Fort Bend County EMS – Part 2; “We’re Not Just Ambulance Drivers”

Chief Graig Temple

Our 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 breath, 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 breath 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 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 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 no 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. That is something we run into most 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 that 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 for 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 project 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 ambulanced 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 the million.

4. 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 has explored yet. But again, the most important thing is to let your elected officials know that you support whatever it takes to get is to that level to make sure that we are providing the exceptional care that you need.