With national trends forecasting more demand for emergency medical services (EMS) as the population ages and diminishing revenue sources for local governments, county EMS providers are at a turning point in service delivery. Many local governments plan or already have begun to re-evaluate their service structure and to identify permanent, long-range solutions to such issues as:
• How can our county maximize our emergency medical services with our limited financial resources?
• How can we avoid duplicating services within our county?
• How can we make changes that will be accepted by our workers or volunteers and will bring us into the new century?
In response to these questions, many counties have turned to regional and consolidated EMS models or strategic planning to restructure their services.
The federal-state-local paradigm that has defined 20th century government in America is being replaced by a global-regional-neighborhood model expected to carry government into the 21st century. Traditional jurisdictional boundaries will no longer restrain service delivery to a single city, town, township and county. Governmental units of all sizes are looking to regional models for service delivery.
Service providers at the county level, such as emergency medical, fire and public safety departments, have already identified the need to adapt to the changing environment. Preparing for hazardous material disasters, for example, has been found to be most cost-effective on a regional basis.
Eight counties in Ohio have joined forces to create a unified hazardous materials response team. Similarly, regionalized 911 central dispatch agreements have made providing efficient, cost-effective services to a large region a viable alternative for small counties as well as metropolitan areas, and may well be a solution for many regions across the county.
A regional approach is not always politically feasible or realistic for a county’s EMS, but functional consolidation of city and county services proves to be an efficient and effective alternative to the regional approach. Combined city-county services have provided many tangible benefits that residents and EMS staff can see on a daily basis. Consolidated EMS:
• eliminates duplication
• provides more efficient administration and resource utilization
• improves service to residents (better response times)
• improves ability to handle large incidents
• reduces insurance premiums
• allows for specialization of departments
• creates a better revenue / broader tax base
• provides more opportunities to advance in the larger organization
• standardizes service delivery, and
• provides for the potential to expand services.
Implementing structural change in a police, fire or emergency medical services environment can become a daunting task. The strict discipline, rigid rules and procedures, and hierarchy of these organizations are reinforced by the structure. The nebulous nature of long-range planning is incongruous with the structured environment of EMS.
Strategic planning should be considered as a means for structural change when an organization faces such issues as shrinking revenue, rapid changes in technology or professional practice, daunting expectations for improved performance, and a lack of vision for the future.
Inherent in choosing strategic planning as a vehicle for change is a willingness of the agency or department to include all levels of the organization in the planning process, from the bottom up. As a proactive process, the basis for strategic planning lies in building consensus from everyone, including the front-line workers who will carry out the plan on a daily basis.
Vision is the key to the next millennium. Regardless of whether they are using strategic planning, regionalization, consolidation or other approaches, local governments are stepping up to meet EMS delivery challenges.
(Research News was written by Cynthia Shultz, research assistant.)
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