Ben Oakley of Blanco EMS

Ben Oakley serves as the countywide EMS chief for Blanco County (North Blanco County EMS  and Blanco County ESD 2). TEMSA recently sat down with Ben to get his thoughts on the future of EMS in Texas.

Ben Oakley (pictured with the microphone) speaking at EMS EVOLUTION 2018.

TEMSA: What are the greatest challenges that you currently face in Blanco County?

Ben Oakley: Similar to a lot of other agencies, our greatest challenges all tie back to funding. As many know, emergency services districts (ESDs) are subject to a constitutionally imposed tax cap of $0.10 per $100 of valuation. Our district’s tax rate has been at $0.10 for many years now, and we continue to struggle to generate sufficient revenue from ad valorem taxes as a result of our limited tax base, of which a substantial amount has agricultural exemptions. We continue to see some increases in our tax base, but these increases are not even close to our increased demand for services. We recently turned to our voters for a 1 percent sales tax election, which was successful, and this has helped our budget, but we still lack funding to increase our staffing levels to the needed level.

Ultimately, our limited funding has a profound impact on our current staffing levels, which are far below our desired levels. As a result, we have trialed different deployment models and staffing models, to make the most effective use of the staff we do have. The biggest challenge associated with this is the workload on our staff and managing fatigue. Considering the rural setting we work in, our call volume and the time our units are “committed” to incidents (modified UHU) is astounding, and can easily rank up there with some of the busiest urban ambulances in Texas. Nonetheless, as a rural agency with funding challenges, we take a tremendous amount of pride in our ability to deliver progressive, state-of-the-art medicine to our community, in the most fiscally responsible manner.

Our second greatest challenge relates to the recruitment of new personnel. With the funding challenges previously discussed, developing a compensation package that is in line with other agencies can be quite challenging. Because our tax revenue is maxed out, we are unable to increase taxes, and as such have a limited amount of funding available. As such, this sometimes has resulted in having to decide between offering particular benefits or increasing compensation. Additionally, being in a rural setting means that we have to be creative in our recruiting, as there is a lack of candidates in our local area,  so we constantly have to reach out to farther areas to seek potential new employees.

TEMSA: What are some of the greatest advances in EMS that you have witnessed over the past decade? 

Ben Oakley: Overall, I feel the biggest advancement in EMS over the past decade has been the integration of EMS into the health care system from a data standpoint. We can now electronically link our patient care reports with the hospital record, which results in essentially unlimited access into the hospital data set of our patients. With these data sets combined, we can now drive the future of EMS based on actual patient outcomes. We are now truly able to see what benefits patients, what doesn’t make a difference, and even what harms patients. In our own system, we have made massive changes to our clinical care guidelines over the past year based on what we’re actually seeing, and how our own patients are responding to our treatments.

On a local level, it was a result of this data becoming available that we developed our sepsis identification and management program six years ago that incorporates not only lactate monitoring, but also blood cultures, broad-spectrum antibiotics and now the Marik protocol (vitamin C, thiamine and Solu-Cortef). Additionally, it was the driving factor in our implementation of point-of-care laboratory testing on our ambulances, intra-arrest cooling, heads up CPR, expanded use of tranexamic acid (TXA) in medical conditions such as GI bleeds, and, most notably, the implementation of intravenous Tylenol (OFIRMEV).

TEMSA: Where do you see EMS in Texas in 10 years?

Ben Oakley: As we move into the future, I see EMS continuing to further integrate with the health care system over the next 10 years. We are at a critical turning point in the history of EMS where we really have an opportunity to redefine who we are and what we do. With the growth of paramedicine programs and our overall commitment to true evidence-based medicine, I see EMS being successful in getting away from being viewed as “transportation based” and placing our focus on solving patients’ problems.

Through enhancing our education and scope of practice, we can focus more on prevention activities and the treatment of patients in the field, rather than merely transporting everyone to the hospital. Everyone knows that emergency department overcrowding is a huge problem, and it’s a problem that EMS actively contributes to! With the right training, the right tools, and redefining reimbursement processes, we can skip the trip to the hospital in so many cases. Through this change, we will truly begin to become a key component of appropriately navigating patients through the health care system, as many agencies have already begun to do through community paramedicine programs. In other words, imagine if community paramedicine was the norm (applied agency-wide)!

I think we’ll also see a substantial redesign of education over the next 10 years. More education is important, but it’s a slippery slope because rural agencies already have limited access to advanced education programs. In our agency, as a result of our recruiting difficulties, we are already transitioning towards taking our EMT-level providers and sending them to become paramedics. We need to focus more on programs like these that take fantastic providers who want to learn more and do more, but are unable to do so due to limited resources.

On a local level, as we continue to redefine “who we are and what we do” coupled with our funding challenges, I think we will see a completely different deployment model in 10 years. A concept we have been working on is the deployment of “paramedic squad” units. These are staffed with a single paramedic and are capable of handling low acuity calls that don’t require an ambulance. In addition, they can assist on critical calls as additional manpower, which alleviates the need for additional ambulances. In between the calls, they can perform prevention activities.\

Incorporating paramedic squads into our system would greatly improve the health of our community while reducing workload of our already overworked transport units. This can all be done for a fraction of the cost of adding an additional ambulance. This sure does sound like the IHI Triple Aim, doesn’t it?

TEMSA: Why do you think that it is important for EMS agencies to be part of TEMSA?

Ben Oakley: When you think about it, EMS in Texas is really unique. We are the second largest state in the United States by both area and population. Collectively, as the EMS Providers of Texas, we provide care to over 29 million residents, which is nearly 9 percent of the entire United States! Furthermore, thanks to delegated practice, each EMS system in Texas is unique and tailored to meet the needs of their individual community. Because of how unique each agency is, working together is of the utmost importance for agencies in Texas. Together, we can share ideas, solve problems collectively, and speak with one voice, and let our voice be heard! Not only does this have huge implications at the state level, but we can really turn some heads at the federal level and truly be effective at driving change as we move into the future.

Membership in TEMSA is important because it is our “conduit” to make these changes happen, and is a place where all of us can work together as one team to not only improve EMS at our respective agencies, but the system as a whole!