Response Time

What is response time? It is a term that is widely used in the media (Herald Sun 2010, 2011, 2013) but much misunderstood by those not in the emergency services. Unfortunately this seemingly easy measure is complicated, as many services measure different things and report them as response time. Response time can consist of the sum or parts of the following:

o Time of first call o Call taking o Dispatch/Turnout o Travel time o Arrival on scene

o Arrival at patient (International Association of Firefighters 2002)

An international model which explains the component parts of response time has been published by the National Fire Protection Association, a leading international

codes and standards developer based in Boston, USA. The model provided included target response times for each component.

Figure 13 Response time for EMS as recommended by NFPA 1710 (2010) from Emergency Medical Services: A Guidebook for Fire based Systems

Source: International Association of Firefighters (2002)

Even within Australia, different ambulance services measure different things as part of their response time; some include call taking, whilst others start measuring time from dispatch of responders. There is also no common target used within Australia (Sassella 2005); comparatively, in the USA the National Fire Protection Association produces NFPA 1710, which does outline a timeline for EMS calls.

Response time targets in Australia have no basis in science and are governmental in nature. There is not a definitive EMS response time in the Australian literature although all agree that shorter response times to time critical incidents are desirable. The lack of national targets across Australia is demonstrated by the wide spread of response times. Below are some examples of response time and performance of Code One calls (Emergency, Sirens and Lights):

• Queensland Ambulance Service (2012-2013): Do not have targets but report

performance at 50 percentile and 90 percentile - Metro North (Brisbane): 50 percentile, 8.4 mins. 90 percentile: 16 mins; Metro South (Brisbane): 50 percentile, 8.5 mins. 90 percentile: 15.4 mins. (Queensland Ambulance Service 2013)

• Ambulance Service of NSW (2011-2012): Do not provide any targets and

only report 50 percentile for entire state. The 50 percentile was 10.93 mins. (Ambulance Service of NSW 2013)

• Ambulance Victoria 2011-2012: Do not provide 50 or 90 percentile but

provide percentile against a target of 15 mins. The goal is to achieve this target on 90% of occasions. In metro areas with a population in excess of 7,500 the performance is 87.4% (Ambulance Victoria 2013)

• SA Ambulance Service (2011-2012): Performance is stated to be responding

to 90.6% of life threatening cases in 16 minutes (SA Ambulance Service 2011-2012).

• Metropolitan Ambulance Service, Western Australia: achieved 92% for

Priority One incidents against a target of 15 mins. (St Johns Ambulance WA 2011-2012).

The following figure highlights the problems presented when trying to benchmark ambulance response times across Australia.

Figure 14 Measure of response times for ambulance services in Australia (Response times are counted from different point s in time in different jurisdictions)

Figure 15 Ambulance response times, capital cities, 90th percentile

Source: (Australian Productivity Commission 2017b)

In Victoria, Ambulance Victoria defines response time as the time from a triple zero (000) call being answered and registered by the Emergency Services Telecommunications Authority (ESTA) to the time the first AV resource arrives at the incident scene (Ambulance Victoria 2016b).

The problems of ambulance response times are an ongoing problem in Australia. In 2015 it was reported by the NSW Auditor General that ambulances are arriving at the slowest time in five years, with response times well above the national average: the median response time for urgent calls has risen from 10.8 minutes in 2013-14 to 11.2 minutes in 2014-15, while the national median response time is 9.4 minutes (Wood 2015).

It has been reported that NSW Ambulance Service is taking 20-30 minutes to respond to emergencies when the target is 8.2 minutes. The 2015 Report on Government Services states that Sydney has the worst record for answering 000 calls and the longest response times of any capital city (Miranda & Dunlevy 2015).

As a comparison, in the USA target response times may vary from 4 to 8 minutes (International Association of Fire Chiefs & International Association of Firefighters). The same problems exist in that they all record different things. For example, in Seattle the Fire Department has a response time target to life threatening emergencies of 4 minutes on 90% of occasions (Seattle Fire Department 2012). The

target time does not include call handling or dispatch, which is included in the Victorian figures. A major challenge will be to compare like to like.

The Western Australian Auditor General acknowledges that response times are widely used in Australia and internationally as the main performance measure for Ambulance services, and that the response time target of 90% of Priority One calls within 15 is being met (Auditor General 2013). He also makes the point that this measure does not take into account patient outcomes, a view shared by the CEO of Ambulance Victoria (Sassella 2005). He indicated a need to look at issues such as patient outcome, pain management and patient satisfaction in addition to response times (Sassella 2005). Similar changes were occurring worldwide (McLay & Mayorga 2010; Myers et al. 2008; Turner 2011; Wankhade 2011). Issues such as cardiac survival, pain management and patient satisfaction were common themes across all countries regardless of system delivery method. The Australian Productivity Commission includes patient satisfaction in its current performance measures for Ambulance Services (Australian Productivity Commission 2017b).