EMSThe current state of emergency care

in West Texas

Texas Highways

A total of 17,078 square miles (which is bigger than Denmark, the Netherlands, or Switzerland)

Country SQMI

Russia 6,592,771

Turkey 302,535

Ukraine 233,090

France 211,209

Spain 194,897

Sweden 173,732

Germany 137,846

FMHIRCH 135,783

Finland 130,674

Norway 125,182

Big Bend area SQMI

Brewster 6,193

Presidio 3,855

Jeff Davis 2,265

Pecos 4,765

Introduction

West Texas is 131,459 sq. miles with 108 counties

The population is 2,836,499

There are eight major cities

Three interstates: I-10, I-20, I-40

West Texas

What is EMS?

As defined by the State of Texas: Emergency Medical Services“Means services used to respond to an individual’s perceived need for immediate medical care and to prevent death or aggravation of physiological or psychological illness or injury.”

TEXAS HEALTH AND SAFETY CODE, CHAPTER 773. EMERGENCY MEDICAL SERVICES

History

EMS began in France around 1700.

In 1865, the First EMS was established in the US in Cincinnati, Ohio.

Hearses were used to transport patients. Medical staff consisted of interns and physicians of all different specialties.

In 1966, The National Academy of Science published the “Accidental Death and Disability Report”: The Neglected Disease of Modern Society. The Report identified problems with EMS.

1966 - Texas formed the Division of Disaster Health and Medical Services with the Texas Department of Health.

History

In 1970, Texas formed an EMS Personnel Registry. At this time, a list was also approved by the Texas Attorney General requiring qualification for an ambulance permit.

In 1973, the U.S. Congress authorized the Emergency Medical Services Systems Act.

Texas enacted the “EMS Act”, by the 63rd legislature. It established the first advisory council, mandated designation of Trauma Service Areas, stated delivery areas and one Trauma hospital in each, and identified any public or private agencies available for EMS utilization.

Assets

196 EMS Services

3705 EMS personnel3094 paid staff 611 volunteers

258 EMS stations

539 Ambulances

2249 Average Calls per year

Assets

Coverage

Air Medical Transport

There are 56 heliports in West Texas out of 554 statewide.

Helicopters and Fixed Wing planes are used for transport.

Helicopters cannot cover all of West Texas due to fuel constraints.

Air ambulances are at an advantage since there is no traffic and they can travel twice as fast. West Texas weather may cause problems.

There are 75 Rotary Wing aircrafts in the state, with 12 in West Texas; and 17 Fixed Wing aircrafts, with 7 in West Texas.

 

EMTF

Emergency Medical Task Force (EMTF) 4 EMTFs in 108 counties Each EMTF has:

AmBus Mobile Medical Unit (MMU) Ambulance Strike Team (AST) AmBus Strike Team (ABST) Registered Nurse Strike Team (RNST)

EMTF 1 EMTF 2 EMTF 9 EMTF 8

Ambus 1 3 1 2

Mobile Medical Units 1 1 1 1

EMS Funding

EMS is not a mandated service in Texas cities. Only Fire and Police Departments are mandated by the Texas Administrative Code.

“There is no entity required to provide emergency Medical service (it is not classified as an essential Service). This has led to a variety of methods for the provision of EMS and an enormous disparity of levels of services- what could be termed as a patchwork quilt of EMS in Texas.”

- Texas Department of State Health Services/EMS Trauma Systems

DSHS is the governing body over Emergency Medical services EMS has several funding sources Most of the funds are from House Bills and legislative acts that have been

set aside specifically for EMS

EMS Funding

The Driver’s Responsibility Act A Tobacco Settlement with the American Tobacco Company 911 Equalization Surcharge DUI and DWI Conviction Surcharges State Traffic Fines Extraordinary Emergency Account

Grants Texas A&M Engineering Extension Service - TEEX Local Project Grant

Regional Advisory Council Money from some of the above funding sources is

distributed through the RAC. There are 22 RACs in TX, with 8 in West TX. A service must

belong to a RAC to qualify for such funds.

Funding

Funding is dependent on the money available in the accounts and calculation of the funding criteria

Each fund has different criteria for distribution

The total allotted funds for EMS in 2012 was $2.99 million dollars- Texas Department of State Health Services Trauma Systems

Service Type

Mun

icip

al

Volun

teer

Mun

+Vol

Priv

ate Air

0

10

20

30

40

50

60

70

80

90

100

89

51

724

7

Count

Personnel

Personnel

West Texas

Non-Medical

First Responders Drivers

DSHS Survey

ECA 410 169

EMT 3458 1688

EMT-I 599 356

Paramedic 2281 1615

Total 6748 3685

Wages and Compensation

EMT - 12/hr. (25K)

Paramedic - 17/hr. (35K)

Average Salary for a Texas Registered Nurse – 64K

Average Salaries for

Volunteerism

“Recruiting can be difficult in Rural/frontier Texas because of dependency on volunteer EMS personnel.”

- 2004 GETAC report: TEXAS ELECTED OFFICIALS’ GUIDE TO EMERGENCY MEDICAL SERVICES

Many volunteer services face a lack of personnel

Volunteers have a difficult time leaving their jobs to go on a call

Older volunteers may not be able to handle the physical stress

Interest in volunteering amongst the younger population has decreased over time

Not economically feasible

Volunteerism

“A volunteer emergency medical services provider with a specific hardship may apply for a variance from the minimum standards for staffing and equipment for the provision of basic life-support emergency medical services.”

- Texas Department of State Health Services

In 2013, 36 variances were issued by the state of Texas, 26 which are located in West Texas.

 

Personnel

Education and Training

Texas Department of State Health Services (DSHS) keeps track of all Licenses

As of Jan 2013, paramedics must attend a two-year accredited college paramedic program

West Texas has few accredited paramedic programs and distance is a factor for many outlying counties

Education and Training

Schools now have to pay a fee to be accredited as well as an ongoing maintenance each year

The cost for the program is about $8,000 for residents; $9,000 for non-residents

The state has made training available to ECA’s

Texas A&M University, through National Highway and Safety Administrations grants, offers classes to rural and frontier areas for EMS basic, refresher, CEUs, and instructor training

Distance

Golden-HourMerriam Webster defines “golden hour” as the hour immediately following traumatic injury in which medical treatment to prevent irreversible internal damage and optimize the chance of survival is most effective

Distance between facilities

Age of the equipment tends to be more as the distance to trauma facilities increases 80% of the ambulances (2005 or older) belong to rural

counties

Border Patrol helps in border areas where there is no EMS

Ambulances

Burnout

“Burnout is typically described as an individual’s pattern of negative affective responses that further reduce his or her own job satisfaction, productivity and job performance.” - EMS World

EMS workers are exposed to many Traumatic situations: Abuse, Assault, Motor Vehicle Crashes, Deaths, Crime scenes

Many of these providers have little or no training dealing with this high level of stress. Without intervention this mental and emotional fatigue can lead to burnout.

Critical Incident Stress Management (CISM) - a team of workers that is composed of mental health professionals, chaplains, and peers with 24hr. availability

Texas has teams across the state

Smaller services would have to request help from a larger CISM team

Special Thanks

West Texas AHECTexas Department of State Health Services-EMS

and Trauma Systems

And a very special thanks to West Texas EMS services