HFD Emergency Medical Services
Emergency Medical Services
Since 1838, the Houston Fire Department has provided high quality fire service to its citizens. In 1971 the Houston Fire Department began providing the citizens of Houston with quality emergency medical care. High quality emergency medical care is not defined solely in terms of life saving interventions for critically ill or injured patients. High quality emergency medical care is defined by the decisions made on each and every patient encounter. The challenge EMS providers face is to make important, sometimes critical decisions with a limited amount of information. Other times Houston Fire Department personnel are called upon solely for their opinion as EMS professionals.
The highly educated EMS personnel of the Houston Fire Department pursue excellence in their profession by combining the benefits of medical science with the art of compassionate care. In all cases, potential patients are approached with the greatest professionalism and concern for their well being.
Overview and Demographics
There are over 2,000 state certified EMTs available to staff the 51 BLS units. This is an adequate supply of EMTs to meet current and projected needs for BLS staffing. Furthermore, the future supply of EMTs is ensured by the departmental requirement that all new cadets hired receive EMT training.
There are approximately 300 paramedics currently assigned to ALS units. This figure does not include EMS supervisors. The department's goal is to staff two paramedics on all ALS units and maintain a sufficient reserve pool to accommodate staffing and training requirements.
One step to achieve this goal began in April 1996. During fiscal years 97 & 98, three Fire Training Academy Cadet classes were trained as paramedics upon completion of their fire suppression training. The positive impact of this training was felt departmentally in March 1999.
To ensure quality care to all sections of the city, each unit is located where it can respond predominantly in its defined territory and can arrive at an emergency within the fractal time frames established by the system based on an area's need for emergency service. One territory may have three units to serve its high call volume and another territory may have one unit to serve its low call volume. Both territories, however, have the same response time goals.
In an effort to minimize the response time to citizen's emergency calls, we implemented a "Squad" program in the 2001. A Squad consists of two paramedics, usually in a suburban or other vehicle, that respond to an incident to administer advanced care. If they are not needed to actually transport the patient, once a BLS unit has arrived, the BLS unit can take the patient to the hospital and the Squad can return to service ready to provide additional care to citizens.
The Demand for Emergency Medical Service
Incidents represent the demand for emergency services by the public, while transports represent the resources deployed to satisfy the public's demand for emergency services. To aid with its growing demand for service the Houston Fire Department has enhanced its medical priority dispatch system and has implemented the First Responder program.
Medical Priority Dispatch
EMS Performance Measures
Although the overall cardiac arrest survival rate is often referred to as a quality indicator, EMS professionals use witnessed Ventricular Fibrillation (VF) survival rates as a standard.
Currently, HFD EMS is developing a continuous comprehensive evaluation program, which will assess all aspects of the EMS system. This program will include evaluation of structural, process and outcome measures. In addition to survival, other outcomes such as disease, disability, discomfort, dissatisfaction, and destitution could be utilized for evaluation. This enables appreciation of the complete spectrum of EMS effects for the community.
The City of Houston EMS Medical Director is responsible for all medical aspects of prehospital patient care. The Medical Director has the authority to approve the level of prehospital care which may be rendered by each of the departments members, establish and monitor compliance with field performance guidelines and establish and monitor training standards. A staff of four physicians provides on-line and/or on-scene medical direction for all critical patients 24 hours per day. EMS nurses assist in the development and revision of protocols, medical standing orders, continuing education programs and addressing equipment and legislative issues.
An Assistant Chief heads the EMS administrative staff with the direct assistance of the District Chief for EMS. These two individuals in essence are the executive classified arm of EMS operations. They are responsible for the implementation of the operational structure- EMS staffing assignments; disciplinary action; complaint disposition; fiscal management; and compliance with all bulletins, orders, policy and procedures. An administrative support staff of approximately 30 people execute these functions.