2022 EMS Agency of the Year: Washington County EMS

Texas thrives in large part due to the economic and cultural contributions from the rural areas of the state. In many rural areas of Texas, the local EMS agency plays a critical role in the health care delivery system, and, in many cases, the EMS agency might be the sole provider.

Texas EMS agencies take great pride in ensuring that rural Texans have the same level of emergency care as all Texans. Washington County EMS has excelled at rural EMS care over the past decade and pushed rural EMS to the forefront of EMS care in Texas.

Washington County EMS’s goal is to provide an urban or a suburban level of care for STEMI, strokes and trauma patients to Texans who prefer to live in the rural areas of our state. This overarching goal has served as an impetus for Washington County EMS to think, react and respond in a different way.

Washington County is an area of Texas that lacks many of the facets that are featured in hospitals to respond to emergency situations:  cardiologists, neurologists, pulmonologists, cath labs, trauma centers and stroke centers. Washington County EMS rises to this challenge by creating solutions to address these deficiencies and ensure that rural patients have the highest quality emergency care possible.  

Eight years ago, Washington County EMS created performance-based benchmarks surrounding time performances of the ground EMS response. Washington County EMS complemented the benchmarks  with the addition of the air division by instituting similar performance metrics to mandate full integration and system performance.

Prior to full air integration, the Washington County EMS’s best time-sensitive treatment was approximately one hour from “first medical contact” to definitive care. The following is an actual case prior to full integration:

12:01               Call received

12:02               EMS en route

12:10               First paramedic contact

12:10               Air support requested (from Bryan/College Station)

12:39               Aircraft arrived in Brenham at the rendezvous location

13:04               Aircraft left the scene to definitive care

13:18               Patient arrives at definitive care

__________

1 hour 8 minutes

As a result of Washington County EMS’s aviation full integration within the EMS system and applied scene time benchmarks, lift-off benchmarks, and notification benchmarks, the following is an actual case:

18:32 Call rec

18:33 Ground Crew en route

18:37 First Paramedic contact

18:50 Aircraft on scene

19:13 patient arrives to cath lab

_________

Thirty-six minutes from first medical contact to the cath lab (three times faster than the prior procedure).

The new procedure provides a whole new opportunity for Washington County EMS’s patients. However, simply adding air services does not change these numbers to that degree. Washington County EMS tried utilizing air medical services for nearly two decades without success in decreasing the time to definitive care. This was primarily because air medical providers preferred to “re-assess” and spend valuable scene time (despite the fact that it takes time for aircraft to arrive on scene). 

The above scenario featuring full integration is one of many successful patient responses in Washington County. In fact, Washington County EMS has a document that is 22 minutes from first paramedic arrival to trauma center arrival, which is rare in any area of Texas – urban or rural – and unimaginable in a part of rural Texas with limited to no capabilities.

This 22-minute case did not simply consist of transport to the trauma center either; it featured  whole blood transfusion, rapid sequence induction and a number of other services during that 22 minutes. The 22-minute case did not just stop at clinical care. The department takes great care in not bankrupting these patients with the high flight rates that some communities experience. As a result, Washington County EMS ensures that a patient is not balance billed.

Washington County EMS’s innovation does not stop at integrated care. In addition, the agency has enhanced its pre-hospital care through the addition of whole blood products; ultrasound for trauma care and pulmonary disease; an advanced community paramedic response model and infrastructure develop of rural paramedic stations in Burton, Chappell Hill and Washington (three new stations in three years).