unavailable-for-response episodes, cost effectiveness.
  
  
  RESULTS
  Evaluating 23,833 EMS responses that occurred during the study period, staffing changes resulted in a 93 percent average reduction and 100 percent maximum reduction in unavailable-for-response episodes and were cost effective, based on evaluation of cost versus revenue, in this EMS agency.
  
  
  CONCLUSIONS
  Identification of opportunities for system staffing improvement in a midsized EMS agency demonstrated feasibility and usability of mapping temporal patterns of unavailable-for-response episodes to substantially reduce the number of unavailable-for-response episodes and was cost effective.
authors.affiliation: Department of Emergency Medicine, UPMC Hamot, Erie, Pennsylvania.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Risavi
authors.affiliation: Department of Emergency Medicine, UPMC Hamot, Erie, Pennsylvania.
authors.forename: Saad
authors.initials: S
authors.lastname: Mahmood
authors.affiliation: Department of Emergency Medicine, UPMC Hamot, Erie, Pennsylvania.
authors.forename: Kevin
authors.initials: K
authors.lastname: Andryc
authors.affiliation: EMT-P, McGonigle Ambulance Service, Inc., Sharon, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Libonati
authors.affiliation: Assistant Dean for Faculty Development, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Terrell
mesh_terms: D000552:Ambulances; D003362:Cost-Benefit Analysis; D004632:Emergency Medical Services / Q000600:supply & distribution; D060731:Emergency Responders; D006801:Humans; D010414:Pennsylvania; D010561:Personnel Staffing and Scheduling; D017149:Private Sector; D058996:Quality Improvement; D000078329:Workforce