Preliminary Case Study: Kenosha Fire Department

Kenosha Fire Department
  Kenosha, Wisconsin
    Provides ALS 911 services      Located in southeastern WI 
13,000 calls per year Population of about 100,000
150 full-time employees 28 square miles

In December, 2021, when Kenosha Fire Department (KFD), in Kenosha, Wisconsin, rolled out a new policy to decrease their L&S responses, it was a huge culture shock for their providers. Since then, progress has been slow, but the lessons they've learned have been invaluable.

KFD's new policy established 6 dispatch codes, with the 2 lowest-acuity codes (about 20% of calls) designated as non-L&S responses. The policy also stated that providers could upgrade to a L&S response if they felt it was appropriate. During the spring and summer of 2021, Kenosha's leaders discussed the policy with their stakeholders in preparation for the December rollout. Then, on December 1st, they turned the policy on.

Immediately, providers began to report issues. They stated they felt "like we're not doing as good of a job because we're going non-emergent." They just "didn't feel right" getting to their patients slower. There were also a few instances of higher-acuity calls being dispatched non-emergent, and a resulting distrust of the new code system.

Some providers approached leadership after the rollout, saying, "Nationwide data is fine, but here in Kenosha, we haven't had any emergent ambulance crashes recently. So we don't think that we are at increased risk. Does this data really apply to us?"

In response, KFD's leadership held more open discussions and listening sessions, giving providers a chance to unload their reactions to the policy. These meetings identified that many people did not know they could upgrade their response to L&S, as long as they could justify why. Leadership quickly changed the policy's wording to better convey allowance for provider discretion. In May, 2022, they sent out a newsletter highlighting when and why providers could upgrade.

Since then, progress has slowly begun as people get used to the policy. But Kenosha is still picking up the pieces after their shaky rollout, and leadership has several tips for other systems to avoid these hurdles.

Tips from Kenosha Fire Department

  1. Give L&S policy change a long transition period. Don't go from 100% L&S responses down to 80% overnight.
  2. Spend a lot of time socializing any L&S policy change with crews and key stakeholders. Start early, and talk about it often. Allow providers to voice their concerns without fear of punishment.
  3. Make evidence-based changes so that you always have data to fall back on, even if that data doesn't seem relevant to your system.

Get your crews onboard early, and let them guide it and make it grow. You can offer those little tidbits of "What do you think 2 minutes are really doing clinically for your patient?" and let them come to the conclusion of "Huh, this is a smarter way to go. What am I doing?"

Lights and siren use is a huge part of EMS culture, and changing it is difficult. But with continuous, open communication with providers and a gradual rollout, your system has a better shot at meaningful quality improvement.

Additional Resources:

Dispatch Codes and Priority:

Dispatch Code Response
          Omega                      Non-L&S          
Alpha Non-L&S
Bravo L&S
Charlie L&S
Delta L&S
Echo L&S