Emergency Medical Response Time

The Department of Public Safety and Denver Health provide emergency medical services to the City and County of Denver. The agencies have a duty to ensure medical emergencies are responded to fast and efficiently. This requires collaboration among Denver 911, Denver Fire, and Denver Health to identify problems within the system, support each other’s efforts, and build a sound foundation to deliver quality emergency medical services. Not doing so could cause people to not receive the medical care they need in a timely manner and reduce the public’s trust in the emergency medical response system.

FINDING 1 – The city has not met its response time goals for emergency medical response services

From May 2023 through March 2024, Denver 911, Denver Fire, and Denver Health did not meet response time goals: call answering time of 15 seconds 90% of the time, alarm-processing time of one minute and 30 seconds 90% of the time, and assign-to-arrive time of five minutes for Denver Fire and nine minutes for Denver Health. The agencies need to assess staffing levels and response time goals to ensure quality delivery of emergency medical services.

FINDING 2 – The city does not have a comprehensive understanding of the total time it takes to respond to a medical emergency

The total response time does not match the caller or patient experience with emergency medical services. The city’s response time goals are not comprehensive and do not meet national standards.

FINDING 3 – The Emergency Medical Response System Advisory Committee could be more effective

The advisory committee does not have structured meeting practices in place to ensure its responsibilities are carried out. The lack of formalized policies and procedures prevents the necessary collaboration and communication needed to identify issues within Denver’s emergency medical response system.

FINDING 4 – Documented policies and procedures for emergency medical response time reporting are incomplete

Policies and procedures on response time data analysis and reporting are not detailed enough that the processes can be replicated by someone unfamiliar with the processes. Data reporting review procedures are not documented and contractual oversight procedures on data exclusions are not reviewed.

1.1 Regularly assess Denver 911 staffing levels and use results to request more staff – The Department of Public Safety, including Denver 911, should document and implement a plan to regularly conduct staffing assessments. This plan should use a methodology that considers leading practices and should outline the steps that will be taken to complete the assessment, how often the assessment will be completed, and how gaps will be addressed. The Department of Public Safety should use that assessment to request additional staff and funding.

Agency Response: Agree, Implementation Date – June 1, 2024

1.2 Ensure emergency medical response time goals are realistic – The Department of Public Safety, including the Denver Fire Department and Denver 911, should conduct an assessment to determine how relevant factors, risks, and hazards can impact emergency medical response times. At a minimum, this assessment should consider the degree to which factors such as population size, geography, external barriers, and internal processes, such as those required to determine the nature of a call, can impact response times.

Managers should document these assessment results, use those results to determine whether response time goals should be revised, and use those results to inform and support any revisions made. Managers should also consider time frames for conducting future assessments. Managers should use these results to update and amend the operating agreement as needed.

Agency Response: Agree, Implementation Date – June 30, 2026

2.1 Measure and track the complete total response time from the time a call is placed to when help arrives at a patient’s side – The Department of Public Safety should align the city’s total response time measurement with industry standards to ensure total response time captures the total time callers and patients wait before help arrives — from the time an emergency call is placed to the moment when a responder reaches a patient’s side. Managers should include call answering times and initiating action times in their analysis. When upgrading or implementing new record keeping systems, the Department of Public Safety should ensure the systems used to track emergency medical response are interoperable to allow tracking data to be collected and reviewed in a central repository.

Agency Response: Disagree

2.2 Leverage total response time data for increased alignment with emergency medical response time standards – After the Department of Public Safety has implemented a system in place that can measure the time from the moment a call is placed to when a responder reaches a patient’s side the Department of Public Safety should use this data to identify potential delays, inefficiencies, and other issues that may impact a patient’s safety.

Agency Response: Disagree

3.1 Develop and implement written policies and procedures for conducting committee meetings – The Emergency Medical Response System Advisory Committee should develop and implement formal policies and procedures aligned with leading practices. At a minimum these should include:

• Setting agendas.
• Providing relevant materials to committee members, such as previous meeting minutes, reports, compliance items, and background information on discussion items.
• Designating a committee chair, other roles, and member responsibilities.
• Keeping meeting minutes for each meeting.

Agency Response: Agree, Implementation Date – Dec. 31, 2025

4.1 Develop and implement policies and procedures – The Department of Public Safety should work with the emergency medical response system data analyst to develop, document, and implement policies and procedures that provide a sufficient level of detail on all steps in the monitoring and analysis of data.

In addition to the requirements specified in the operating agreement, at a minimum, this documentation should include detailed procedures that:

• Specify the processes used to compile, clean, and analyze emergency medical response time data.
• Align with contract provisions, including provisions associated with identifying root causes of data excluded from compliance reporting.
• Specify processes used to review and approve data and reporting, including identifying those responsible for carrying out such review.

The policies and procedures should be reviewed and approved by a supervisor or manager before being adopted.

Management should also ensure the data analyst has the required knowledge and training needed to carry out responsibilities required by the operating agreement, including exception review and root cause identification.

Agency Response: Disagree

Recommendation 2.1 – Auditor's addendum to agency response: The Department of Public Safety disagreed with Recommendation 2.1, citing system limitations that prevent the integration of call answering and initiating action times in total emergency medical response time measurements. We acknowledge this limitation but recommend the Department of Public Safety consider selecting a system capable of including these metrics when evaluating new database systems.

Further, the department also disagreed with our statement that its methodology is not compliant with industry standards. However, as shown in Figure 7, on page 17 of our report, the department’s approach excludes call answering and initiating action times, conflicting with the National Fire Protection Association Standard 1710, Section 3.3.64.6. This standard defines total response time as the interval from the alarm receipt at the public safety answering point (the Denver 911 Communications Center) to the first emergency intervention. The 1710 standard further breaks this into three phases:

1. Alarm handling time (transfer, answering, and processing times).
2. Turnout and travel time.
3. Initiating action/intervention time.

Public Safety’s methodology excludes call answering time and the time to reach a patient’s side after arrival. If timestamps are inaccurate, we recommend the department develop a way of ensuring accurate recording. Aligning response time measurements with industry standards provides a complete view of emergency response performance, enabling process improvements and efficiency gains in response times.

Recommendation 2.2 – Auditor's addendum to agency response: In disagreeing with Recommendation 2.2, the Department of Public Safety claims that tracking the time from initial call placement to reaching the patient’s side is of low clinical importance and subject to uncontrollable factors that would possibly lead to inaccurate data.

While we acknowledge that external factors can affect data validity, this does not remove the fact that the department is currently not collecting and analyzing total medical emergency response time compliant with the National Fire Protection Association Standard 1710. Specifically, section A.3.3.64.5 of that standard emphasizes tracking and evaluating these times to identify delays and inefficiencies — something that is not being done.

This recommendation is intended to ensure data collection and analysis align with industry standards to enhance decision-making, improve patient safety, and address potential inefficiencies in response times.

Recommendation 4.1 – Auditor's addendum to agency response: In response to Recommendation 4.1, the Department of Public Safety says it has developed policies and procedures for analyzing response time data. However, we found weaknesses in these policies and procedures. Specifically, they are incomplete, lack sufficient detail to enable users to fully understand the required tasks and how to perform them, and detailed steps necessary for the analyst to analyze the data and create compliance reporting.

We also found the policies and procedures lacked key processes for data analysis, including the process to review a sample of exclusions and identify root causes. This is the responsibility of the data analyst and is required by the operating agreement. The enhancement of the policies and procedures is critical to capture institutional knowledge and ensure data analysis and reporting can continue if there are staff changes.