Washington County EMS

2018 Annual Report

New Report Format

The Department is transitioning away from the hard print copy of the annual report and into the e-format report. Please bear with us as we make the transition. We have been using the smore.com software for our internal department communication over the past year and believe this will improve our ability to communicate with you. However, do not be alarmed we can also print this report for you should you desire it in a print format. We believe it will allow for easier access from the potential recipients, easier editing, and much less costly than using a print company. The new format will also allow more interaction. We can upload supplementary reports, videos, and images to assist in explaining the accomplishments and direction of the department. The new format is viewable in tablet, smartphone, Apple or a pc if you so choose. Please, please, please let us know if you need help navigating the report. The previous reports have also become somewhat lengthy and while these have a purpose of educating newly elected officials, citizens, and departments stakeholders. We are really trying to give you statistically significant data within this new report as we realize your time is limited.


Washington County EMS is a true third service governmental public safety EMS department (completely separate from fire and law enforcement) that covers over 670 square miles of mostly rural southeast Texas. The department is rapidly approaching our 40th year of existence as a county department. For a little, over a decade the department has become known around the state as one of the most progressive, efficient and effective EMS agencies. We believe that setting goals, benchmarks, and accomplishments are important but without proper data analysis, these things remain goals and not accomplishments. Therefore we strive every year to acknowledge both our strengths and weaknesses and improve upon these by using data supported decisions course corrections. WCEMS is the only department in the region that operates a full mobile intensive care unit (MICU) licensed department. The Department of State Health Services has multiple licensure levels that an EMS agency can apply for. Clinically speaking, the highest is the MICU level. This guarantees certain equipment and personnel arrive at your emergency should this unfortunate event occur. The department had been recognized at the local, state, and even national level for its work in superior clinical outcomes while maintaining cost efficiencies that few can compare with. This years annual report is an attempt to capture the past 12 months progresses and to educate the court and constituents on any concerns and upcoming needs. The department also puts forth a five-year strategic planning document which you'll see an update at the end of the annual report.

Message from the Director

2018 was both one of the best and also by far the toughest year in my tenure in regards to staffing. The turn around in both the national and local economy has made it difficult on us in regards to keeping up with pay raises that surrounding county agencies secured. Withing a 12 month period when compairing us to surrounding agencies (such as Austin, Waller, and Fayette County) we went from near the middle of the pay chart to near the bottom. This along with the loss of some poor performing employees made this year unusually difficult for us. However, it also gave us an opportunity to evaluate our selves and truly "prune the bush" back some in regards to ensuring we are providing the absolute optimal employees as possible for public safety work. Yes, we lost 6 full times employees (several to our neighboring county's) however one of the hidden facts is that several of them had poor evaluations and were headed in a very unfavorable direction and of course we dealt with false accusations that were made as some of these employees left.

In October of 2017, I told our Court Liason Commissioner Hanath in a casual conversation that in order to correct the direction of the staffing issues that were plaguing us we needed to "lose a few employees" that are stifling new employees from growing, learning and becoming excellent employees. I firmly believe that any individual with a poor or negative attitude is not conducive for learning or teaching. Therefore, we must choose attitude over talent everytime when dealing with hiring new and maintaining employees. We can not correct negative performance if the attitude is not conducive for learning.

What was left after the exodus was some of the most genuine, hard-working, and humble employees? That can now enjoy their passion for taking care of others without the negative influence that once surrounded them.

From March to June of this year I spent a large amount of time building an internal leadership academy. I acknowledge that for the past ten years I, and by extension, this department has spent an enormous amount of effort and time creating absolutely top notch amazingly talented Paramedics and have been extremely successful in doing this. However, in that, we have forgotten to focus on developing the leaders of the department. From August to December every leader within our department attended a twice a month leadership series focused on:

  • Defining our Leadership Philosophy
  • Understanding that every good leader was even a better follower
  • Understanding what type of employee we are really after when recruiting (using the ideal team player book as our curriculum)
  • Improving both our young and experienced mid-managers ability to understand what their role and expectations are in regards to leadership.
  • We defined the employee's area of operations and what was meant by having extreme ownership of our decisions.
  • We discussed proper and improper ways to implement policy changes and expectations that surrounded this.
  • We also discussed tendencies and attitudes that would not be tolerated within this department.

After the 4 month course, I have never felt more positive about a group of people and the direction we are headed specifically in regards to leadership, department morale and direction.

The strategic placement of Paramedics into our super rural districts, such as Burton, Chappell Hill, and now Washington, has proved to not only be lifesaving but the most efficient model of EMS in our 40-year history. One of the many ways we judge our success, both clinically and operationally, is by customer satisfaction. In 2008 we started tracking customer satisfaction and since that time we have experienced a 97% customer satisfaction rating with our patients for over ten years in a row. These surveys are mailed to EVERY patient we treat and or transport. Over this same time period (2008-2018) we have received $984,698 in donations from our community. Which is one of the ways to demonstrate their satisfaction and appreciation. That is slightly over a $100,000 of donations per year!

Financial Analysis

A quick overview of revenue:

  • $2,402,091.37 from "fees for service" (insurance money)
  • $300,000 from our Advanced Community Paramedic Program from federal DSRIP (delivery system reform incentive program)
  • $275,894.29 - TASP (Texas Ambulance Supplement Program)
  • $14,936.36 - Texas Task Force deployment reimbursement
  • $11,438.87 - Brazos Valley COG reimbursement
  • $116,121.29 - Donations

Total Revenue 2018 $3,120,482.18

Total Operating Expenses 2018 $3,719,610.33

This equates to 84% of our budget being offset by revenue. Leaving just 16% for the taxpayers. Of the 3.7 million dollar budget taxpayers paid for less than $600k of this budget. Unheard of for any public safety agency. We are still expecting and projecting over $84,327 for salary reimbursement from Texas Task Force. This will narrow the cost vs revenue to our department to just under 87% funded (only 13% of our budget coming from tax dollars)

Additional dollars were allocated from non-tax dollars for the facility construction of Station #3 and Station #5. This money was allocated from the TASP fund and accounted for just over $253,070 to build two EMS rural response stations. One in Washington (in conjunction with WVFD and one in the City of Burton).

What is DSRIP?

Delivery System Reform Incentive Program. DSRIP´s purpose is to fundamentally restructure the health care delivery system by reinvesting in the Medicaid program, with the primary goal of reducing avoidable hospital use by 25% over 5 years. Texas plugged into the DSRIP program in 2011. Which is why it became known as the 1115 Waiver program (2011-2015). We had created a program called the advanced community paramedic program and presented this program to the regional anchor team (Texas A&M Health Science Center) and was approved as a DSRIP subcontractor. We have received over 1.3 million dollars from the federal government for the program thus far and prevented nearly $775,000 in healthcare expenditures since the program's inception in 2012. (see below DRIP Frequently Ask Questions for more detailed information)

What is TASPP?

The Texas Ambulance Supplement Provider program is a statewide program that allows only government EMS departments to collect money lost due to non insured, underinsured, or Medicaid patients that require EMS transportation and treatment. We were the first provider in the Brazos Valley to enter into the TASPP funding model and one of twelve that started in the State of Texas. Originally it felt like this may be more work than it is worth. However, after working with Kevin Coyle and Revenue Optimation Inc we discovered this was well worth the effort. Since starting the TASP program we have recovered over $865,266. See below for details. The middle column details the amount we paid Revenue Optimiation, Inc to assist us in the collection of those dollars and the column on the right is the net total deposited to the county since 2015.

2018 - $275,894.29 - $26,209.96 = $249,684.33

2017 - $173,513.92 – 16,483.82 = $157,030.10

2016 - $234,063.43 – 22,236.03 = $211,827.40

2015 - $181,795.34- 17,270.56 = $164,524.78

Total - $865,266.98 from TASPP

What is the BVCOG and how do we get funding through this mechanism?

The Brazos Valley Council of Governments (BVCOG) is a multi-purpose voluntary organization of, by and for local governments in the seven-county Brazos Valley Region of Texas. The BVCOG serves over 315,000 citizens and covers an area of 5,109 square miles. This area, known and referred to as the Brazos Valley Region consists of seven counties, which are Brazos, Burleson, Grimes, Leon, Madison, Robertson and Washington.

Director Deramus serves as the Pre-Hospital Chair for the Brazos Valley Regional Trauma Advisory Council known as the RAC. The RAC is a fundamental component of the emergency healthcare services in the State of Texas. Texas is divided up into 22 RAC's. Deramus serves as the Chairman for the BVRAC Pre-Hospital Committee. The BVRAC is under the management auspices of the BVCOG. Last year the BVRAC funded nearly $11,000 of training and or equipment for Washington County EMS. This does not include additional free training opportunities that are taken advantage of by our paramedics. Such as the bi-annual cadaver labs hosted by the BVRAC. These labs cost approximately $6,000 each to host and we send approximately 5 paramedics a year to these training opportunities.

The BVCOG also manages the regions Homeland Security Advisory Council known as HSAC. Director Deramus also is appointed to serve on this advisory council. The HSAC coordinates planning and training initiatives that help public safety agencies better prepare for disasters within the Brazos Valley. Last year the HSAC awarded a grant for state of the art night vision goggles (NVG) that will enable a safer response for the Sheriff's Office tactical operators and the EMS Departments swift water rescue paramedics. The HSAC grant awarded was approximately $56,000.

Texas Task Force-1 (TEEX)

Since 2008, Washington County EMS has been a part of the world renowned search and rescue agency known as Texas Task Force 1 (TXTF1). TXTF1 is a nationally know and internationally recognized search and rescue team that has a primary goal of responding to the needs of the State of Texas during natural or man-made disasters. TXTF1 offers the absolute best training opportunities for our rescue paramedics to become competent in swift water rescue operations. Our boat operators are deployed to state disasters and 100% of the expenses incurred by the county are reimbursed by the State of Texas. So far for 2018 we have received $14,936 of salary reimbursement and are expected to receive an additional $84,327.72 from salaries expended to assist the great state of Texas in 2018. There is some misinformation going around about the task force dollars. This program is designed by TEEX to provide a statewide rescue response component for the Governor of Texas to call upon during a state disaster. We (your EMS dept) are one of the agencies that make up this response. However, we are only EMS department in the State to be a bailment boat team. Meaning one of the teams that the Task Force has relocated a cache of equipment at. In this case, they give us a rescue boat and associated equipment to be able to quickly respond to the state request. We also have an existing MOU (agreement) that requires the state to pay for the salaries and back salaries or overtime accrued due to this response. There are no (none) local tax dollars utilized for these responses. In fact, the county often experiences a net positive in regards to salaries. For example, if the state deploys the Director of EMS as a water manager, then the state not only pays for the overtime accrued but for the salary as well. Using the 2018 year as an example, approximately 10-13% of the EMS Directors budgeted salary was paid for by the State of Texas plus all associated over time.


Starting in 2007 we initiated a customer service feedback policy and wanted to ensure we fully understand how the patients "perceive" we are doing. Since the inception of the program. We collect plenty of data that support and assist us in improving clinically. However, up to this point, we really didn't know what the patients "though". This survey not only allows us to see this allows the patient an opportunity to "give" to the department through a donation feedback form. Since inception, this has earned just shy of a $1,000,000 in donation dollars. $116,121.29 was the total donation giving for 2018.

I would like to express gratitude to the county finance committee who has assisted the EMS Department in properly investing our revenue for the future. Recently we placed $350,000 of TASPP dollars in CD's and then an additional $100,000 of donation money in a CD to better "grow" our interest on these dollars. For the first time in history, we have four accounts (including the tobacco fund) growing interest that can offset future expenses.

Infrastructure Development

CAD (Computer Aided Dispatching):

In regards to developing our infrastructure in March of 2018, we went live with a fully integrated computer-aided dispatch program that created a more robust ability to share public safety data across all disciplines and improved the dispatcher's ability to dispatch the public safety agencies. This has been a near two-year implementation project that started when former the former police chief and other law enforcement agencies became unsatisfied with the former CAD's ability to function in regards reports and customer service. The new CAD was unanimously voted on by all five of the primary CAD users in 2016 (Sheriff's Office, Brenham PD, Brenham FD, Washington County Communications, and WCEMS). Zuercher software went live in March. Of course, with a transition of this magnitude, there have been some hurdles to overcome. I believe we are better off today than where we were two years ago and at a much cheaper price to the taxpayers.

The one area we, the EMS department believes was not as advertised is the current mobile routing application. This feature is cumbersome, slow, and has been somewhat of a safety concern for the EMS department. The goal of the mobile routing software is ultimately to safely and reliably route paramedics to the 911 call with speed, efficiency, and a very high degree of accuracy. That has not been our experience since implementing. We have experienced extremely slow "refresh" times and what appears to be network routing issues. While we have gotten no resolution from Zuercher or our County IT, we have simultaneously been researching alternative solutions. We believe Genesis-Pulse which is a CAD enhancement software may be the solution. You will be hearing about this potential solution over the next few weeks and we hope to go live with this product. We've been able to cut the original payment to Zuercher by $10,000 to assist with this project implementation.

Cradlepoint Technology:

As we added stations to rural response districts (Chappell Hill, Burton, and Washington) we quickly realized we needed a solution for communications, accessing the internet and moving data to and from the county network. We task Lt. Tanner Jacob with the idea of finding a secure, protected, and rugged enough solution that would build small networks within a larger network platform. We needed a platform that would work now on 4GLTE network and that would also allow us to transition to the new public safety broadband network becoming known as "FirstNet". What we found was a perfect fit for both the mobility required for our ambulances and the station data access points needed for our rural EMS stations.

The project goals between Tanner and I were to create:

  1. A computer network that was capable of accessing high-speed 4GLTE / internet access with unlimited data.
  2. Able to utilize a VPN (virtual private network) to connect each facility and each EMS ambulance into the county core network to move data between the two when needed.
  3. Access our internet and cloud-based software program for continuity of operations such as ESO (our patient charting software), OPIQ (operative IQ which is our inventory and asset management software)
  4. Have large enough bandwidth to carry all IP devices such as internet protocol phones, and security cameras.
  5. We also needed the CP modems on the units to be able to carry patient clinical data points from our clinical monitors and send to receiving hospitals. Examples such as LP-12 ECG, ultra sounds video, vital signs, etc...
  6. Create a large enough wireless (WiFi) network footprint for our BYOD (own devices to access the internet) or wireless printers.

We are happy to report to you that this project is now complete. Not only have we met all our goals as set forth we have in my mind exceeded our expectations. We can now do management of these networks remotely, monitor them remotely, and have support from cradlepoint in place to fix issues as needed. Huge thanks to Lt. Jacob for being the tip of the spear on this project. We certainly would not have made this a reality without him.

It's my recommendation that other departments or offices within the county that work in remote or mobile environments take a hard look at how cradlepoints could improve their departments as well. We have made these recommendations to the County IT Director as well.

We currently have 12 Cradlepoint Modems in operation:

  • Ambulances
  • Squads
  • SRT Vehicle
  • Station 3
  • Station 4
  • Station 5


2018 was a huge year in regards to strategic plan completion. As you know at the EMS department break down our strategic planning goals into five (5) year increments. This allows for realistic benchmark and goal planning. The 2015-2020 plan called for the completion of Station 3 in Burton and to "plan for" a facility in the Washington area. Thanks primarily to the Chief and staff at the Washington VFD we were not only able to plan for but build and in December of 2018 move into a new remote satellite facility in deepest response area of the county. In 2018 we built two satellite facilities using TASPP (non-local tax dollars). This has done two major things for us. Not only has it allowed us to have an advanced life support paramedic in these remote areas for life-saving response time improvements. It also will allow a responsible growth plan of staffing and coverage in regards to infrastructure development. Essentially this has put us way ahead of the plan in regards to strategic planning.

I can't thank Captain Knuppel and the County maintenance staff enough for all the work they've done on these projects. I would also like to point out that Lt. Tanner Jacob tied each of these stations to the county network and has been a godsend in regards to public safety IT planning for our department. I would also give many thanks to Vincent, Ross and the entire R&B Department for all their assistance and continued support with these and our existing facilities.

I've attached a few pictures of each of these new below for you to view. But please take the time to come to visit when in the area.

Cardiac Monitor Replacement:

Capitalizing on the Texas tobacco funds that our county received nearly 20 years ago and invested under previous County Judge Dorothy Morgan. We were able to upgrade our near 15 year old cardiac monitor fleet and add a LUCAS (mechanical CPR device) during the 2018 year. Currently, every monitor in the fleet is under 2 years old and our patients enjoy the latest clinical advances science has made available. These monitors have the ability to:

  • Perform live saving escaling defibrillation
  • ECG monitor
  • 12-LEAD ECG monitoring
  • Pulse Oximetery monitoring
  • EtC02 monitoring
  • Capable of transmitting information to receiving facilities
  • Performance review software that improves quality improvement programs.
  • Temperature monitoring

The $147,769 upgrade package for five monitors and one LUCAS chest compressor is the most expensive and most life-saving piece of equipment on the ambulance. See video below for more details on this purchase. I would reiterate this came from the interest account of our Tobacco funds not tax dollars.

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Operational Analysis

Great news on the operation side. For the first time in over a decade, we had a reduction in calls for service. Let me repeat that statement. For the first time in over a decade, we experienced a reduction in calls for service. Since prior to Hurrican Katrina, the call volume for EMS has steadily increased some years by 2-3% and some years over 5%. In 2012 we instituted a plan to reduce some of the "frequent flyers". As with any program it takes time and some instances years to change a culture. We believe the 2018 numbers are the fruits of nearly four years of laboring with our advanced community paramedicine program. In 2017 we responded to 9,161 calls for service (CFS) generated by CAD (computer aided dispatch) at the 911 center. In 2018 we recorded 8,615 CFS's. Just over 6% reduction in calls for service for EMS. That the largest % reduction in CFS since the age of electronic charting and documentation (prior to e-charting we have historically poor data to pull from).

  • 2018 - 8,615 calls for service
  • 2017 - 9,161 calls for service

This may have been even a more significant drop in CFS if jail medicine had not soared to an all-time record high in 2018. While this may not be seen as significant to many it may be the most significant finding of the 2018 annual report. Most public safety departments secretly desire to grow call volume because this allows growth of the department.

Advanced Community Paramedic Program

The ACP program is now in its fifth year. With over 240 patients currently enrolled in the program, it has exceeded our expectations in nearly all aspects. The paramedics working within this program made over 385 home visits (house calls) in 2018 and responded to over 3,030 (911) calls in rural response districts. The program has provided over $1,000,000 in additional revenue since inception and an additional $300,000 in the 2018 year. Additional data points:

  • $300,000 of additional revenue in 2018
  • 276 jail call visits from ACP's
  • 393 times these paramedics reduced the workload on the "typical EMS crew"
  • 310 times in 2018 the program prevented an ambulance response.

The last bullet point is an important one and is used to calculate one of the cost savings numbers for the program. Each time the program reduces an ambulance response it saves local healthcare dollars a minimal amount of $2,500. For 2018 this saved over $775,000 of local health care dollars. Bringing our five (5) year total to $2,170,000 saved.

Special Operations

Our special operations division in 2018 was once again very busy in 2018:

  • The Water Rescue Division responded to five (5) different statewide disasters to assist our neighbors in the State of Texas.
  • The swift water rescue paramedics within the division logged more than 300 hours of swift water and boat based operational training.
  • The overall special operations division logged over 1,000 hours of combined tactical, Swiftwater, and rope rescue training.
  • We graduated two more paramedics from swift water technician school and qualified two additional paramedics as swift water boat operators. This is the highest level of water rescue training in the state and takes nearly two years to complete.
  • The water rescue paramedics also responded to 5 in county water rescues and performed standby activities.
  • Currently, the existing team is one of the most experienced swift water teams in the entire state of Texas. Deploying to over 19 of the last 22 state disasters in the last six years.

The division recently added a new Zodiac FC420 swift water rescue boat to the fleet replacing the 10-year-old vessel. However, we still maintain the older zodiac for training purposes. The division performed training at the Oklahoma City Olympic training facility, Broken Bow Oklahoma, Rock Island Tennessee, Guadeloupe River, and the Brazos River in 2018. 100% of the training, equipment, and reimbursement of salaries is either grant, donation, or Texas reimbursed.

In total there are 14 members of our special operation division. These are some of the highest skilled, talented and humble men I've ever worked with. I'm extremely excited about the group and the direction that we are headed. They truly are a hidden gem for this community that they serve. They completely embody the self-sacrifice and service to others mentality.

TX-TF1 Water Rescue


Nearly six years ago we took an innovative idea to our fleet manufacturer with the intent to build a patient-centric and paramedic friendly that was both efficient and safe for the public safety personnel utilizing this equipment. The idea was to improve the total miles per vehicle in a safe manner by increasing the size of the payload capacity (we went from an F350 to an F450). This brought bigger brakes, more payload, and less wear and tear on the chassis as a whole. Essentially it was no longer overweight and wearing out front-ends, brakes, and transmissions at an alarming rate. The plan was to improve overall efficiency by having all ambulances in the fleet exactly the same in regards to design and construction. Six years later, we have successfully implemented this plan. We are now working towards remounting this fleet of six units. Our intent now is to re-mount every unit one time. We have done a considerable amount of research on the options of remounting units more than one time. However, this puts the modules at an age that doesn't keep up with vehicle safety enhancements that could improve the outcome of our paramedics and patients should an accident occur. To help explain this, we remount a unit at 200,000 miles and typically when its six years old. This means by the time we get rid of that module it's actually 12 years old. Think of the safety enhancements and vehicle improvements have occurred in the last 12 years. It doesn't make sense fiscally nor in regards to patient safety.

What is a remount?

A remount is a where you remove the Frazer Module (or "box") from the existing chassis and mount it onto the newer chassis.

Current Fleet:

  • Medic 301 - 28,395 miles - scheduled for 2024 remount
  • Medic 302 - 194,768 miles - was scheduled for 2020 budget year, however, recent engine replacement will allow us to keep this unit until 2021 under warranty.
  • Medic 303 - 165,798 miles - scheduled for 2020 remount
  • Medic 304 - 46,858 miles - scheduled for 2023 remount
  • Medic 305 - 101,460 miles - scheduled for 2022 remount
  • Medic 306 - 271,026 miles - this unit is being remounted now 2019 budget

Our fleet in 2018 traveled 416,021 miles. That's just shy of a half million miles. We must be cognizant of this and ensure we are doing all we can to provide vehicle safety and patient safety practices. This equates to a vehicle incident occurring once every 137,666 miles. While we strive for perfection we also know that accident-free is not realistic. For example one of these incidents was a low handing tree on a 911 emergency call another was a black horse in the middle of U.S. Hwy 105.

(see below youtube of current patient module design)


Revisions to Fleet Plan

Each year we take a hard look at our fleet and how to better ensure a safe public safety response and how to limit potential catastrophic failure during such a response. We performed mileage assessments of our diesel fleet by totaling expenditures for each vehicle for every 10,000 miles driven after 100,000 miles. What this told us is that the most significant cost and where we lose the return on our investment is between 190,000-210,000. What this tells us is we must lean towards getting these chassis out of our fleet by the time they reach 200,000 miles. Twice in nearly five years we've blown a motor or had to replace a diesel engine just after the 200,000-mile warranty expired. These are upwards of $18,000 expenditures each! We can no longer allow the fleet to age past 200,000 miles. We have tasked Capt. Knuppel with correcting this piece of the fleet plan over the next two years.

For the past five years, we have utilized a unique flex design staffing in conjunction with our advanced community paramedic program. Combined these two programs allow us to place highly skilled paramedic (system credentialed P-III providers) into rural areas of our county that for the last 35 years has gone without EMS Paramedics placed in their area. These paramedics operate out of a "squad" vehicle. These squads are nimble, quick, and much more fuel efficiency than a full ambulance. In most instances they allow us to arrive within 5 minutes of a 911 call and provide immediate life-saving procedures until the full ambulance can arrive. This process has saved countless lives just in the short time we have been doing this. Below you will see an ambulance, squad and the SRT vehicle (rescue vehicle) we operate.
Pictured here: SRT Vehicle, Squad Vehicle, and Ambulance

Clinical Operations

2018 was a big clinical year for the department. We implemented the first innovation to CPR in nearly 20 years. When the FDA approved the Zoll Rescue Pump we trained our entire staff and was the first department in the region and one of the first in the state to implement this novel approach to CPR. In truth, we have been waiting for this for nearly 18 months. Each year we send 2-3 paramedics to the Zoll Cardiac Resuscitation lab (known as the pig lab) in Minnesota. This has proved extremely beneficial for us clinically and keeps us well above the standard medical response. I've included a link to a video of how this device works. We have already seen three (3) cardiac arrest victims saved while using this device.

Update on our cardiac arrest survival numbers:

For over four years we have been tracking and providing feedback through benchmark driven paramedic protocols. The results of this have been overwhelmingly positive. We believe our cardiac arrest survival rates are not a single component success. We believe the following changes over the past five years all most likely equally contributed to the improvements:

  • PIII credentialing
  • Strategic Paramedic placement in rural response districts
  • Improving response time to cardiac arrest victims
  • Improving dispatch "call received to CPR instructions" times
  • Improving blood flow during cardiac arrest by using mechanical and manual CPR innovations. (LUCAS / RESCUE PUMP)
  • Paramedic Training

As a reminder, ROSC, means the return of spontaneous circulation. Meaning how often do we regain pulses of victims who suffer sudden cardiac arrest. These rates average across the country in single digits and currently, we have the highest ROSC rates in the Brazos Valley and one of the highest recorded in the State of Texas. Currently, our ROSC (return of spontaneous circulation) rates are as follows:

  • 64% of the time when we arrive and the patient is in ventricular fibrillation or pulseless ventricular tachycardia we convert them to a rhythm with a viable pulse and blood pressure.
  • 47% of the time when we arrive at any sudden cardiac arrest (all rhythms) we are able to resuscitate the victim to a viable pulse and blood pressure.

In 2008 our ROSC rate was 17%. As shown above, we've improved this by over 175% in less than 10 years. This is a dramatic increase. This data includes over 167 victims of cardiac arrest. The one area we have struggled with and is difficult to assess the reasons is our neuro intact discharge rate (NIDC) rate. This is the percentage of time a patient who suffers from cardiac arrest leaves the hospital neurologically intact. This is not always a reflection of the prehospital care and is often a better reflection of the overall systems of care provided by in hospital, rehabilitation, and prehospital care. For the first time in nearly half a decade in 2018, we moved our NIDC rate in a positive direction. Previously from 2012-2017, our NIDC rate remained flat at 22%. In 2018, our NIDC rate improved by over 51%. We believe this rate increase is from two primary improvements. The rescue pump (see below) and strategic placement of the rural district paramedics.

  • Our 2018 NIDC rate was 33%.

Overall Clinical Data Analysis

Of course the department does not simply just focus on cardiac arrest victims. This is in fact a very small percentage of what we do. While it is one of the most critical patients its typically less than 5% of our overall patient load. As you can see below we see a wide range of patient age groups. Over half of all our patients are older than 65 years old and 15% is under the age of 21 years old.

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In addition to the age of the patients, we respond to we also track very closely the type of injury or illnesses they have. This allows us to properly manage and direct continuing education to our paramedics. This is a breakdown of the top 30 primary clinical impressions. There were over 118 different primary impressions due to the level of detail that we track the data. Therefore you will see a large percentage placed in the "Generalized Weakness" category.
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Our responses to the County Jail for inmate care has skyrocketed over the past two years. Some light at the end of the tunnel seems near though. As December of 2018 was the lowest responses to the county jail we incurred in the last 24 months.
Big picture


The EMS Department has the monumental task of taking care of patients and victims of traumatic injuries not just from 911 calls but also those that require care not offered in our local community. The chart below indicates the "specialty care" that these patients require. You will notice cardiology care is over 25% of our transfers to definitive care facilities. These are some of our sickest and most clinical demanding patients. Make no mistake about it, these patients that most would consider are routine transfers are nothing routine when required to manage them for over 45 minutes. Below you will see the transferring specialty care needed for all our 2018 transfers.

Big picture

Prehospital Ultrasound Care

Cardiac arrest is not the only thing we focused on in 2018. The department has been gearing up for significant change in clinical practice with the expected release of the next generation ultrasound point of care machines. For over 2 years we have sent supervisor level staff to ultrasound training and late in 2018, we were invited by Travis County Star Flights Program Director to be included in a nationwide ultrasound study. The expectation is to prove and verify that paramedics in the field can adequately identify certain lung disease pathologies and therefore provide more appropriate care and transport destinations. See below video for further information on this novel approach to respiratory disease treatment by our paramedics.

WCEMS Point of Care Ultrasound