PULSE Magazine | February 2019 Issue

outstanding young citizens and he undertook EMT training himself to prepare for his role in monitor- ing the Austin system. The quality assurance team has been expanded to 30 members, in the mean- time six of whom are physicians. During 1975, the city recruited a director for the new system and began to put the pieces of Austin EMS department in place. It was launched on January 1, 1976 as a combination emergency and non-emergency service. Five of the original six am- bulances were committed to emergency work (both basic and advanced life support) and one unit was used strictly for BLS non-emergency transfer calls. The original units were based in rented apartments throughout the city and at the EMS department headquarters. Presently the Austin system operates 12 emergency ambulances (five ALS and seven BLS). In 1980 the city did away with the non-emergency transfer services, it is now handled by a private service operating under a city franchise. Each emergency ambulance is commanded by a senior crew member (senior paramedic or senior EMT). In addition , there are two field supervisor on duty at all times, they cover the north and south sectors of the city in non transporting vehicles. Austin is one of the fastest growing city in the US, and that growth is reflected in ever greater use of the EMS system. In 1984, the system handled nearly 34,000 calls with a city wide average response of 5.35 minutes. The dual tier system of BLS and ALS units relies on its dispatchers to determine whether a basic or advanced unit is re- quired. A basic call screening protocol is used to determine whether an ambulance is needed and, whether a BLS or ALS unit should be dispatched. Austin is located in Travis county. Since 1977, the Ems department has been serving the entire county as well as the city. The county population is 492,365 of which 403,723 is within the city limits. Inside the city the Austin Fire Department provides first responder services. In the unincorporated county areas, volunteer fire departments serve as first responders. Where other ambulance systems have become pawns as battles between competing hospital emergency departments the Austin system did not face that problem in its early days. There was only one emergency department in the city, Bracken- ridge Hospital, which is operated by the city. Currently there are four emergency departments and policies have been established to assure a fair distribution of patients between them. Bracken- ridge houses the city's only trauma center. There are 138 authorized positions in the Austin Ems department, including a director, assistant director, three program mangers of operations, training and evaluation, and support services and six shift supervisors. The system also employees a full time public information officer. More than half

the administration and supervisory staff has been with the system since it started. The systems open recruitment policies have brought a rich collection of people and experiences from throughout the country. Employment opportunity ads for the Austin EMS Department have regularly appeared in JEMS and other publications. The campaign generates about 200 applicants each year, about 70% from outside Texas. Out-of-state applicants must be certified in their home state and must have a least six months emergency ambulance experience. Regardless of prior training , certification and experience all new personnel are hired by the Austin system as EMT’s (BLS). They must then go through a six month probationary period. Probationary employees spend their first six months working as a third person with a training crew on a BLS ambulance. Even though most peo- ple who come to the system have already served as a paramedic somewhere else. Employees of the Austin system become paramedics by a process of promotion, which includes succeeding in the Ems department s certification program. At least one new employee was promoted to paramedic in 10 months, but for most it takes longer. When the process was first described to us, we wondered about decay of skills for the paramedic who comes to Austin from Illinois, Ohio, Georgia or elsewhere. Wouldn’t there be some regression in the year or more of starting over at the BLS level? Not necessarily, advised Victoria Lummur, assistant director of the EMS department. Basic life support skills—especially patient assessment is the area of greatest decay among active paramedics she pointed out, and those skills are actually emphasized or enhanced by the BLS ambulance experience preparatory to Austin’s advancement to the paramedic level. The very few scientific studies of paramedic skill decay support Lummur’ view- point. After promotion to paramedic, there is an addition- al period of performance review and scrutiny. For the first 48 hours in his new position, the Austin paramedic is accompanied and observed by a field evaluator. For the first six months new paramedics are on a six month probationary status under the watchful eye of a senior paramedic. Starting salaries for new employees currently are set at $15,500 per year, with top salary levels for EMTs at $23,063. Probationary paramedics earn $21,049 per year and can advance to senior para- medic at $25,494 per year. The Austin EMS system operates from 11 stations: eight of those stations are shared quarters with Austin Fire Department, but three of the are independent EMS stations. In 1982 I had the pleasure of speaking at the dedication of one of those independent stations a spacious, attractive

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