Chapter 7 – Emergency Medical Services (EMS) and Emergency ...
EMS The current state of emergency care in West Texas.
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Transcript of EMS The current state of emergency care in West Texas.
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