By Taggart George

– Executive Summary –

Non-emergent ambulance use is a significant problem which affects emergency medical services (EMS) systems across the United States. It is a complex issue which increases health care costs, contributes to the misuse of emergency resources, and is detrimental for responders. A variety of mitigation strategies have been employed to reduce the impact, but many providers are uncertain which measures will be right for their community. The objective of this research is to determine which mitigation strategies are impactful and if certain types of mitigation are a better fit for different types of communities. As these questions are answered, a tool will be created for policymakers to evaluate the requirements and impacts of different mitigation strategies and assist with selecting the mitigation type that will be a good fit for their community.

RESEARCH DESIGN

This thesis conducts a systematic analysis of the research on non-emergent ambulance use to identify mitigation strategies and develops a typology that associates configurations of mitigation types with community characteristics. The analysis draws on configuration theory and task-technology fit (TTF) theory to guide the identification of community characteristics and need.[1] These theories were selected because they explore the relationship between task (potential mitigation strategy) and organizational structure (community type). The resulting typology could inform policymakers’ decisions regarding which mitigation strategies are a best fit for their local jurisdictions.

The output of the analysis is a typology of mitigation strategies that will allow policymakers to determine the specific requirements and impacts of each mitigation type and which type will be the best fit for their jurisdictions.

This research followed an iterative and emergent approach to qualitative analysis, which involved multiple stages to address both research questions. The research comprised four key steps: 1) thematic analysis of existing cases studies to identify and categorize mitigation strategies, 2) analysis of cases by category to identify requirements and outcomes of mitigation strategies, 3) analysis of cases to characterize types of communities, and 4) matching of mitigation strategies and community types.

RESULTS OF ANALYSIS

Four mitigation types were identified: Prevention, Alternative Response, Augmented Response, and EMS Education. All four mitigation types reduce the impact of non-emergent ambulance use, but each has a slightly different effect due to its specific intervention mechanism, desired outcome, and target group. Prevention reduces low acuity calls from frequent EMS users, which in turn reduces EMS responses, non-emergent ambulance transport, and unnecessary emergency room visits. Alternative Response provides specialized response resources for certain types of calls or specific populations, which reduces impact on emergency responders, non-emergent ambulance use, and unnecessary emergency room visits. Augmented Response gives responders additional tools and skills to handle low acuity calls and offer solutions other than ambulance transportation, which reduces non-emergent ambulance use and unnecessary emergency room visits. EMS Education focuses on changing the public’s perception of when to use EMS and reduces the volume of low acuity EMS usage. Each mitigation type utilizes a different intervention, which in turn produces a different effect on non-emergent ambulance use.

Communities were typed using characteristics that affect EMS delivery: EMS capability, ability to implement changes to the EMS system, nature and extent of vulnerable populations, and physical features. (Each of these characteristics includes sub-characteristics.) Representative community types were used to find a best fit for mitigation types. These included “Inner City Downtown,” “Affluent Suburbs,” “Small Town America,” “Suburban Sprawl,” “Master-Planned Community,” and “Midsized City.” Table 1 provides a summary of the fit analysis.

Table 1.           Community Type and Mitigation Type Compatibility

Community Type	Prevention	Alternative Response	Augmented Response	EMS Education
Inner City Downtown	* * *	* * * *	* *	**
Affluent Suburbs	* * * *		* * *	**
Small Town America			* * * *	* *
Suburban Sprawl	* * *	* * *	* *	* * *
Master-Planned Community	* * *		* *	* * * *
Midsized City	* * *	* * *	* * * *	* * *

Key: **** = best match, *** = strong match, ** = good match, * = fair match, blank = not a match

CONCLUSION

The analysis demonstrated that different communities need different mitigation strategies to be successful. The mitigation strategy that will be a best fit for a particular community can be determined by examining the different types of mitigation and their impact, identifying the key community characteristics, and selecting a representative community type that illustrates community structure. With these three pieces of information, an evaluation can be done and the mitigation type that will be a best fit for the community selected.

The thesis includes a tool in Appendix A based on the analysis which will allow community leaders to select mitigation strategies that are successful in reducing the impact of non-emergent ambulance use and a good fit for their community.

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[1] Brent Furneaux, “Task-Technology Fit Theory: A Survey and Synopsis of the Literature,” in Information Systems Theory: Explaining and Predicting Our Digital Society, Vol. 1, ed. Yogesh K. Dwivedi, Michael R. Wade, and Scott L. Schneberger (New York: Springer, 2012), 87–106, https://doi.org/10.1007/978-1-4419-6108-2_5; Alan D. Meyer, Anne S. Tsui, and C. R. Hinings, “Configurational Approaches to Organizational Analysis,” The Academy of Management Journal 36, no. 6 (1993): 1175–95, https://doi.org/10.2307/256809.