“We are not just ambulance drivers,” says Fort Bend County EMS Chief Graig Temple

Temple
By DONNA FERGUSON

Fort Bend County EMS was formed in 1972 and is still going strong and growing, There are currently 16 paramedic units, called MICUs (Mobile Intensive Care Unit) and three single paramedics that are in squad which are SUVs located in rural areas. Fort Bend EMS has one in Needville, one in Orchard and one in the Fulshear-Simonton area.

There are also three 24-hour supervisors on duty strategically placed on East, one North and one central.

With more than 48 years of pre-hospital experience, the Fort Bend Count EMS is committed to serving its patients, its citizens and its staff with Compassion, Empathy, Teamwork, Innovation, Professionalism and Safety.

We sat down with Chief Graig Temple to ask him more about EMS and what he would like the community to know about them.

What kind of procedures can you do in an ambulance?

•It is has changed so much! Early medical emergency services really began to take stride in the late 60’s and early 70’s so it is a relatively new profession. We work under a medical director’s license and we have what we call protocols (or a recipe as you might call it) of how we take care of patients. It provides both treatments and medications that we intermix to make sure that you are going to see the same level of care as you see in an emergency room.

•First and foremost, we carry a cardiac monitor. That device is a huge piece of equipment, not in size, but in performance. That device costs about $35,000 but it allows us to monitor your heart, do a 12 lead EKG just like the emergency room.

We can also defibrillate, which means deliver electricity to the heart when it’s in a lethal rhythm we can stun the heart and get it to beat in a normal rhythm again. We can also take a heart that is beating way too fast, and we can slow it down with electricity. That is called cardioversion.

That device unto itself is the heart and soul of our EMS care. It takes your blood pressure, it does pulse oximetry so we can see how well you are breathing, we can see how much carbon dioxide you are breathing out. It is a phenomenal piece of equipment.

•We also have what’s called a LUCAS device and that’s a CPR assist device. Gone are the days that a paramedic has to pound on a patient’s chest. It also frees up the paramedic so that way than can manage an airway or they can be pushing medications and treating other things. It’s another great helper that we have on the truck as well.

•We can intubate just like an anesthesiologist in a hospital. If someone is not breathing well, we carry medications to paralyze your muscles and put you to sleep so we can perform the procedure and you are not fighting against us or breathing against us when you are fighting to breathe, we want that procedure to be just like in an operating room where it is nice and controlled and smooth. We can put a breathing tube in and breathe for you and again, maintain that all the way to the hospital.

•We can do chest decompressions where we actually stick needles into the chest to allow air to come out when you have pneumothorax (collapsed lung).

•We carry glucometers to check your blood sugar, we carry everything down to band aids. Pretty much anything you can think of, we can do. We can start those procedures in the field.

•On top of starting just regular IVs, we also have access through your bone marrow. We can use a medical grade drill and we can drill into your shoulder or into your lower leg and get you medications through your bone marrow. That works extremely well in critical patients, and that is called Intraosseous infusion.

•Again, I could go through a laundry list of things we can do in the back of the ambulance but those are some of the highlights that folks just don’t know that paramedics can do.

According to Temple, the running joke and the things EMS tries to educate the public is “We’re not Ambulance Drivers, we are much more than that. We are definitely clinicians. Paramedics go through several thousand hours of training, we work side-by-side with your ER doctors and ER nurses to make sure we are delivering the best possible care to you at your point of injury.”

When someone has a do not resuscitate or a living will, and they call 911, what happens?

•That is truly a unique situation and unfortunately, we do run into it quite a bit. Living wills are generally for a medical facility. If you are in a nursing home or a hospital and your condition is terminal, or you elect not to have any heroic measures done. That’s generally when a living will is used. It has other specific parameters related to whether you want IVs and feedings, things like that.

•DNR (Do not resuscitate) orders are for patients that are terminal. They have to voluntarily sign the paperwork. But what happens generally, and this is definitely because the patient and the family need to have an understanding and there has to be that dialog, that discussion, between the family members and the patient before something critical happens.

Something we run into often is that the family is not ready to let go of the patient and there is a DNR there and it is legal, and it is appropriate. Our paramedics are there to take care of the patient and the patient is our main role but unfortunately we have to then deal with the family members who do not want to follow the DNR because they want that last few minutes with their loved ones.

Sometimes it runs us into a very tricky situation. We have to try to do the best to honor the patient’s wishes, but we also look at the situation and we look at the family’s request.

There are times that the family has not had this discussion and the family thinks that the patient wants these heroic measures and they want CPR and they want that LUCAS device to push on their chest and unfortunately we can’t save everyone. That is the sad thing, out in the field when someone goes into cardiac arrest, it’s really only 3 or 4 percent get pulses back out on the scene and actually by the time we deliver them to the hospital, very few people survive those types of incidents. The one thing our paramedics in the field are going to do is they are not going to give you false hope, they are going to tell you how critical the event is.

We are going to do our best to follow the DNR when we are engaged in full resuscitative events, we are going to do everything possible for the family and for the patient.

What are your plans for expansion in Fort Bend County, can you tell us?

We are very open and transparent in what we are trying to do. We have had phenomenal support from Commissioners Court and our Judges over the past five years.

We have more than doubled our budget, we have added four additional MICUs, we have added two additional Squads and two supervisors. Our budget now is about $18,500,000, we have 108 full-time paramedics that are out on the street, we have 22 part-time as well.

Our staff runs about 36,000 calls a year and that is not including other moves to include other parts of the district.

•We are engaged in looking at the growth of the county, where the next subdivision, where the next mobility project is happening.

•We just constructed a 5-year strategic master plan to look at the growth projections and essentially go to our elected officials with a blueprint.

A blueprint of strategy, of how we can stay ahead of the curve. Our goal is to arrive at your residence 10-minutes or less 90% of the time.

We use that metric because that’s the high end of the metric; 50% of the time we are at your house in 5-1/2 minutes or less; 50% of the time you are going to blink an eye and we are rolling up in your driveway.

Unfortunately, we are not big enough to have an ambulance on every street corner, we don’t have enough ambulances to cover the population of Fort Bend County, but we are taking those strides to make sure that we do that. We are going to be very dynamic in how we manage our resources

•I think over the next five years you are going to see at least four additional MICUs strategically placed through the county.

We are going to be very dynamic in how we manage our resources to make sure that we cover the geographical footprint of Fort Bend County so that every resident whether you are in downtown Rosenberg or whether you are all the way out in Guy, you are going to get an ambulance within a specified amount of time and get our paramedics there to treat you and provide exceptional care.

•Again, our budget needs to grow, we are going to need support of the commissioners, we are going to need support of the public. We are funded by Fort Bend County.

Your tax dollars pay for our services and we do bill for our EMS transports and any money that is recovered goes right back to the general fund to offset our costs.

Unfortunately, the way healthcare is today, even ambulance bills aren’t being paid for fully. We are seeing a significant decrease in what insurance is paying and our federal payers are actually paying. Again, it falls back to the County at this point to continue to be that huge sponsor for us and to make sure that this service is well suited for the future as our population continues to grow from the 800,000 toward a million.

What can the citizens of this county do to help?

•The biggest thing is to make sure you reach out to your Commissioner, any of the four if you live in their district, and let them know how much you support emergency medical services in the county.

It’s a pride thing also, not many of the 254 counties in Texas run their own EMS service as large as what we have here. The ones that do, have a hospital district to help offset that cost. It’s another funding mechanism that Fort Bend County hasn’t explored yet. But again, the most important thing is to let your elected officials know that you support whatever it takes to get us to that level to make sure that we are providing the exceptional care that you need.

We understand that you have special programs that the greater community may not know about.

•It is much more than just the ambulances you see going down the road. I’ll start with the Ambus program. We are a member of the Southeast Texas Regional Advisory Council and we do participate in disaster responses.

Obviously when we have flooding, hurricane, and weather-related events we have a specialized vehicle that was paid for through grant funding. You have probably seen a lot of press about it. It is a specialized ambulance built on a tractor trailor type of chassis and we can transport more than 25 patients at once with a crew of six paramedics that are on that truck.

We go to disasters such as a mass casualty incident, for example, a school bus accident, where a lot of people are injured at once. We would deploy that vehicle so we can take care of a lot of people with that apparatus.

•We also have bike paramedics and if you have ever been to the Fort Bend County Fair you’ve seen us out there. However, we are available for any parade, or bicycle safety lectures or anything like that in the community.

It allows our paramedics to not only exercise, but they can get through crowds quickly where the large ambulances can’t make it through. We look for opportunities to come out to your local communities so we can talk to children about helmet safety and the parents understand how important it is for children of all ages to wear helmets.

•We also have tactical paramedics that are part of the Fort Bend County SWAT team.

They are embedded with the SWAT team and go out on high-risk incidents. They are there to take care of the police officers as well as other people that are involved in this situation. So, that takes a specialized group who go through very rigorous training to essentially become SWAT certified to be able to provide that level of care.

•Additionally, we have toxicology paramedics (we call them tox medics for short), but they carry specific medication. We are in a farming community and if someone gets exposed to organophosphate, which is big in farming, we have special medication to treat those individuals. We also have antidotes for other biochem situations.

After 9/11 we received a lot of grant funding for tox medics to make sure we have weapon of mass destruction antidotes, so we have those as well.

•Lastly, our new team that we are going to be forming, in collaboration with Fort Bend County, is our technical rescue paramedics.

They will be working with the Fire Department to take care of individuals that may be involved in some type of technical rescue situation. They will carry specialized medical equipment for their medical care and trauma care. It is essential that we be at the point of injury so we can begin treating as soon as possible before we deliver them to a hospital.

There are always situations where their immediate thought is call 911. The county is growing, but if you have a cough or stub your toe, should you be calling 911?

•The way we look at it, if you have called 911 that is your emergency and we are going to treat it like it is your worst day and we are going to do everything we can to make it better for you.

•There are certain situations where it is better to look to your family doctor. Especially if you have chronic type cough for instance, it may not be best to go to an emergency room. If it is something where your physician can see you right away and get you in and get you on some treatments.

•So, yes, we do get all types of calls but typical emergent type of calls are cardiac patients, so any time you have chest pain, shortness of breath or unexplained nausea and vomiting, any type of discomfort in your chest that may is radiating to your shoulder or your back absolutely call 911.

•Also, we are always out in the public trying to educate the public about strokes, so that is another situation where we can intervene right away so we can get you to the appropriate medical center where you can get back to where you were.

In the past, may people believed that because we had a stroke it was terminal, and you would never recover from it. That is not the case anymore. Because we have hospitals such as OakBend, and others that are doing phenomenal care, giving that treatment right away where we can break up those clots, or provide that intervention, that way you can live a very fruitful life. So, it is especially important to call us right away if you have stroke-like symptoms.

If we have someone with stroke-like symptoms or a heart attack and they live alone, what should they do to help before you arrive, if it is possible.

•We have fantastic partnerships with our Fire Department, and they act as first responders for us. They have some specialized tools and they sometimes must force into a house if the door is locked to get us in there to take care of you as our patient. If possible, unlock the door and turn off the alarm.

•There are a few things you could do to help us help you. Turn on an outside light, make sure the house number is visible. We use spotlights, but it is sometimes difficult to see. If you have someone with you, have them go out and flag us down to make sure we get to the right house immediately.

•If you have animals put them in another room. Your fur baby my be loving to you but not when a stranger comes in wearing a mask and the animals are unfamiliar with them. We don’t want our paramedics getting bit by an animal so if you could help out with that it will speed up the process.

•Turn off the TV, so we are not trying to compete with your local news program or whatever while we are doing an assessment with that in the background.

What about our medications, should we bring those with us or a list of our doctors?

•Not so much bringing your medications, but if you have a list that would be wonderful. We don’t see enough of that. We also understand that as your health changes and as your medications change, you are not always going to have the most up to date list.

But if you have a word program on your computer at home and you can update it and print out copies, that is extremely helpful to have your information there.

Even if you do live alone another next of kin that we can contact not only about your medications, but also if you have any allergies to medications. We don’t want to give you a medication that can harm you.

It would be great if you put together a medical synopsis. Not necessarily of your childhood, but if you have had any surgeries, a heart attack, or a pacemaker, if you have a stroke in the past or if you are a diabetic, If you put those on your list that is extremely helpful and it allows us to move much quicker through the assessment to get you the care you need.

(Donna Ferguson, VP of Physician Services, at OakBend Medical Center, did this interview through OakBend Medical Center Happy Hour Podcast which airs every Friday at 5 P M.)