Remaining Challenges. ALS Resources our delivery of ALS. We still struggle with the availability of medic units, and our response times for first arriving paramedic on critical medical calls have not improved. Our senior leadership team has spent the last few months looking at this challenge. And we have concluded that we need more ALS resources. We already decided in early 2015 that we needed to hire more Firefighter Paramedics and over the last 18 months we hired 45. We have identified the need and will push to hire additional Firefighter Paramedics, with another two classes planned for this fiscal year. This is in addition to the 48 Firefighter EMTs and 36 cadets we have hired during the last two years and the additional classes (one each) of Firefighter EMTs and cadets planned for FY 2017. Ultimately, with today’s call volume and a climbing District population, we think we need 20 medic units and 21 PECs to begin to address our ALS needs into the future. Getting to this level of staffing will take time and budget dollars. But we think that with the additional Firefighter Paramedics who are either on board now or in the mentoring pipeline, soon we will convert three of our BLS units into medic units. We plan to do this as early as March 5, 2017. We will convert the basic ambulances at Engines 3, 10 and 25 into medic units. Working closely with our unions, we are also planning to pilot a different staffing model for these units, where the station houses will be responsible for staffing both the medic unit and the paramedic engine company using their own rosters, rather than the resources of detailed members. We are interested in seeing whether such a staffing model will yield efficiencies in staffing, managing supplies and medication, mentoring, training, teamwork and other areas. We look forward to your feedback on this as a concept and as a work in practice. But we know that we cannot hire our way out of our ALS resource challenges. We also need to make some significant changes in the way we operate, in order to make the best use of our existing ALS resources. First, our ALS providers should only be doing ALS work. Our ALS providers are a highly skilled and limited resource and we need to preserve their availability for our most critical patients. We have been monitoring this issue and talking to you about it for several months. After the launch of the AMR contract, we began to see a gradual decrease in the percentage of BLS transports by ALS providers, which we attributed ...
Remaining Challenges. Much progress has been made in setting up the adaptive dynamics framework over the past five years. Nevertheless, many interesting directions for future research remain widely open. Three examples illustrate this assertion. Xxxxx Xxxxx, University of Helsinki, Finland, and Ge´za Mesze´na, Eo¨tvo¨ s University Budapest, Hungary, independently reported findings which demonstrate the importance of environmental dimensionality. The environment closes the feedback loop from the current phenotypic state to changes in this state. How many variables are necessary to characterize this feedback? How can its dimensionality be assessed empirically? Issues of this kind appear likely to become more important in our understanding of adaptive outcomes than they are today. Xxx Xxxxxxxx, University of Utrecht, and Xxxx Xxxxxx, Leiden University, both in the Netherlands, have analyzed the evolution of reproductive timing in xxxxxxx. Their model seems to show that adaptive dynamics’ invasion functions can not always be obtained from the growth rates of mutants when these are rare. Under which conditions can attention remain focused on initial invasion dynamics when predicting phenotypic substitutions? The invasion-oriented approach to phenotypic evolution already has succeeded in advancing our understanding substantially (Xxxxxxxx et al. 1996), but its limitations still have to be evaluated in more detail. Xxxx Xxxx, Xxxxxx Xxxxxx and Xxxxx Xxxxxx, Leiden University, the Netherlands, are exploring the options of building a bifurcation theory of evolutionarily stable strategies. Similar to the bifurcation theory of ordinary differential equations, such a framework could enable qualitative predictions of evolutionary outcomes that are robust under small alterations in the underlying ecological settings. Although encouraging results for one-dimensional phenotypes already are available, a general account of evolutionary bifurcations is pending. With problems of this calibre unsolved but now tractable, adaptive dynamics research promises to remain a fertile ground for innovative ideas on evolution, coevolution and complex adaptation in the years to come. References : Evolutionarily unstable fitness max- ima and stable fitness minima of continuous traits. Evol. Ecol. 7, 465–487 (1993) : Evolutionary cycling of predator-prey interactions: population dynamics and the Red Queen J. theor. Biol. 176, 91–102 (1995) : The dynamical theory of coevolution: a derivation from stochastic ecolo...
