Public Utility Model
Encyclopedia
Public Utility Model is an Emergency Medical Service (EMS) system. In a Public Utility Model system, the government is a "purchaser" of Dispatcher
s, EMT
’s and Paramedic
providers from a EMS provider (contractor). In most cases, this is a private (for-profit) ambulance company. In the ownership of a Public Utility Model, the community retains control of EMS system capital assets and accounts receivable through daily oversight. The EMS provider (contractor) manages the day-to-day operations of the service and provides the system with properly trained providers.
The system is designed whereas the government not only regulates and oversees system performance, but the ambulance service contractor is held accountable to meet or exceed performance requirements. These requirements include, but not limited to, time constraints. Such limits are set to ensure an ambulance arrives to life-threatening emergencies without delay. The contractors failure in fulfilling the contractual obligations can result in fines being imposed, up to and including termination of contract. The agreement and contract between government and contractor are done through a competitive bidding process. This insures that the most cost-effective provision of EMS services is guaranteed. In the Unites States, roughly 5% of all Emergency Medical Services
agencies are Public Utility Model EMS systems.
History=
Around 1983 Jack Stout proposed System Status Management in the Denver City and County EMS system. Soon after, he proposed, or was instrumental in developing Public Utility Models, EMS Performance Contracts, and helped design the very first Computer Aided Dispatch (CAD) system, specific to EMS needs. This gave communities the ability to monitor and measure the performance of their EMS providers (spurring continuous quality improvement and accountability). From this the response time standards were developed that most PUM's use.
, the 9-1-1
public utility model is known as "MedStar". However, the contractor up until 2005 was Rural/Metro. In Richmond, Virginia
, the 9-1-1 public utility model is called the "Richmond Ambulance Authority". Recently, the Richmond Ambulance Authority terminated its contract with American Medical Response and is self-operated. American Medical Response replaced a previous contractor many years ago who lost its bid to provide services under contract to the authority.
Purists will argue, with merit, that a true PUM must encompass all five of these hallmarks. However, many existing PUM operations are a hybrid of a simple third-service EMS organization utilizing one or more of the above listed characteristics in an effort to provide the best advanced life support patient care possible.
SSM enables a public utility model EMS contractor to match resources to demand more accurately than using a more traditional 'static' model of fixed staffing and fixed stations for all hours of the day and days of the week.
"Public utility model EMS." Emerg Med Serv. 2004 Mar;33(3):87-91 (Dean S.) University of Maryland, Baltimore County, Emergency Health Services Department, USA. PMID: 15055076
Dispatcher
Dispatchers are communications personnel responsible for receiving and transmitting pure and reliable messages, tracking vehicles and equipment, and recording other important information...
s, EMT
EMT
EMT may refer to:In education:* European Master's in Translation, a quality label for university programmes in translator trainingIn health and medicine:* Emergency medical technician, a healthcare workerIn music:...
’s and Paramedic
Paramedic
A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...
providers from a EMS provider (contractor). In most cases, this is a private (for-profit) ambulance company. In the ownership of a Public Utility Model, the community retains control of EMS system capital assets and accounts receivable through daily oversight. The EMS provider (contractor) manages the day-to-day operations of the service and provides the system with properly trained providers.
The system is designed whereas the government not only regulates and oversees system performance, but the ambulance service contractor is held accountable to meet or exceed performance requirements. These requirements include, but not limited to, time constraints. Such limits are set to ensure an ambulance arrives to life-threatening emergencies without delay. The contractors failure in fulfilling the contractual obligations can result in fines being imposed, up to and including termination of contract. The agreement and contract between government and contractor are done through a competitive bidding process. This insures that the most cost-effective provision of EMS services is guaranteed. In the Unites States, roughly 5% of all Emergency Medical Services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...
agencies are Public Utility Model EMS systems.
History=
Around 1983 Jack Stout proposed System Status Management in the Denver City and County EMS system. Soon after, he proposed, or was instrumental in developing Public Utility Models, EMS Performance Contracts, and helped design the very first Computer Aided Dispatch (CAD) system, specific to EMS needs. This gave communities the ability to monitor and measure the performance of their EMS providers (spurring continuous quality improvement and accountability). From this the response time standards were developed that most PUM's use.
Public Utility Models In USA
In Fort Worth, TexasFort Worth, Texas
Fort Worth is the 16th-largest city in the United States of America and the fifth-largest city in the state of Texas. Located in North Central Texas, just southeast of the Texas Panhandle, the city is a cultural gateway into the American West and covers nearly in Tarrant, Parker, Denton, and...
, the 9-1-1
9-1-1
9-1-1 is the emergency telephone number for the North American Numbering Plan .It is one of eight N11 codes.The use of this number is for emergency circumstances only, and to use it for any other purpose can be a crime.-History:In the earliest days of telephone technology, prior to the...
public utility model is known as "MedStar". However, the contractor up until 2005 was Rural/Metro. In Richmond, Virginia
Richmond, Virginia
Richmond is the capital of the Commonwealth of Virginia, in the United States. It is an independent city and not part of any county. Richmond is the center of the Richmond Metropolitan Statistical Area and the Greater Richmond area...
, the 9-1-1 public utility model is called the "Richmond Ambulance Authority". Recently, the Richmond Ambulance Authority terminated its contract with American Medical Response and is self-operated. American Medical Response replaced a previous contractor many years ago who lost its bid to provide services under contract to the authority.
Public Utility Model EMS Systems In United States
- EMSA (Oklahoma CityOklahoma cityOklahoma City is the capital and largest city of the U.S. state of Oklahoma.Oklahoma City may also refer to:*Oklahoma City metropolitan area*Downtown Oklahoma City*Uptown Oklahoma City*Oklahoma City bombing*Oklahoma City National Memorial...
& Surrounding, Oklahoma/Tulsa, OklahomaTulsa, OklahomaTulsa is the second-largest city in the state of Oklahoma and 46th-largest city in the United States. With a population of 391,906 as of the 2010 census, it is the principal municipality of the Tulsa Metropolitan Area, a region with 937,478 residents in the MSA and 988,454 in the CSA. Tulsa's...
)http://www.emsaonline.com - REMSA (RenoRenoReno is the fourth most populous city in Nevada, US.Reno may also refer to:-Places:Italy*The Reno River, in Northern ItalyCanada*Reno No...
& Washoe County, NevadaWashoe County, NevadaWashoe County is a county located in the U.S. state of Nevada. The population was 421,407 at the 2010 census. Its county seat is Reno. Washoe County includes the Reno-Sparks metropolitan area.-History:...
)http://www.remsa-cf.com - MEMS (Little RockLittle Rock, ArkansasLittle Rock is the capital and the largest city of the U.S. state of Arkansas. The Metropolitan Statistical Area had a population of 699,757 people in the 2010 census...
& Surrounding, Arkansas)http://www.metroems.com - Sunstar (Pinellas County, FloridaPinellas County, FloridaPinellas County is a county located in the state of Florida. Its county seat is Clearwater, Florida, and its largest city is St. Petersburg. This county is contained entirely within the telephone area code 727, except for some sections of Oldsmar, which have the area code 813...
) http://www.sunstar-ems.com - RAA (Richmond, VA) http://www.raaems.org
- MedStar (Fort WorthFort Worth, TexasFort Worth is the 16th-largest city in the United States of America and the fifth-largest city in the state of Texas. Located in North Central Texas, just southeast of the Texas Panhandle, the city is a cultural gateway into the American West and covers nearly in Tarrant, Parker, Denton, and...
& Surrounding, Texas)http://www.medstar911.org - MEDIC (Charlotte, North CarolinaCharlotte, North CarolinaCharlotte is the largest city in the U.S. state of North Carolina and the seat of Mecklenburg County. In 2010, Charlotte's population according to the US Census Bureau was 731,424, making it the 17th largest city in the United States based on population. The Charlotte metropolitan area had a 2009...
) & (Mecklenburg County, NC) http://www.medic911.com - TRAA (Fort Wayne, IN) http://www.traa-ems.com/Welcome.html
- Rural/Metro of East Tennessee, (Knoxville, TN) http://www.ruralmetrosouth.com/index.php?option=com_content&view=article&id=48&Itemid=107
Distinguishing Characteristics
Public Utility Model EMS systems have certain characteristics which make it different from other emergency medical services delivery models. They are:Oversight
There must be a governmental oversight agency which coordinates the provision of emergency medical services throughout the entire service area. These are usually boards made up of stakeholders in an EMS system (citizens, elected/appointed government officials, physicians, paramedics, nurses, financial gurus, and even consumer advocates)Patient Care
High quality patient care is the number one focus of a public utility model EMS service. Continuous quality improvement is paramount, and every aspect of the EMS delivery process is examined and re-examined exhaustively in a never-ending cycle.Performance-based contracts
Services are provided by contractors who are under "performance-based" agreements. These type of arrangements require results be achieved using the creativity and innovative methods of the providers. There are performance benchmarks established for dispatchers, unit response times.Financial control
Financial controls must be in place where the public utility model oversight authority controls all EMS system funding. A public utility model is designed to be funded through the collection of user fees and not reliance on tax money. While some systems struggle with reimbursement issues, the fact remains that a substantial portion of PUM operating revenues are derived from user fees not tax subsidy.Response Level
Advanced Life Support (ALS) resources are sent to all calls - there may be a tiered response with a local fire department providing BLS first response via an engine or truck company, but the level of transporting care is always ALS and ALWAYS at the paramedic level.Purists will argue, with merit, that a true PUM must encompass all five of these hallmarks. However, many existing PUM operations are a hybrid of a simple third-service EMS organization utilizing one or more of the above listed characteristics in an effort to provide the best advanced life support patient care possible.
System Status Management
System Status Management or (SSM) is the most widely accepted method for managing ambulance/EMS resources in the PUM environment. SSM has two dominant components:Dynamic Deployment
Ambulances are geographically deployed based on projected demand by the time of day and day of week by using historic demand data. This model responds to the fact that as populations move from home to work and back, geographic demand patterns vary. Using SSM, ambulances do not respond from fixed stations, but are "posted" to street corners on an hour to hour basis. The "posts" are selected to provide the best response times for the projected demand at that time of day.Peak Demand Staffing
Shift schedules are designed to provide the number of ambulances needed for the time of day and day of week projected demand. Consequently, in a typical PUM EMS provider system, ambulances typically begin duty every hour from 5:00 a.m. until noon and then the numbers start declining about 5:00 p.m. until midnight. Shift lengths are typically 8, 9, 10, 11, 12 and 24 hours in a large and busy system.SSM enables a public utility model EMS contractor to match resources to demand more accurately than using a more traditional 'static' model of fixed staffing and fixed stations for all hours of the day and days of the week.
External links
Other Reference
Fitch, Joseph J.; Prehospital Care Administration ISBN# 0-8151-3391-X"Public utility model EMS." Emerg Med Serv. 2004 Mar;33(3):87-91 (Dean S.) University of Maryland, Baltimore County, Emergency Health Services Department, USA. PMID: 15055076