Transcript EMS - West Texas AHEC

EMS
The current state of emergency care
in West Texas
Texas Highways
Country
SQMI
Russia
6,592,771
Big Bend area
SQMI
Turkey
302,535
Brewster
6,193
Ukraine
233,090
Presidio
3,855
Jeff Davis
2,265
Pecos
4,765
France
211,209
Spain
194,897
Sweden
173,732
Germany
137,846
FMHIRCH
135,783
Finland
130,674
Norway
125,182
A total of 17,078 square miles
(which is bigger than Denmark,
the Netherlands, or Switzerland)
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
Introduction
West Texas
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?

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.
History
 196 EMS Services
 3705 EMS personnel
3094 paid staff
611 volunteers
 258 EMS stations
 539 Ambulances
 2249 Average Calls per year
Assets
Assets
Coverage

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

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
EMTF
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.
EMS 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
100
90
80
70
60
50
40
30
20
10
0
Count
89
51
24
7
Service Type
7
Personnel
West Texas
DSHS
Survey
ECA
410
169
EMT
3458
1688
599
356
Paramedic
2281
1615
Total
6748
3685
EMT-I
Non-Medical


First Responders
Drivers
Personnel
Average Salaries for
EMT
Paramedic
- 12/hr. (25K)
- 17/hr. (35K)
Average Salary for a Texas Registered Nurse – 64K
Wages and Compensation
“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.
Volunteerism
Personnel

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
Education and Training

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
Ambulances

“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
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