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EMS. The 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). Introduction. West Texas. As defined by the State of Texas : Emergency Medical Services

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Presentation Transcript
slide1

EMS

The current state of emergency care

in West Texas

slide3

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

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

What is EMS?
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
history1

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.
History
assets

196 EMS Services

  • 3705 EMS personnel

3094 paid staff

611 volunteers

  • 258 EMS stations
  • 539 Ambulances
  • 2249 Average Calls per year
Assets
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.
Air Medical Transport
slide13

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
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
ems funding1

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.
EMS Funding
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
Funding
personnel1

West Texas

Non-Medical

  • First Responders
  • Drivers
Personnel
wages and compensation

Average Salaries for

Average Salary for a Texas Registered Nurse – 64K

Wages and Compensation
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
volunteerism1

“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.
Volunteerism
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
education and training1

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
Education and Training
distance

Golden-Hour

    • Merriam 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
Distance
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
Burnout
special thanks

West Texas AHEC

Texas Department of State Health Services-EMS and Trauma Systems

And a very special thanks to

West Texas EMS services

Special Thanks