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Thursday, March 02, 2006

The Matrix Report

On September 28, 2004, The Matrix Consulting Group presented its findings to the Peoria city council regarding Emergency Medical Services (EMS) in Peoria. The city hired Matrix for $79,000. Currently, Peoria has two EMS responders: the Peoria Fire Department (PFD) and Advanced Medical Transport (AMT) a private, ambulance company co-owned by the three Peoria hospitals. AMT responds to 911 calls, provides three levels of life support: basic, intermediate, and advanced (paramedic), and transports all Peoria patients. The PFD responds to 911 calls and is only permitted to provide basic life support. They are not allowed to transport patients.

Two gentlemen from the California-based firm made a very polished PowerPoint presentation accompanied by an impressive-looking 149 page report. The presentation covered issues ranging from PFD organizational issues to paramedic and transport services provided in Peoria by AMT. Matrix’s primary recommendation, after all was said and done, was for Peoria to make no changes in ambulance service. How and why they arrived at this conclusion remains a mystery. Their report contains evidence that suggests changes to ambulance service could be beneficial to Peorians. Furthermore, data crucial to evaluating EMS and ambulance service is no where to be found in the report.

According to the report, the current EMS system in Peoria is supervised by the Illinois Department of Public Health (IDPH), which maintains a district office in Peoria. When I spoke to a representative from the office, he stated that he was unaware of the contents of the Matrix study and had only general data from AMT. He was unable to answer my specific questions regarding how Peoria pre-hospital patients suffering from chest pain, breathing problems, cardiac arrest, or trauma had done over the last decade.

The Matrix report states that AMT’s performance data was also submitted to the project medical director (the doctor in charge of all EMS and ambulances in central Illinois) who is located at OSF St. Francis Medical Center. When I spoke with the emergency services manager in the EMS office at OSF, she stated they had no aggregate data regarding how AMT performed in 2003 or for any year. How could the project medical director not have this data? Data that normal EMS systems collect would include: successful cardiac resuscitation in the field, survival to hospital admission, survival to hospital discharge, etc. Where is Peoria’s data?

Consistent with my conversations, the Matrix report contains absolutely no data about patient outcomes. The report states that performance data is provided to IDPH and the project medical director, but my conversations with individuals from these offices indicates that this data has not been compiled or analyzed.

The Matrix report continues with a chart depicting the average response time by the PFD and AMT to life-threatening emergencies. The PFD arrival is almost two minutes quicker than AMT. The consultants go on to explain how medical research shows that advanced life support (ALS) may help people with chest pain and breathing problems. Indeed, patients suffering severe trauma incur five percent increased mortality for each minute that they are not transported (remember Princess Diana?) The PFD is not permitted to provide ALS or transport patients. Of the more than 9,000 EMS calls the PFD responded to in 2003, 1,800 were for breathing problems, 900 for chest pain, and 1,700 for trauma. Based on the above, Matrix outlined a plan that would “increase the level of service” by allowing four fire department engines to be staffed with paramedics to respond to “targeted areas” in Peoria. If the PFD could provide ALS, lives would be saved as Matrix notes that “early establishment of intravenous fluids and certainly advanced airway management will be beneficial in certain cases.” The seriously ill or injured patient would no longer have to wait for AMT to arrive for advanced interventions.

Matrix then did a cost analysis of the above and stated that for a “relatively low cost of approximately $100,000 per year . . .the city could move to a four company ALS engine company system.” What Matrix overlooked was the fact that the PFD firefighters who are currently paramedics could provide their expertise for the four engines if only the project medical director would agree. This may be difficult because the medical director’s supervisor at OSF is the corporate medical director at AMT.

The Matrix report states that the PFD recently acquired a transport capable ambulance. They state that since there are no “service gaps” (i.e. AMT is always available) the PFD ambulance is not necessary. Many EMS providers in the Peoria area and families I have spoken with give numerous examples of “service gaps.” Patients and Peoria firefighters have waited precious minutes for AMT to arrive at the scene. AMT has even called the PFD for help when AMT finds themselves overextended responding to emergencies. Matrix notes that AMT maintains the “proprietary nature” of its staffing and financial information and so this information was not contained in the report. Just imagine if the PFD wouldn’t reveal where they were located or their operating budget.

Matrix’s conclusion that there are no gaps in service is incorrect. However, their advice to sell the only existing PFD ambulance may be sound since it sits unused for emergencies. According to the Matrix report, “the PFD has applied to the project medical director for permission to outfit the ambulance with various basic and life support materials and equipment. This request has been, to this point, denied by the medical director. . .”

In conclusion, evidence and healthcare statistics regarding emergency medical services in Peoria are glaringly absent from the Matrix report. Conclusions based on invisible or non published data are opinions and nothing more. If leaders are to make credible decisions about Peoria’s EMS and ambulance services, these judgments must be based on complete, unbiased, accurate data. We should ask the question: why is such critical information so hard to come by?

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