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Oklahoma City, Oklahoma, USA

Using Evidence to Improve Emergency Medical Care

Project Type:
Health and Wellbeing, Homelessness, Housing

At a Glance

The City of Oklahoma City became the lead for the Key to Home Partnership — a collaboration of over 50 organizations working to prevent and end homelessness — and successfully housed 1,610 individuals in 2024.

Developed an evidence-based emergency response strategy, providing nearly 100 trauma patients with life-saving blood transfusions in the field before they get to the hospital.

Launched an innovation team, which leads data governance efforts and partners with the “Leading With Results” performance management team to continually monitor, evaluate and improve City operations.

Formed a data governance board to engage city departments in finding ways to make data more shareable, secure and useful in decision making.

In January 2024, two Oklahoma City paramedics found themselves 120 miles from a hospital tending to a man who had been crushed by a bulldozer. They did something unusual in civilian trauma cases: They administered a blood transfusion in the field. The man survived the two-hour trip to the hospital, where he received additional treatment.

The idea of transfusing a patient in the field may not sound revolutionary, but it actually flips traditional protocols upside down. For years, the status quo in these trauma cases has been the same: Blood transfusions happen in the hospital, and the paramedics’ goal is to get to the hospital as fast as possible.

In Oklahoma City, paramedics with the Fire Department had an idea: What if instead of transporting the patient to the blood, they brought blood to the patient? It might buy trauma patients valuable time to make it to the hospital alive.

Image Courtesy of the City of Oklahoma.

Rather than immediately launching a new program, Fire Department leaders started by looking at experiences of other cities. They reviewed the research on emerging practices and found evidence that the approach would save lives. Not only that, but their peers in San Antonio had started a groundbreaking program just like this in 2018. It was working so well it had become a national model.

Backed with hard evidence, Oklahoma City leaders built their new program. Two Fire Department emergency units carry mobile transfusion kits that include bags of refrigerated blood and a device that quickly warms the blood to body temperature. Paramedics are now able to transfuse patients in the field, ahead of additional care at the hospital. As Carl Cobb, Battalion Chief of Emergency Medical Services for the Oklahoma City Fire Department, puts it, “It helps the paramedics or EMTs that are providing care know that they are giving them the best chance of survival.”

“Our data governance board is an important piece of breaking down silos between departments, and it couldn’t happen without leadership support. It makes sure that departments know it’s not just that we want to measure stuff but that we want to make sure the measures are correct, easy to access, and actionable.”

Dr. Kelly Williams, Chief Innovation Officer

“The way our data governance board approaches issues is not about one department being better than another. It’s about all of us being good together.”

City Manager Craig Freeman
Oklahoma City paramedics prepare a blood transfusion on the scene.

1,610 individuals successfully housed in 2024

Now, it’s making a big difference for Oklahoma City residents. Through the program, OKCFD and EMSA paramedics have administered whole blood to more than 90 patients in the field. Of those the Fire Department responded to, 89 percent survived the trip to the hospital. And 69 percent of them survived to hospital discharge.

The Oklahoma City program is a partnership among the Fire Department, Oklahoma University Health, EMSA, Our Blood Institute, the regional blood bank and more. The partners meet to review every case where whole blood is used to assess how the program is working. They’ve already made some tweaks based on their ongoing evaluations. For example, at first, only male patients aged 15 and up, and females over age 50 were eligible — there were concerns about risks of reactions to O-positive blood among women of childbearing age. Now, all patients aged 15 and up are eligible, and the partners are looking at whether the age limit can be lowered to 6.

Paramedics say the new program, grounded from the start in evidence that it would work, is a game-changer. “I’ve been working for 30 years,” says Oklahoma City paramedic Jennifer Hamilton. “No changes have made more impact in my work than the whole blood program.”

“Achieving What Works Cities Certification is more than just validation of the work we’ve been doing with data. More importantly, it sets us on a path where we can grow and get even better.”

City Manager Craig Freeman

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Tulsa, Oklahoma, USA

Tulsa Scales Up Data-First Innovation.

Project Type:
Communications, Cross-Sector, Economic Development

Tulsa most recently achieved 2024 Silver What Works Cities Certification. The following narrative was written for Tulsa’s 2020 Silver What Works Cities Certification. Some content may be outdated. For the most current information, please visit cityoftulsa.org.

At a Glance

Created a cross-departmental team that identifies the most effective methods for achieving the city’s top goals and leads the city’s data-driven transformation.

Found patterns in 911 repeat call data that signaled the need for a new referral program to deliver specialized healthcare and social services for residents. Within the first three months of launching the program, there was a 70% reduction in calls from its top 911 utilizers.

Partnered city agencies and civic tech nonprofits to develop a text reminder system that reduced missed fines and warrants that have helped the City’s Court see an annual 187,000 increase in revenue.

Using Data to Power Innovation

G.T. Bynum has leadership in his veins. One of the youngest people ever elected mayor of Tulsa, Oklahoma, he’s the fourth person in his extended family to serve in the role since the turn of the last century. But he is the city’s first mayor to place data-driven decision making at the top of a change agenda. Since becoming mayor in December 2016, his administration has marked a turning point in how Tulsa uses data to power innovation and improve the quality of life in Tulsa.

Mayor Bynum didn’t waste any time after being elected. The idea of improving city services and using data to make key decisions was at the core of his mayoral campaign. One of his first moves as Mayor was the creation of the Office of Performance Strategy and Innovation (OPSI). The office works to align the city’s top goals with effective strategies. It quickly became key to the city’s data-driven transformation, says James Wagner, who led OPSI at its inception and is now the city’s director of finance and CFO.

Ben Harris, OPSI’s Data Analytics Manager, convened a team of employees from 16 departments to lead the city’s data governance and strategic planning efforts. The Data Governance Committee, which sets the standard and strategy for data quality, integrity, and use for the city government, has helped integrate the use of data citywide through the creation of a Central Data Repository where any employee or resident can request data.

“Through this cross-departmental team, we encourage transparency, access to data, and a feedback loop; ultimately it creates a trust relationship between departments,” Harris said.

“In addition to teamwork, technology played a huge role in orchestrating communication, automating data movement, securing data, and making it accessible.”

Data Analytics Manager Ben Harris

OPSI and the Committee also facilitate regular sessions with department leaders to focus on the value of performance metrics. These meetings aren’t just about tracking progress reviewing data — they’ve created a new space within the city to cultivate innovation.

“Mayor Bynum and other city leaders have consistently looked to OPSI to drive data-driven innovation work in Tulsa. This matters because we’re making real changes that improve city services and save taxpayers money.”

Chief Financial Officer James Wagner

A Caring Fire Department

For years, the number of calls to the Tulsa Fire Department was increasing, putting stress on their resources and capacity. By analyzing the data, the fire department discovered the source of the increased calls was not an increase in fires, but instead an increasing aging population who needed lift assists. Lift assists are calls to the 911 system for a non-emergency fall — the help the resident is requesting is to literally be picked up off of the ground. The city discovered a repeat lift assist pattern, with some residents requesting a lift assist as many as nine times a day.

Under the direction of Chief Michael Baker, the Fire Department developed and launched the Tulsa Community Assistance Referral and Educational Services (CARES) program, which was designed to connect high-utilizers of the emergency system to healthcare and social service providers. Visits to the highest utilizers became proactive, with the CARES team working on simple fixes such as installing low-cost solutions like handrails and opening up a dialogue with the resident’s primary care doctor. Within the first three months of the pilot, the fire department saw a 70 percent reduction in calls from its top 911 utilizers.

With preliminary results in hand, Baker presented his findings through the TulStat forum.

“TulStat,” based on the successful “LouieStat” program out of Louisville, Kentucky, has created a forum for change in Tulsa. City leaders gather to discuss priority problems, define success, innovate solutions, and develop methods for measuring progress. They identify specific, quantifiable goals, such as average time for reviewing building permit applications (previously 5 weeks, now 92 percent completed in 5 days) or responding to a 911 call, and troubleshoot obstacles to achieving them.

While CARES was developed before Bynum’s administration founded TulStat, having a space to build off of the pilot’s success was critical in connecting more residents to much-needed services. The program has served 204 clients; in 2020, four Tulsans have “graduated” the program and have the needed support services in place for them to live safely in their homes.

In the future, CARES hopes to work with OPSI to expand their data capacity to learn how to predict who is at risk for becoming a repeat caller to the 911 system and intervening early to distribute tools and services. Aligning community resources to provide innovative, proactive care will not only save the city’s Medicare and Medicaid partners money, it could save a resident’s life.

Breaking the Cycle

Working with What Works Cities and the Behavioural Insights Team, OPSI also helped the Tulsa Municipal Court solve a problem that had burdened the court and vulnerable residents for years.

Previously, when the court issued a resident a fine in a criminal case, but that resident wasn’t able to pay that fine on time, the court would offer an extension in the form of a “Time to Pay Order.” Some found themselves with a fine due more than 12 months in the future — enough time for them to save money for the payment, but also plenty of time to forget when it was due. As of early 2018, more than 70 percent of those orders resulted in a failure-to-pay warrant. For many, a warrant can exacerbate the cycle of poverty: a driver’s license might be suspended and additional fines can accrue, pulling someone further into the criminal justice system.

To combat the problem, OPSI partnered with the Court and Code for Tulsa to figure out how to reduce the number of warrants issued. Within a month, a text message pilot project was underway, designed around a simple hypothesis: Many people missed their Time to Pay Order deadline because they forgot the due date or lost paperwork. Together, OPSI, the Court, and Code for Tulsa developed a system to text simple, personalized reminders to a randomly selected pool of Time to Pay Order recipients. The test group received a text message reminder once a month leading up to their deadline.

Image Courtesy of the City of Tulsa.

The results were remarkable. During the six-month pilot, 63 percent of those who received a reminder paid all of their outstanding fees, compared to 48 percent of residents who did not receive reminders. Armed with data showing this 15 percent point increase, the Court system adopted the new reminder system. It now estimates an additional 320 people are paying their fees on time each year, avoiding warrants and additional problems because of the system. The Court benefited as well, seeing an annual $187,000 increase in revenue and a morale boost among employees who helped implement the solution.

“I’ve never been so excited about a job,” said Jamie King, a cost administrator at the court.

At the City’s Core

OPSI’s successful partnerships with city departments go beyond the fire department and courts. Three years in, OPSI has implemented practices and programs that have positioned Tulsa as a leader in data and innovation. In 2017, the office launched Urban Data Pioneers, an award-winning program consisting of teams of residents and city employees who analyze data to help the city solve key challenges and present policy recommendations.

With OPSI’s clear-cut ability to drive innovation, Mayor Bynum decided to integrate the office into the city’s key funding decisions. When Wagner became Director of Finance and CFO in early 2019, he brought OPSI with him to the Finance Department. This has changed the way Tulsa funds innovation. In essence, a data-driven approach has been institutionalized and scaled. Today, the city bases funding on data that proves programs work. OPSI vets data.

“We had the opportunity to take the approach and plug it into the finance department,” Mayor Bynum said. “It helps make it have much more of a citywide cultural impact.”

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