Emergency Services: Field Operations, Special Operations / Air Operations (STARFLight)

The department operates 21** paramedic ambulances, 5 paramedic rescue ambulances, 1 tactical paramedic rescue ambulance, 1 shock/trauma air rescue helicopter (STARFlight) and 4 Field Ops & 2 Special Ops command units which are equipped with Advanced Life Support, special rescue & WMD equipment, multi-casualty gear, and rehab support supplies but do not have transport capabilities. In addition, the department provides a variety of special purpose units on an as need basis, including: peak demand paramedic ambulances, bike teams, standby paramedic ambulances and a medical rescue/casualty management unit.  (note: **two new  stations will be added in the summer/fall of 2006 within the City of Austin)

Because the City of Austin is located within the center of Travis County, 20 EMS units are located within the corporate city limits of Austin the other 7 are strategically positioned within the county. All EMS units located within the city limits are stationed at either joint-use EMS/Fire stations or dedicated free standing EMS stations. Within the city there are 15 EMS/Fire joint-use stations and 5 free standing EMS stations. County EMS units are stationed at Emergency Service District Fire stations. EMS response selection is based on closest EMS unit without regard for city/county political boundaries.

All EMS ambulances are staffed with at least two paramedics and currently work a 48 hour work week schedule. Our shift schedules now consist of 12's, 24's and hybrids Circadian Consulting has assisted the department in identifying what specific schedules to deploy for this transition from a 56 hour to a 48 hour work week. As a new employee you most likely will be placed on a 12 hour shift schedule. Employee selection of a schedule/station will be through a tenured bidding process. The bidding process in addition to related issues including an overtime schedule has been developed by the Austin-Travis County EMS Command Team in close cooperation and the Employee's Association.

EMS paramedics must maintain their primary certifications with the State Department of Health EMS Division, and the Austin/Travis County EMS System, along with certifications in advanced cardiac life support, pre-hospital trauma life support, pediatric advanced life support, haz-mat-I. EMS paramedics assigned to Special Operations must also maintain certifications and yearly competencies in a variety of rescue skills, including rope, swiftwater, confined space, technical, haz-mat and helo-rescue. They must also maintain a specified physical conditioning level that is tested bi-annually.

The department rescue helicopter, STARFlight, is a Travis County funded program but is operationally managed on a day to day basis by the City of Austin. Travis County covers all operations costs for the helicopters, pilots, rescue flight paramedics and nurses, maintenance staff, aviation facilities and Senior Division Command STARFlight Program administration. Pilots and mechanic staff are paid directly by and receive benefits through Travis County. All EMS medical and Command staff are paid directly by and receive benefits through the City of Austin.

STARFlight is considered part of the Austin/Travis County EMS Department’s Special Operations section (Air Operations). It responds regularly to calls within Travis County as a first-in EMS unit. It also services a 19 county regional area as an on-scene and interfacility transport unit for the critically injured and ill. Besides medevac services STARFlight also provides rescue, fire suppression and special law enforcement support.

STARFlight is normally staffed with one rescue flight paramedic, one rescue flight nurse and a pilot. On special rescue missions, the flight crew is supplemented with additional rescue staff from EMS rescue ambulances. All flight crew members work 12 hour shifts or a 42 hour work week.

Tactical and HazMat Paramedic Ambulances

The Austin-Travis County EMS (A/TCEMS) Tactical Paramedic Team directly supports the Austin Police Department SWAT team providing immediate on-scene advanced life support medical care to tactical team members, hostages, victims, bystanders, and suspects in the inner perimeter. Nine paramedics make up the team and were selected from the Field and Rescue sections of the department after an extensive application process. All members actively participate in weekly training with the SWAT team and must pass the APD Basic SWAT Tactics and Operations course before joining the team. The A/TCEMS Tactical Medic team also provides medical support at the Texas Tactical Police Officer's Association's yearly conference and annual SWAT competition across the State of Texas. Team members have also directly supported APD K-9 units during federal missions outside the USA.

The Austin- Travis County EMS (A/TCEMS) Haz-medic Team is a select group of A/TCEMS paramedics which integrate into hazardous materials operations with the  Austin Fire Department Hazardous Materials Team, Travis County Hazardous Materials team and other regional CBRNE teams to provide immediate on-scene advanced life support medical care to hazardous materials team members, victims, bystanders, and other response personnel. Team members are trained to the 80hr Hazardous Materials Technician level and also have additional training from several Federal Training Centers in Biohazard, Chemical, Radiological/Nuclear and Explosive Bomb response. The Haz-medic vehicle (Medic 10) is a Wheeled Coach Medium Duty Ambulance mounted on a International DT-466 Chassis and carries SCBA, PAPR's, multiple detectors and a wireless Panasonic Toughbook laptop with hazardous material diagnostic and medical treatment software.

Emergency Communications

The EMS Communication Center is located within the Combined Transportation Emergency & Communications Center (CTECC) in north east Austin. The EMS section is staffed with a mix of EMT, EMT-I and paramedics. All EMS communication medics are certified both in Medical Priority Dispatch and as a practicing medical provider for the Austin/Travis County EMS System. In addition Austin EMS is the 39th Center in the World and the First in Texas to be certified as a Medical Priority Dispatch Center of Excellence.

Five to eight communication medics staff the EMS Communication Center daily depending on the time of day and the expected work load. These medics work 8 hour shifts on a forty-hour work week.

All City/County 911 calls for EMS assistance are processed through this center. The center uses a Computer-telephony based 911 system that is shared through the telephone company central office for all primary and secondary Public Safety Answering Points in Travis County. The communication center also uses a computer-aided dispatch system to process all incoming 911 requests, dispatch EMS units, request fire and police support services, and manage general EMS system status.

First Responder Support Agencies

First responder support services are provided by fifteen city/county EMS/Fire agencies and 24 in-house corporate groups. Within the City of Austin, first response is provided by the City of Austin Fire Department. Outside the city limits, within Travis County, responsibilities for first response are shared among fourteen EMS/Fire agencies (both volunteer and paid).

City of Austin
The Austin Fire Department provides first responder support services from 39 fire stations within the City of Austin. All, but one, of the approx. 1000 firefighters are certified at the EMT-B level or higher.

The Austin Fire Department responds only to EMS calls that are potentially life threatening or that may require special advanced rescue, fire suppression support or hazardous material mitigation. All 37 engine companies, 11 ladder companies, 2 quints, 3 rescue companies and the municipal airport's (Austin Bergstrom International Airport) crash-rescue team are equipped with EMT medical kits, airway/oxygen kits and semi-automatic defibrillators. First Response services are basic life support only at this time. However, additional first response intermediate and advanced life support medical enhancements are in the plans.

Medical first response accounts for around 60% of the Austin Fire Department's yearly work load.

Travis County
Within Travis County there are over 250 volunteer and paid EMS first responders representing fourteen (14) EMS/Fire agencies who provide EMS support services outside of the City of Austin. Of these 14 agencies, none provide any services beyond intermediate life support. Travis County EMS/Fire Agencies respond to ALL EMS responses within their assigned districts. The majority of county responders are certified at the EMT level. Through the oversight auspices of the Travis County Emergency Services Department, all first responder agencies are provided special medical training, medical kits, airway/oxygen kits and semi-automatic defibrillators. Like their city counterparts, county first response is at the basic life support level but plans are underway to enhance their service level to an intermediate or advanced life support level.

Corporate First Responders
Supporting the Austin/Travis County EMS first response system is a growing network of corporate first response teams. There are 24 teams currently registered as participants in the Austin/Travis County EMS System including Abbott Labs, Applied Materials, IBM, Motorola, Tandem Computers, Solectron, 3M, Texas Comptroller of Public Accounts and the City of Austin Public Works.

EMS System Medical Direction

In 1995, the City of Austin EMS Department, Austin Fire Department and Travis County Emergency Services Department jointly created and funded a full time Medical Director to be responsible for all clinical aspects of out-of-hospital emergency care in the city and county. Historically, only Austin EMS had formal Medical Direction. With dramatic regional growth and advances in the field of out-of-hospital care, the community consensus was to nurture a "seamless" patient care system. While emergency care is provided by multiple public, private, volunteer & career agencies, Medical Oversight became a unifying factor. The Austin / Travis EMS Clinical Practice represents our clinical alliance.

In October 1995, Edward M. Racht, M.D. was hired as the EMS system Medical Director. His responsibilities include Medical Oversight for approximately 1700 Providers in 38 different agencies including the Austin EMS Department, Austin Fire Department, thirteen Travis County First Responders, STARFlight, Travis County Park Rangers, Lower Colorado River Authority Rangers, Travis County Tactical Medics, Aviation Police and a unique network of Corporate Response Teams. The Medical Director coordinates the establishment and implementation of Standards of Care (developed, researched & proposed by a Peer Standards of Care Committee), the field practice of medicine, Communications Standards, Quality Improvement issues and review of clinical care, as well as educational development. All system Providers (volunteer or career) at all levels (ECA, EMT, Intermediate, Paramedic or Flight Nurse) are required to practice according to the Standards of Medical Care and must successfully pass a written examination covering the Standards on a yearly basis.

Dr. Racht serves as a liaison between the out-of-hospital system and the Austin medical community through the Travis County Medical Society and various hospital committees. By design, the Medical Director's practice of medicine is in the field with Providers from all agencies. The system prides itself on clinical sophistication, a well-developed Field Training Officer program and an interest in out-of-hospital research.

Area Hospitals

The Austin community supports six primary hospitals from two networks (St. David's Healthcare Partnership & Seton Daughters of Charity) and one independent (Heart Hospital) that are integrated with the EMS System. There is a Level II Trauma Center (Brackenridge), Children's Hospital and two Hyperbaric Medicine Centers. All Emergency Departments have 12-lead ECG receiving capability from EMS ambulances. In addition, there are multiple specialty hospitals integrated into the health care system. The health care community participates in EMS QI activities, provides data to the system and has integrated EMS into their Clinical Pathways Management. Additionally, all hospitals participate in a jointly developed EMS/Hospital Diversion System to manage patient flow during high volume patient admission periods.

The hospital community has monthly meetings (Austin Interagency Disaster Committee) with all components of the EMS system as well as biannual half-day workshops to review issues of importance to patient care and operations.