Virginia Beach Department of EMS: Annual Report 2014

Annual Report 2014
“Our organization is based upon a belief in neighbor caring for neighbor in their time of need; to
deliver valued services to the community that preserve life, improve health, and promote the
safety of citizens and visitors, who live, learn, work and play in our community “

2014 Highlights
40,937
Calls for EMS service
460
Active Ambulance Certified Volunteers
Per Month (Average)
130
New EMT’s Trained and Graduated
$23,856,182
Dollars Saved Thanks to Volunteers and
Rescue Squads

The City of Virginia Beach
DEPARTMENT OF EMERGENCY MEDICAL SERVICES
OFFICE OF THE EMS CHIEF
757.385.1999
757.425.7864 FAX
71 TITY
THE PINEHURST CENTRE
477 VIKING DRIVE
SUITE 130
VIRGINIA BEACH, VIRGINIA 23452
Dear Mr. Spore:
I am pleased to present you with the Department of Emergency Medical Services’ Annual Report
for calendar year 2014. This report provides the highlights of my staff’s accomplishments in
following with our Departmental vision and goals as we continued with our mission to provide high
quality and timely emergency medical treatment, transportation and rescue services. Our excellent
customer service ratings continue based largely on our compassionate and technically proficient
rescue squad volunteers and a small core of career staff to lead, train, augment and mentor them.
Again this year, we have achieved a number of important milestones with the support of you and
our community even in these difficult economic times. As we continue to strive toward developing
new processes that will lead to delivering sustainable and efficient advanced patient care, rescue
and preventative services. Our volunteers continue to comprise 96% of all ambulance crews.
We continue to embrace the future and the challenges and rewards that we will achieve. I am
honored to continue to lead this talented and caring team of providers and support staff that help
make our City, “A Community For a Lifetime.”
Sincerely,
Bruce W. Edwards
EMS Chief

City of Virginia BeachCity of Virginia BeachCity of Virginia Beach
Executive LeadershipExecutive LeadershipExecutive Leadership
City Council Members
Mayor
William D. Sessoms, Jr.
Vice Mayor
Loius R. Jones
Bob Dyer
Centreville
Shannon DS Kane
Rose Hall
John E. Uhrin
Beach
Barbara M. Henley
Princess Anne
Amelia N. Ross-
Hammond
Kempsville
City Manager
James K. Spore
John D. Moss
At Large
Benjamin Davenport
At Large
Rosemary Wilson
At Large
James L. Wood
Lynnhaven

Our organization is based upon a belief in neighbor caring for neighbor in their time of need. This
belief is supported by the organization’s commitment to the citizens’ open access to the highest
quality of health care services. These organizational values guide our performance and define our
desired organizational culture and quality of life.
Our Mission
The mission of the Department of Emergency Medical Services is to deliver valued services to the
community that preserve life, improve health, and promote the safety of citizens and visitors, who
live, learn, work and play in our community while maintaining sustainable systems approach that
is focused on dynamic resource utilization to enhance the overall quality of life in Virginia Beach.
Our Vision
We are the leader in the emergency medical services field and the community is confident in our
services.

We Value
QUALITY CUSTOMER SERVICE:
Service to customers is the fundamental reason the City of
Virginia Beach Municipal Government and our Department
exists.
• Customers define quality service.
• Members are committed to quality service delivery.
• Service exceeds customer expectations.
• Customer feedback is sought and valued.
TEAMWORK:
Organizational goals are attained when members and customers
work together.
• Team members share opportunity, knowledge and accountability.
• Team members develop mutual trust and respect.
• Team members participate in collaborative decision-making.
• Team members value diversity.
VOLUNTEERISM:
Volunteers are an integral part of the Department and the services we
deliver.
• Volunteers bring resources and manpower to provide essential services.
• Volunteers participate in patient care services and leadership roles.
• Volunteers share opportunities, knowledge and compassion.
LEADERSHIP AND LEARNING:
Learning at every level of the organization creates opportunities for
leadership experience and for members to continuously expand our
capacity to create a quality organization.
• Products, services, and technologies are enhanced through creativity and
innovation.
• An environment is created where members, regardless of our place in the
organization, learn together.
• Members are engaged in new and expansive patterns of thinking.

We Value
INTEGRITY:
Integrity creates the trust essential to Quality Service and long-term per-
sonal and organizational growth.
• Members have the courage to examine personal paradigms about roles and
how excellence is achieved.
• Members are entrusted with the stewardship of public resources.
• Members fulfill commitments to Quality Service by treating customers and
each other fairly.
• Members tell the truth.
COMMITMENT:
Commitment is the necessary mechanism enabling members to
focus our behavior on attaining organizational goals.
• Members have the opportunity to convert jobs from ordinary assign-
ments to extraordinary experiences.
• Members participate in decision-making and accept responsibility for
outcomes.
• Public service professionalism is demonstrated by each member’s
performance, accountability, and work ethic.
INCLUSION AND DIVERSITY:
Members value and respect our similarities and differences
to encourage and fully utilize our human potential, and to
foster a culture of openness, engagement and respect for
all.
• Member diversity helps ensure quality service delivery.
• An inclusive environment allows all members to contribute to
the success of our organization and to express ourselves openly
and with respect.
• Members understand and appreciate varying perspectives, experiences and
cultures.
• Members listen to understand each other.
• Member feedback is sought and valued.

Ten All –Volunteer Rescue Squads Provide
Emergency medical Services Free of Charge
Ocean Park Volunteer Fire and Rescue Unit, Inc.
Rescue 1
Davis Corner Volunteer Fire Department and
Rescue Squad, Inc.
Rescue 2
Chesapeake Beach Volunteer Fire Department
and Rescue Department, Inc.
Rescue 4
Princess Anne Courthouse Volunteer Fire
Department and Rescue Squad, Inc.
Rescue 5
Creeds Volunteer Fire Department and Rescue
Squad, Inc.
Rescue 6
Kempsville Volunteer Rescue Squad, Inc.
Rescue 9
Blackwater Volunteer Rescue Squad, Inc.
Rescue 13
Virginia Beach Volunteer Rescue Squad, Inc.
Rescue 14
Plaza Volunteer Fire Company and Rescue
Squad, Inc.
Rescue 16
Sandbridge Rescue and Fire, Inc.
Rescue 17

Since the mid-1940s, Virginia Beach has been receiving pre-hospital emergency patient care
services (EMS) from independently operated volunteer fire departments and rescue squads.
Princess Anne County saw the arrival of its first ambulance in
1947 and it was primarily utilized for providing emergency care
at the scene of fires. However, its role quickly expanded as the
local citizens began requesting the services of the ambulance
to transport them to area hospitals. On February 12, 1952,
Virginia Beach was designated as a city of the second class
with a population of 42,277 and the first incorporated volunteer
rescue squad was formed. This was the beginning of what is
now the largest volunteer based EMS rescue system among
this nation’s 200 most populous cities.
Beginning in the 1960s, local physicians became aware of the importance of the services provid-
ed by these volunteer rescue squads and interested doctors began volunteering their time to ad-
vise the rescue squads in medical techniques and procedures. A centralized training program in
cardiopulmonary resuscitation (CPR) strengthened the association between the physicians and
the rescue squads.
This advancement trend continued and, in 1972, culminated with the formation of the nation’s
first all-volunteer advanced life support (ALS) program. The Emergency Coronary Care Program
not only enhanced the provision of patient care but also served as the catalyst that catapulted
the rescue squads from an era of simple first aid provision to that of providing sophisticated med-
ical procedures as an EMS system. Medical techniques previously performed only by physicians
and few allied health professionals were successfully performed by specially trained volunteer
rescue squad members known as cardiac technicians. Basic care providers were also enhanced
as emergency medical technician (EMT) training courses were offered in support of these cardi-
ac technicians. The rescue squads began to “practice medicine” within an EMS system closely
associated with physicians, nurses and other health care providers.
History of the Virginia Beach Department of
Emergency Medical Services

During this developmental period, the administrative mechanism that evolved was a central coor-
dinating and training office. To maintain close relationships with the volunteer rescue squads,
the physicians encouraged the formation of a Rescue Squad Captain Advisory Board in
1972. This organization continued to expand and, in 1974, began to receive its direction from
the formally established Rescue Council, an outgrowth of the
original Rescue Squad Captain Advisory Board. In 1975, sup-
port was gained from City government to perpetuate the es-
tablished central administrative and coordinating office.
An ordinance was passed by City Council on April 13, 1981 to protect the interest of the medical
directors and, at the same time, ensure the continuance of the all-volunteer rescue concept
that the City had supported over the years as a cost effective service. Three years later the staff,
medical directors and Rescue Council recommended to the City Manager the establishment of a
revised ordinance that would centralize management of rescue services under a unified organi-
zation. Hence, in 1984, an independent Division of Emergency Medical Services was created.
This Division combined a single medical director and all the volunteer rescue squad members
within one EMS organization headed by a director.
By 1990, the Division had grown in numbers, equipment and
visibility, so, in July of that year, the Division was elevated to the
status of Department by the City Council and specialty rescue
teams were created (Search and Rescue, Bike and others) and the
responsibility of the lifeguard services contract oversight was
assumed.
In early 2000, in partnership with the Fire Department, the Emergency Response System (ERS)
was formed. This initiative was aimed at fully utilizing all of the combined resources of advanced
life support providers in both Departments to provide increased services. In 2004, to further
strengthen response capabilities in the face of the steady rise in the demand for services, 24 ca-
reer paramedics and four brigade chiefs were added to augment the volunteer rescue squads’
efforts. Under the oversight of EMS, over 125 AEDs were deployed on police cars across the
City. Meanwhile, significant investments were made in ongoing volunteer member recruitment
and retention programs.

The ERS enhancements continued in 2005 with the addition of eight more career paramedics. A
Monday-Friday daytime power shift schedule was implemented to place additional personnel on
duty during the busiest times of the week. This was accomplished while absorbing a 6.8% in-
crease in call demand. The EMS system, composed of the volunteer rescue squads, remained
strong with nearly 90% of all ambulance crews being comprised of volunteers.
In 2006 EMS witnessed the completion of the strategic planning
process. In addition, a major leap in recruitment occurred when
the Department partnered with the Virginia Beach Rescue
Squad Foundation on a massive campaign to secure new
volunteer members for the entire service. That year also
launched advancement in coronary care: infarction (STEMI)
ECG’s. The Sentara Princess Anne (SPA) free standing
emergency department opened on the grounds of the future
SPA Hospital in the PA Commons section of the City.
The Partnership with the VBRS Foundation continued into 2007 and the addition of the Rescue
Council Recruitment Trailer complemented these efforts. The first Career EMS Captains were
appointed and the First Landing Fire/EMS Station opened on shore Drive at Great Neck Road. In
2008, EMS Explorer Post #800 was formed through the sup-
port and guidance of Rescue Council. This was the first time
in over (30) years that a junior group affiliated with the EMS
system existed to assist these young members to learn more
community service and lifesaving skills. It also presents the
opportunity to them to join the seniors when they reach age
18. The new Station 8 opened on Bayne Drive and EMS
Headquarters moved from Artic Avenue where it had been for
25 years, to a more central location in the Pinehurst Centre
off Lynnhaven Parkway.
2009 witnessed 32 cardiac arrest survivors, a system record and the results of years of ERS
coordination, protocol upgrades, modality improvements and strong leadership. To continue with
these enhancements and to set new elevated medical standards the Police/EMS Medvac
Helicopter project was launched and transported its first patients and the foundation for the new
hypothermic cooling protocol, the acquisition of replacement and upgraded defibrillators/monitors

And development of the new Electronic Medical Reporting
System were all laid for a 2010 implementation. All of these
projects launched successfully in 2010. The arrival of the
Electronic Medical Reporting (EMR) System in 2010 allowed
EMS providers to enter and transmit information digitally to
hospitals prior to arrival, including patient vitals and cardiac
monitor reports. The successful implementation of this
electronic mobile data technology along with transition to a
wireless IP system for dispatching and mapping, placed The
Department of EMS at the cutting edge of patient care
reporting and provided valuable savings and quality controls to
the City.
Another historic development in 2010 was the City’s direct provision of lifeguard services for the
Sandbridge beaches. Maintaining rigorous USLA standards, the Department hired 41 guards
and eight supervisors for the 2010 summer season and did not have a drowning or receive any
complaints as to their service, increasing service levels and saving taxpayer dollars.
In 2011, the Virginia Beach EMS Marine Rescue Team was awarded the
national Aquatic Rescue Response Team Certification from the United
States Lifesaving Association (USLA). Virginia Beach EMS Marine Rescue
Team/Lifeguard Services was just the second agency to pass the rigorous
process and meet the USLA standards.
Also, in 2011 EMS embarked in a new area, Medically Friendly Shelter
(MFS). The MFS was created to accommodate persons with special needs
during a Category 2 hurricane. Planning, development of the program and
a citywide exercise took place in June. In anticipation of Hurricane Irene the
Medically Friendly Shelter was activated at Salem High School. The activa-
tion was truly a team effort with collaboration of the Health Department, Police Department,
Sherriff's Office, Fire Department, Parks & Recreation, City Manager’s Office and private agen-
cies. The shelter was operational for about 42 hours and accommodated over 120 people.
Year 2013 saw the introduction of the new life saving technology known as the “Lucas” automat-
ed CPR device. This device allows manpower to be used more efficiently and provides proper
chest compression during cardiac arrest cases much more proficiently than provider CPR.

The Lucas™ Chest Compression System is a tool that stand-
ardizes chest compressions in accordance with the latest sci-
entific guidelines. It provides the same quality for all patients
and over time, independent of transport conditions, rescuer fa-
tigue, or variability in the experience level of the caregiver. By
doing this, it frees up rescuers to focus on other life-saving
tasks and creates new rescue opportunities.
2013 also saw the implementation of an extensive training and devel-
opment program developed by VBEMS to train new and existing
members to better leverage new technologies and medical research
to enhance emergency medical services delivery. VBEMS provided
numerous “March Madness” EMS training classes during the month
of March which covered not only protocol updates and changes, but
also covered some needed enhancements and improvements to our
12-lead EKG program and cardiac arrest resuscitation program. This
program was/is meant to improve the overall care that we deliver to
the public that we serve.
Year 2014 kept with The Department of EMS’s continuation to facilitate the implementation of
new technologies and clinical care procedures to improve patient
care; In partnership with the Virginia Beach Fire Department the
Department of Emergency Medical Services (EMS) implemented
a hydrogen cyanide poisoning antidote program for victims of
smoke inhalation; the Department of Emergency Medical Ser-
vices (EMS) purchased twenty (20) automated external defibrilla-
tors (AEDs) for allocation to the Police Department and the Vir-
ginia Department of Health awarded FULL ACCREDITATION to
the City of Virginia Beach Emergency Medical Services (EMS
Training Center through Year 2018.

Ebola Preparedness
The Department of Emergency Medical Services (EMS) in partnership with the Department of
Public Health instituted 911-caller screening and EMS screening for Ebola Virus disease risk fac-
tors. In addition, comprehensive response guidelines and patient protocols were implemented
and staff facilitated a City-wide health and medical preparedness discussion and represented the
City at various local, regional and state meetings.
Swift and Organized Response to Tornado Emergency
The Department of Emergency Medical Services (EMS) responded to an EF-0 tornado at the
Oceanfront July 10th. The storm left behind significant structural damage to homes and com-
mercial buildings and resulted in several people being injured. Within a matter of minutes the
Department of EMS established an Area Command post for medical operations at the Virginia
Beach Volunteer Rescue Squad, set-up a casualty collection point and staffed an additional 10
ambulances.
In addition, the Department of EMS answered a call for mutual aid assistance for reports of sig-
nificant damage and multiple injuries due to a Tornado on the Eastern Shore. The Department
sent six ambulances (staffed with volunteers), a zone car, two mass casualty response trucks
and an EMS supervisor to assist however needed, which included assisting with patient triage
and providing advanced life support level care to the critically injured.
Lifepak 15 Upgrades
Through a 50% reimbursement grant award from the Virginia Office
of EMS the Department of Emergency Medical Services was able
to upgrade 19 cardiac monitors with full 12-lead EKG capabilities.
Over $75,000 of grant funds were applied for and received by the
department in order to offset the costs; these upgrades ensure the
Department’s ability to deliver the highest level of pre-hospital
service in order to ensure a safe community.
March Madness Training Program
In March of 2014 the Department of Emergency Medical Services (EMS) held a system-wide
training event which provided related updates and new information to over 1,000 prehospital pro-
viders. Personnel were instructed on new protocols, reviewed high-performance CPR infor-
mation, trained with the new Cyanokits and reviewed documentation via the electronic medical
records system.
Accomplishments

AEDs Procured for the Virginia Beach Police Department
The Department of Emergency Medical Services (EMS) purchased twenty (20) automated exter-
nal defibrillators (AEDs) for allocation to the Police Department. Funding to purchase these
AEDs was made possible through a Rescue Squad Assistance Fund grant award of $74,000 that
the Department of EMS successfully applied to the Virginia Office of EMS. Police Officers
providing early CPR and defibrillation contribute to the sudden cardiac arrest survival rate in the
City of Virginia Beach, which exceeds the national average.
Cyanokit “Smoke Inhalation” Program Implemented
In partnership with the Virginia Beach Fire Department the Department of Emergency Medical
Services (EMS) implemented a hydrogen cyanide poisoning antidote program for victims of
smoke inhalation. Often times what severely harms and/or kills victims of smoke inhalation is the
hydrogen cyanide that binds to the hemoglobin. The Cyanokit program includes a medicine that
can be administered to these patients in order to inactivate the hydrogen cyanide and facilitate
removal from the body. This program received recognition from the smoke coalition and resulted
in several staff members receiving certificates of appreciation from the Fire Department.
VPHIB Computer Grant
Through the submittal of a successful application, the Department of EMS was able to secure
$57,000 in grant funding from the Virginia Office of EMS in order to replace electronic medical
record hardware. The electronic medical record program utilized by the Department of EMS is
seen as a “model” not only across the Commonwealth but across the United States as
well. Representatives from a myriad of agencies often contact the Department of EMS (and/or
visit) to learn about our electronic medical records program.
Virginia Department of Health Fully Accredits Basic Life Support Training Institute
The Virginia Department of Health awarded FULL ACCREDITATION to the City of Virginia
Beach Emergency Medical Services (EMS) Training Center through Year 2018. The accredita-
tion decision was based upon an extensive review of the self-study document, the visiting team’s
report, and the institution’s responses. This culminated in a significant undertaking that required
a comprehensive review of the Emergency Medical Technician (EMT) program and included the
volunteer rescue squads, volunteer students, staff and faculty. Virginia Beach EMS is the first
and only local government based Basic Life Support (BLS) training program that has achieved
this FULL ACCREDITATION.
Accomplishments

Our Dedicated Volunteer Members
Mr. Charles L. Gurley has been a member with the Department of Emergency
Medical Services in Virginia Beach, VA since November 1, 1979. Mr. Gurley
continues to give 24 hours a month of his time to the EMS Volunteer
Program. In 2010 Mr. Gurley received his 30 years of service pin with the
Department of Emergency Medical Services.
Patricia “Patsy” Rowland has been a member of Plaza Volunteer Rescue
Squad since July 21, 1997 as an Administrative Member. As an Admin
Member she has served in an elected position as Board of Directors
Member-at-Large and Administration Lieutenant. She also served as Vice
Chairperson on the Board of Directors in 2010. In 2011 Patsy received the
honorary award of Hometown Hero during the Neptune Festival.

Act of Service
This individual should have performed and/or conducted “special” event(s) or program(s), which
promoted a positive image of the volunteer rescue system and the Department of Emergency
Medical Services .
Benjamin Dobrin
Tracey Rene McElhenie
Patient Care Provider
Awarded for outstanding dedication and service to the community in providing exceptionally
skilled patient care and exemplifying professionalism as a Department of EMS emergency
healthcare provider as viewed by patients and other service providers .
Nickolas Askew
Outstanding “Specialist/Support” Member of the Year
Any member serving in the capacity of operational or administrative positions that exemplify out-
standing support of the rescue squads through special team services, training, leadership, or ad-
ministrative functions.
Fred Greene
Commending Our Members
Honors and Awards
Each year, the Department of Emergency medical Services honors individuals who exemplify the
best in all the various aspects of service. Because our mission is to provide a continuum of care
that starts at the moment an individual calls 911 and ends at the hospital, this year the department
chose to honor the best of those who support our mission, from start to finish.

30 Years of Service
David Baust
Jeffrey Brennaman
William Coulling
Norman Sterling
Volunteer Years of Service
35 Years of Service
Charles Gurley
John Irish
40 Years of Service
Doris Foster
James Kellam
38 Virginia Beach EMS cardiac arrest patients were discharged from the hospital and reunited
with their families in 2014 which resulted in over 500 Life Saver Awards
“CPR Saves Lives. Learn CPR – It Makes A Difference”
38 Cardiac
Arrest Survivors

Volunteer Years of Service
5 Years of Service
Amber Achesinski
Matthew Armey
Eric Bonney
Sharon Brown
Brian Burke
Teryl Chauncey
John Doub
Katie Dunne
Cheryl Feick
Christopher Florio
Pamela Good
Jason Grimes
Kyle Hanrahan
Daniel Haug
Jonathan Jarbo
Stephen Snell
Rebecca Soules
Brian Stocks
Keith Stolte
Kristen Sundberg
Paula Swartz
Becky Teal
David Jimerson
Michael Leary
Cecil Londeree
Amir Louka
Amy Lutz-Sexton
Dwayne Morris
Melody Osborne
Richard Peters
Sharon Pinto
Dennis Popiela
Crystal Price
Gandolfo Prisinzano
Jacqueline Reith
Alexander Rodriguez
Travis Smith
Erin Thalman
Joseph Tidwell
Thomas Trumbauer
Winifred Tunstall
Justin Urquhart
Lynn Van Auken
Gary Wilks
Mosheh Yishrael
25 Years of
Service
20 Years of
Service
15 Years of
Service
10 Years of
Service
Edward Brazle
Gary Jani
Barbara Moore
Normalee Barclift
Kathleen Budy
Randy Dozier
Denise Henson
Jan James
Trevor Kirk
James Leach
Brian Ledwell
Jennifer Moore
Tiffany Robbins
Donald Washburn
Margaret Zontini
Diana Ball
Erin Britt
James Cromwell
Richard Davis
Fred Greene
Serenity Latham
Douglas
Lighthart
James Moore
Deborah Volzke
Kenneth
Amerman
Nickolas Askew
Ronald Bauman
William Cole
Rita Cwynar
Christopher Daly
Raymond Ford
Jason Frye
Brenda George
Mary Haynes
Tracy Hegglund
Linda Hoffman
Stephanie Louka
David Luca
Amber Mitchell
Susan Palmer
Pamela Pietrzak
Teri Reeder
Patricia Single-
ton
Erik Svejda
Ira Swartz
Daniel Walker
Lawrence Wines
“Your dedication, compassion, and selflessness are greatly admired and appreciated”

Volunteer Rescue Squad Contribution

The Department of Emergency Medical Services is structured in four divisions. The Administra-
tive Division provides leadership, direction and support through the provision of manpower; the
promulgation of policies; the management of financial affairs; the performance of liaison activities
with related agencies; the processing of public inquiries and increasing awareness; the provision
of logistics support, the gathering and analysis of data; the performing of research; and the de-
velopment of programs.
Administrative Division Major Functions:
Administration Division
 Planning and Development
 General Management
 Facilities Management
 Recruitment
 Retention
 Human Resource Management
 STET
 Emergency and Disaster
 Risk Management
 Public Awareness
 Legislative and Political Liaison
 Administrative Support Services
 Media Relations
 Professional Development
 Awards and Recognition

Partnerships:
Programs:
Administration Division
 Planning and
Development
 General Management
 Facilities Management
 Recruitment
 Retention
 Human Resource
Management
 STET
 Emergency and Disaster
Planning
 Risk Management
 Public Awareness
 Legislative and Political
Liaison
 Administrative Support
Services
 Media Relations
 Professional Development
 Awards and Recognition
 Tidewater Community
College BLS and ALS
Recruitment
 Every 15 Minutes Program
with High Schools
 Family Night at the
Aquarium
 Lifesaver Awards
 Annual Awards and
Recognition
 Duty Crew Member
Support
 Promotion and Graduation
Ceremonies
 Santa on the Air
 Class Act Awards
 TEMS Annual Awards and
Family Picnic
 Keeping the Best
Recruitment and Retention
 Stork Awards
 Minority Expos and Career
Opportunities
 Civic League
Communications
 File of Life
 Member Communications
 Volunteer Hampton
Roads.com and Volunteer
Match.com
 Social Networking
 Best Practices
 Medical friendly Shelter
 Capital Improvement Plan

Prospective Volunteer Orientation Data: Year
775
893 921
750
714
0
100
200
300
400
500
600
700
800
900
1000
2010 2011 2012 2013 2014
#ofindividuals
# Prospective Volunteer
OrientationAttendance:Year
# Individuals that attended orientation
47%
15%
3%
-19%
-5%
-60%
-40%
-20%
0%
20%
40%
60%
0
100
200
300
400
500
600
700
800
900
1000
2010 2011 2012 2013 2014
%Change
#individuals
% Change Prospective Volunteer
OrientationAttendance:Year
Yellow Bar= % Increase Black Bar=% Decrease
The Department of EMS has seen a continual drop in the number of prospective volunteers in
the past two years of annual observations. . Prospective volunteers may simply be returning to
normalized levels as observed in years prior to the “Great Recession”.

Prospective Volunteer Orientation Data: Quarter
The Department of EMS had a drop in the number of prospective volunteers in the first two
quarters of the year, but then saw increases in the last two quarters of the year. These
increases did not offset the decreases that occurred however.
0
50
100
150
200
250
300
1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
#ofindividuals
OrientationAttendance:Quarter
# Individuals that attended orientation
2010 2011 2012 2013 2014
-14% -14%
4%
14%
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
0
50
100
150
200
250
%Change
#ofindividuals
OrientationAttendance:Quarter(2013-2014)
Yellow Bar= % Increase Black Bar=% Decrease
2013 2014 % Change 2013-2014

Prospective Volunteer Orientation Data: Month
The number of prospective volunteer orientation attendance illustrates a degree of seasonality;
there are seasonal fluctuations in the data during the year. Overall, attendance was down but
some months did exhibit relative increases in attendance.
0
20
40
60
80
100
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
#Individuals
OrientationAttendance:Month
2013 2014
-25% -24%
22%
-25%
2%
-15%
6%
15%
-6%
17%
-4%
65%
-80%
-60%
-40%
-20%
0%
20%
40%
60%
80%
0
20
40
60
80
100
%Change
#Individuals
OrientationAttendance:Month
Yellow Bar= % Increase Black Bar= % Decrease
% Change 2013-2014 2013 2014

Approved Volunteer Applicants Data: Year
The number of approved volunteer applications illustrates a degree of a negative downward
linear trend. Approved volunteer applications have experienced two consecutive annual years of
decline.
332 336
362
308
259
0
50
100
150
200
250
300
350
400
2010 2011 2012 2013 2014
#ApprovedApplications
# ApprovedApplications
Year Total: 2007-2014
Year Total Linear (Year Total)
36%
1%
8%
-15% -16%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
0
50
100
150
200
250
300
350
400
2010 2011 2012 2013 2014
%Change
% Change ApprovedApplications
Yellow Bar=% Increase BlackBar=% Decrease

Approved Volunteer Applicants Data: Quarter
The number of approved volunteer applications experienced a decline each observed quarter in
comparison to the previous year.
-9%
-13%
-29%
-9%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
0
20
40
60
80
100
%Change
Per Quarter:2013-2014
Yellow Bar=% Increase Black Bar=% Decrease
2013 2014
0
20
40
60
80
100
120
Per Quarter:2010-2014
2010 2011 2012 2013 2014

Approved Volunteer Applicants Data: Month
The number of approved volunteer applications data illustrates a degree of seasonality; the
overall trend for the year was a decline in the number of approved applications, though some
months did report increases over the prior year.
0
10
20
30
40
50
Per Month:2013-2014
2013 2014
-61%
38%
19%
-5%
-38%
17%
-8%
-40%
-28%
13%
-9%
-21%
-80%
-60%
-40%
-20%
0%
20%
40%
60%
80%
0
10
20
30
40
50
%Change
Per Month:2013-2014
# Approved Applications 2013 # Approved Applications 2014

New Attendant In Charge (AIC) Data: Year
AIC stands for Attendant In Charge; this is an individual that is ambulance certified EMT-B and
higher and has passed State approved certification, training requisites and has been approved
to provide emergency care services. The overall trend is flat, with the prior two years reporting
declines in the number of new AICs released.
131
169
190
149
139
0
50
100
150
200
2010 2011 2012 2013 2014
#AIC
# NewAICRelease
Year Totals Linear (Year Totals)
46%
29%
12%
-22%
-7%
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
30%
40%
50%
0
20
40
60
80
100
120
140
160
180
200
2010 2011 2012 2013 2014
%Change
#AIC
% Change NewAIC Release

New Attendant In Charge (AIC) Data: Quarter
The number of new released AICs experienced an overall rate of decline, but did show an
increase in the 1st quarter of the year.
0
10
20
30
40
50
60
70
#AIC
# NewAICRelease PerQuarter:2007-2014
2010 2011 2012 2013 2014
72%
-18%
-35%
-4%
-80%
-60%
-40%
-20%
0%
20%
40%
60%
80%
0
10
20
30
40
50
60
%Change
#AIC
% Change NewAIC Release Per Quarter:2013-
2014
2013 2014

New Attendant In Charge (AIC) Data: Month
The number of new released AICs experienced an overall rate of decline, but did experience a
few months with increases over the prior year. *Please note the large % increases are a result
of the relatively small figures in the data. Example: February shows 160% increase which
equals 8 new AICs over the previous year.
15
5 5
19
15
6
16
20
21
12
7
8
21
13
9
10
9
14 14 14
9 9
7
10
0
5
10
15
20
25
#AIC
# NewAIC Release PerMonth:2013-2014
2013 2014
40%
160%
80%
-47% -40%
133%
-13%
-30%
-57%
-25%
0%
25%
-200%
-150%
-100%
-50%
0%
50%
100%
150%
200%
0
5
10
15
20
25
%Change
#AIC
% Change NewAIC Release Per Month:
2013-2014
2013 2014

Active Qualified *Volunteers Data: Year
The number of qualified members is the total number of volunteers that are ambulance
certified; they are released, State certified and able to perform emergency medical services.
The overall trend is positive, though there was a light decrease in the prior year and flat in year
2013.
449 452
548 550 542
0
100
200
300
400
500
600
2010 2011 2012 2013 2014
#Members
# AverageTotal QualifiedMembers
Year:2010-2014
Average Linear (Average)
13%
1%
21%
0%
-2%
-25%
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
0
100
200
300
400
500
600
2010 2011 2012 2013 2014
%Change
#Members
% Change Average Total Qualified Members
Year:2010-2014
Yellow Bar= %Increase Black Bar= %Decrease
*Volunteers are referred to as Members by VBEMS; volunteers are members to individual Rescue Squads .

Active Qualified *Volunteers Data: Month
The number of qualified members saw some minor rates of decline over the months of
observation in comparison to the prior year, there were three months in which increases were
reported. However, there was a decline overall.
*Volunteers are referred to as Members by VBEMS; volunteers are members to individual Rescue Squads .
0
100
200
300
400
500
600
#Members
# AverageTotal QualifiedMembers
Per Month:2013-2014
2013 2014
9%
-1% -2%
-1%
3%
-3%
1%
-1%
-4%
-6% -6% -6%
-10%
-5%
0%
5%
10%
0
100
200
300
400
500
600
%Change
#Members
% Change Average Total QualifiedMembers
Per Month:2013-2014
2013 2014

Volunteers Research: Volunteer Survey
Survey enabled VBEMS to gain insight
and valuable feedback from our
volunteer members to provide
leadership personnel with information
to help identify how to make
improvements to the volunteer EMS
system, enhance volunteer satisfaction,
increase recruitment, grow retention
and find new ways to improve overall
service delivery to the residents and
visitors of the City of Virginia Beach.
Future surveys are in development to
further examine and evaluate.

Volunteers dedicate a minimum of 48 hours (four 12 hours shifts) per individual month. When
that time is worked is variable and can change. As such, the majority share of VBEMS’s ambu-
lance certified personnel would be classified as part time personnel by human resources calcula-
tions. This is a caveat to keep in consideration when examining VBEMS resources pertaining to
ambulance certified personnel.
There was a spike in the number of ambulance certified individuals following the recession of
2008. Following 2007 up till 2010 there was an increase in the number of individuals that provid-
ed their time as a volunteer for EMS service. Four years following the onset of the recession, the
number of ambulance volunteer personnel seems to be returning to the previous levels observed
during pre-recession years. The “Great Recession” began in December of 2007 and was
declared over in the Summer of 2009.
Volunteers Research: Are they declining?
3.2%
4.2%
7.1% 7.5% 7.1%
6.5%
6.0%
5.0%
0%
2%
4%
6%
8%
10%
2007 2008 2009 2010 2011 2012 2013 2014
%Unemployment
Annual Unemployment Rate
City of VirginiaBeach
VirginiaBeac-Norfolk-Newport News, VA-NC Metropolitan Statistical Area
Recession Unemployment rate
481 471 528
775
893 921
750 714
3.2%
4.2%
7.1% 7.5% 7.1%
6.5%
6.0%
5.0%
0
200
400
600
800
1000
0%
2%
4%
6%
8%
10%
2007 2008 2009 2010 2011 2012 2013 2014
#ProspectiveVolunteers
%Unemployment
Annual Unemployment Rate &
Prospective Volunteers
VirginiaBeac-Norfolk-Newport News, VA-NC Metropolitan Statistical Area
Prospective Volunteers Unemployment rate

Statistical test indicates that 41% of the change in the number of volunteers may probabilistic be
explained by the unemployment rate; in other words, as the unemployment rate increased it may
have accounted for 41% of the change seen in the number of prospective volunteers (vice versa
for unemployment rate decreases). As the unemployment rate improves (declines) there is a
probabilistic rate of occurrence that the number of prospective volunteers may decline; just as
the unemployment rate increases the number of prospective volunteers may increase as the
data observations illustrate in prior years.
National and International news along with validated existing research identified that the impacts
of the great recession hindered monetary contributions to non-profit and volunteer organizations,
but inverse of that decline, the number of individuals and the amount of time people gave to
volunteer exponentially increased between years 2009-2010. According to a report put out by the
National Park Service, the number of laid off or furloughed individuals reduced monetary giving
capacity to volunteer organizations but did create an increase in “donated time” to organizations.
They may be cash-poor, but are now time-rich. Also, some underemployed want to be able to
show productive volunteer work experience on their resumes and job applications to be more
competitive in applying for jobs. The Corporation for National and Community Service conducted
a study and found empirical evidence that volunteering experience can increase employment.
As the unemployment rate begins to decrease along with positive economic indicators identifying
the U.S. economy is improving, this in turn decreases the level of unemployed individuals and
the number of hours individuals have available to dedicate to volunteer based activities.
0
200
400
600
800
1000
0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% 7.0% 8.0%
#ofProspectiveVolunteers
Unemployment Rate
RegressionStatistical Test:
Unemployment Rate andProspective Volunteers
RegressionStatistics
R Square=0.41
Signifigance F=0.08
41% of the change innumberof
prospective volunteers may
probabalistic be explainedby
the unemployment rate
8% chance results occuredas a
result of random chance

Of the reasons given by volunteers that leave EMS, the reasons which comprise ≥10% of drops
are in relation to reduce availability to donate their time to service. Moving, comprises the largest
% share of drop reasons followed by indication of job commitments to their employer.
0% 1% 1% 2%
4% 4%
8%
10% 11% 12%
14%
16% 17%
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
20%
ReasonVolunteersLeaving EMS % of Total Drops
2010-2013 (Average)
*Red Bar= ≥10%

While demand for EMS services continues to increase, volunteer ambulance personnel is
retreating inversely of demand increases; in other words, demand is going up as personnel to
meet demand is decreasing.
Though prospective EMS volunteers are decreasing, the number of retained qualified ambulance
volunteers has remained relatively strong comparatively; however, as demand increases and
volunteer rates remain flat, this will further exacerbate strain on current volunteers as they will be
expected to provide more to meet increasing call demand for EMS services.
35,607 36,239 37,028 37,718 36,291 39,130 38,980 40,937
481 471
528
775
893 921
750 714
0
100
200
300
400
500
600
700
800
900
1,000
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2007 2008 2009 2010 2011 2012 2013 2014
#ProspectiveVolunteers
#EMSDemand
EMS Demand and EMS Prospective Volunteers
EMS Demand Prospective Volunteers
35,607 36,239 37,028 37,718 36,291 39,130 38,980 40,937
330 347
396
449 452
548 550 542
0
100
200
300
400
500
600
-
10,000
20,000
30,000
40,000
50,000
2007 2008 2009 2010 2011 2012 2013 2014
#AmbulanceVolunteers
EMSDemand
EMS Demand and EMS Ambulance Volunteers
EMS Demand Qualified Members (Ambulance Certified)

The Operations Division contains the major components of the department which include the Vol-
unteer rescue Squads, Special Operations and supplemental first responder services provided by
the Fire and Police Departments.
Emergency Medical Response: To provide for the rapid response to an proper provision of basic
and advanced patient care services to the general public to reduce patient morbidity and mortality.
 Basic Life Support Program
 Advanced Life Support Program
 Supplemental Response Program
Special Rescue response: To provide for the rapid response to and proper provision of
specialized rescue services to supplement basic and advanced services in the delivery of
emergency medical care and rescue to the general public to reduce patient suffering, morbidity and
mortality.
 Squad Truck team
 Volunteer Duty Field Supervisor Team
 Marine Rescue Team
 Search and Rescue Team
 Bike Medic Team
 SWAT Tactical Medical and Rescue Response
Anti-Terrorism and Disaster Preparedness: To provide for a special response in extra ordinary
emergency medical and rescue situations in which greater coordination and resources are needed
to assist basic and advanced providers in the delivery of emergency medical and rescue services.
 Mass Casualty Operations
 Disaster Operations
 Anti-Terrorist Incident Response
Operations Division

The Lifeguard services Division is organized to provide a safe environment for thousands of peo-
ple who utilize all Virginia Beach area resort beaches utilizing contractual and career Department
of EMS Lifeguards; the Lifeguard Services Division supervises the provision of all lifeguard ser-
vices for the entire Resort and Sandbridge Resort Beaches.
As an United States Lifeguard Association Certified Open water Rescue Agency, the Virginia
Beach EMS Lifeguard Services Division performs the functions of beach safety, through compre-
hensive training and coordinated rescue operations by providing lifeguard services for such are-
as as Sandbridge beach Little Island Park beaches, and other areas of the city.
Our mission is accomplished by maintaining a staff of
highly trained seasonal professional lifeguards who are in
top physical condition and possess great skill in medical
lifesaving techniques and equipment. Such equipment
includes our departments Marine Rescue Team, with all-
terrain vehicles, 4-wheel drive vehicles, Personal Water-
crafts with rescue sleds, rapid response boats, Advanced
Life-Support units staffed by medic/lifeguard teams,
AirMed (EMS Medavac helicopter), and a variety of spe-
cialized ocean rescue equipment. This equipment and
training keeps us on the cutting edge of professionalism.
(Note: A private contractor provides such services to the
resort beach area.)
The Lifeguard services Division also hosts and participates in
special events and competitions throughout the year. Virginia
Beach EMS is recognized as a leader in lifesaving throughout
the country with our continued commitment to excel in our pro-
fession and provide excellent service for all individuals who
recreate along our beaches. In addition, the division will em-
phasize teaching the public about the ocean environment
through public education, lifesaving seminars and the Kid Safe
Program.
Lifeguard Division

Response Times 90th Percentile
The Department of EMS measures response times as the time which elapses from when a EMS
unit is notified, to when that EMS unit arrives onscene. 90th Percentile measures the amount of
time which occurs 90% of the time and is considered a more statistically accurate measure of
response time.
Operations Data: Response Times
4%
-6%
-5%
-2%
1%
0:15:23 0:16:04
0:15:07 0:14:26 0:14:07 0:14:13
-10%
-5%
0%
5%
10%
0:00:00
0:02:53
0:05:46
0:08:38
0:11:31
0:14:24
0:17:17
0:20:10
2009 2010 2011 2012 2013 2014
%Change
90thResponseTime
EMS Ambulance Units 90th Percentile Response Time
Unit Dispatch to Onscene
*Bars= % Change; Yellow Bar=%Increase Black Bar=%Decrease
6%
-3%
-6%
-1%
1%
0:13:56
0:14:45 0:14:19
0:13:31 0:13:19 0:13:29
-10%
-5%
0%
5%
10%
0:00:00
0:02:53
0:05:46
0:08:38
0:11:31
0:14:24
0:17:17
0:20:10
2009 2010 2011 2012 2013 2014
%Change
90thResponseTime
EMS Zone Car Units 90th Percentile Response Time
Unit Disptach to Unit Onscene
*Bars=%Change; Yellow Bar=%Increase Black Bar=%Decrease

The Department of EMS has been able to continually increase the average daily staffed number
of staffed ambulance units; this is in large part thanks to the Departments Volunteer members.
Operations Data: Staffed Ambulances
10.7
11.9
12.6 12.6 12.7
0
2
4
6
8
10
12
14
2010 2011 2012 2013 2014
#AmbulancesStaffed
Average #StaffedAmbulances
Year 2010-2014
Average # Staffed Ambulances Linear (Average # Staffed Ambulances)
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
90% 93% 96% 96% 95%
10% 8% 4% 4% 5%
%AmbulancesStaffed
% of Ambulances Staffedby Volunteers
Year 2010-2014
% of Ambulances Staffed By Volunteers % of Ambulances Staffed By Career

Operations Data: EMS Call Demand
37,718 36,291
39,130 38,980 40,937
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
2010 2011 2012 2013 2014
#ofcallsforservice
Year
Call Demand for EMS Services:Year
# of calls for service (Demand) Linear (# ofcalls for service (Demand))
2%
-4%
8%
0%
5%
-25%
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
25%
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
2010 2011 2012 2013 2014
#Callsforservice
% Change in EMS Call Demand
Yellow Bar=%Increase Black Bar=%Decrease
% Change # of calls for service (demand)
EMS call demand continues along a positive linear trend; the most recent year saw an overall
increase in call demand by 5% after the prior year (2013) saw 0% change in demand for EMS
services. This calculation takes into account only calls in which an ambulance or paramedic
zone car unit responds to an EMS call for service.

EMS call demand continues along a positive linear trend; every quarter observed in 2014 saw a
% increase in demand with the exception of 1st Quarter. This calculation takes into account
only calls in which an ambulance or paramedic zone car unit responds to an EMS call for
service.
9,496
9,806
10,325
9,353
9,498
10,526
10,861
10,052
-
2,000
4,000
6,000
8,000
10,000
12,000
Q1 (January-March) Q2 (April-June) Q3 (July-September) Q4 (October-December)
#ofCalls
# of Calls for EMS Service Per Quarter
Years 2011-2013
2013 2014
0%
7%
5%
7%
-10%
-5%
0%
5%
10%
-
2,000
4,000
6,000
8,000
10,000
12,000
Q1 (January-March) Q2 (April-June) Q3 (July-September) Q4 (October-December)
%change
#ofcalls
# of Calls for EMS Service Per Quarter:% Change in Demand
Years 2013-2014
2013 2014

EMS call demand continues along a positive linear trend; every month observed in 2014 saw a %
increase in demand with the exception of January. January of 2013 experienced an abnormal
spike, this may explain why demand for the month was comparatively down. This calculation takes
into account only calls in which an ambulance or paramedic zone car unit responds to an EMS call
for service.
-
1,000
2,000
3,000
4,000
5,000
3,312
2,851
3,335 3,339
3,547 3,640 3,776 3,638
3,447 3,421
3,156
3,475
#ofCalls
# of EMS Calls for Service Per Month
Year 2014
-4.4%
3.2%
2.0%
4.0%
7.1%
10.9%
6.3%
4.5% 4.7%
5.9%
1.9%
14.8%
-10%
-5%
0%
5%
10%
15%
20%
0
1000
2000
3000
4000
5000
%change
#ofcalls
# of EMS Calls for Service Per Month: % Change in Demand
Years 2013-2014
2013 2014

EMS call demand continues along a positive linear trend; every day of the week observed in 2014
saw a % increase in demand. This calculation takes into account only calls in which an ambulance
or paramedic zone car unit responds to an EMS call for service.
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
5,650 5,868 5,898 5,800 5,869 5,893 5,959
#ofCalls
# of EMS Calls for Service By Day of Week
Year 2014
5%
7%
3%
7%
3%
6% 6%
-25%
-15%
-5%
5%
15%
25%
-
1,000
2,000
3,000
4,000
5,000
6,000
7,000
Sunday Monday Tuesday Wednesday Thursday Friday Saturday
%Change
#ofCalls
# of EMS Calls for Service By Day of Week:% Change
Year 2013-2014
2013 2014

EMS call demand continues along a positive linear trend; every hour of day observed in 2014 saw
a % increase in demand; with the exception of 3:00am, 4:00am (decreased) and 9:00pm
(remained unchanged). This calculation takes into account only calls in which an ambulance or
paramedic zone car unit responds to an EMS call for service.
-
500
1,000
1,500
2,000
2,500
3,000
3,500
0:00:00
1:00:00
2:00:00
3:00:00
4:00:00
5:00:00
6:00:00
7:00:00
8:00:00
9:00:00
10:00:00
11:00:00
12:00:00
13:00:00
14:00:00
15:00:00
16:00:00
17:00:00
18:00:00
19:00:00
20:00:00
21:00:00
22:00:00
23:00:00
1,255
1,161
1,078
856
788
807
1,038
1,334
1,724
2,128
2,241
2,407
2,397
2,271
2,245
2,087
2,284
2,246
2,115
1,953
1,905
1,711
1,552
1,354
#ofCalls
# of EMSCalls for Service Per Hour ofDay
Year 2014
*00:00:00=12am & 23:00:00=11pm (24 Hour Period)
8%
3% 3%
-1%-1%
11%
13%
6%
3%
6%
4%
7%
9%
4%
6%
1%
10%
3%
7%
1%
4%
0%
7%
4%
-20%
-15%
-10%
-5%
0%
5%
10%
15%
20%
-
500
1,000
1,500
2,000
2,500
3,000
0:00:00
1:00:00
2:00:00
3:00:00
4:00:00
5:00:00
6:00:00
7:00:00
8:00:00
9:00:00
10:00:00
11:00:00
12:00:00
13:00:00
14:00:00
15:00:00
16:00:00
17:00:00
18:00:00
19:00:00
20:00:00
21:00:00
22:00:00
23:00:00
%change
#ofcalls
# of EMS Calls for Service Per Hour of Day
% Change Year 2013-2014
*00:00:00=12am & 23:00:00=11pm (24Hour Period)
2013 2014

Operations Data: Demand and Population
EMS call demand continues along a positive linear trend along with population changes. EMS
demand has continued to increase at a rate greater than that of population. Population is based
on U.S. Census 1 Year Estimates.
437,994 441,246 447,489 449,628 451,672
37,718
36,291
39,130 38,980
40,937
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
400,000
450,000
500,000
2010 2011 2012 2013 2014
EMSDemand
TotalPopulation
Demand for EMS Service andCity of VirginiaBeachPopulation
Population # of calls for service (demand)
-8%
-6%
-4%
-2%
0%
2%
4%
6%
8%
2010 2011 2012 2013 2014
0.2% 0.7% 1.4% 0.5% 0.5%
2%
-4%
8%
0%
5%
% Change in Population& % Change in Demand for EMS Service
% Change-Population % Change-Demand

Operations Data: Demand and Population
EMS call demand per 1,000 of the population and as a % share of the total population continues
to increase along a positive linear trend. Simply put, a larger share of the population is
requesting EMS based services. Population is based on U.S. Census 1 Year Estimates.
86.1
82.2
87.4
86.7
90.6
78
80
82
84
86
88
90
92
2010 2011 2012 2013 2014
EMSDemandPer1,000People
EMS Demand Per 1,000 of Total population
Demand Per 1,000 of Total population Linear (Demand Per1,000 of Total population)

Operations Data: Type of Service Demand
EMS call demand resulting in either medical treatment and/or transport has increased along a
positive linear trend; the % share of EMS calls requiring medical services have continued to
increase making up a larger share of call demand. The patients receiving care are aging as well
along with population changes. Simply put, a larger share of request for EMS based services is
resulting in medical care being provided (Transport ALS/BLS, Treated and Transferred Care,
Patient Refused Transport Only).
0%
50%
100%
2011 2012 2013 2014
24% 20% 14% 12%
76% 80% 86% 88%
%ofEMSCalls
% of EMS Calls Requiring Medical Services
Years 2011-2014
% of EMS Calls Not Resulting in Medical Services Provided % of EMS Calls Resulting in Medical Services Provided
55 55 57 58
34.9 34.9 35.0 35.0
0
10
20
30
40
50
60
70
2011 2012 2013 2014
AgeofPatients/Population
Age of Patients ProvidedCare&Transport
Years 2011-2014
Median Age of Patients Provided Care Median Age of Population
Linear (Median Age of Patients Provided Care)
*2014 Median Age of Population is a forecast value based on prior years

EMS call demand resulting in either medical transport has increased along a positive linear trend;
the % share of EMS calls requiring medical transport have continued to increase making up a
larger share of call demand. Interestingly, ALS transports are making up a larger share of
transports in comparison to BLS. Simply put, a larger share of request for EMS based services is
resulting in patients being transported to the hospital (Transport ALS/BLS).
32% 33% 36% 37%
47% 48% 47% 47%
21% 19% 17% 16%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2011 2012 2013 2014
%EMSDemand
ALS & BLS Transports as % of Total EMS Demand
ALS Transports as % of EMS Calls BLS Transports as % of EMS Calls Remainder of Calls as % ofEMS Calls
0%
50%
100%
2011 2012 2013 2014
21% 19% 17% 16%
79% 81% 83% 84%
%ofEMSDemand
Transports as % of EMSDemand
Year:2011-2014Remainder as % of EMSCalls Transports as % of EMS Calls

BLS transports continue to make up the majority share of medical transports, however, ALS
transports continue to increase. The % share of patients receiving medical transports continued to
be consumed by older patients 60 and older; patients age 60 and older make up 48% of the total
medical transport services delivered in year 2014.ALS: Advanced Life Support; a set of life saving
protocols and skills that extend Basic Life Support. BLS: Basic Life Support; medical care which is
used until full medical care can be given (i.e. hospital if needed).
98%
2%
2014 Incidents By Priority
Priority 1 or 2 Priority 3
Priority 1: Urgent/Life Threatening
Priority 2: Serious/PotentiallyLife
ALS,
44%BLS,
56%
2014 Transport Response
ALS BLS
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
<5-14 15-34 35-59 60+
1,239
5,788
8,938
14,676
Patient Age Groups
2014 Transports By Age
4%
19%
29%
48%
2014 % of Total Transports By
Patient Age
<5-14 15-34 35-59 60+

-3%
-1%
2%
4%
-6%
-4%
-2%
0%
2%
4%
6%
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
<5-14 15-34 35-59 60+
%Change
#EMSTransports
Patient Age Group
% Change in EMS Transports by Age Group
Year 2013-2014
# Transports (2013) # Transports (2014)
The % share of EMS medical transports that are provided continually are dedicated to the portion
of the population age 60 and older. The number of transport medical services provided to pa-
tients age 60 and older increased by 4% over the prior year.

The Training Division serves the various basic and advanced certification and recertification
needs of EMS, volunteer rescue squad and Fire Department patient care providers. In addition,
as a designated American Heart Association Community Training Center, EMS meets the cardi-
opulmonary resuscitation certification and recertification needs for members of the Virginia
Beach Police Department, strategically located AED response teams and the general public.
Training Division Major Functions:
Training Division
 Basic Life Support
Education
 Cardio Pulmonary
Resuscitation (CPR) and
Automated External
Defibrillation ( AED)
Training and Certification
 Emergency Medical
Technician (EMT)
Education and Certification
 Clinical Education
 Continuing Education
 Advanced Life Support
Education
 Advanced Cardiac Life
Support (ACLS) Training
and Certification
 Pediatric Advanced Life
Support (PALS) Training
and Certification
 Difficult Airway and Rapid
Sequence Induction (RSI)
Training
 Specialized Technical
Education and Training
 CPR, PALS and ACLS
Instructor Education and
Certification
 Emergency Vehicle
Operator Course (EVOC)
Training & Certification
 OSHA Training Online
 Rescue Training
 Mass Casualty Training
 Dispatcher Emergency
Medical Dispatch (EMD)
Training

CPR – Cardio Pulmonary Resuscitation
This course is designed to provide the member and City personnel with the knowledge and skills
to properly perform the basic life support as recommended by the American Heart Association.
Students learn to recognize several life-threatening emergencies, provide CPR to victims of all
ages, use an AED, and relieve choking in a safe, timely and effective manner. Successful
participants are provided an AHA CPR certification card in accordance with the specific course
requirements.
EMT – Emergency Medical Technician
The Emergency Medical Technician (EMT) certification program is designed to train an individual
to function independently in a medical emergency. It is recognized that the majority of
prehospital emergency medical care will be provided by the EMT. This course provides the basic
knowledge and skills needed to deliver Basic Life Support (BLS) care and is required to progress
to more advanced levels of prehospital patient care.
Advanced Life Support Programs: EMT – Enhanced (Advanced EMT),
EMT – Intermediate and EMT – Paramedic
VBEMS sponsors volunteer members for continued emergency medical training through the
highest level of prehospital advanced life support care – the Paramedic certification level. The
member can chose to pause their training at any of the certification levels and resume their
training within a fixed interval. When the member completes their Paramedic training they will
have over 1250 hours of training, not including internship time to release to general supervision.
Members may complete their field internship clinical hours with VBEMS or another EMS agency.
Successful participants are allowed to sit for the Virginia or National EMS examinations requiring
successful completion of both a standardized cognitive and national psychomotor skills
examination.
EVOC – Emergency Vehicle Operators Course
The Emergency Vehicle Operator Course (EVOC) is patterned after the State Office of
Transportation Safety EVOC guide. The course emphasizes safe driving skills. Additionally, the
course provides the member the vehicle codes of Virginia and Policies of VBEMS. This course is
designed to increase the situational awareness of the emergency vehicle operator and reduce
the number of crashes involving emergency vehicles. The course includes classroom and driving
range skills.
Training Division: Certification Training Programs

Vehicle Rescue Awareness and Operations
This course developed by the VAVRS, Office of EMS and Dept. of Fire Programs stresses the
skills and latest techniques of vehicle extrication. Emphasis is placed on:
• Orderly and efficient approach to the accident situation
• Safety procedures
• Protective equipment
• Use of tools (hand tools, power tools, hydraulic tools, air bags, etc)
Training Division: Certification Training Programs
Training Division: Continuing Education Training
ALS Release Program
These classes provide the ALS student/intern with the knowledge, skills and abilities to function
within the protocols and VBEMS system requirements at their certification level. The courses spe-
cifically cover the explicit technology, equipment and protocols required for a field clinician to func-
tion under the general supervision of the OMD.
ALS CE Program
These classes are designed for practicing ALS providers to earn the credits needed to recertify
their National and Virginia EMS certifications. The courses consist of review of the U.S. Depart-
ment of Transportation's National Standard Curriculum and NREMT recertification core and elec-
tive areas for ALS providers. Subjects cover respiratory emergencies, communicable diseases, pe-
diatrics, OB, allergy and anaphylaxis emergencies, EMS operations, geriatric issues, trauma, res-
piratory and cardiovascular emergencies. The classes incorporate updates on treatment proce-
dures, medical research and equipment relevant to the VBEMS system.
BLS CE Program
These classes are designed for practicing BLS providers to earn the
credits needed to recertify their Virginia EMS certification. The
courses consist of review of the U.S. Department of Transportation's
National Standard Curriculum. Subjects cover patient assessment,
airway, medio-legal, communicable diseases, pediatrics, OB, medi-
cal emergencies and trauma emergencies. The classes incorporate
updates on treatment procedures, medical research and equipment
relevant to the VBEMS system.

Training Division: Continuing Education Training
ACLS – Advanced Cardiac Life Support Update
Advanced Cardiac Life Support (ACLS) is an advanced,
instructor-led classroom course that highlights the
importance of team management of a cardiac arrest, team
dynamics and communication, systems of care and
immediate post-cardiac-arrest care. Specific skills in airway
management and related pharmacology are also featured.
Skills are taught through discussion and group learning,
while testing stations offer case-based scenarios using
simulators. Providers enhance their skills in treating adult
patients of cardiac arrest or other cardiopulmonary
emergencies, while earning their American Heart
Association ACLS (AHA ACLS) for Healthcare Providers
Course Completion Card.
PALS – Pediatric Advanced Life Support Update
Pediatric Advanced Life Support (PALS) is a classroom, video-based, Instructor-led course that
uses a series of simulated pediatric emergencies to reinforce the important concepts of a systemat-
ic approach to pediatric assessment, basic life support, PALS treatment algorithms, effective
resuscitation and team dynamics. The goal of the PALS
Course is to improve the quality of care provided to
seriously ill or injured children, resulting in improved
outcomes. Providers enhance their skills in treating
pediatric patients of cardiac arrest or other
cardiopulmonary emergencies, while earning their
American Heart Association PALS (AHA PALS)
Course Completion Card.

Data illustrates an overall negative linear trend in EMT enrollment rates when examining the 5
year historical trend; this indicates that overall total EMT enrollments are declining. Forecasting
EMT enrollments for the next three years illustrates that the negative linear trend is probable to
continue.
Training Division: Data
206
293
215 219
202
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014
Fiscal Year EMTEnrollment
Year 2010-2014
206
293
215 219
202
253
208
225
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014 2015 2016 2017
Fiscal Year EMTEnrollment
Year 2010-2017(Forecast)
*Green Bar =Forecast

Though overall EMT enrollments may have declined over the five year period observed, data il-
lustrates that the number and % share of EMTs that enroll in training are graduating at a higher
rate. Forecasting out for the next three years illustrates that the trend is probable to continue with
more enrollees graduating at a higher rate of success.
111
178
148 150
164
0
20
40
60
80
100
120
140
160
180
200
2010 2011 2012 2013 2014
Fiscal Year EMTs Graduated
Year 2010-2014
54% 61%
69% 68%
81%
46% 39%
31% 32%
19%
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
Fiscal Year % of EMTs Graduated
Year 2010-2014
% Graduate % NOT Graduate

Data findings illustrate that the unemployment rate visually correlates with reduced overall EMT
enrollments; as the economy improves, it may be probable that fewer individuals have the need
to seek EMT training for career development or do not have the time to enroll for training as they
are finding employment opportunities that limit availability.
A regression test does not validate a relationship between the two variables; enrollment and un-
employment.
206
293
215 219
202
7.5% 7.3% 7.2%
6.5%
6.0%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014
Fiscal Year EMT Enrollment and Unemployment Rate
Year 2010-2014
EMT Enrollment Unemployment Rate-Virgina Beach

14
20 20
35
42
0
10
20
30
40
50
2005 2006 2007 2008 2009
# of On-site NewCPR Classes
171
267
252
309
247
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014
# of On-site NewCPR Students
272
242
261
20
36
0
50
100
150
200
250
300
350
2010 2011 2012 2013 2014
# of Off-site New CPR Classes
1382 1395
1867
222 213
0
500
1,000
1,500
2,000
2010 2011 2012 2013 2014
# of Off-site NewCPR Students
24 16 20
186
201
0
50
100
150
200
250
2010 2011 2012 2013 2014
# of Recert CPR Classes
93 83 105
905
1,680
0
500
1,000
1,500
2,000
2010 2011 2012 2013 2014
# of Recert CPR Students

The Regulation and Enforcement Division is responsible for the safety of members and citizens,
and ensures this through regulation of the provision emergency health services within the City
limits in accordance with City code, enforcement of Beach, Boats and Waterways codes, sub-
mission of quality management programs and fielding of customer feedback. Additionally, Divi-
sion personnel ensure the safety of medical devices, evaluate new medical equipment and pro-
vide infection control services to all members of the Department of EMS.
Regulation and Enforcement Division Major Functions:
Regulation and Enforcement Division
 Federal, State and Local Regulation
Compliance
 Commercial EMS Ambulance Agency
Oversight
 Infection Control
 EMS Medical Oversight and Enforcement
 Departmental Evaluation
 Medical Care Partners Liaison
 Oversight of Contractual Lifeguard
Services
 Department Procurement
 Federal and State Grants Management
 Office of Planning and Analysis
 Safety Office
 HIPAA/Patient Confidentiality Compli-
ance
 Data Collection and Analysis
 Continuous Quality Improvement (CQI)
 Electronic Medical records
 Special Events Planning
 EMS Representative for Health and Safe-
ty Matters at the Beach
 TEMS Regional Medical Operations
Committee, and Performance Improve-
ment Committee Representation
The Division is led by Division Chief Jason E. Stroud and consists of Captain Jerry Sourbeer,
Public Safety Analyst Robert M. Davis, Business Application Specialist Eric Llanes and
Storekeeper Anthony Elston.

Regulation and Enforcement Division: CQI

Standards/Guidelines
 Hospital Door-to-Balloon
of 90 minutes or less
 FMC = First Medical
Contact – time of
eye-to-eye contact
between STEMI patient
and caregiver with 12
Lead ECG abilities
 AHA: First unit on scene
in 8 minutes or less
 AHA: EMS on scene
time of 15 minutes or
less
 AHA: FMC-to-balloon in
120 minutes or less
Regulation and Enforcement Division: CQI
Totals Data
Total Number of Cases 61
Male 38
Female 23
Average Age 62
Number of Transports to VBGH 49
Number of Transports to SLH 10
Number of Transports to SPAH 2
Prehospital 12-Lead ECG Obtained? 57
Percent with Pre-Hospital 12-Lead ECG 93%
Response
Average Time from Chest Pain to 911 93 minutes
Average Time from 911 to First Unit 7 minutes
Percentage of Time 8 minutes or Less 69%
On Scene
Average Ambulance On Scene Time 16 minutes
Percent On Scene Time ≤15 Mins. 46%
Average Time 911 to 12 Lead ECG 23 minutes
Average Time FMC to 12 Lead ECG 11 minutes
Percent FMC to 12 Lead ECG ≤10 Mins. 49%
Average Time from First Unit to Aspirin 13 minutes
Average Time from First Unit to Nitroglycerin 19 minutes
Percent 12 Lead ECGs Transmitted 70%
Transport
Average Time from 911 to Hospital Arrival 39 minutes
Average Time from EMS 12 Lead ECG to STEMI Alert 23 minutes
Percent STEMI Alerts Called by EMS 48%
Balloon Times*
Average ED Door-to-Balloon 72 minutes
Percent ED Door-to-Balloon ≤90 Mins. 75%
Average Time from FMC to Balloon 104 minutes
Average Time from 911 to Balloon 116 minutes
Average Time of EMS 12 Lead ECG to Balloon 90 minutes
Percent EMS 12 Lead ECG to Balloon ≤90 Mins. 49%
2014 STEMI Patients

The office of planning and analysis serves as the research and analytic arm of EMS operations;
employing statistical methods, quantitative data analytics and robust research methods and ap-
plications to better improve the operations and effective delivery of emergency medical services
to residents and visitors of the City of Virginia Beach. Current research endeavors include the
following:
Demand Analysis
What is Demand Analysis? Demand analysis refers to the act of aggregate planning and
scheduling of resources and involves identifying demand patterns and to the extent that it is
practical, deploying resources to match those patterns. Simplified, this means determining where
available ambulances should be placed while they await the next request for emergency aid. De-
mand analysis is intended to provide adequate emergency response capacity for typical peak
demands (when calls for service are at their highest), with excess capacity during non-peak
times (when calls for service are at their lowest) kept to a minimum or used for non-emergency
responses.
Office of Planning And Analysis
-
500
1,000
1,500
2,000
2,500
3,000
0:00
1:00
2:00
3:00
4:00
5:00
6:00
7:00
8:00
9:00
10:00
11:00
12:00
13:00
14:00
15:00
16:00
17:00
18:00
19:00
20:00
21:00
22:00
23:00
#ofCallsforEMS
Demand for EMS Service:
Per Hour of Day
Years 2011-2014
2011 2012 2013 2014

GIS Mapping EMS Demand 2014
GIS allows the ability to take demand analysis location data and interpret it spatially against pre-
defined geographic characteristics of the service region being analyzed. A GIS map which uses
“heat mapping” or “density mapping” can determine where demand for EMS is the most concen-
trated per 1sq. mile.
The analysis reveals association with existing research examining GIS density mapping of
populations and their relationship with demand for EMS services. The VBEMS findings identify
that a correlation is present between population densities and demand for EMS services. The
more individuals residing and working within a sq. mileage, the greater the demand for EMS
services; demand is therefore concentrated in pockets or dispersions. The concentration of call
volume for year 2014 is located in areas of dense population concentration. The less densely
populated regions in the southern region are among the less concentrated population de-
mographics.

EMS Demand Per Shift “Time of Day”
A review of existing medical research found that these identified trends and patterns can be ex-
plained as a result of circadian rhythm patterns which occur on the biological level of individuals.
The research shows that demand for EMS service is not a random event and can be tracked and
anticipated to a degree. The density or areas of high concentration are once again where popu-
lation is the greatest per sq. mile; you will notice that the density of the map changes and
spreads into areas that are residential (i.e. housing). This seems to validate what existing re-
search has asserted; that change in population movements occurs in a 24 hour cycle. These
changes in location relate to what is known as population migration changes, how the population
moves from various locations depending on the time of day (i.e. daytime commercial, evening
time residential).
Shift 1: 5:00am-5:00pm Shift 2: 5:00pm-5:00am

Forecasting Future EMS Demand
What is forecasting? Demand forecasting is the area of predictive analytics dedicated to under-
standing consumer demand for goods and services. That understanding is used to forecast con-
sumer demand. When thinking of demand in EMS, it is best to equate it with a person calling 911
asking for medical help; that way, you can visually construct what demand in an EMS system will
look like. The analysis has discussed demand as the calls for EMS service, so as you read de-
mand throughout this section just equate it to someone who needs an ambulance for example.
The goods and services in this case would be the medical attention provided by EMS. This can
be bandages, an ambulance transporting someone to a hospital and other associated EMS ser-
vices on would expect to come when 911 is called.
Demand forecasting in its simplest form is taking what you know currently about demand for a
service or good and then probabilistically calculating what it may be in the future.
Why is forecasting important? Forecasting can help determine how many resources may be
needed in the future in order to meet demand. In the case of EMS, forecasting future demand for
EMS services can help determine funding allocations that can be used to purchase medical sup-
plies, ambulances and medics that may be needed. Also, leveraging GIS mapping analysis can
help determine where EMS services may be needed; if we know where demand is taking place,
the forecast demand will aid in calculating what resources may be needed and how much.
Forecasting allows the ability to (ideally) operate EMS service delivery more efficiently and effec-
tively. If you know how many ambulances you may need and the staff to operate them, the GIS
mapping tells you where, then you could improve how those services are delivered. Forecasting
when coupled with demand analysis and GIS mapping may be used as a proactive measure; if
the forecast model probabilistically calculates that stroke calls will increase next July and the
GIS data gives the locations where strokes are historically determined to occur, then EMS pro-
viders and other associated groups of interests can organize preventative actions to help miti-
gate those associated risks with call demand.

Forecasting Future EMS Demand: Year
34593
35607
36239
37028
37718
36291
39130
38980
40937
34,987
35,472
36,378
37,079
37,844
38,555
37,763
39,397
39,813
41,231
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
EMSCallDemand
ForecastsandActual Demand
*Yellow Bars=Overestimation
Black Bars=Underestimation
Actual Demand Averaged Demand (Forecast) Linear (Actual Demand)
1%
0%
0% 0% 0%
6%
-3%
1%
-3%
-0.15
-0.1
-0.05
0
0.05
0.1
0.15
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
2006 2007 2008 2009 2010 2011 2012 2013 2014
ForecastAccuracy
EMSCallDemand
Forecast Accuracy
*Yellow Bars=Overestimation
Black Bars=Underestimation
Actual Demand Averaged Demand (Forecast) Linear (Actual Demand)

Forecasting Future EMS Demand: Month
This illustrates the proba-
bilistic EMS call demand
that will occur in totality for
the given month over the
course of the 2015 year.
This illustrates the proba-
bilistic % change in EMS
call demand that will occur
in totality for the given
month over the course of
the 2015 year.
This illustrates the accuracy
of the forecasts model in
comparison to the actual
call demand that was re-
ported in year 2014. Overall
the model underestimated
actual call demand for
2014; due in large part that
year 2014 saw a 5% in-
crease in demand.
3,406
2,906
3,152
3,396
3,549
3,630
3,798
3,668
3,472
3,443
3,171
3,384
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
#EMSCalls
EMS Demand Forecast:Year 2015
3% 2%
-5%
2%
0%
0%
1% 1% 1% 1% 0%
-3%
-10%
-5%
0%
5%
10%
0
1,000
2,000
3,000
4,000
%Change
#EMSCalls
EMS Demand Forecast:Year 2015
Forecast % Change
3%
1%
-2% -1%
-5% -6%
-3% -2% -3% -3% -2%
-11% -15%
-5%
5%
15%
0
1,000
2,000
3,000
4,000
ForecastAccuracy
EMSCallDemand
Forecast Accuracy 2014:Forecast &Demand
*Yellow Bars=Overestimation Black Bars=Underestimation

Forecasting Future EMS Demand: Demand Based Staffing Ambulance
Utilizing the demand analysis to track the historic call demand for EMS services, that data is then
fed into the statistical forecast model to help calculate how many calls for Ems may probabilistic
occur at a given hour of day. In addition, the 90th percentile time a unit spends out of service per
EMS call is also calculated (the time from when a unit is dispatched to the time a unit is back in
service); this provides the amount of time a unit may be out of service 90% of the time when it is
dispatched to an EMS call.
Taking the forecasted number of calls per hour, and multiply that forecast value by the amount of
time a unit is probabilistic to be out of service produces a “staffing recommendation”. Essentially,
how many ambulance units will be needed at this hour of the day, on this day of the week for this
period of months in order to meet call demand.
Two demand based staffing models were created; one model was created for the off-season
(October-March) and one for the on-season (April-September). While this lessens the accuracy of
the staffing model due to the seasonality effect (demand changes based on the time of year) it
provides a 6 month staffing template that is designed to adequately meet probabilistic future
demand for EMS services and may improve inconsistencies in current split shift staffing models.
The goal of the model is to limit the number of staffed ambulances during troughs in demand (low
demand times) and increase the number of staffed ambulances when they are needed most
during peak demand times when ambulance units are needed most.

Forecasting Future EMS Demand: Demand Based Staffing Ambulance
7 7 7 6
4 4
6
7
9
10 10
11 11 11 11 10 10
11
10
9 9
8 7 7
0
2
4
6
8
10
12
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
ReccomendedAmbulancesStaffed
Hour of Day
Ambulances Needed:BasedonDemand
Off Season:October-March
*Includes 10% Increase Buffer
7
8 8
5 5 4
6
7
9
11
12 11 11 12 12 11 11 11 10 10 10 10 9
8
0
2
4
6
8
10
12
14
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
ReccomendedAmbulancesStaffed
Hour of Day
Ambulances Needed:BasedonDemand
On Season:April-September
*Includes 10% Increase Buffer
This illustrates the recommended demand based staffing model for ambulance units for the
off-season and the on-season; forecasted demanded via the statistical model is
supplemented with a 10% buffer. This means that an extra 10% increase in the forecasted
EMS call demand is factored into the staffing recommendation. This provides a slight cushion
in the event that call demand spikes at a rate higher than forecasted.

EMS Research: Elderly Fall Study
The fastest growing population group in the U.S. is individuals age 85 and older. By 2030, 20%
of the U.S. population will be older than 65. The elderly account for 16% of ER visits and half of
all critical care admissions. As geriatric patients have become a larger subset of the population,
their demand on the existing healthcare field has increased in kind. To help alleviate the burden
of this increase for medical services, greater responsibility has fallen to EMS providers.
There are a variety of lethal and traumatic events that place individuals 65 and older at risk.
However, falls are the most common cause of injury in the elderly population and account for as
much as 40% of deaths caused by injury among individuals 65 and older. “Every 15 seconds an
older adult is treated in an Emergency department for a fall related injury...every 29 minutes, an
older adult dies from a fall”. With the U.S. population aging, the number of falls and fall related
injuries are projected to increase. 1 in 3 adults age 65 and older falls every year.
Older individuals 65 and older who fall, 23% of those falls will result in moderate to severe inju-
ries that may increase the risk of early death. Even those that do fall and do not sustain injury
may develop a fear of falling which may lead to reduced mobility, loss of physical activity that in-
creases their actual risk of falling and sustaining injury from a fall.
The City of Virginia Beach ranks 10 out of the 33 total localities in which the Centers for Disease
Control reported deaths resulting from unintentional falls among individuals age 60 and older
(Years 2004-2010).
*This year the Virginia Beach Department of EMS was
contacted by the Virginia Department of Health and has
begun the early stages of the formulation of a patient
referral system partnership; this new endeavor will allow
the Department of EMS to share its collected data with
VDH and help direct repeat patients struggling with
chronic illnesses such as: hypertension, diabetes, falls
among the elderly and help guide those patients to VDH
community educators that can direct them to services
such as health coaching, prescription medication
management and other various health referral services
that patients and members of the community may not
know are available for them to use.*

EMS Research: Elderly Fall Data
-
500
1,000
1,500
2,000
2,500
3,000
2011 2012 2013 2014
2,315 2,371
2,637 2,762
#ofFallIncidents
# of Fall Incidents
Patients Age 60 andolder
2%
11%
5%
-15%
-5%
5%
15%
-
1,000
2,000
3,000
2011 2012 2013 2014
#ofFallIncidents
% Change Fall Incidents
Patients Age 60 and older
% Change # of Fall Incidents
-
1,000
2,000
3,000
2011 2012 2013 2014
2,010 2,039
2,266 2,450
#ofFallPatients
# of Fall Patients
Patients Age 60 andolder
1%
11%
8%
-15%
-5%
5%
15%
-
1,000
2,000
3,000
2011 2012 2013 2014
#ofFallPatients
% Change Fall Patients
% Change # of Fall Patients
0
50
100
150
200
250
2011 2012 2013 2014
204 216
241 245
#ofFallRepeatPatients
# of Fall Repeat Patients
# Patients that Fall ≥2
6%
12%
2%
-15%
-5%
5%
15%
0
100
200
300
2011 2012 2013 2014
#ofFallRepeatPatients
# of Fall Repeat Patients
% Change # of Repeat Fall Patients

EMS Research: Elderly Fall Data
16,994
18,695 18,534 18,547
13,174 14,305 15,470 16,228
-
5,000
10,000
15,000
20,000
2011 2012 2013 2014
#EMSIncidents
# EMS Incidents Patient Age
60 and Older & Younger than 60
# Incidents Patient Age younger than 60
# Incidents Patient Age 60and older
9% 8%
5%
-15%
-5%
5%
15%
-
5,000
10,000
15,000
20,000
2011 2012 2013 2014
%Chnage
#EMSIncidents
% Change EMS Incidents Patients Age
60 and older
% Change Incidents Patient Age 60and older
# Incidents Patient Age 60and older
0%
20%
40%
60%
80%
100%
2011 2012 2013 2014
49.7% 51.6% 51.3% 50.9%
38.6% 39.5% 42.8% 44.6%
11.7% 8.9% 5.9% 4.5%
%ShareofIncidents
% Share of Incidents PatientAge 60 andolder
% Share Data Not Available
% Share of Incidents Patient Age 60 and
older
% Share of Incidents Patient Age
younger than 60

EMS Research: Elderly Fall Maps
The maps illustrate an EMS incident hot map (left map) where Falls occurred involving patients
age 60 and older; the map on the right, displays the population density per Census Tract of pop-
ulation age 60 and older. There is a spatial correlation between higher population densities of
patients age 60 and older, and the number of EMS Fall incidents.

EMS Research: Elderly Fall Maps
These maps illustrate the locations of nursing homes, assisted living facilities and other elderly
living communities; the map on the right is a heat map of the locations of EMS Fall incidents
involving patients age 60 and older, overlaid with the elderly living facilities presented in the map
on the right. There is a spatial correlation between the number of EMS Fall incidents and the
location of elderly living communities.

EMS Research: Cardiac Arrest
Sudden cardiac arrest (SCA) is a condition in which the heart suddenly and unexpectedly stops
beating. If this happens, blood stops flowing to the brain and other vital organs.
SCA usually causes death if it's not treated within minutes.
To understand SCA, it helps to understand how the heart works. The heart has an electrical sys-
tem that controls the rate and rhythm of the heartbeat. Problems with the heart's electrical sys-
tem can cause irregular heartbeats called arrhythmias (ah-RITH-me-ahs).
There are many types of arrhythmias. During an arrhythmia, the heart can beat too fast, too
slow, or with an irregular rhythm. Some arrhythmias can cause the heart to stop pumping blood
to the body—these arrhythmias cause SCA.
SCA is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart
muscle is blocked. During a heart attack, the heart usually doesn't suddenly stop beating. SCA,
however, may happen after or during recovery from a heart attack.
People who have heart disease are at higher risk for SCA. However, SCA can happen in people
who appear healthy and have no known heart disease or other risk factors for SCA.
Most people who have SCA die from it—often within minutes.
When it comes to cardiac arrests, time is of the essence. The longer a
patient goes without critical intervention of either CPR or defibrillation
via an AED the decreased likelihood they will survive. Data illustrates
that the number of cardiac incidents and cardiac arrest have been
increasing and may probabilistically continue to increase as the
population of the City of Virginia Beach both grows and ages.
While the 90th percentile response time of 1st help unit onscene has
improved during the observed years, it simply falls short of the critical
intervention baseline that has been identified in greatly improving
patient outcome and survival rates. Simply adding more medics and
more response units may help, but economically and logistically such
a measure is not currently feasible. Given these limitations of
resources in the face of increasing demand, a new community based
program has been suggested to aid in improving cardiac survival
rates.

EMS Research: Cardiac Arrest Data
16%
-5% -3%
16%
6%
-50%
0%
50%
0
200
400
600
2010 2011 2012 2013 2014
%
C
han
ge
#
Cardia
c
In
cid
en
ts
% Change in Cardiac Arrest
1st Unit Help Onscene >4 Minutes
*Yellow Bar=% Increase Black Bar=% Decrease
# of Cardiac Arrest 1st Unit Help >4 Minutes
513
441
381
413
477
0
100
200
300
400
500
600
2010 2011 2012 2013 2014
#CardiacArrest
# Cardiac Arrest
*All types(drowning, overdose, suddencardiac, etc)
# Cardiac Arrest
101%
-14% -14%
8% 15%
-120%
-100%
-80%
-60%
-40%
-20%
0%
20%
40%
60%
80%
100%
120%
0
100
200
300
400
500
600
2010 2011 2012 2013 2014
%Change
#CardiacArrest
% Change Cardiac Arrest
*All types(drowning, overdose, suddencardiac, etc)
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
45% 40% 37% 36% 36%
22% 25% 27% 28% 27%
%Share
% Share of Cardiac Arrest Dispatches
that result in a True Cardiac Arrest Onscene
% of Dispatches that are truecardiac arrest % ofDispatches that are NOTtrue cardiac arrest
0:07:41 0:07:34 0:07:02 0:07:23 0:07:01
0:00:00
0:05:46
0:11:31
2010 2011 2012 2013 2014
ResponseTime
1st Unit Help Onscene Cardiac Arrest
Dispatch Response Time 90th Percentile
1st Unit Help onsceneResponseTime90th Percentile
Linear (1st Unit Help onscene Response Time 90th Percentile )
3.6%
-1.5%
-7.0%
5.0%
-5.0%
-15%
-5%
5%
15%
0:00:00
0:02:53
0:05:46
0:08:38
0:11:31
2010 2011 2012 2013 2014
%Change
ResponseTime
% Change in 1stUnit Help OnsceneCardiac
Arrest Dispatch ResponseTime 90th
Percentile
Yellow Bar=%IncreaseBlack Bar=%Decrease

EMS Research: Sudden Cardiac Arrest Data
The chance of surviving a Sudden Cardiac Arrest (SCA) event in the United States is 1:19; one
survivor and nineteen deaths. SCA is the leading cause of death in the U.S., affecting more peo-
ple than breast cancer, prostate cancer, colorectal cancer, AIDS, traffic accidents, house fires
and gunshot wounds combined.
25
30
33
36 37
0
10
20
30
40
50
2010 2011 2012 2013 2014
#SuddencardiacArrest
# Sudden Cardiac Arrest
Linear (# Sudden Cardiac Arrest)
-47%
20%
10% 9%
3%
-60%
-40%
-20%
0%
20%
40%
60%
0
10
20
30
40
2010 2011 2012 2013 2014
%Change
% Change Sudden Cardiac Arrest
30
36 37
31
38
0
10
20
30
40
2010 2011 2012 2013 2014
#SuddencardiacSurvivors
# Sudden Cardiac Survivors
# Sudden Cardiac Arrest Survivors
-3%
20%
3%
-16%
23%
-60%
-40%
-20%
0%
20%
40%
60%
0
10
20
30
40
2010 2011 2012 2013 2014
%Change
% Change Sudden Cardiac Survivors
# Sudden Cardiac Arrest Survivors

EMS Research: Cardiac Arrest Maps
Individuals, who suffer a cardiac arrest, have a higher likelihood of survival if they receive CPR
from a bystander; survival was greatest in areas where an AED was available in public spaces
according to a study produced by the American Heart Association. Research by Blackwell (2002)
and Pons (2005) suggest that to truly improve patient outcomes and survivability, emergency
medical response times would need to be consistently reduced to less than five minutes. The
feasibility of being able to reach a patient within 5 minutes or less 90% of the time is currently
non-feasible given logistical and economical limitations within the current EMS system. “The ma-
jority of sudden cardiac deaths occur outside hospital so specific programs are needed in the
community. Friends and relatives of people at risk of [Cardiac Arrest] should learn CPR…
Improving outcomes requires addressing the entire picture through population education”.
0
100
200
300
400
500
$- $20,000 $40,000 $60,000 $80,000 $100,000
NumberofCardiacArrest
Quintile Income Groups
Linear Regression Analysis:
Cardiac Arrest and Median Household Income
Number ofCardiac Arrest Predictor Variable
Linear (Predictor Variable)
Regression Statistics
R Square 0.920906
Significance f 0.040361
*The regression analysis illustrates that there is a strong
correlation between the number of cardiac arrest and the
median household income per U.S. Census tract; 92% of the
change in the occurrence rate of cardiac arrest may be
attributable to median household income; the results of this
output occurring by random chance alone is 4%, which is
statistically significant. Lower income neighborhoods have a
higher rate of cardiac arrest while upper income neighborhoods
have a lower rate of cardiac arrest.

EMS Research: Cardiac Arrest Survival
Bystander CPR has been shown to more than double a victim’s change of surviving an out of
hospital cardiac arrest event. Using an automated external defibrillator (AED) in conjunction with
bystander CPR further improves the probability of survival; however, bystander CPR and AED’s
are not employed in a majority of cardiac events. Time is critical in cardiac events; the adage of
“time is brain” is a popularized phrase which employs the importance of time in critical
intervention. Once a cardiac arrest occurs, blood flow to the brain is halted and the onset of brain
death begins; oxygen deprivation results as blood is the conduit which carries oxygen to the
brain. Without adequate blood flow, the brain begins to die and the body’s systems begin to shut
down.
Bystander CPR allows the ability to maintain blood flow and keeps oxygen flowing to the brain
preventing brain death; without clinical intervention as is provided through CPR, the individual
suffering a cardiac arrest event will likely “flatline” within a few seconds. If the patient is not
revived within 5 minutes, the patient could suffer irreversible brain damage and or become brain
dead; hence “time is brain”.
Providing critical blood flow to the heart and brain during a cardiac arrest is critical, in addition, it
improves the likelihood of a successful shock from use of an AED. Together, bystander CPR and
successful application and use of an AED work in tandem to improve resuscitation, survival and
outcome. These actions comprise what is known as the “Chain of Survival”; the chain of survival
helps explain the Emergency Cardiovascular Care system; early CPR and rapid defibrillation are
two key components of the chain of survival in response to a cardiac arrest event.
The Emergency Medical Services field along with the nation’s healthcare system is moving
towards community intervention initiatives to enhance the role of pre-delivery of care before
professional rescuers arrive on scene; there is a vested interest in developing public awareness,
training and AED location assistance to members of the community to improve the delivery of
bystander CPR and AED application to cardiac arrest events.
While the City of Virginia Beach’s land size per sq. mile and its population density make it a chal-
lenge for EMS to respond to a cardiac arrest event in 5 minutes, it also is the City’s greatest as-
set in leveraging use of bystander CPR and defibrillation via AED within that critical intervention
window. There may not be an EMS provider on every corner of every hour of every day, but a
Virginia Beach resident may be! Critical intervention via CPR and defibrillation by an AED can
make the difference between life and death for an individual suffering a cardiac arrest event.

EMS Research: Sudden Cardiac Arrest Comparison
0%
20%
40%
60%
80%
100%
2010 2011 2012 2013 2014
32%
45% 36% 33% 41%
68%
55% 64% 67% 59%
SuddenCardiacArrestSurvivalRate
Sudden Cardiac Arrest Survival Rate
% Did NOTSurvive
Sudden Cardiac Arrest
% Survived Sudden
Cardiac Arrest
0%
25%
50%
2011
2012
2013
2014
31% 32%
33%
45%
36%
33% 41%
SurvivalRate
National SuddenCardiac Arrest Survival Comparison
VBEMS Sudden Cardiac Arrest Survival
(2014 National DataN/A)
National Sudden Cardiac Arrest Survival Rate VBEMS Sudden Cardiac Arrest Survival Rate
31% 32% 33%
45%
36%
33%
41%
0%
25%
50%
2011 2012 2013 2014
SurvivalR
ate
National SuddenCardiac Arrest Survival Comparison
VBEMS Sudden Cardiac Arrest Survival
(2014 National DataN/A)
National Sudden Cardiac Arrest Survival Rate VBEMS Sudden Cardiac Arrest Survival Rate

EMS System Performance: Unit Hour Unit Utilization
Unit Hour Unit Utilization (UHUU) is the percent of time a staffed unit (e.g. ambulance and/or
zone car) is consumed by work; work in this context refers to “amount of time a unit spends out
of service in response to a demand for EMS service”. What is the amount of time consumed by
an EMS incident? Incident hours; total time a unit spends in response to an EMS incident (time
of dispatch to time unit clears).
Demand for EMS service has/is increasing; incident hours are increasing. Zone car incident
hours have experienced the greatest rate of growth. Average number of EMS units staffed and
response time are positively correlated; as the number of staffed units increase, the response
time decreases. As the number of units staffed decreases, the response time increases.
Unit Hour Unit Utilization is the % of time a staffed unit (ambulance and/or zone car) spends
responding to an EMS incident in a 1 hour period. Unit Hour Unit Utilization correlates with EMS
incident hours; as the number of incident hours increase, the reported UHUU rate increases.
Shift 1 experiences the majority share of EMS call demand and incident hours, but has the
lowest average units staffed to meet demand; shift 1 has a higher reported UHUU rate.
Recommend variable staffing model to meet EMS demand; add more staffed units during shift 1
during peak demand hours to improve UHUU and ameliorate “call holding” incidents. Target
staffing to high demand areas.
Initial findings reveal that zone cars
have a higher reported UHUU rate
than ambulances. % increase in
zone car incident hours outpaces
increases in zone car staffing.
Despite increases in demand for
EMS services, EMS system perfor-
mance has actually improved: de-
creases in response time, decreases
in unit out of service time, decreases
in unit time at hospital.
EMS system performance may be
improved through efficiency en-
hancements and resource
utilization efforts.

Virginia Beach Department of EMS: Annual Report 2014

Virginia Beach Department of EMS: Annual Report 2014

Recommended

Recommended

More Related Content

What's hot

What's hot (6)

Viewers also liked

Viewers also liked (7)

Similar to Virginia Beach Department of EMS: Annual Report 2014

Similar to Virginia Beach Department of EMS: Annual Report 2014 (20)

More from Robert M. Davis, MPA

More from Robert M. Davis, MPA (20)

Recently uploaded

Recently uploaded (20)

Virginia Beach Department of EMS: Annual Report 2014