Virginia Beach Department of EMS: Annual Report 2014

Annual Report 2014

“Our organization is based upon a belief in neighbor caring for neighbor in their time of need; to

deliver valued services to the community that preserve life, improve health, and promote the

safety of citizens and visitors, who live, learn, work and play in our community “

2014 Highlights

40,937 Calls for EMS service

460 Active Ambulance Certified Volunteers

Per Month (Average)

130 New EMT’s Trained and Graduated

$23,856,182 Dollars Saved Thanks to Volunteers and

Rescue Squads

The City of Virginia Beach

DEPARTMENT OF EMERGENCY MEDICAL SERVICES OFFICE OF THE EMS CHIEF 757.385.1999 757.425.7864 FAX 71 TITY

THE PINEHURST CENTRE 477 VIKING DRIVE

SUITE 130 VIRGINIA BEACH, VIRGINIA 23452

Dear Mr. Spore:

I am pleased to present you with the Department of Emergency Medical Services’ Annual Report for calendar year 2014. This report provides the highlights of my staff’s accomplishments in following with our Departmental vision and goals as we continued with our mission to provide high quality and timely emergency medical treatment, transportation and rescue services. Our excellent customer service ratings continue based largely on our compassionate and technically proficient rescue squad volunteers and a small core of career staff to lead, train, augment and mentor them.

Again this year, we have achieved a number of important milestones with the support of you and our community even in these difficult economic times. As we continue to strive toward developing new processes that will lead to delivering sustainable and efficient advanced patient care, rescue and preventative services. Our volunteers continue to comprise 96% of all ambulance crews.

We continue to embrace the future and the challenges and rewards that we will achieve. I am honored to continue to lead this talented and caring team of providers and support staff that help make our City, “A Community For a Lifetime.”

Sincerely,

Bruce W. Edwards

EMS Chief

City of Virginia Beach City of Virginia Beach City of Virginia Beach

Executive LeadershipExecutive LeadershipExecutive Leadership

City Council Members

Mayor

William D. Sessoms, Jr.

Vice Mayor

Loius R. Jones

Bob Dyer

Centreville

Shannon DS Kane

Rose Hall

John E. Uhrin

Beach

Barbara M. Henley

Princess Anne

Amelia N. Ross-

Hammond

Kempsville

City Manager James K. Spore

John D. Moss

At Large

Benjamin Davenport

At Large

Rosemary Wilson

At Large

James L. Wood

Lynnhaven

Our organization is based upon a belief in neighbor caring for neighbor in their time of need. This

belief is supported by the organization’s commitment to the citizens’ open access to the highest

quality of health care services. These organizational values guide our performance and define our

desired organizational culture and quality of life.

Our Mission

The mission of the Department of Emergency Medical Services is to deliver valued services to the

community that preserve life, improve health, and promote the safety of citizens and visitors, who

live, learn, work and play in our community while maintaining sustainable systems approach that

is focused on dynamic resource utilization to enhance the overall quality of life in Virginia Beach.

Our Vision

We are the leader in the emergency medical services field and the community is confident in our

services.

We Value

QUALITY CUSTOMER SERVICE: Service to customers is the fundamental reason the City of Virginia Beach Municipal Government and our Department

exists.

• Customers define quality service.

• Members are committed to quality service delivery.

• Service exceeds customer expectations.

• Customer feedback is sought and valued.

TEAMWORK:

Organizational goals are attained when members and customers

work together.

• Team members share opportunity, knowledge and accountability.

• Team members develop mutual trust and respect.

• Team members participate in collaborative decision-making.

• Team members value diversity.

VOLUNTEERISM:

Volunteers are an integral part of the Department and the services we deliver.

• Volunteers bring resources and manpower to provide essential services.

• Volunteers participate in patient care services and leadership roles.

• Volunteers share opportunities, knowledge and compassion.

LEADERSHIP AND LEARNING:

Learning at every level of the organization creates opportunities for leadership experience and for members to continuously expand our

capacity to create a quality organization.

• Products, services, and technologies are enhanced through creativity and

innovation.

• An environment is created where members, regardless of our place in the

organization, learn together.

• Members are engaged in new and expansive patterns of thinking.

We Value

INTEGRITY:

Integrity creates the trust essential to Quality Service and long-term per-

sonal and organizational growth.

• Members have the courage to examine personal paradigms about roles and

how excellence is achieved.

• Members are entrusted with the stewardship of public resources.

• Members fulfill commitments to Quality Service by treating customers and

each other fairly.

• Members tell the truth.

COMMITMENT:

Commitment is the necessary mechanism enabling members to

focus our behavior on attaining organizational goals.

• Members have the opportunity to convert jobs from ordinary assign-

ments to extraordinary experiences.

• Members participate in decision-making and accept responsibility for

outcomes.

• Public service professionalism is demonstrated by each member’s

performance, accountability, and work ethic.

INCLUSION AND DIVERSITY:

Members value and respect our similarities and differences

to encourage and fully utilize our human potential, and to

foster a culture of openness, engagement and respect for

all.

• Member diversity helps ensure quality service delivery.

• An inclusive environment allows all members to contribute to

the success of our organization and to express ourselves openly

and with respect.

• Members understand and appreciate varying perspectives, experiences and

cultures.

• Members listen to understand each other.

• Member feedback is sought and valued.

Ten All –Volunteer Rescue Squads Provide

Emergency medical Services Free of Charge

Ocean Park Volunteer Fire and Rescue Unit, Inc.

Rescue 1

Davis Corner Volunteer Fire Department and

Rescue Squad, Inc.

Rescue 2

Chesapeake Beach Volunteer Fire Department

and Rescue Department, Inc.

Rescue 4

Princess Anne Courthouse Volunteer Fire

Department and Rescue Squad, Inc.

Rescue 5

Creeds Volunteer Fire Department and Rescue

Squad, Inc.

Rescue 6

Kempsville Volunteer Rescue Squad, Inc.

Rescue 9

Blackwater Volunteer Rescue Squad, Inc.

Rescue 13

Virginia Beach Volunteer Rescue Squad, Inc.

Rescue 14

Plaza Volunteer Fire Company and Rescue

Squad, Inc.

Rescue 16

Sandbridge Rescue and Fire, Inc.

Rescue 17

Since the mid-1940s, Virginia Beach has been receiving pre-hospital emergency patient care

services (EMS) from independently operated volunteer fire departments and rescue squads.

Princess Anne County saw the arrival of its first ambulance in

1947 and it was primarily utilized for providing emergency care

at the scene of fires. However, its role quickly expanded as the

local citizens began requesting the services of the ambulance

to transport them to area hospitals. On February 12, 1952,

Virginia Beach was designated as a city of the second class

with a population of 42,277 and the first incorporated volunteer

rescue squad was formed. This was the beginning of what is

now the largest volunteer based EMS rescue system among

this nation’s 200 most populous cities.

Beginning in the 1960s, local physicians became aware of the importance of the services provid-

ed by these volunteer rescue squads and interested doctors began volunteering their time to ad-

vise the rescue squads in medical techniques and procedures. A centralized training program in

cardiopulmonary resuscitation (CPR) strengthened the association between the physicians and

the rescue squads.

This advancement trend continued and, in 1972, culminated with the formation of the nation’s

first all-volunteer advanced life support (ALS) program. The Emergency Coronary Care Program

not only enhanced the provision of patient care but also served as the catalyst that catapulted

the rescue squads from an era of simple first aid provision to that of providing sophisticated med-

ical procedures as an EMS system. Medical techniques previously performed only by physicians

and few allied health professionals were successfully performed by specially trained volunteer

rescue squad members known as cardiac technicians. Basic care providers were also enhanced

as emergency medical technician (EMT) training courses were offered in support of these cardi-

ac technicians. The rescue squads began to “practice medicine” within an EMS system closely

associated with physicians, nurses and other health care providers.

History of the Virginia Beach Department of

Emergency Medical Services

During this developmental period, the administrative mechanism that evolved was a central coor-

dinating and training office. To maintain close relationships with the volunteer rescue squads,

the physicians encouraged the formation of a Rescue Squad Captain Advisory Board in

1972. This organization continued to expand and, in 1974, began to receive its direction from

the formally established Rescue Council, an outgrowth of the

original Rescue Squad Captain Advisory Board. In 1975, sup-

port was gained from City government to perpetuate the es-

tablished central administrative and coordinating office.

An ordinance was passed by City Council on April 13, 1981 to protect the interest of the medical

directors and, at the same time, ensure the continuance of the all-volunteer rescue concept

that the City had supported over the years as a cost effective service. Three years later the staff,

medical directors and Rescue Council recommended to the City Manager the establishment of a

revised ordinance that would centralize management of rescue services under a unified organi-

zation. Hence, in 1984, an independent Division of Emergency Medical Services was created.

This Division combined a single medical director and all the volunteer rescue squad members

within one EMS organization headed by a director.

By 1990, the Division had grown in numbers, equipment and

visibility, so, in July of that year, the Division was elevated to the

status of Department by the City Council and specialty rescue

teams were created (Search and Rescue, Bike and others) and the

responsibility of the lifeguard services contract oversight was

assumed.

In early 2000, in partnership with the Fire Department, the Emergency Response System (ERS)

was formed. This initiative was aimed at fully utilizing all of the combined resources of advanced

life support providers in both Departments to provide increased services. In 2004, to further

strengthen response capabilities in the face of the steady rise in the demand for services, 24 ca-

reer paramedics and four brigade chiefs were added to augment the volunteer rescue squads’

efforts. Under the oversight of EMS, over 125 AEDs were deployed on police cars across the

City. Meanwhile, significant investments were made in ongoing volunteer member recruitment

and retention programs.



The ERS enhancements continued in 2005 with the addition of eight more career paramedics. A

Monday-Friday daytime power shift schedule was implemented to place additional personnel on

duty during the busiest times of the week. This was accomplished while absorbing a 6.8% in-

crease in call demand. The EMS system, composed of the volunteer rescue squads, remained

strong with nearly 90% of all ambulance crews being comprised of volunteers.

In 2006 EMS witnessed the completion of the strategic planning

process. In addition, a major leap in recruitment occurred when

the Department partnered with the Virginia Beach Rescue

Squad Foundation on a massive campaign to secure new

volunteer members for the entire service. That year also

launched advancement in coronary care: infarction (STEMI)

ECG’s. The Sentara Princess Anne (SPA) free standing

emergency department opened on the grounds of the future

SPA Hospital in the PA Commons section of the City.

The Partnership with the VBRS Foundation continued into 2007 and the addition of the Rescue

Council Recruitment Trailer complemented these efforts. The first Career EMS Captains were

appointed and the First Landing Fire/EMS Station opened on shore Drive at Great Neck Road. In

2008, EMS Explorer Post #800 was formed through the sup-

port and guidance of Rescue Council. This was the first time

in over (30) years that a junior group affiliated with the EMS

system existed to assist these young members to learn more

community service and lifesaving skills. It also presents the

opportunity to them to join the seniors when they reach age

18. The new Station 8 opened on Bayne Drive and EMS

Headquarters moved from Artic Avenue where it had been for

25 years, to a more central location in the Pinehurst Centre

off Lynnhaven Parkway.

2009 witnessed 32 cardiac arrest survivors, a system record and the results of years of ERS

coordination, protocol upgrades, modality improvements and strong leadership. To continue with

these enhancements and to set new elevated medical standards the Police/EMS Medvac

Helicopter project was launched and transported its first patients and the foundation for the new

hypothermic cooling protocol, the acquisition of replacement and upgraded defibrillators/monitors



And development of the new Electronic Medical Reporting

System were all laid for a 2010 implementation. All of these

projects launched successfully in 2010. The arrival of the

Electronic Medical Reporting (EMR) System in 2010 allowed

EMS providers to enter and transmit information digitally to

hospitals prior to arrival, including patient vitals and cardiac

monitor reports. The successful implementation of this

electronic mobile data technology along with transition to a

wireless IP system for dispatching and mapping, placed The

Department of EMS at the cutting edge of patient care

reporting and provided valuable savings and quality controls to

the City.

Another historic development in 2010 was the City’s direct provision of lifeguard services for the

Sandbridge beaches. Maintaining rigorous USLA standards, the Department hired 41 guards

and eight supervisors for the 2010 summer season and did not have a drowning or receive any

complaints as to their service, increasing service levels and saving taxpayer dollars.

In 2011, the Virginia Beach EMS Marine Rescue Team was awarded the

national Aquatic Rescue Response Team Certification from the United

States Lifesaving Association (USLA). Virginia Beach EMS Marine Rescue

Team/Lifeguard Services was just the second agency to pass the rigorous

process and meet the USLA standards.

Also, in 2011 EMS embarked in a new area, Medically Friendly Shelter

(MFS). The MFS was created to accommodate persons with special needs

during a Category 2 hurricane. Planning, development of the program and

a citywide exercise took place in June. In anticipation of Hurricane Irene the

Medically Friendly Shelter was activated at Salem High School. The activa-

tion was truly a team effort with collaboration of the Health Department, Police Department,

Sherriff's Office, Fire Department, Parks & Recreation, City Manager’s Office and private agen-

cies. The shelter was operational for about 42 hours and accommodated over 120 people.

Year 2013 saw the introduction of the new life saving technology known as the “Lucas” automat-

ed CPR device. This device allows manpower to be used more efficiently and provides proper

chest compression during cardiac arrest cases much more proficiently than provider CPR.



The Lucas™ Chest Compression System is a tool that stand-

ardizes chest compressions in accordance with the latest sci-

entific guidelines. It provides the same quality for all patients

and over time, independent of transport conditions, rescuer fa-

tigue, or variability in the experience level of the caregiver. By

doing this, it frees up rescuers to focus on other life-saving

tasks and creates new rescue opportunities.

2013 also saw the implementation of an extensive training and devel-

opment program developed by VBEMS to train new and existing

members to better leverage new technologies and medical research

to enhance emergency medical services delivery. VBEMS provided

numerous “March Madness” EMS training classes during the month

of March which covered not only protocol updates and changes, but

also covered some needed enhancements and improvements to our

12-lead EKG program and cardiac arrest resuscitation program. This

program was/is meant to improve the overall care that we deliver to

the public that we serve.

Year 2014 kept with The Department of EMS’s continuation to facilitate the implementation of

new technologies and clinical care procedures to improve patient

care; In partnership with the Virginia Beach Fire Department the

Department of Emergency Medical Services (EMS) implemented

a hydrogen cyanide poisoning antidote program for victims of

smoke inhalation; the Department of Emergency Medical Ser-

vices (EMS) purchased twenty (20) automated external defibrilla-

tors (AEDs) for allocation to the Police Department and the Vir-

ginia Department of Health awarded FULL ACCREDITATION to

the City of Virginia Beach Emergency Medical Services (EMS

Training Center through Year 2018.



Ebola Preparedness

The Department of Emergency Medical Services (EMS) in partnership with the Department of

Public Health instituted 911-caller screening and EMS screening for Ebola Virus disease risk fac-

tors. In addition, comprehensive response guidelines and patient protocols were implemented

and staff facilitated a City-wide health and medical preparedness discussion and represented the

City at various local, regional and state meetings.

Swift and Organized Response to Tornado Emergency

The Department of Emergency Medical Services (EMS) responded to an EF-0 tornado at the

Oceanfront July 10th. The storm left behind significant structural damage to homes and com-

mercial buildings and resulted in several people being injured. Within a matter of minutes the

Department of EMS established an Area Command post for medical operations at the Virginia

Beach Volunteer Rescue Squad, set-up a casualty collection point and staffed an additional 10

ambulances.

In addition, the Department of EMS answered a call for mutual aid assistance for reports of sig-

nificant damage and multiple injuries due to a Tornado on the Eastern Shore. The Department

sent six ambulances (staffed with volunteers), a zone car, two mass casualty response trucks

and an EMS supervisor to assist however needed, which included assisting with patient triage

and providing advanced life support level care to the critically injured.

Lifepak 15 Upgrades

Through a 50% reimbursement grant award from the Virginia Office

of EMS the Department of Emergency Medical Services was able

to upgrade 19 cardiac monitors with full 12-lead EKG capabilities.

Over $75,000 of grant funds were applied for and received by the

department in order to offset the costs; these upgrades ensure the

Department’s ability to deliver the highest level of pre-hospital

service in order to ensure a safe community.

March Madness Training Program

In March of 2014 the Department of Emergency Medical Services (EMS) held a system-wide

training event which provided related updates and new information to over 1,000 prehospital pro-

viders. Personnel were instructed on new protocols, reviewed high-performance CPR infor-

mation, trained with the new Cyanokits and reviewed documentation via the electronic medical

records system.

Accomplishments

AEDs Procured for the Virginia Beach Police Department

The Department of Emergency Medical Services (EMS) purchased twenty (20) automated exter-

nal defibrillators (AEDs) for allocation to the Police Department. Funding to purchase these

AEDs was made possible through a Rescue Squad Assistance Fund grant award of $74,000 that

the Department of EMS successfully applied to the Virginia Office of EMS. Police Officers

providing early CPR and defibrillation contribute to the sudden cardiac arrest survival rate in the

City of Virginia Beach, which exceeds the national average.

Cyanokit “Smoke Inhalation” Program Implemented

In partnership with the Virginia Beach Fire Department the Department of Emergency Medical

Services (EMS) implemented a hydrogen cyanide poisoning antidote program for victims of

smoke inhalation. Often times what severely harms and/or kills victims of smoke inhalation is the

hydrogen cyanide that binds to the hemoglobin. The Cyanokit program includes a medicine that

can be administered to these patients in order to inactivate the hydrogen cyanide and facilitate

removal from the body. This program received recognition from the smoke coalition and resulted

in several staff members receiving certificates of appreciation from the Fire Department.

VPHIB Computer Grant

Through the submittal of a successful application, the Department of EMS was able to secure

$57,000 in grant funding from the Virginia Office of EMS in order to replace electronic medical

record hardware. The electronic medical record program utilized by the Department of EMS is

seen as a “model” not only across the Commonwealth but across the United States as

well. Representatives from a myriad of agencies often contact the Department of EMS (and/or

visit) to learn about our electronic medical records program.

Virginia Department of Health Fully Accredits Basic Life Support Training Institute

The Virginia Department of Health awarded FULL ACCREDITATION to the City of Virginia

Beach Emergency Medical Services (EMS) Training Center through Year 2018. The accredita-

tion decision was based upon an extensive review of the self-study document, the visiting team’s

report, and the institution’s responses. This culminated in a significant undertaking that required

a comprehensive review of the Emergency Medical Technician (EMT) program and included the

volunteer rescue squads, volunteer students, staff and faculty. Virginia Beach EMS is the first

and only local government based Basic Life Support (BLS) training program that has achieved

this FULL ACCREDITATION.

Accomplishments

Our Dedicated Volunteer Members

Mr. Charles L. Gurley has been a member with the Department of Emergency

Medical Services in Virginia Beach, VA since November 1, 1979. Mr. Gurley

continues to give 24 hours a month of his time to the EMS Volunteer

Program. In 2010 Mr. Gurley received his 30 years of service pin with the

Department of Emergency Medical Services.

Patricia “Patsy” Rowland has been a member of Plaza Volunteer Rescue

Squad since July 21, 1997 as an Administrative Member. As an Admin

Member she has served in an elected position as Board of Directors

Member-at-Large and Administration Lieutenant. She also served as Vice

Chairperson on the Board of Directors in 2010. In 2011 Patsy received the

honorary award of Hometown Hero during the Neptune Festival.

Act of Service

This individual should have performed and/or conducted “special” event(s) or program(s), which

promoted a positive image of the volunteer rescue system and the Department of Emergency

Medical Services .

Benjamin Dobrin

Tracey Rene McElhenie

Patient Care Provider

Awarded for outstanding dedication and service to the community in providing exceptionally

skilled patient care and exemplifying professionalism as a Department of EMS emergency

healthcare provider as viewed by patients and other service providers .

Nickolas Askew

Outstanding “Specialist/Support” Member of the Year

Any member serving in the capacity of operational or administrative positions that exemplify out-

standing support of the rescue squads through special team services, training, leadership, or ad-

ministrative functions.

Fred Greene

Commending Our Members Honors and Awards

Each year, the Department of Emergency medical Services honors individuals who exemplify the

best in all the various aspects of service. Because our mission is to provide a continuum of care

that starts at the moment an individual calls 911 and ends at the hospital, this year the department

chose to honor the best of those who support our mission, from start to finish.

30 Years of Service

David Baust

Jeffrey Brennaman

William Coulling

Norman Sterling

Commending Our Members Volunteer Years of Service

35 Years of Service

Charles Gurley

John Irish

40 Years of Service

Doris Foster

James Kellam

38 Virginia Beach EMS cardiac arrest patients were discharged from the hospital and reunited with their families in 2014 which resulted in over 500 Life Saver Awards

“CPR Saves Lives. Learn CPR – It Makes A Difference”

38 Cardiac

Arrest Survivors

Commending Our Members Volunteer Years of Service

5 Years of Service

Amber Achesinski

Matthew Armey

Eric Bonney

Sharon Brown

Brian Burke

Teryl Chauncey

John Doub

Katie Dunne

Cheryl Feick

Christopher Florio

Pamela Good

Jason Grimes

Kyle Hanrahan

Daniel Haug

Jonathan Jarbo

Stephen Snell

Rebecca Soules

Brian Stocks

Keith Stolte

Kristen Sundberg

Paula Swartz

Becky Teal

David Jimerson

Michael Leary

Cecil Londeree

Amir Louka

Amy Lutz-Sexton

Dwayne Morris

Melody Osborne

Richard Peters

Sharon Pinto

Dennis Popiela

Crystal Price

Gandolfo Prisinzano

Jacqueline Reith

Alexander Rodriguez

Travis Smith

Erin Thalman

Joseph Tidwell

Thomas Trumbauer

Winifred Tunstall

Justin Urquhart

Lynn Van Auken

Gary Wilks

Mosheh Yishrael

25 Years of

Service

20 Years of

Service

15 Years of

Service

10 Years of

Service

Edward Brazle

Gary Jani

Barbara Moore

Normalee Barclift

Kathleen Budy

Randy Dozier

Denise Henson

Jan James

Trevor Kirk

James Leach

Brian Ledwell

Jennifer Moore

Tiffany Robbins

Donald Washburn

Margaret Zontini

Diana Ball

Erin Britt

James Cromwell

Richard Davis

Fred Greene

Serenity Latham

Douglas

Lighthart

James Moore

Deborah Volzke

Kenneth

Amerman

Nickolas Askew

Ronald Bauman

William Cole

Rita Cwynar

Christopher Daly

Raymond Ford

Jason Frye

Brenda George

Mary Haynes

Tracy Hegglund

Linda Hoffman

Stephanie Louka

David Luca

Amber Mitchell

Susan Palmer

Pamela Pietrzak

Teri Reeder

Patricia Single-

ton

Erik Svejda

Ira Swartz

Daniel Walker

Lawrence Wines

“Your dedication, compassion, and selflessness are greatly admired and appreciated”

Organizational Chart

Department Budget

Department Budget

Volunteer Rescue Squad Contribution

The Department of Emergency Medical Services is structured in four divisions. The Administra-

tive Division provides leadership, direction and support through the provision of manpower; the

promulgation of policies; the management of financial affairs; the performance of liaison activities

with related agencies; the processing of public inquiries and increasing awareness; the provision

of logistics support, the gathering and analysis of data; the performing of research; and the de-

velopment of programs.

Administrative Division Major Functions:

Administration Division

Planning and Development

General Management

Facilities Management

Recruitment

Retention

Human Resource Management

STET

Emergency and Disaster

Risk Management

Public Awareness

Legislative and Political Liaison

Administrative Support Services

Media Relations

Professional Development

Awards and Recognition

Partnerships:

Programs:

Administration Division

Planning and

Development

General Management

Facilities Management

Recruitment

Retention

Human Resource

Management

STET

Emergency and Disaster

Planning

Risk Management

Public Awareness

Legislative and Political

Liaison

Administrative Support

Services

Media Relations

Professional Development

Awards and Recognition

Tidewater Community

College BLS and ALS

Recruitment

Every 15 Minutes Program

with High Schools

Family Night at the

Aquarium

Lifesaver Awards

Annual Awards and

Recognition

Duty Crew Member

Support

Promotion and Graduation

Ceremonies

Santa on the Air

Class Act Awards

TEMS Annual Awards and

Family Picnic

Keeping the Best

Recruitment and Retention

Stork Awards

Minority Expos and Career

Opportunities

Civic League

Communications

File of Life

Member Communications

Volunteer Hampton

Roads.com and Volunteer

Match.com

Social Networking

Best Practices

Medical friendly Shelter

Capital Improvement Plan

Prospective Volunteer Orientation Data: Year

775

893 921

750714

0

100

200

300

400

500

600

700

800

900

1000

2010 2011 2012 2013 2014

# o

f in

div

idu

als

# Prospective Volunteer Orientation Attendance: Year

# Individuals that attended orientation

47%

15%

3%

-19%

-5%

-60%

-40%

-20%

0%

20%

40%

60%

0

100

200

300

400

500

600

700

800

900

1000

2010 2011 2012 2013 2014

% C

han

ge

# in

div

idu

als

% Change Prospective Volunteer Orientation Attendance: Year

Yellow Bar= % Increase Black Bar=% Decrease

The Department of EMS has seen a continual drop in the number of prospective volunteers in

the past two years of annual observations. . Prospective volunteers may simply be returning to

normalized levels as observed in years prior to the “Great Recession”.

Prospective Volunteer Orientation Data: Quarter

The Department of EMS had a drop in the number of prospective volunteers in the first two

quarters of the year, but then saw increases in the last two quarters of the year. These

increases did not offset the decreases that occurred however.

0

50

100

150

200

250

300

1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

# o

f in

div

idu

als

# Prospective Volunteer Orientation Attendance: Quarter

# Individuals that attended orientation

2010 2011 2012 2013 2014

-14% -14%

4%

14%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

0

50

100

150

200

250


% C

han

ge

# o

f in

div

idu

als

% Change Prospective Volunteer Orientation Attendance: Quarter (2013-2014)

Yellow Bar= % Increase Black Bar=% Decrease

2013 2014 % Change 2013-2014

Prospective Volunteer Orientation Data: Month

The number of prospective volunteer orientation attendance illustrates a degree of seasonality;

there are seasonal fluctuations in the data during the year. Overall, attendance was down but

some months did exhibit relative increases in attendance.

0

20

40

60

80

100

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

# In

div

idu

als

# Prospective VolunteerOrientation Attendance: Month

2013 2014

-25% -24%

22%

-25%

2%

-15%

6%15%

-6%

17%

-4%

65%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

0

20

40

60

80

100


% C

han

ge

# In

div

idu

als

% Change Prospective VolunteerOrientation Attendance: Month

Yellow Bar= % Increase Black Bar= % Decrease

% Change 2013-2014 2013 2014

Approved Volunteer Applicants Data: Year

The number of approved volunteer applications illustrates a degree of a negative downward

linear trend. Approved volunteer applications have experienced two consecutive annual years of

decline.

332 336362

308

259

0

50

100

150

200

250

300

350

400

2010 2011 2012 2013 2014

# A

pp

rove

d A

pp

licat

ion

s

# Approved ApplicationsYear Total: 2007-2014

Year Total Linear (Year Total)

36%

1%

8%

-15% -16%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

0

50

100

150

200

250

300

350

400

2010 2011 2012 2013 2014

% C

han

ge

# A

pp

rove

d A

pp

licat

ion

s

% Change Approved ApplicationsYear Total: 2010-2014

Yellow Bar=% Increase Black Bar=% Decrease

Approved Volunteer Applicants Data: Quarter

The number of approved volunteer applications experienced a decline each observed quarter in

comparison to the previous year.

-9%-13%

-29%

-9%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

0

20

40

60

80

100


% C

han

ge

# A

pp

rove

d A

pp

licat

ion

s

% Change Approved ApplicationsPer Quarter: 2013-2014


2013 2014

0

20

40

60

80

100

120


# A

pp

rove

d A

pp

licat

ion

s

# Approved ApplicationsPer Quarter: 2010-2014

2010 2011 2012 2013 2014

Approved Volunteer Applicants Data: Month

The number of approved volunteer applications data illustrates a degree of seasonality; the

overall trend for the year was a decline in the number of approved applications, though some

months did report increases over the prior year.

0

10

20

30

40

50

# A

pp

rove

d A

pp

licat

ion

s

# Approved ApplicationsPer Month: 2013-2014

2013 2014

-61%

38%

19%

-5%

-38%

17%

-8%

-40%

-28%

13%

-9%

-21%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

0

10

20

30

40

50

% C

han

ge

# A

pp

rove

d A

pp

licat

ions

% Change Approved ApplicationsPer Month: 2013-2014


# Approved Applications 2013 # Approved Applications 2014

New Attendant In Charge (AIC) Data: Year

AIC stands for Attendant In Charge; this is an individual that is ambulance certified EMT-B and

higher and has passed State approved certification, training requisites and has been approved

to provide emergency care services. The overall trend is flat, with the prior two years reporting

declines in the number of new AICs released.

131

169

190

149139

0

50

100

150

200

2010 2011 2012 2013 2014

# A

IC

# New AIC ReleaseYear Totals Linear (Year Totals)

46%

29%

12%

-22%

-7%

-50%

-40%

-30%

-20%

-10%

0%

10%

20%

30%

40%

50%

0

20

40

60

80

100

120

140

160

180

200

2010 2011 2012 2013 2014

% C

han

ge

# A

IC

% Change New AIC ReleaseYear Total: 2010-2014


New Attendant In Charge (AIC) Data: Quarter

The number of new released AICs experienced an overall rate of decline, but did show an

increase in the 1st quarter of the year.

0

10

20

30

40

50

60

70


# A

IC

# New AIC Release Per Quarter: 2007-20142010 2011 2012 2013 2014

72%

-18%

-35%

-4%

-80%

-60%

-40%

-20%

0%

20%

40%

60%

80%

0

10

20

30

40

50

60


% C

han

ge

# A

IC

% Change New AIC Release Per Quarter: 2013-2014

Yellow Bar=% Increase Black Bar=% Decrease2013 2014

New Attendant In Charge (AIC) Data: Month

The number of new released AICs experienced an overall rate of decline, but did experience a

few months with increases over the prior year. *Please note the large % increases are a result

of the relatively small figures in the data. Example: February shows 160% increase which

equals 8 new AICs over the previous year.

15

5 5

19

15

6

16

2021

12

78

21

13

910

9

14 14 14

9 97

10

0

5

10

15

20

25


# A

IC

# New AIC Release Per Month: 2013-20142013 2014

40%

160%

80%

-47% -40%

133%

-13%-30%

-57%-25%

0%25%

-200%

-150%

-100%

-50%

0%

50%

100%

150%

200%

0

5

10

15

20

25


% C

han

ge

# A

IC

% Change New AIC Release Per Month: 2013-2014


2013 2014

Active Qualified *Volunteers Data: Year

The number of qualified members is the total number of volunteers that are ambulance

certified; they are released, State certified and able to perform emergency medical services.

The overall trend is positive, though there was a light decrease in the prior year and flat in year

2013.

449 452

548 550 542

0

100

200

300

400

500

600

2010 2011 2012 2013 2014

# M

em

be

rs

# Average Total Qualified MembersYear: 2010-2014

Average Linear (Average)

13%

1%

21%

0%

-2%

-25%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

25%

0

100

200

300

400

500

600

2010 2011 2012 2013 2014

% C

han

ge

# M

em

be

rs

% Change Average Total Qualified MembersYear: 2010-2014

Yellow Bar= %Increase Black Bar= %Decrease

*Volunteers are referred to as Members by VBEMS; volunteers are members to individual Rescue Squads .

Active Qualified *Volunteers Data: Month

The number of qualified members saw some minor rates of decline over the months of

observation in comparison to the prior year, there were three months in which increases were

reported. However, there was a decline overall.

*Volunteers are referred to as Members by VBEMS; volunteers are members to individual Rescue Squads .

0

100

200

300

400

500

600


# M

em

be

rs

# Average Total Qualified Members Per Month: 2013-2014

2013 2014

9%

-1% -2%-1%

3%

-3%

1%

-1%

-4%

-6% -6% -6%

-10%

-5%

0%

5%

10%

0

100

200

300

400

500

600


% C

han

ge

# M

em

be

rs

% Change Average Total Qualified Members Per Month: 2013-2014


2013 2014

Volunteers Research: Volunteer Survey

Survey enabled VBEMS to gain insight

and valuable feedback from our

volunteer members to provide

leadership personnel with information

to help identify how to make

improvements to the volunteer EMS

system, enhance volunteer satisfaction,

increase recruitment, grow retention

and find new ways to improve overall

service delivery to the residents and

visitors of the City of Virginia Beach.

Future surveys are in development to

further examine and evaluate.

Volunteers dedicate a minimum of 48 hours (four 12 hours shifts) per individual month. When

that time is worked is variable and can change. As such, the majority share of VBEMS’s ambu-

lance certified personnel would be classified as part time personnel by human resources calcula-

tions. This is a caveat to keep in consideration when examining VBEMS resources pertaining to

ambulance certified personnel.

There was a spike in the number of ambulance certified individuals following the recession of

2008. Following 2007 up till 2010 there was an increase in the number of individuals that provid-

ed their time as a volunteer for EMS service. Four years following the onset of the recession, the

number of ambulance volunteer personnel seems to be returning to the previous levels observed

during pre-recession years. The “Great Recession” began in December of 2007 and was

declared over in the Summer of 2009.

Volunteers Research: Are they declining?

3.2%4.2%

7.1% 7.5% 7.1%6.5%

6.0%5.0%

0%

2%

4%

6%

8%

10%

2007 2008 2009 2010 2011 2012 2013 2014

% U

nem

ploy

me

nt

Annual Unemployment RateCity of Virginia Beach

Virginia Beac-Norfolk-Newport News, VA-NC Metropolitan Statistical Area

Recession Unemployment rate

481 471 528

775893 921

750 7143.2%

4.2%

7.1% 7.5% 7.1%6.5%

6.0%5.0%

0

200

400

600

800

1000

0%

2%

4%

6%

8%

10%

2007 2008 2009 2010 2011 2012 2013 2014

# P

rosp

ect

ive

Vo

lun

tee

rs

% U

nem

ploy

me

nt

Annual Unemployment Rate &Prospective Volunteers

Virginia Beac-Norfolk-Newport News, VA-NC Metropolitan Statistical Area

Prospective Volunteers Unemployment rate

Statistical test indicates that 41% of the change in the number of volunteers may probabilistic be

explained by the unemployment rate; in other words, as the unemployment rate increased it may

have accounted for 41% of the change seen in the number of prospective volunteers (vice versa

for unemployment rate decreases). As the unemployment rate improves (declines) there is a

probabilistic rate of occurrence that the number of prospective volunteers may decline; just as

the unemployment rate increases the number of prospective volunteers may increase as the

data observations illustrate in prior years.

National and International news along with validated existing research identified that the impacts

of the great recession hindered monetary contributions to non-profit and volunteer organizations,

but inverse of that decline, the number of individuals and the amount of time people gave to

volunteer exponentially increased between years 2009-2010. According to a report put out by the

National Park Service, the number of laid off or furloughed individuals reduced monetary giving

capacity to volunteer organizations but did create an increase in “donated time” to organizations.

They may be cash-poor, but are now time-rich. Also, some underemployed want to be able to

show productive volunteer work experience on their resumes and job applications to be more

competitive in applying for jobs. The Corporation for National and Community Service conducted

a study and found empirical evidence that volunteering experience can increase employment.

As the unemployment rate begins to decrease along with positive economic indicators identifying

the U.S. economy is improving, this in turn decreases the level of unemployed individuals and

the number of hours individuals have available to dedicate to volunteer based activities.


0

200

400

600

800

1000

0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%

# o

f P

rosp

ect

ive

Vo

lun

tee

rs

Unemployment Rate

Regression Statistical Test:Unemployment Rate and Prospective Volunteers

Regression Statistics

R Square=0.41Signifigance F=0.08

41% of the change in number of prospective volunteers may probabalistic be explained by the unemployment rate

8% chance results occured as a

result of random chance

Of the reasons given by volunteers that leave EMS, the reasons which comprise ≥10% of drops

are in relation to reduce availability to donate their time to service. Moving, comprises the largest

% share of drop reasons followed by indication of job commitments to their employer.


0% 1% 1% 2%4% 4%

8%10% 11% 12%

14%16% 17%

0%2%4%6%8%

10%12%14%16%18%20%

Reason Volunteers Leaving EMS % of Total Drops

2010-2013 (Average)*Red Bar= ≥10%

While demand for EMS services continues to increase, volunteer ambulance personnel is

retreating inversely of demand increases; in other words, demand is going up as personnel to

meet demand is decreasing.

Though prospective EMS volunteers are decreasing, the number of retained qualified ambulance

volunteers has remained relatively strong comparatively; however, as demand increases and

volunteer rates remain flat, this will further exacerbate strain on current volunteers as they will be

expected to provide more to meet increasing call demand for EMS services.


35,607 36,239 37,028 37,718 36,291 39,130 38,980 40,937

481 471528

775

893 921

750 714

0

100

200

300

400

500

600

700

800

900

1,000

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

2007 2008 2009 2010 2011 2012 2013 2014

# P

rosp

ect

ive

Vo

lun

tee

rs

# EM

S D

em

and

EMS Demand and EMS Prospective Volunteers

EMS Demand Prospective Volunteers

35,607 36,239 37,028 37,718 36,291 39,130 38,980 40,937

330 347396

449 452

548 550 542

0

100

200

300

400

500

600

-

10,000

20,000

30,000

40,000

50,000

2007 2008 2009 2010 2011 2012 2013 2014

# A

mbu

lanc

e V

olun

teer

s

EMS

De

man

d

EMS Demand and EMS Ambulance Volunteers

EMS Demand Qualified Members (Ambulance Certified)

The Operations Division contains the major components of the department which include the Vol-

unteer rescue Squads, Special Operations and supplemental first responder services provided by

the Fire and Police Departments.

Emergency Medical Response: To provide for the rapid response to an proper provision of basic

and advanced patient care services to the general public to reduce patient morbidity and mortality.

Basic Life Support Program

Advanced Life Support Program

Supplemental Response Program

Special Rescue response: To provide for the rapid response to and proper provision of

specialized rescue services to supplement basic and advanced services in the delivery of

emergency medical care and rescue to the general public to reduce patient suffering, morbidity and

mortality.

Squad Truck team

Volunteer Duty Field Supervisor Team

Marine Rescue Team

Search and Rescue Team

Bike Medic Team

SWAT Tactical Medical and Rescue Response

Anti-Terrorism and Disaster Preparedness: To provide for a special response in extra ordinary

emergency medical and rescue situations in which greater coordination and resources are needed

to assist basic and advanced providers in the delivery of emergency medical and rescue services.

Mass Casualty Operations

Disaster Operations

Anti-Terrorist Incident Response

Operations Division

The Lifeguard services Division is organized to provide a safe environment for thousands of peo-

ple who utilize all Virginia Beach area resort beaches utilizing contractual and career Department

of EMS Lifeguards; the Lifeguard Services Division supervises the provision of all lifeguard ser-

vices for the entire Resort and Sandbridge Resort Beaches.

As an United States Lifeguard Association Certified Open water Rescue Agency, the Virginia

Beach EMS Lifeguard Services Division performs the functions of beach safety, through compre-

hensive training and coordinated rescue operations by providing lifeguard services for such are-

as as Sandbridge beach Little Island Park beaches, and other areas of the city.

Our mission is accomplished by maintaining a staff of

highly trained seasonal professional lifeguards who are in

top physical condition and possess great skill in medical

lifesaving techniques and equipment. Such equipment

includes our departments Marine Rescue Team, with all-

terrain vehicles, 4-wheel drive vehicles, Personal Water-

crafts with rescue sleds, rapid response boats, Advanced

Life-Support units staffed by medic/lifeguard teams,

AirMed (EMS Medavac helicopter), and a variety of spe-

cialized ocean rescue equipment. This equipment and

training keeps us on the cutting edge of professionalism.

(Note: A private contractor provides such services to the

resort beach area.)

The Lifeguard services Division also hosts and participates in

special events and competitions throughout the year. Virginia

Beach EMS is recognized as a leader in lifesaving throughout

the country with our continued commitment to excel in our pro-

fession and provide excellent service for all individuals who

recreate along our beaches. In addition, the division will em-

phasize teaching the public about the ocean environment

through public education, lifesaving seminars and the Kid Safe

Program.

Lifeguard Division

Response Times 90th Percentile

The Department of EMS measures response times as the time which elapses from when a EMS

unit is notified, to when that EMS unit arrives onscene. 90th Percentile measures the amount of

time which occurs 90% of the time and is considered a more statistically accurate measure of

response time.

Operations Data: Response Times

4%

-6%-5%

-2%

1%

0:15:23 0:16:040:15:07 0:14:26 0:14:07 0:14:13

-10%

-5%

0%

5%

10%

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

0:20:10

2009 2010 2011 2012 2013 2014

% C

hang

e

90th

Res

pons

e Ti

me

EMS Ambulance Units 90th Percentile Response TimeUnit Dispatch to Onscene

*Bars= % Change; Yellow Bar=%Increase Black Bar=%Decrease

6%

-3%

-6%

-1%

1%

0:13:560:14:45 0:14:19

0:13:31 0:13:19 0:13:29

-10%

-5%

0%

5%

10%

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

0:17:17

0:20:10

2009 2010 2011 2012 2013 2014

% C

ha

ng

e

90

th R

esp

on

se T

ime

EMS Zone Car Units 90th Percentile Response TimeUnit Disptach to Unit Onscene

*Bars=%Change; Yellow Bar=%Increase Black Bar=%Decrease

The Department of EMS has been able to continually increase the average daily staffed number

of staffed ambulance units; this is in large part thanks to the Departments Volunteer members.

Operations Data: Staffed Ambulances

10.7

11.912.6 12.6 12.7

0

2

4

6

8

10

12

14

2010 2011 2012 2013 2014

# A

mbu

lanc

es S

taff

ed

Average # Staffed AmbulancesYear 2010-2014

Average # Staffed Ambulances Linear (Average # Staffed Ambulances)

0%

20%

40%

60%

80%

100%

2010 2011 2012 2013 2014

90% 93% 96% 96% 95%

10% 8% 4% 4% 5%

% A

mb

ula

nce

s St

affe

d

% of Ambulances Staffed by VolunteersYear 2010-2014

% of Ambulances Staffed By Volunteers % of Ambulances Staffed By Career

Operations Data: EMS Call Demand

37,718 36,291 39,130 38,980 40,937

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2010 2011 2012 2013 2014

# o

f ca

lls f

or

serv

ice

Year

Call Demand for EMS Services: Year# of calls for service (Demand) Linear (# of calls for service (Demand))

2%

-4%

8%

0%

5%

-25%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

25%

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

2010 2011 2012 2013 2014

# Ca

lls fo

r se

rvic

e

% Change in EMS Call DemandYellow Bar= %Increase Black Bar= %Decrease

% Change # of calls for service (demand)

EMS call demand continues along a positive linear trend; the most recent year saw an overall

increase in call demand by 5% after the prior year (2013) saw 0% change in demand for EMS

services. This calculation takes into account only calls in which an ambulance or paramedic

zone car unit responds to an EMS call for service.


EMS call demand continues along a positive linear trend; every quarter observed in 2014 saw a

% increase in demand with the exception of 1st Quarter. This calculation takes into account

only calls in which an ambulance or paramedic zone car unit responds to an EMS call for

service.

9,4

96

9,8

06

10

,32

5

9,3

53

9,4

98

10

,52

6

10

,86

1

10

,05

2

-

2,000

4,000

6,000

8,000

10,000

12,000

Q1 (January-March) Q2 (April-June) Q3 (July-September) Q4 (October-December)

# of

Cal

ls

# of Calls for EMS Service Per QuarterYears 2011-2013

2013 2014

0%

7%

5%

7%

-10%

-5%

0%

5%

10%

-

2,000

4,000

6,000

8,000

10,000

12,000

Q1 (January-March) Q2 (April-June) Q3 (July-September) Q4 (October-December)

% c

han

ge

# of

cal

ls

# of Calls for EMS Service Per Quarter: % Change in DemandYears 2013-2014


2013 2014


EMS call demand continues along a positive linear trend; every month observed in 2014 saw a %

increase in demand with the exception of January. January of 2013 experienced an abnormal

spike, this may explain why demand for the month was comparatively down. This calculation takes

into account only calls in which an ambulance or paramedic zone car unit responds to an EMS call

for service.

-

1,000

2,000

3,000

4,000

5,000

3,312

2,851

3,335 3,339 3,547 3,640 3,776 3,638

3,447 3,421 3,156

3,475

# o

f C

alls

# of EMS Calls for Service Per MonthYear 2014

-4.4%

3.2%2.0%

4.0%

7.1%

10.9%

6.3%4.5% 4.7%

5.9%

1.9%

14.8%

-10%

-5%

0%

5%

10%

15%

20%

0

1000

2000

3000

4000

5000

% c

ha

ng

e

# o

f ca

lls

# of EMS Calls for Service Per Month: % Change in DemandYears 2013-2014


2013 2014


EMS call demand continues along a positive linear trend; every day of the week observed in 2014

saw a % increase in demand. This calculation takes into account only calls in which an ambulance

or paramedic zone car unit responds to an EMS call for service.

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

5,650 5,868 5,898 5,800 5,869 5,893 5,959

# of

Cal

ls

# of EMS Calls for Service By Day of WeekYear 2014

5%7%

3%7%

3%6% 6%

-25%

-15%

-5%

5%

15%

25%

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

% C

hang

e

# of

Cal

ls

# of EMS Calls for Service By Day of Week: % Change Year 2013-2014


2013 2014


EMS call demand continues along a positive linear trend; every hour of day observed in 2014 saw

a % increase in demand; with the exception of 3:00am, 4:00am (decreased) and 9:00pm

(remained unchanged). This calculation takes into account only calls in which an ambulance or

paramedic zone car unit responds to an EMS call for service.

-

500

1,000

1,500

2,000

2,500

3,000

3,500

0:0

0:0

0

1:0

0:0

0

2:0

0:0

0

3:0

0:0

0

4:0

0:0

0

5:0

0:0

0

6:0

0:0

0

7:0

0:0

0

8:0

0:0

0

9:0

0:0

0

10

:00

:00

11

:00

:00

12

:00

:00

13

:00

:00

14

:00

:00

15

:00

:00

16

:00

:00

17

:00

:00

18

:00

:00

19

:00

:00

20

:00

:00

21

:00

:00

22

:00

:00

23

:00

:00

1,2

55

1,1

61

1,0

78

85

6

78

8

80

7

1,0

38

1,3

34

1,7

24

2,1

28

2,2

41

2,4

07

2,3

97

2,2

71

2,2

45

2,0

87

2,2

84

2,2

46

2,1

15

1,9

53

1,9

05

1,7

11

1,5

52

1,3

54

# o

f C

all

s

# of EMS Calls for Service Per Hour of DayYear 2014

*00:00:00=12am & 23:00:00=11pm (24 Hour Period)

8%

3% 3%

-1%-1%

11%13%

6%3%

6%4%

7%9%

4%6%

1%

10%

3%

7%

1%4%

0%

7%

4%

-20%

-15%

-10%

-5%

0%

5%

10%

15%

20%

-

500

1,000

1,500

2,000

2,500

3,000

0:0

0:0

0

1:0

0:0

0

2:0

0:0

0

3:0

0:0

0

4:0

0:0

0

5:0

0:0

0

6:0

0:0

0

7:0

0:0

0

8:0

0:0

0

9:0

0:0

0

10

:00

:00

11

:00

:00

12

:00

:00

13

:00

:00

14

:00

:00

15

:00

:00

16

:00

:00

17

:00

:00

18

:00

:00

19

:00

:00

20

:00

:00

21

:00

:00

22

:00

:00

23

:00

:00

% c

han

ge

# o

f ca

lls

# of EMS Calls for Service Per Hour of Day% Change Year 2013-2014

*00:00:00=12am & 23:00:00=11pm (24 Hour Period)Yellow Bar= %Increase Black Bar= %Decrease

2013 2014

Operations Data: Demand and Population

EMS call demand continues along a positive linear trend along with population changes. EMS

demand has continued to increase at a rate greater than that of population. Population is based

on U.S. Census 1 Year Estimates.

437,994 441,246 447,489 449,628 451,672

37,718 36,291

39,130 38,980 40,937

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

2010 2011 2012 2013 2014

EM

S D

em

an

d

To

tal

Po

pu

lati

on

Demand for EMS Service and City of Virginia Beach Population

Population # of calls for service (demand)

-8%

-6%

-4%

-2%

0%

2%

4%

6%

8%

2010 2011 2012 2013 2014

0.2% 0.7% 1.4% 0.5% 0.5%

2%

-4%

8%

0%

5%

% Change in Population & % Change in Demand for EMS Service% Change-Population % Change-Demand

Operations Data: Demand and Population

EMS call demand per 1,000 of the population and as a % share of the total population continues

to increase along a positive linear trend. Simply put, a larger share of the population is

requesting EMS based services. Population is based on U.S. Census 1 Year Estimates.

86.1

82.2

87.486.7

90.6

78

80

82

84

86

88

90

92

2010 2011 2012 2013 2014

EMS

De

man

d P

er

1,0

00

Pe

ople

EMS Demand Per 1,000 of Total population

Demand Per 1,000 of Total population Linear (Demand Per 1,000 of Total population)

Operations Data: Type of Service Demand

EMS call demand resulting in either medical treatment and/or transport has increased along a

positive linear trend; the % share of EMS calls requiring medical services have continued to

increase making up a larger share of call demand. The patients receiving care are aging as well

along with population changes. Simply put, a larger share of request for EMS based services is

resulting in medical care being provided (Transport ALS/BLS, Treated and Transferred Care,

Patient Refused Transport Only).

0%

50%

100%

2011 2012 2013 2014

24% 20% 14% 12%

76% 80% 86% 88%

% o

f EM

S C

alls

% of EMS Calls Requiring Medical ServicesYears 2011-2014

% of EMS Calls Not Resulting in Medical Services Provided % of EMS Calls Resulting in Medical Services Provided

55 55 57 58

34.9 34.9 35.0 35.0

0

10

20

30

40

50

60

70

2011 2012 2013 2014

Age

of

Pati

ent

s/Po

pula

tion

Age of Patients Provided Care&TransportYears 2011-2014

Median Age of Patients Provided Care Median Age of PopulationLinear (Median Age of Patients Provided Care)

*2014 Median Age of Population is a forecast value based on prior years


EMS call demand resulting in either medical transport has increased along a positive linear trend;

the % share of EMS calls requiring medical transport have continued to increase making up a

larger share of call demand. Interestingly, ALS transports are making up a larger share of

transports in comparison to BLS. Simply put, a larger share of request for EMS based services is

resulting in patients being transported to the hospital (Transport ALS/BLS).

32% 33% 36% 37%

47% 48% 47% 47%

21% 19% 17% 16%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2011 2012 2013 2014

% E

MS

De

ma

nd

ALS & BLS Transports as % of Total EMS DemandALS Transports as % of EMS Calls BLS Transports as % of EMS Calls Remainder of Calls as % of EMS Calls

0%

50%

100%

2011 2012 2013 2014

21% 19% 17% 16%

79% 81% 83% 84%

% o

f E

MS

De

ma

nd

Transports as % of EMS DemandYear: 2011-2014

Remainder as % of EMS Calls Transports as % of EMS Calls


BLS transports continue to make up the majority share of medical transports, however, ALS

transports continue to increase. The % share of patients receiving medical transports continued to

be consumed by older patients 60 and older; patients age 60 and older make up 48% of the total

medical transport services delivered in year 2014.ALS: Advanced Life Support; a set of life saving

protocols and skills that extend Basic Life Support. BLS: Basic Life Support; medical care which is

used until full medical care can be given (i.e. hospital if needed).

98%

2%

2014 Incidents By Priority

Priority 1 or 2 Priority 3

Priority 1: Urgent/Life ThreateningPriority 2: Serious/Potentially Life

ALS,

44%BLS,

56%

2014 Transport ResponseALS BLS

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

<5-14 15-34 35-59 60+

1,239

5,788

8,938

14,676

Patient Age Groups

2014 Transports By Age

4%

19%

29%

48%

2014 % of Total Transports By Patient Age

<5-14 15-34 35-59 60+


-3%

-1%

2%

4%

-6%

-4%

-2%

0%

2%

4%

6%

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

<5-14 15-34 35-59 60+

% C

ha

ng

e

# E

MS

Tra

nsp

ort

s

Patient Age Group

% Change in EMS Transports by Age GroupYear 2013-2014


# Transports (2013) # Transports (2014)

The % share of EMS medical transports that are provided continually are dedicated to the portion

of the population age 60 and older. The number of transport medical services provided to pa-

tients age 60 and older increased by 4% over the prior year.

The Training Division serves the various basic and advanced certification and recertification

needs of EMS, volunteer rescue squad and Fire Department patient care providers. In addition,

as a designated American Heart Association Community Training Center, EMS meets the cardi-

opulmonary resuscitation certification and recertification needs for members of the Virginia

Beach Police Department, strategically located AED response teams and the general public.

Training Division Major Functions:

Training Division

Basic Life Support

Education

Cardio Pulmonary

Resuscitation (CPR) and

Automated External

Defibrillation ( AED)

Training and Certification

Emergency Medical

Technician (EMT)

Education and Certification

Clinical Education

Continuing Education

Advanced Life Support

Education

Advanced Cardiac Life

Support (ACLS) Training

and Certification

Pediatric Advanced Life

Support (PALS) Training

and Certification

Difficult Airway and Rapid

Sequence Induction (RSI)

Training

Specialized Technical

Education and Training

CPR, PALS and ACLS

Instructor Education and

Certification

Emergency Vehicle

Operator Course (EVOC)

Training & Certification

OSHA Training Online

Rescue Training

Mass Casualty Training

Dispatcher Emergency

Medical Dispatch (EMD)

Training

CPR – Cardio Pulmonary Resuscitation

This course is designed to provide the member and City personnel with the knowledge and skills

to properly perform the basic life support as recommended by the American Heart Association.

Students learn to recognize several life-threatening emergencies, provide CPR to victims of all

ages, use an AED, and relieve choking in a safe, timely and effective manner. Successful

participants are provided an AHA CPR certification card in accordance with the specific course

requirements.

EMT – Emergency Medical Technician

The Emergency Medical Technician (EMT) certification program is designed to train an individual

to function independently in a medical emergency. It is recognized that the majority of

prehospital emergency medical care will be provided by the EMT. This course provides the basic

knowledge and skills needed to deliver Basic Life Support (BLS) care and is required to progress

to more advanced levels of prehospital patient care.

Advanced Life Support Programs: EMT – Enhanced (Advanced EMT),

EMT – Intermediate and EMT – Paramedic

VBEMS sponsors volunteer members for continued emergency medical training through the

highest level of prehospital advanced life support care – the Paramedic certification level. The

member can chose to pause their training at any of the certification levels and resume their

training within a fixed interval. When the member completes their Paramedic training they will

have over 1250 hours of training, not including internship time to release to general supervision.

Members may complete their field internship clinical hours with VBEMS or another EMS agency.

Successful participants are allowed to sit for the Virginia or National EMS examinations requiring

successful completion of both a standardized cognitive and national psychomotor skills

examination.

EVOC – Emergency Vehicle Operators Course

The Emergency Vehicle Operator Course (EVOC) is patterned after the State Office of

Transportation Safety EVOC guide. The course emphasizes safe driving skills. Additionally, the

course provides the member the vehicle codes of Virginia and Policies of VBEMS. This course is

designed to increase the situational awareness of the emergency vehicle operator and reduce

the number of crashes involving emergency vehicles. The course includes classroom and driving

range skills.

Training Division: Certification Training Programs

Vehicle Rescue Awareness and Operations

This course developed by the VAVRS, Office of EMS and Dept. of Fire Programs stresses the

skills and latest techniques of vehicle extrication. Emphasis is placed on:

• Orderly and efficient approach to the accident situation • Safety procedures • Protective equipment • Use of tools (hand tools, power tools, hydraulic tools, air bags, etc)

Training Division: Certification Training Programs

Training Division: Continuing Education Training ALS Release Program

These classes provide the ALS student/intern with the knowledge, skills and abilities to function

within the protocols and VBEMS system requirements at their certification level. The courses spe-

cifically cover the explicit technology, equipment and protocols required for a field clinician to func-

tion under the general supervision of the OMD.

ALS CE Program

These classes are designed for practicing ALS providers to earn the credits needed to recertify

their National and Virginia EMS certifications. The courses consist of review of the U.S. Depart-

ment of Transportation's National Standard Curriculum and NREMT recertification core and elec-

tive areas for ALS providers. Subjects cover respiratory emergencies, communicable diseases, pe-

diatrics, OB, allergy and anaphylaxis emergencies, EMS operations, geriatric issues, trauma, res-

piratory and cardiovascular emergencies. The classes incorporate updates on treatment proce-

dures, medical research and equipment relevant to the VBEMS system.

BLS CE Program

These classes are designed for practicing BLS providers to earn the

credits needed to recertify their Virginia EMS certification. The

courses consist of review of the U.S. Department of Transportation's

National Standard Curriculum. Subjects cover patient assessment,

airway, medio-legal, communicable diseases, pediatrics, OB, medi-

cal emergencies and trauma emergencies. The classes incorporate

updates on treatment procedures, medical research and equipment

relevant to the VBEMS system.

Training Division: Continuing Education Training

ACLS – Advanced Cardiac Life Support Update

Advanced Cardiac Life Support (ACLS) is an advanced,

instructor-led classroom course that highlights the

importance of team management of a cardiac arrest, team

dynamics and communication, systems of care and

immediate post-cardiac-arrest care. Specific skills in airway

management and related pharmacology are also featured.

Skills are taught through discussion and group learning,

while testing stations offer case-based scenarios using

simulators. Providers enhance their skills in treating adult

patients of cardiac arrest or other cardiopulmonary

emergencies, while earning their American Heart

Association ACLS (AHA ACLS) for Healthcare Providers

Course Completion Card.

PALS – Pediatric Advanced Life Support Update

Pediatric Advanced Life Support (PALS) is a classroom, video-based, Instructor-led course that

uses a series of simulated pediatric emergencies to reinforce the important concepts of a systemat-

ic approach to pediatric assessment, basic life support, PALS treatment algorithms, effective

resuscitation and team dynamics. The goal of the PALS

Course is to improve the quality of care provided to

seriously ill or injured children, resulting in improved

outcomes. Providers enhance their skills in treating

pediatric patients of cardiac arrest or other

cardiopulmonary emergencies, while earning their

American Heart Association PALS (AHA PALS)

Course Completion Card.

Data illustrates an overall negative linear trend in EMT enrollment rates when examining the 5

year historical trend; this indicates that overall total EMT enrollments are declining. Forecasting

EMT enrollments for the next three years illustrates that the negative linear trend is probable to

continue.

Training Division: Data

206

293

215 219202

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014

Fiscal Year EMT EnrollmentYear 2010-2014

206

293

215 219202

253

208225

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014 2015 2016 2017

Fiscal Year EMT EnrollmentYear 2010-2017 (Forecast)

*Green Bar = Forecast

Though overall EMT enrollments may have declined over the five year period observed, data il-

lustrates that the number and % share of EMTs that enroll in training are graduating at a higher

rate. Forecasting out for the next three years illustrates that the trend is probable to continue with

more enrollees graduating at a higher rate of success.


111

178

148 150164

0

20

40

60

80

100

120

140

160

180

200

2010 2011 2012 2013 2014

Fiscal Year EMTs GraduatedYear 2010-2014

54% 61%69% 68%

81%

46% 39%31% 32%

19%

0%

20%

40%

60%

80%

100%

2010 2011 2012 2013 2014

Fiscal Year % of EMTs GraduatedYear 2010-2014

% Graduate % NOT Graduate

Data findings illustrate that the unemployment rate visually correlates with reduced overall EMT

enrollments; as the economy improves, it may be probable that fewer individuals have the need

to seek EMT training for career development or do not have the time to enroll for training as they

are finding employment opportunities that limit availability.

A regression test does not validate a relationship between the two variables; enrollment and un-

employment.


206

293

215 219202

7.5% 7.3% 7.2%

6.5%

6.0%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014

Fiscal Year EMT Enrollment and Unemployment RateYear 2010-2014

EMT Enrollment Unemployment Rate-Virgina Beach


14

20 20

35

42

0

10

20

30

40

50

2005 2006 2007 2008 2009

# of On-site New CPR Classes

171

267252

309

247

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014

# of On-site New CPR Students

272242

261

2036

0

50

100

150

200

250

300

350

2010 2011 2012 2013 2014

# of Off-site New CPR Classes

1382 1395

1867

222 213

0

500

1,000

1,500

2,000

2010 2011 2012 2013 2014

# of Off-site New CPR Students

24 16 20

186201

0

50

100

150

200

250

2010 2011 2012 2013 2014

# of Recert CPR Classes

93 83 105

905

1,680

0

500

1,000

1,500

2,000

2010 2011 2012 2013 2014

# of Recert CPR Students

The Regulation and Enforcement Division is responsible for the safety of members and citizens,

and ensures this through regulation of the provision emergency health services within the City

limits in accordance with City code, enforcement of Beach, Boats and Waterways codes, sub-

mission of quality management programs and fielding of customer feedback. Additionally, Divi-

sion personnel ensure the safety of medical devices, evaluate new medical equipment and pro-

vide infection control services to all members of the Department of EMS.

Regulation and Enforcement Division Major Functions:

Regulation and Enforcement Division

Federal, State and Local Regulation

Compliance

Commercial EMS Ambulance Agency

Oversight

Infection Control

EMS Medical Oversight and Enforcement

Departmental Evaluation

Medical Care Partners Liaison

Oversight of Contractual Lifeguard

Services

Department Procurement

Federal and State Grants Management

Office of Planning and Analysis

Safety Office

HIPAA/Patient Confidentiality Compli-

ance

Data Collection and Analysis

Continuous Quality Improvement (CQI)

Electronic Medical records

Special Events Planning

EMS Representative for Health and Safe-

ty Matters at the Beach

TEMS Regional Medical Operations

Committee, and Performance Improve-

ment Committee Representation

The Division is led by Division Chief Jason E. Stroud and consists of Captain Jerry Sourbeer,

Public Safety Analyst Robert M. Davis, Business Application Specialist Eric Llanes and

Storekeeper Anthony Elston.

Regulation and Enforcement Division: CQI




Standards/Guidelines

Hospital Door-to-Balloon

of 90 minutes or less

FMC = First Medical

Contact – time of

eye-to-eye contact

between STEMI patient

and caregiver with 12

Lead ECG abilities

AHA: First unit on scene

in 8 minutes or less

AHA: EMS on scene

time of 15 minutes or

less

AHA: FMC-to-balloon in

120 minutes or less


Totals Data

Total Number of Cases 61

Male 38

Female 23

Average Age 62

Number of Transports to VBGH 49

Number of Transports to SLH 10

Number of Transports to SPAH 2

Prehospital 12-Lead ECG Obtained? 57

Percent with Pre-Hospital 12-Lead ECG 93%

Response

Average Time from Chest Pain to 911 93 minutes

Average Time from 911 to First Unit 7 minutes

Percentage of Time 8 minutes or Less 69%

On Scene

Average Ambulance On Scene Time 16 minutes

Percent On Scene Time ≤15 Mins. 46%

Average Time 911 to 12 Lead ECG 23 minutes

Average Time FMC to 12 Lead ECG 11 minutes

Percent FMC to 12 Lead ECG ≤10 Mins. 49%

Average Time from First Unit to Aspirin 13 minutes

Average Time from First Unit to Nitroglycerin 19 minutes

Percent 12 Lead ECGs Transmitted 70%

Transport

Average Time from 911 to Hospital Arrival 39 minutes

Average Time from EMS 12 Lead ECG to STEMI Alert 23 minutes

Percent STEMI Alerts Called by EMS 48%

Balloon Times*

Average ED Door-to-Balloon 72 minutes

Percent ED Door-to-Balloon ≤90 Mins. 75%

Average Time from FMC to Balloon 104 minutes

Average Time from 911 to Balloon 116 minutes

Average Time of EMS 12 Lead ECG to Balloon 90 minutes

Percent EMS 12 Lead ECG to Balloon ≤90 Mins. 49%

2014 STEMI Patients

The office of planning and analysis serves as the research and analytic arm of EMS operations;

employing statistical methods, quantitative data analytics and robust research methods and ap-

plications to better improve the operations and effective delivery of emergency medical services

to residents and visitors of the City of Virginia Beach. Current research endeavors include the

following:

Demand Analysis

What is Demand Analysis? Demand analysis refers to the act of aggregate planning and

scheduling of resources and involves identifying demand patterns and to the extent that it is

practical, deploying resources to match those patterns. Simplified, this means determining where

available ambulances should be placed while they await the next request for emergency aid. De-

mand analysis is intended to provide adequate emergency response capacity for typical peak

demands (when calls for service are at their highest), with excess capacity during non-peak

times (when calls for service are at their lowest) kept to a minimum or used for non-emergency

responses.

Office of Planning And Analysis

-

500

1,000

1,500

2,000

2,500

3,000

0:0

0

1:0

0

2:0

0

3:0

0

4:0

0

5:0

0

6:0

0

7:0

0

8:0

0

9:0

0

10

:00

11

:00

12

:00

13

:00

14

:00

15

:00

16

:00

17

:00

18

:00

19

:00

20

:00

21

:00

22

:00

23

:00

# o

f C

alls

fo

r EM

S

Demand for EMS Service:Per Hour of DayYears 2011-2014

2011 2012 2013 2014

GIS Mapping EMS Demand 2014

GIS allows the ability to take demand analysis location data and interpret it spatially against pre-

defined geographic characteristics of the service region being analyzed. A GIS map which uses

“heat mapping” or “density mapping” can determine where demand for EMS is the most concen-

trated per 1sq. mile.

The analysis reveals association with existing research examining GIS density mapping of

populations and their relationship with demand for EMS services. The VBEMS findings identify

that a correlation is present between population densities and demand for EMS services. The

more individuals residing and working within a sq. mileage, the greater the demand for EMS

services; demand is therefore concentrated in pockets or dispersions. The concentration of call

volume for year 2014 is located in areas of dense population concentration. The less densely

populated regions in the southern region are among the less concentrated population de-

mographics.


EMS Demand Per Shift “Time of Day”

A review of existing medical research found that these identified trends and patterns can be ex-

plained as a result of circadian rhythm patterns which occur on the biological level of individuals.

The research shows that demand for EMS service is not a random event and can be tracked and

anticipated to a degree. The density or areas of high concentration are once again where popu-

lation is the greatest per sq. mile; you will notice that the density of the map changes and

spreads into areas that are residential (i.e. housing). This seems to validate what existing re-

search has asserted; that change in population movements occurs in a 24 hour cycle. These

changes in location relate to what is known as population migration changes, how the population

moves from various locations depending on the time of day (i.e. daytime commercial, evening

time residential).


Shift 1: 5:00am-5:00pm Shift 2: 5:00pm-5:00am

Forecasting Future EMS Demand

What is forecasting? Demand forecasting is the area of predictive analytics dedicated to under-

standing consumer demand for goods and services. That understanding is used to forecast con-

sumer demand. When thinking of demand in EMS, it is best to equate it with a person calling 911

asking for medical help; that way, you can visually construct what demand in an EMS system will

look like. The analysis has discussed demand as the calls for EMS service, so as you read de-

mand throughout this section just equate it to someone who needs an ambulance for example.

The goods and services in this case would be the medical attention provided by EMS. This can

be bandages, an ambulance transporting someone to a hospital and other associated EMS ser-

vices on would expect to come when 911 is called.

Demand forecasting in its simplest form is taking what you know currently about demand for a

service or good and then probabilistically calculating what it may be in the future.

Why is forecasting important? Forecasting can help determine how many resources may be

needed in the future in order to meet demand. In the case of EMS, forecasting future demand for

EMS services can help determine funding allocations that can be used to purchase medical sup-

plies, ambulances and medics that may be needed. Also, leveraging GIS mapping analysis can

help determine where EMS services may be needed; if we know where demand is taking place,

the forecast demand will aid in calculating what resources may be needed and how much.

Forecasting allows the ability to (ideally) operate EMS service delivery more efficiently and effec-

tively. If you know how many ambulances you may need and the staff to operate them, the GIS

mapping tells you where, then you could improve how those services are delivered. Forecasting

when coupled with demand analysis and GIS mapping may be used as a proactive measure; if

the forecast model probabilistically calculates that stroke calls will increase next July and the

GIS data gives the locations where strokes are historically determined to occur, then EMS pro-

viders and other associated groups of interests can organize preventative actions to help miti-

gate those associated risks with call demand.


Forecasting Future EMS Demand: Year

Office of Planning And Analysis 3

45

93

35

60

7

36

23

9

37

02

8

37

71

8

36

29

1

39

13

0

38

98

0

40

93

7

34

,98

7

35

,47

2

36

,37

8

37

,07

9

37

,84

4

38

,55

5

37

,76

3

39

,39

7

39

,81

3

41

,23

1

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

EMS

Cal

l D

em

and

Forecasts and Actual Demand*Yellow Bars=Overestimation

Black Bars=Underestimation

Actual Demand Averaged Demand (Forecast) Linear (Actual Demand)

1%

0%

0% 0% 0%

6%

-3%

1%

-3%

-0.15

-0.1

-0.05

0

0.05

0.1

0.15

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

2006 2007 2008 2009 2010 2011 2012 2013 2014

Fore

cast

Acc

ura

cy

EMS

Cal

l D

em

and

Forecast Accuracy*Yellow Bars=Overestimation

Black Bars=Underestimation

Actual Demand Averaged Demand (Forecast) Linear (Actual Demand)

Forecasting Future EMS Demand: Month

This illustrates the proba-

bilistic EMS call demand

that will occur in totality for

the given month over the

course of the 2015 year.

This illustrates the proba-

bilistic % change in EMS

call demand that will occur

in totality for the given

month over the course of

the 2015 year.

This illustrates the accuracy

of the forecasts model in

comparison to the actual

call demand that was re-

ported in year 2014. Overall

the model underestimated

actual call demand for

2014; due in large part that

year 2014 saw a 5% in-

crease in demand.

Office of Planning And Analysis 3

,40

6

2,9

06

3,1

52

3,3

96

3,5

49

3,6

30

3,7

98

3,6

68

3,4

72

3,4

43

3,1

71

3,3

84

0500

1,0001,5002,0002,5003,0003,5004,000

# EM

S C

alls

EMS Demand Forecast: Year 2015

3% 2%

-5%

2%0%

0%

1% 1% 1% 1% 0%

-3%

-10%

-5%

0%

5%

10%

0

1,000

2,000

3,000

4,000

% C

han

ge

# EM

S C

alls

EMS Demand Forecast: Year 2015Forecast % Change


3%1%

-2% -1%-5% -6%

-3% -2% -3% -3% -2%

-11% -15%

-5%

5%

15%

0

1,000

2,000

3,000

4,000

Fore

cast

Acc

ura

cy

EMS

Cal

l D

em

and

Forecast Accuracy 2014: Forecast & Demand*Yellow Bars=Overestimation Black Bars=Underestimation

Forecasting Future EMS Demand: Demand Based Staffing Ambulance

Utilizing the demand analysis to track the historic call demand for EMS services, that data is then

fed into the statistical forecast model to help calculate how many calls for Ems may probabilistic

occur at a given hour of day. In addition, the 90th percentile time a unit spends out of service per

EMS call is also calculated (the time from when a unit is dispatched to the time a unit is back in

service); this provides the amount of time a unit may be out of service 90% of the time when it is

dispatched to an EMS call.

Taking the forecasted number of calls per hour, and multiply that forecast value by the amount of

time a unit is probabilistic to be out of service produces a “staffing recommendation”. Essentially,

how many ambulance units will be needed at this hour of the day, on this day of the week for this

period of months in order to meet call demand.

Two demand based staffing models were created; one model was created for the off-season

(October-March) and one for the on-season (April-September). While this lessens the accuracy of

the staffing model due to the seasonality effect (demand changes based on the time of year) it

provides a 6 month staffing template that is designed to adequately meet probabilistic future

demand for EMS services and may improve inconsistencies in current split shift staffing models.

The goal of the model is to limit the number of staffed ambulances during troughs in demand (low

demand times) and increase the number of staffed ambulances when they are needed most

during peak demand times when ambulance units are needed most.


Forecasting Future EMS Demand: Demand Based Staffing Ambulance


7 7 7 64 4

67

910 10

11 11 11 11 10 1011

109 9

8 7 7

0

2

4

6

8

10

12

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Re

cco

me

nd

ed

Am

bu

lan

ces

Sta

ffe

d

Hour of Day

Ambulances Needed: Based on DemandOff Season: October-March

*Includes 10% Increase Buffer

78 8

5 5 46

79

1112 11 11 12 12 11 11 11 10 10 10 10 9

8

0

2

4

6

8

10

12

14

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Rec

com

ende

d A

mbu

lanc

es S

taff

ed

Hour of Day

Ambulances Needed: Based on DemandOn Season: April-September

*Includes 10% Increase Buffer

This illustrates the recommended demand based staffing model for ambulance units for the

off-season and the on-season; forecasted demanded via the statistical model is

supplemented with a 10% buffer. This means that an extra 10% increase in the forecasted

EMS call demand is factored into the staffing recommendation. This provides a slight cushion

in the event that call demand spikes at a rate higher than forecasted.

EMS Research: Elderly Fall Study

The fastest growing population group in the U.S. is individuals age 85 and older. By 2030, 20%

of the U.S. population will be older than 65. The elderly account for 16% of ER visits and half of

all critical care admissions. As geriatric patients have become a larger subset of the population,

their demand on the existing healthcare field has increased in kind. To help alleviate the burden

of this increase for medical services, greater responsibility has fallen to EMS providers.

There are a variety of lethal and traumatic events that place individuals 65 and older at risk.

However, falls are the most common cause of injury in the elderly population and account for as

much as 40% of deaths caused by injury among individuals 65 and older. “Every 15 seconds an

older adult is treated in an Emergency department for a fall related injury...every 29 minutes, an

older adult dies from a fall”. With the U.S. population aging, the number of falls and fall related

injuries are projected to increase. 1 in 3 adults age 65 and older falls every year.

Older individuals 65 and older who fall, 23% of those falls will result in moderate to severe inju-

ries that may increase the risk of early death. Even those that do fall and do not sustain injury

may develop a fear of falling which may lead to reduced mobility, loss of physical activity that in-

creases their actual risk of falling and sustaining injury from a fall.

The City of Virginia Beach ranks 10 out of the 33 total localities in which the Centers for Disease

Control reported deaths resulting from unintentional falls among individuals age 60 and older

(Years 2004-2010).

*This year the Virginia Beach Department of EMS was

contacted by the Virginia Department of Health and has

begun the early stages of the formulation of a patient

referral system partnership; this new endeavor will allow

the Department of EMS to share its collected data with

VDH and help direct repeat patients struggling with

chronic illnesses such as: hypertension, diabetes, falls

among the elderly and help guide those patients to VDH

community educators that can direct them to services

such as health coaching, prescription medication

management and other various health referral services

that patients and members of the community may not

know are available for them to use.*


EMS Research: Elderly Fall Data


-

500

1,000

1,500

2,000

2,500

3,000

2011 2012 2013 2014

2,315 2,371 2,637 2,762

# o

f Fa

ll In

cid

en

ts

# of Fall IncidentsPatients Age 60 and older

2%

11%

5%

-15%

-5%

5%

15%

-

1,000

2,000

3,000

2011 2012 2013 2014

# o

f Fa

ll In

cid

en

ts

% Change Fall IncidentsPatients Age 60 and older

% Change # of Fall Incidents

-

1,000

2,000

3,000

2011 2012 2013 2014

2,010 2,039 2,266 2,450

# o

f Fa

ll P

atie

nts

# of Fall PatientsPatients Age 60 and older

1%

11%8%

-15%

-5%

5%

15%

-

1,000

2,000

3,000

2011 2012 2013 2014

# o

f Fa

ll P

atie

nts

% Change Fall PatientsPatients Age 60 and older

% Change # of Fall Patients

0

50

100

150

200

250

2011 2012 2013 2014

204 216241 245

# o

f Fa

ll R

ep

eat

Pat

ien

ts

# of Fall Repeat PatientsPatients Age 60 and older

# Patients that Fall ≥2

6%

12%

2%

-15%

-5%

5%

15%

0

100

200

300

2011 2012 2013 2014

# o

f Fa

ll R

ep

eat

Pat

ien

ts

# of Fall Repeat PatientsPatients Age 60 and older

% Change # of Repeat Fall Patients

EMS Research: Elderly Fall Data


16,994 18,695 18,534 18,547

13,174 14,305 15,470 16,228

-

5,000

10,000

15,000

20,000

2011 2012 2013 2014

# E

MS

Inci

de

nts

# EMS Incidents Patient Age60 and Older & Younger than 60

# Incidents Patient Age younger than 60

# Incidents Patient Age 60 and older

9% 8%5%

-15%

-5%

5%

15%

-

5,000

10,000

15,000

20,000

2011 2012 2013 2014

% C

hnag

e

# EM

S In

cid

ents

% Change EMS Incidents Patients Age

60 and older% Change Incidents Patient Age 60 and older# Incidents Patient Age 60 and older

0%

20%

40%

60%

80%

100%

2011 2012 2013 2014

49.7% 51.6% 51.3% 50.9%

38.6% 39.5% 42.8% 44.6%

11.7% 8.9% 5.9% 4.5%

% S

har

e o

f In

cid

en

ts

% Share of Incidents Patient Age 60 and older

% Share Data Not Available

% Share of Incidents Patient Age 60 andolder

% Share of Incidents Patient Ageyounger than 60

EMS Research: Elderly Fall Maps

The maps illustrate an EMS incident hot map (left map) where Falls occurred involving patients

age 60 and older; the map on the right, displays the population density per Census Tract of pop-

ulation age 60 and older. There is a spatial correlation between higher population densities of

patients age 60 and older, and the number of EMS Fall incidents.


EMS Research: Elderly Fall Maps

These maps illustrate the locations of nursing homes, assisted living facilities and other elderly

living communities; the map on the right is a heat map of the locations of EMS Fall incidents

involving patients age 60 and older, overlaid with the elderly living facilities presented in the map

on the right. There is a spatial correlation between the number of EMS Fall incidents and the

location of elderly living communities.


EMS Research: Cardiac Arrest

Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops beating. If this happens, blood stops flowing to the brain and other vital organs.

SCA usually causes death if it's not treated within minutes.

To understand SCA, it helps to understand how the heart works. The heart has an electrical sys-tem that controls the rate and rhythm of the heartbeat. Problems with the heart's electrical sys-tem can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs).

There are many types of arrhythmias. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood to the body—these arrhythmias cause SCA.

SCA is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart muscle is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. SCA, however, may happen after or during recovery from a heart attack.

People who have heart disease are at higher risk for SCA. However, SCA can happen in people who appear healthy and have no known heart disease or other risk factors for SCA.

Most people who have SCA die from it—often within minutes.

When it comes to cardiac arrests, time is of the essence. The longer a patient goes without critical intervention of either CPR or defibrillation via an AED the decreased likelihood they will survive. Data illustrates that the number of cardiac incidents and cardiac arrest have been increasing and may probabilistically continue to increase as the population of the City of Virginia Beach both grows and ages.

While the 90th percentile response time of 1st help unit onscene has improved during the observed years, it simply falls short of the critical intervention baseline that has been identified in greatly improving patient outcome and survival rates. Simply adding more medics and more response units may help, but economically and logistically such a measure is not currently feasible. Given these limitations of resources in the face of increasing demand, a new community based program has been suggested to aid in improving cardiac survival rates.


EMS Research: Cardiac Arrest Data


16%

-5% -3%

16%6%

-50%

0%

50%

0

200

400

600

2010 2011 2012 2013 2014

% Change

# Cardiac Incidents

% Change in Cardiac Arrest

1st Unit Help Onscene >4 Minutes*Yellow Bar=% Increase Black Bar=% Decrease

# of Cardiac Arrest 1st Unit Help >4 Minutes

513

441381

413477

0

100

200

300

400

500

600

2010 2011 2012 2013 2014

# C

ard

iac

Arr

est

# Cardiac Arrest*All types (drowning, overdose, sudden cardiac, etc)

# Cardiac Arrest101%

-14% -14%

8% 15%

-120%-100%-80%-60%-40%-20%0%20%40%60%80%100%120%

0

100

200

300

400

500

600

2010 2011 2012 2013 2014

% C

hang

e

# Ca

rdia

c A

rres

t

% Change Cardiac Arrest*All types (drowning, overdose, sudden cardiac, etc)


0%

20%

40%

60%

80%

100%

2010 2011 2012 2013 2014

45% 40% 37% 36% 36%

22% 25% 27% 28% 27%

% S

hare

% Share of Cardiac Arrest Dispatches

that result in a True Cardiac Arrest Onscene% of Dispatches that are true cardiac arrest % of Dispatches that are NOT true cardiac arrest

0:07:41 0:07:34 0:07:02 0:07:23 0:07:01

0:00:00

0:05:46

0:11:31

2010 2011 2012 2013 2014

Re

spo

nse

Tim

e

1st Unit Help Onscene Cardiac Arrest

Dispatch Response Time 90th Percentile 1st Unit Help onscene Response Time 90th PercentileLinear (1st Unit Help onscene Response Time 90th Percentile )

3.6%-1.5%

-7.0%

5.0%-5.0%

-15%

-5%

5%

15%

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

2010 2011 2012 2013 2014

% C

ha

ng

e

Re

spo

nse

Tim

e

% Change in 1st Unit Help Onscene Cardiac Arrest Dispatch Response Time 90th

PercentileYellow Bar=%Increase Black Bar=%Decrease

EMS Research: Sudden Cardiac Arrest Data

The chance of surviving a Sudden Cardiac Arrest (SCA) event in the United States is 1:19; one survivor and nineteen deaths. SCA is the leading cause of death in the U.S., affecting more peo-ple than breast cancer, prostate cancer, colorectal cancer, AIDS, traffic accidents, house fires and gunshot wounds combined.


2530

3336 37

0

10

20

30

40

50

2010 2011 2012 2013 2014

# Su

dden

car

dia

c A

rres

t

# Sudden Cardiac Arrest# Sudden Cardiac ArrestLinear (# Sudden Cardiac Arrest)

-47%

20%10% 9%

3%

-60%

-40%

-20%

0%

20%

40%

60%

0

10

20

30

40

2010 2011 2012 2013 2014

% C

hang

e

# Su

dden

car

diac

Arr

est

% Change Sudden Cardiac ArrestYellow Bar=%Increase Black Bar=%Decrease

# Sudden Cardiac Arrest

30

36 37

31

38

0

10

20

30

40

2010 2011 2012 2013 2014

# Su

dden

car

dia

c Su

rviv

ors

# Sudden Cardiac Survivors# Sudden Cardiac Arrest Survivors

-3%

20%

3%

-16%

23%

-60%

-40%

-20%

0%

20%

40%

60%

0

10

20

30

40

2010 2011 2012 2013 2014

% C

hang

e

# Su

dden

car

diac

Arr

est

% Change Sudden Cardiac SurvivorsYellow Bar=%Increase Black Bar=%Decrease

# Sudden Cardiac Arrest Survivors

EMS Research: Cardiac Arrest Maps

Individuals, who suffer a cardiac arrest, have a higher likelihood of survival if they receive CPR

from a bystander; survival was greatest in areas where an AED was available in public spaces

according to a study produced by the American Heart Association. Research by Blackwell (2002)

and Pons (2005) suggest that to truly improve patient outcomes and survivability, emergency

medical response times would need to be consistently reduced to less than five minutes. The

feasibility of being able to reach a patient within 5 minutes or less 90% of the time is currently

non-feasible given logistical and economical limitations within the current EMS system. “The ma-

jority of sudden cardiac deaths occur outside hospital so specific programs are needed in the

community. Friends and relatives of people at risk of [Cardiac Arrest] should learn CPR…

Improving outcomes requires addressing the entire picture through population education”.


0

100

200

300

400

500

$- $20,000 $40,000 $60,000 $80,000 $100,000Nu

mb

e r

of

Car

dia

c A

rre

st

Quintile Income Groups

Linear Regression Analysis: Cardiac Arrest and Median Household Income

Number of Cardiac Arrest Predictor Variable

Linear (Predictor Variable)

Regression Statistics

R Square 0.920906

Significance f 0.040361

*The regression analysis illustrates that there is a strong

correlation between the number of cardiac arrest and the

median household income per U.S. Census tract; 92% of the

change in the occurrence rate of cardiac arrest may be

attributable to median household income; the results of this

output occurring by random chance alone is 4%, which is

statistically significant. Lower income neighborhoods have a

higher rate of cardiac arrest while upper income neighborhoods

have a lower rate of cardiac arrest.

EMS Research: Cardiac Arrest Survival

Bystander CPR has been shown to more than double a victim’s change of surviving an out of

hospital cardiac arrest event. Using an automated external defibrillator (AED) in conjunction with

bystander CPR further improves the probability of survival; however, bystander CPR and AED’s

are not employed in a majority of cardiac events. Time is critical in cardiac events; the adage of

“time is brain” is a popularized phrase which employs the importance of time in critical

intervention. Once a cardiac arrest occurs, blood flow to the brain is halted and the onset of brain

death begins; oxygen deprivation results as blood is the conduit which carries oxygen to the

brain. Without adequate blood flow, the brain begins to die and the body’s systems begin to shut

down.

Bystander CPR allows the ability to maintain blood flow and keeps oxygen flowing to the brain

preventing brain death; without clinical intervention as is provided through CPR, the individual

suffering a cardiac arrest event will likely “flatline” within a few seconds. If the patient is not

revived within 5 minutes, the patient could suffer irreversible brain damage and or become brain

dead; hence “time is brain”.

Providing critical blood flow to the heart and brain during a cardiac arrest is critical, in addition, it

improves the likelihood of a successful shock from use of an AED. Together, bystander CPR and

successful application and use of an AED work in tandem to improve resuscitation, survival and

outcome. These actions comprise what is known as the “Chain of Survival”; the chain of survival

helps explain the Emergency Cardiovascular Care system; early CPR and rapid defibrillation are

two key components of the chain of survival in response to a cardiac arrest event.

The Emergency Medical Services field along with the nation’s healthcare system is moving

towards community intervention initiatives to enhance the role of pre-delivery of care before

professional rescuers arrive on scene; there is a vested interest in developing public awareness,

training and AED location assistance to members of the community to improve the delivery of

bystander CPR and AED application to cardiac arrest events.

While the City of Virginia Beach’s land size per sq. mile and its population density make it a chal-

lenge for EMS to respond to a cardiac arrest event in 5 minutes, it also is the City’s greatest as-

set in leveraging use of bystander CPR and defibrillation via AED within that critical intervention

window. There may not be an EMS provider on every corner of every hour of every day, but a

Virginia Beach resident may be! Critical intervention via CPR and defibrillation by an AED can

make the difference between life and death for an individual suffering a cardiac arrest event.


EMS Research: Sudden Cardiac Arrest Comparison


0%

20%

40%

60%

80%

100%

2010 2011 2012 2013 2014

32%45% 36% 33% 41%

68%55% 64% 67% 59%

Sudd

en

Card

iac

Arr

est

Sur

viva

l R

ate

Sudden Cardiac Arrest Survival Rate

% Did NOTSurvive

Sudden Cardiac Arrest

% Survived Sudden

Cardiac Arrest

0%

25%

50%

20112012

20132014

31% 32%33%

45%36%

33% 41%

Surv

ival

Rat

e

National Sudden Cardiac Arrest Survival Comparison VBEMS Sudden Cardiac Arrest Survival

(2014 National Data N/A)National Sudden Cardiac Arrest Survival Rate VBEMS Sudden Cardiac Arrest Survival Rate

31% 32% 33%

45%

36%33%

41%

0%

25%

50%

2011 2012 2013 2014

Survival Rate

National Sudden Cardiac Arrest Survival Comparison VBEMS Sudden Cardiac Arrest Survival

(2014 National Data N/A)National Sudden Cardiac Arrest Survival Rate VBEMS Sudden Cardiac Arrest Survival Rate

EMS System Performance: Unit Hour Unit Utilization

Unit Hour Unit Utilization (UHUU) is the percent of time a staffed unit (e.g. ambulance and/or

zone car) is consumed by work; work in this context refers to “amount of time a unit spends out

of service in response to a demand for EMS service”. What is the amount of time consumed by

an EMS incident? Incident hours; total time a unit spends in response to an EMS incident (time

of dispatch to time unit clears).

Demand for EMS service has/is increasing; incident hours are increasing. Zone car incident

hours have experienced the greatest rate of growth. Average number of EMS units staffed and

response time are positively correlated; as the number of staffed units increase, the response

time decreases. As the number of units staffed decreases, the response time increases.

Unit Hour Unit Utilization is the % of time a staffed unit (ambulance and/or zone car) spends

responding to an EMS incident in a 1 hour period. Unit Hour Unit Utilization correlates with EMS

incident hours; as the number of incident hours increase, the reported UHUU rate increases.

Shift 1 experiences the majority share of EMS call demand and incident hours, but has the

lowest average units staffed to meet demand; shift 1 has a higher reported UHUU rate.

Recommend variable staffing model to meet EMS demand; add more staffed units during shift 1

during peak demand hours to improve UHUU and ameliorate “call holding” incidents. Target

staffing to high demand areas.

Initial findings reveal that zone cars

have a higher reported UHUU rate

than ambulances. % increase in

zone car incident hours outpaces

increases in zone car staffing.

Despite increases in demand for

EMS services, EMS system perfor-

mance has actually improved: de-

creases in response time, decreases

in unit out of service time, decreases

in unit time at hospital.

EMS system performance may be

improved through efficiency en-

hancements and resource

utilization efforts.


EMS System Performance: Unit Hour Unit Utilization Year


14.6 14.8 16.4 17.9 17.9 18.0

35% 37% 35% 35% 34% 35%

0.0

5.0

10.0

15.0

20.0

0%

10%

20%

30%

40%

50%

2009 2010 2011 2012 2013 2014

Average # Staffed Units and Year UHUU*Total units (Ambulance and Zone Car)

# Units Staffed All Units (Ambulance & Zone) UHUU All Units (Ambulance & Zone)

10.4 10.7 11.9 12.6 12.6 12.7

38% 38%35% 34% 34% 35%

0.0

5.0

10.0

15.0

0%

10%

20%

30%

40%

50%

2009 2010 2011 2012 2013

Average Staffed Ambulance Units and Year UHUU*Ambulance units only

# Units Staffed Ambulance UHUU Ambulance

4.2 4.1 4.5 5.3 5.3 5.3

28%34% 36% 36% 36% 35%

0.0

2.0

4.0

6.0

8.0

10.0

0%

10%

20%

30%

40%

50%

2009 2010 2011 2012 2013 2014

Average Staffed Zone Car Units and Year UHUU*Zone Car units only

# Units Staffed Zone Car UHUU Zone Car

EMS System Performance: Unit Hour Unit Utilization Month


0%

10%

20%

30%

40%

50%

UH

UU

UHUU Per Month: 2014Ambulance Zone Car

32%30%

33% 34%37% 36% 36%

38% 37% 36%33%

35%

0%

10%

20%

30%

40%

50%

UH

UU

UHUU Per Month: 2014Ambulance

34% 35%38% 37%

39%41%

38%40%

36% 37%

30%

36%

0%

10%

20%

30%

40%

50%

UH

UU

UHUU Per Month: 2014Zone Car

EMS System Performance: Unit Hour Unit Utilization Hour


0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UH

UU

UHUU All EMS Units By Hour of Day*All units (Ambulance and Zone Car)

*0=12:00am 23=11:00pm 24 Hour Period*Red Line=Performance Threshold

Hour-2009 Hour-2010 Hour-2011

Hour-2012 Hour-2013 UHUU Threshold

Hour-2014

25%23%

21%

17%18%

16%

24%

31%

38%

45%47%

50% 51%

47% 48%

44%

49%46%

42%

37% 38%

34%32%

27%

0%

10%

20%

30%

40%

50%

60%

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

UH

UU

UHUU All EMS Units By Hour of Day: Year 2014*All units (Ambulance and Zone Car)

*0=12:00am 23=11:00pm 24 Hour Period*Red Line=Performance Threshold

UHUU Threshold Hour-2014

EMS System Performance: Unit Hour Unit Utilization Peak Hours


14.2 14.2 15.6 17.4 17.7 17.5

47%50% 48% 47% 46% 48%

45%

0%

10%

20%

30%

40%

50%

60%

0.0

5.0

10.0

15.0

20.0

2009 2010 2011 2012 2013 2014

UH

UU

Ave

rage

Sta

ffe

d U

nit

s

Average Daily Staffing & Average Peak Demand UHUU# Units Staffed All Units (Ambulance & Zone)UHUU All Units (Ambulance & Zone)All Units: UHUU Threshold

10.2 10.3 11.2 12.1 12.2 12.4

52% 54%49% 48% 47% 49%

40%

0%

10%

20%

30%

40%

50%

60%

0.0

5.0

10.0

15.0

2009 2010 2011 2012 2013 2014

UH

UU

Ave

rage

Sta

ffe

d A

mb

ula

nce

Average Daily Staffing & Average Peak Demand UHUUAmbulance

# Units Staffed Ambulance UHUU AmbulanceAmbulance: UHUU Threshold

4.0 3.9 4.45.3 5.5 5.1

35%

42%44% 47%

43% 45%

45%

0%

10%

20%

30%

40%

50%

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

2009 2010 2011 2012 2013 2014

UH

UU

Ave

rage

Sta

ffe

d Z

on

e

Average Daily Staffing & Average Peak Demand UHUUZone Car

# Units Staffed Zone Car UHUU Zone CarZone: UHUU Threshold

EMS System Performance: Call HOLD

The danger of high UHUU: If demand outpaces the available supply of staffed units in a given

area, this creates a “call holding” situation; this means an individual requesting EMS service

must wait until the next available unit clears from its current assignment and is able to respond.

Could you just send a unit from another area that isn’t as busy? The answer is “Yes”, but doing

so would then reduce the available unit coverage for that area you took the unit from. If a call

comes in requesting EMS service for that area you just moved the unit from, you are back where

you started and have created another “call holding” incident.

Why is “call holding” bad? Call holding may be bad for two chief reasons:

1. If it is an emergency medical situation that is triaged (designated) as an emergent incident

(e.g. cardiac arrest) then not having an available unit to respond to that incident may impair

the patient outcome (e.g. condition worsens, possible death)

2. VBEMS as a public provider EMS system adheres to a principle of “quality customer service”

to the residents and visitors of the City of Virginia Beach; this simply means that residents tax

dollars are used to fund VBEMS operations (to an extent) and as such have an expectation of

timely service delivery.

How would “call holding” be ameliorated? High UHUU is the result of too much demand and not

enough available supply; in other words, there are more calls for EMS service than there are

available EMS units to respond. Demand for EMS service fluctuates during the 24 hour period in

a given day; demand for EMS service is at its highest demand point during the day shift of

operations (shift 1). However, the average number of units staffed during the 24 hour period

does not match demand patterns; there are more staffed units on average staffed during the

night shift (shift 2) even though shift 1 comprises the majority share of call volume and rate of

incident hours.


EMS System Performance: Call HOLD Per Hour


0

50

100

150

200

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

# EM

S Ca

lls H

OLD

# Call HOLDYears 2009-2014 By Hour of Day

*0=12:00am 23=11:00pmPeakDemand2009

2010

2011

2012

2013

2014

1 0 1 0 0 0 0 28

40

7487

103

72

58 57 55 60

15 1017

101 0

0

50

100

150

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

# EM

S Ca

lls H

OLD

# Call HOLDYear 2014 By Hour of Day

*0=12:00am 23=11:00pmPeak Demand 2014

1 1 2 6

18

37

17

45

27

24 26

9

-6 -5

-10

9

-4 -1 -2

-50

-25

0

25

50

0

50

100

150

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

# C

hang

e

# EM

S Ca

lls

HO

LD

# Call HOLDYear 2013-2014 # Change By Hour of Day

Yellow Bar=# Increase Black Bar=# Decrease*0=12:00am 23=11:00pm

2013-2014 # Change 2014 2013

EMS System Performance: Call HOLD and Staffed Units


0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Average # Daily Staffed Zone CarsYear 2009-2014

* 0=12:00am 23=11:00pm 24hrs.

Peak Demand 2009 2010 2011 2012 2013 2014

0

20

40

60

80

100

120

0

1

2

3

4

5

6

7

8

9

10

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

# Ca

ll H

OLD

Ave

rage

Sta

ffed

Zon

e Ca

rs

Average # Daily Staffed Zone Cars & # Call HOLDYear 20013-2014

* 0=12:00am 23=11:00pm 24hrs.

Call HOLD 2014 Call HOLD 2013 2013 2014

The data findings illustrate that the current daily staffing levels for zone cars is inverse of actual

demand for EMS service; this simply means that there are more staffed zone car units during the

hours when demand for EMS service is lower, while demand for EMS service is at it’s peak time,

there are fewer staffed units available to provide response. The same results were found in

examining ambulance units. More units are staffed during the evening shift (shift 2) while fewer

units are staffed during the day shift (shift 1) when demand is at its highest period.

EMS System Performance: How to fix Call HOLD

A regression analysis was executed to determine if there was a correlation present between

average daily staffed units and the occurrence rate of the number of Call HOLD incidents. While

no statistically significant correlation was present between Call HOLD incidents and staffed

ambulances, there was a statistically significant relationship between CALL HOLD incidents and

the average daily staffing of zone car units.


0

200

400

600

800

1,000

1,200

1,400

0 1 2 3 4 5 6

# EM

S C

all

HO

LD

Avg. # of Dai ly Staffed Zone Cars

Regression Analysis: Avg. Staffed Zone Cars & Number of EMS Call HOLD

Independent

Variable (CallHOLD)

Predicted

Variable

Linear(PredictedVariable)

Regression Statistics:

R square=0.66

Significance f=0.04

*66% of Cal l Hold may

probabalistic be explained by staffed units

*Increasing staffed units may probabalistic reduce call hold

The regression analysis therefore states that by probabilistically increasing the average daily

staffing of zone car units may lead to a decrease in the number of Call HOLD incidents; given

the observation that the majority of Call HOLD incidents occur during peak demand hours

during the day, it would be apt to direct any additional staffing to those peak demand hours in

order to have the greatest degree of impact in reducing Call HOLD incidents.

EMS System Performance: Performance Measures-Balanced Scorecard

The Balanced Scorecard helps translate an organization’s mission, vision and strategy into

tangible objectives. It focuses on five critical programs which the City of Virginia Beach

Department of EMS (VBEMS) executes to meet the needs of the community and the

organization. The City of Virginia Beach’s Department of EMS uses the Balanced Scorecard as

its performance measurement system to track, report and improve EMS performance.

The key indicators to the success of the Department of EMS’s efforts are measured in our

Department’s Balanced Scorecard. EMS’s Balanced Scorecard Report is displayed over the

following pages. Some examples of our key indicators include the following measures:

Sudden Cardiac Arrest Survival rate

1st Responder *Unit* arrival onscene (90

th Percentile) to calls dispatched as Cardiac

Arrest

Onscene time (90th Percentile of severely injured trauma patients who were

transported from the scene by ambulance

Number of EMS vehicle accidents per 1,000 EMS calls for service

The department’s performance measures were derived internally by VBEMS with the aid of the

Department of Management Services. As well as in conjunction with nationally developed EMS

performance measures by the National Highway Traffic Safety Administration and the

Emergency Medical Services Authority of the California Health and Human Services Agency.

The measures allow the Department of EMS to track,

report and improve EMS system performance (if

needed) by establishing targets and objective driven

outcomes. These measures are designed to

enhance and improve operational accountability for

the Department.

It is the hope of this Department that these measures

will be used to better the operational efficiency and

execution of its duties to fulfil its mission and achieve

its vision in providing excellent customer service to

the residents, citizens and visitors of the City of

Virginia Beach.



Quality in EMS Matters

Quality is not just a buzzword used by statisticians, MBA’s and CEO’s. Quality in the field can

mean the difference between life and death. As an Emergency Medical Service provider, the City

of Virginia Beach’s Department of EMS owes its residents and visitors the highest quality service

possible. Most people do not think about EMS until they need it. But when they do need EMS,

they assume that competent, well trained, professional providers are equipped with the skills to

meet their needs will show up in a timely manner. For the person in need of EMS, failure is not

an option.

Performance in EMS

The Institute of Medicine found in 2006, that there was a widespread lack of accountability in

EMS and provided three recommendations for EMS leaders:

1. Develop Performance Indicators “Goals”

2. Measure System Performance

3. Disseminate Performance Information

These three recommendations form the foundation of ensuring a quality EMS service.

VBEMS Patient Centered Approach to Performance

“The three legged stool approach to patient care”



“The ultimate goal of VBEMS is to provide effective, high-quality healthcare to patients. But

without performance measures, VBEMS providers, administrators, and leaders have no way of

knowing if we are achieving these goals.”

A consistent set of measures will allow VBEMS providers, administrators, and leadership to

monitor performance and improve performance to ensure the best care for patients and the best

service to the community.

Performance measures are critical for individuals, organizations, and the community—without

them it is difficult to recognize:

Whether performance is improving or deteriorating

If an implemented change has had the intended impact

Whether the cost of a program or piece of equipment is worth the expense

In healthcare, the use of performance measures is not new, but their use has expanded

tremendously in the last two decades. EMS is no different.

Measuring performance and keeping track of those measurement numbers allows VBEMS to

compare how we are doing today with how we did in the past. Measuring performance also helps

us measure how we are doing in comparison to other EMS providers (benchmarking). Most

importantly, measuring performance helps VBEMS see how we are doing relative to our goal

achievement. Measuring and recording performance also helps develop trends for long-term

monitoring.

How to Read the Scorecard

“What is a performance measure?”

A healthcare performance measure is a way to calculate whether and how often the health and

healthcare system does what it should. Measures are based on scientific evidence about pro-

cess, outcomes, perceptions, or systems that relate to high-quality care.

The result of the measure is usually shown as a ratio or a percentage, and allows for comparison

to other providers and benchmarking against national and local performance.



The VBEMS Balanced Scorecard has 5 programs

1.Emergency Medical Services

2.Organizational Sustainability

3.Medical Care Intervention

4.Special Operations

5.Resource Utilization

Each of the 5 programs has an associated goal and outcome; within each program there are out-

come initiatives along with an associated performance measure.

If VBEMS meets or exceeds its performance target it “Leads”; if it does not meet the target or

falls below the target it “Lags”.

Improvement means that the measure has gotten closer or has met the target over the previous

time of measurement (yearly, quarterly or monthly). If the performance measure improved, the

box will be Green. If the performance measure did not improve, the box will be RED. If the

measure stayed the same it will be Yellow. If it helps, think about a stop light:



Program: Emergency Medical Services

Goal: To provide quality Emergency Medical Services in order to increase the probability of

stabilizing or improving patients conditions

Outcome: The probability that patients suffering cardiac arrest have an increased rate of

survival

Program Department Objective Outcome Initiative Measure 2014

Performance Data Improve=Green

No Change=Yellow

Worse=Red Target Lead or Lag 2013

Emergency

Medical

Services

To provide quality

emergency medical

services in order to

increase the proba-

bility of stabilizing

or improving pa-

tients' conditions

Outcome: The

probability that

patients suffer-

ing cardiac arrest

have an in-

creased rate of

survival

% of Patients

Surviving (Total

Cardiac Arrest;

Drowning, Drug

overdose, Choking

etc)

11% 10% Lead 10%

Sudden Cardiac

Arrest Survival Rate

Utstein Model

(Etiology=Cardiac)

41% 50% Lag 33%

1st Responder Help

*Unit* arrival on

scene (90th

Percentile) to calls

dispatched as

Cardiac Arrest:

0:07:00 Under 4

minutes Lag 0:07:23

% of Cardiac Patients

that receive LUCAS

Device

47% 50% Lag 21%

% of time 1st Re-

sponder Help

*Unit* arrives on

scene under 4:00

Minutes to calls

dispatched as

Cardiac Arrest

39% 50% Lag 33%

EMS System Performance: Performance Measures





Outcome: Improve the response time arrival of medical help to patients in need of service

Program Department

Objective Outcome Initiative Measure 2014


No Change=Yellow


Emergency

Medical

Services

To provide

quality

emergency

medical

services in

order to

increase the

probability of

stabilizing or

improving

patients'

conditions

Outcome:

Improve the

response time

arrival of

medical help to

patients in need

of service

Transport unit arrival

on scene (90th

Percentile):

Customer received

an Ambulance Unit

to arrive onscene in

"X amount of time"

90% of the time

0:14:13

13

Minutes or

Less

Lag 0:14:07

Response time (all

calls) - % of time

Ambulance arrived

on scene from time

of notification

86% 90% Lag 87%

Zone car unit arrival

on scene (90th

Percentile):

Customer received a

Zone Car Unit to

arrive onscene in "X

amount of time"

90% of the time

0:13:29

13

Minutes or

Less

Lag 0:13:17






Outcome: Improve the rate of clinical intervention application to patients in need



No Change=Yellow


Emergency

Medical

Services

To provide quality

emergency medical


increase the

probability of

stabilizing or

improving patients'

conditions

Outcome:

Improve the rate

of clinical

intervention

application to

patients in need

Time from initial

medical contact to

critical clinical

intervention: 12 Lead

(VBGH) (Average):

Cardiac Arrest Patient

11 mins 10 Minutes

or less Lag 16 mins


that receive a 12 Lead

(AHA recommends

75% per quarter. CP,

35 and older, no

trauma)

93% 75% Lead 87%

% of patients over age

35 with suspected

cardiac chest pain

received a 12-Lead

ECG (or cardiac

monitor)

84% 90% Lag 78%


that receive LUCAS

Device

47% 50% Lag 21%






Outcome: Multiple Outcomes (Reference Scorecard for Detail)



No Change=Yellow


Emergency

Medical

Services

To provide quality

emergency medical


increase the

probability of

stabilizing or

improving patients'

conditions

Outcome: Improve

the probability that

patients’

conditions are

stabilized or

improved is

increased

Percent of patients’

conditions that are

stabilized or improved

while in the care of EMS

99% 90% Lead 99%

Outcome: Improve

the probabilistic

survivability rate of

severely injured

trauma patients

On-scene time (90th

percentile) of severely

injured trauma patients

who were transported

from the scene by

ambulance

0:25:39 14 Minutes or

Less Lag 0:28:09

% of severely injured

trauma patients who

were transported from

the scene to a trauma

center

43% 90% Lag 43%

Outcome: Improve

the probabilistic

survivability rate of

suspected stroke

patients

90th Percentile Scene

time for suspected

stroke patients


Less Lag 0:22:42

% of suspected stroke

patients transported

directly to a stroke

center

97% 90% Lead 96%

% of patients with

suspected stroke have

assessment of blood

glucose level

89% 90% Lag 90%

Outcome:

Decrease the prob-

abilistic occurrence

of "call holding"

incidents

Total number of call

holding incidents 671

Less Than

previous Year Lag 477

% of Total Incidents; calls

for service were placed

in call holding

2% Less than 1% Lag 1%



Program: Organizational Sustainability

Goal: To provide a qualified workforce in order to meet the demand for emergency medical ser-

vices from the community

Outcome: The functional and structural capacity of the department is sufficient to meet the de-

mand for emergency medical services.


Program Department

Objective

Outcome

Initiative Measure 2014


No Change=Yellow


Organizational

Sustainability

To provide a

qualified

workforce in

order to meet the

demand for

emergency

medical services

from the

community

Outcome: The

functional and

structural

capacity of the

department is

sufficient to

meet the de-

mand for

emergency

medical

services.

Ambulance Unit Hour Unit

Utilization (UHUU) 35%

No more than

40% Lead 34%

Zone Car Unit Hour Unit

Utilization (UHUU) 36% 45% Lag 35%

Peak Demand:

Ambulance Unit Hour Unit

Utilization (UHUU)*

49% No more than

40% Lag 47%

Peak Demand: Zone Car

Unit Hour Unit Utilization

(UHUU)*

45% 45% Lead 43%

Average Number of

Ambulances Staffed Per

Day

12.4 12 Lead 12.2

Number of Active

Ambulance Certified

Staff

460 395 Lead 493

Percent of ambulance

staffing provided by

volunteers

96% 95% Lead 95%

EMS Demand Per 1,000

of the Population 90.6 No Target N/A 86.7

% of Population

requesting EMS

Services *Per Month

9.1% No Target N/A 8.7%


Program: Organizational Sustainability

Goal: To provide a qualified workforce in order to meet the demand for emergency medical ser-

vices from the community

Outcome: Recruit and retain skilled, diverse workforce


Program Department



No Change=Yellow


Organizational

Sustainability

To provide a

qualified work-

force in order

to meet the

demand for

emergency

medical ser-

vices from the

community

Outcome: Recruit

and retain skilled

and diverse work-

force (Targets are

set by U.S. Census

Demographic %'s

of The City of

Virginia Beach)

% of career

personnel that are

women

34% 50% Lag 34%

% of career

advancements

that are women

25% 50% Lag 0%

% of career new

hires that are

women

100% 50% Lead 80%

% of career

personnel that are

minority

5% 32% Lag 5%

% of career

advancements

that are minority

0% 32% Lag 0%

% of career new

hires that are

minority

0% 32% Lag 22%


Program: Medical Care Intervention

Goal: To provide medical care education, resources and programs to the Virginia Beach com-

munity in order to reduce repeat calls of the same nature and location, and to reduce the proba-

bility of morbidity and mortality.





No Change=Yellow


Medical

Care

Intervention

To provide medical

care education,

resources and

programs to the

Virginia Beach

community in order

to reduce repeat

calls of the same

nature and location,

and to reduce the

probability of

morbidity and

mortality.

Outcome: The

probability that

more patients

receive bystand-

er CPR to im-

prove the chanc-

es of surviving

sudden cardiac

arrest is in-

creased.

% of cardiac arrest

patients witnessed by a

bystander (layperson)

30% No Target N/A 25%

% of cardiac arrest

events where patient

receives bystander CPR

prior to EMS arrival (CA-

Resus attempted with

bystander CPR)

38% 50% Lag 36%

% of sudden cardiac

arrest patients

witnessed by a

bystander (layperson)

who received "Public

Access" AED prior to

EMS arrival

1% More Than Last

Year Lead 0%

% of sudden cardiac

arrest patients who

received AED prior to

EMS arrival (includes

police unit with AED/

First responder with

AED)

26% No Target N/A 25%

90th Percentile Time of

First Defib (From first

CPR to first Defib)


Less Lag 0:23:12


Program: Medical Care Intervention

Goal: To provide medical care education, resources and programs to the Virginia Beach com-

munity in order to reduce repeat calls of the same nature and location, and to reduce the proba-

bility of morbidity and mortality.



Program Department

Objective

Outcome

Initiative Measure 2014


No Change=Yellow


Medical Care

Intervention

To provide

medical care

education,

resources and

programs to the

Virginia Beach

community in

order to reduce

repeat calls of

the same nature

and location, and

to reduce the

probability of

morbidity and

mortality.

Outcome:

Repeat calls

of the same

nature and

location are

reduced.

Percent of EMS calls that

are repeat incidents

(same nature and

location)


Percent of EMS patients

that are repeat patients

(same patient and

location >1)

9% Less than 10% Lead 11%

Outcome:

Calls of FALL

incidents

involving

patients age

60 and older

are reduced

Percent of total calls

dispatched for patients

age 60 and older that

are slip and fall incidents


Percent of calls dis-

patched as a Fall that

are repeat slip and fall

incidents involving

patients age 60 and

older (nature and

location)


Percent of Fall patients

that are repeat patients

age 60 and older (same

patient and location >1)



Program: Special Operations

Goal: To provide EMS services to the community and in support of other City, State or federal

public safety agencies in special situations and events outside of the 911 calls for service that

are required or are deemed necessary by the Department Chief.

Outcome: Adequate emergency medical support is provided during City-sponsored special

events, specialized rescue situations, and force protection to other City, State and federal public


Program Department



No Change=Yellow

Worse=Red Target Lead or

Lag 2013

Special

operations

To provide EMS

services to the

community and in

support of other

City, State or feder-

al public safety

agencies in special

situations and

events outside of

the 911 calls for

service that are

required or are

deemed necessary

by the Department

Chief.

Outcome: Adequate

emergency medical

support is provided

during City-

sponsored special

events,

specialized rescue

situations, and force

protection to other

City, State and feder-

al public agencies.

% of time EMS maintains

11 staffed lifeguard

stands per day at

Sandbridge Beach during

the summer season

100% 100% Lead 100%

% of time the resort area

lifeguard services

contractor meets

contractual obligations

during the contract period

100% 100% Lead 100%

% of time Medical

Friendly Shelter is

equipped and staffed

within 12 hours of

notification

100% 100% Lead 100%

% of time specialty teams

provide ready response to

no-notice events 94% 100% Lag 100%

% of time specialty teams

provide adequate staffing

for planned events 94% 100% Lag 99%


Program: Resource Utilization

Goal: To provide and efficiently manage quality emergency medical resources in order to meet

request for services.

Outcome: Improving the tracking and monitoring of EMS resources to better understand de-

mand for services and allocate resources to meet demand


Program Department


Performance Data

Improve=Green

No Change=Yellow


Resource

Utilization

Goal: To provide

and efficiently

manage quality

emergency

medical resources

in order to meet

request for

services.

Outcome: Improving

the tracking and moni-

toring of EMS re-

sources to better un-

derstand demand for

services and allocate

resources to meet

demand

Total number of EMS

vehicle accidents 38

Less than

Last Year Lag 34

Number of vehicle

accidents per 1,000

EMS calls for service

1

Less than

or Equal to

1 per

1,000

Lead 1

EMS Cost Per Capita

(Expenses-General

Fund)

$230 Less Than

Last Year Lead $232

EMS System Performance: Performance Measures; Response Times Benchmark

The Department of EMS measures response times as the time which elapses from when a EMS

unit is notified, to when that EMS unit arrives onscene. Utilizing the NEMSIS data warehouse (a

national clearing house for EMS data) a performance benchmark can be created comparing Vir-

ginia Beach EMS’s average response times with the average National response time of EMS or-

ganizations across the United States. This benchmark examines both the National and the U.S.

Census Urban Classification (cities, regions classified as an urban geographic area) average re-

sponse times.


0:11:300:12:09

0:11:220:11:55

0:11:02

0:12:47

0:11:38

0:12:470:12:20 0:12:25 0:12:47

0:12:07

0:09:02 0:08:19 0:08:36 0:08:33 0:08:26 0:08:21 0:08:51 0:08:59 0:09:00 0:08:40 0:08:39 0:08:35

0:12:03 0:12:34 0:12:460:11:13 0:10:29

0:12:02 0:11:310:12:52 0:12:14 0:12:20 0:12:57

0:11:52

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

January February March April May June July August September October November December

Response Time Benchmark 2014

National Unit Dispatch-Unit OnsceneAverage NEMSIS (National) Unit Notified-Unit Onscene (all responses)

Average VBEMS Unit Notified-Unit Onscene (all responses)

Average NEMSIS (National: Urban Classification) Unit Notified-Unit Onscene (all responses)

0:09:020:08:19 0:08:36 0:08:33 0:08:26 0:08:21 0:08:51 0:08:59 0:09:00 0:08:40 0:08:39 0:08:35

0:12:03 0:12:34 0:12:46

0:11:130:10:29

0:12:02 0:11:31

0:12:520:12:14 0:12:20

0:12:570:11:52

0:00:00

0:02:53

0:05:46

0:08:38

0:11:31

0:14:24

January February March April May June July August September October November December

Response Time Benchmark 2014 National Urban Classification

Unit Dispatch-Unit Onscene

Average VBEMS Unit Notified-Unit Onscene (all responses)

Average NEMSIS (National: Urban Classification) Unit Notified-Unit Onscene (allresponses)

EMS Community Outreach

Community outreach initiative focuses on 3 primary programs:

Hands Only CPR and AED

Elderly Fall Prevention

Rider Alert

These programs are specifically tailored to provide informational

support to members of the community to ameliorate possible

mortality.

The Hands only CPR and AED program looks to provide training and information to members of

the community in the hopes of better improving hands only CPR and AED use during cardiac

arrest situations. CPR and use of AED during cardiac arrest has been strongly linked to

improved patient outcomes.

Elderly Fall Prevention aims to provide senior living facilities with information and in-person

sessions to educate elderly residents about the ways to reduce trip and fall hazards around their

place of living in addition to exercises to strengthen balance and mobility .

The Rider Alert Program

provides riders of motorcycles

and bicycles identifying

information cards that allow first

responders to identify important

medical and contact information

for those individuals involved in

an accident requiring EMS

services.


This Page Intentionally Left Blank

Virginia Beach Department of EMS: Annual Report 2014

Government & Nonprofit

rescue services

valued services

preventative services

overall quality of life

high quality

ems service

rescue squads

safety of citizens