Tulsa World: The evolution of emergency services

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The evolution of emergency services

TOM GILBERT/Tulsa World file

By JANET PEARSON Associate Editor
Published: 11/9/2008 2:17 AM
Last Modified: 11/9/2008 3:22 AM

Born of controversy and need, EMSA faced with new challenges

Many who watched from the sidelines — back in October 1978 when the Emergency Medical Services Authority took over the city's ambulance service from Pat Mace's Central Ambulance Co. — held their breath. After all, it was a radical change: from Mace's familiar Cadillac station wagons to these big boxy vehicles nobody had ever seen before.

That wasn't all that was different. Three decades later, Tulsa continues to pioneer emergency medical services and to serve as a national leader in the development of such care.

Back in 1978, the scoop-and-grab technique was the order of the day. It seemed to work well enough then, but requests for higher city subsidies of the service led the Tulsa City Commission (Tulsa's form of government back then) to search for alternatives. Finance Director Norma Eagleton, with the expertise of emerging national consultant Jack Stout, led the effort to develop a model emergency medical service that had its roots in the trauma lessons learned in the Vietnam War.

The basic concept was to not only get a trauma victim to the right kind of care quickly, but to first stabilize the patient as well as possible in an effort to minimize immediate threats to life and limb and to improve later outcomes.

During EMSA's first full year of operation, about 8,000 transports were made with the fledgling fleet's eight ambulances.

Last year, EMSA completed more than 113,000 transports using

a network of 77 strategically placed vehicles.

The service born in Tulsa of controversy and need is now the state's largest EMS provider, serving 16 Oklahoma cities and a total population of more than 1.1 million Oklahomans — about a third of the state's population.

EMSA's public utility model, a hybrid of public and private expertise that ensures both high-quality clinical care and public oversight, has been widely copied across the country. A public board of trustees performs oversight functions over EMSA and its employees as well as the contractor that provides the actual service.

A medical director and Medical Control Board ensure that appropriate and advanced standards of care are met. Routine audits and testing of staff, regular protocol updates, thorough complaint investigation and ongoing research also ensure that EMSA customers receive topnotch care.

Two longtime leaders continue to be instrumental in EMSA's development and on the national scene. Steve Williamson has been president and CEO since EMSA's startup, and this winter will become president of the American Ambulance Association. Dr. John Sacra, currently medical director, has been active in EMSA development for years and also has achieved national recognition — an appointment to the National Highway Traffic Safety Administration's National Emergency Medical Services Advisory Council and the American College of Emergency Physicians' prestigious Outstanding Contributions in EMS national award.

Thanks to a small city subsidy, a new monthly fee paid by subscribers, and payments from insurance companies, Medicare and patients, EMSA's finances are more stable than many others — especially when compared with rural services that have even faced closure in recent years because of insurmountable funding problems.

But cost issues still loom large for all EMS providers. One of Williamson's tasks as the industry's new national leader will be to pursue higher federal reimbursements, which now are below the actual cost of providing the service. With Baby Boomers heading into their senior years, these reimbursements are even more critical. About half of EMSA's business is federally subsidized.

Because of the growth in the aging population, EMSA's volume increases 6 percent to 8 percent per year.

At the same time, medical advances also are occurring rapidly, and of course everyone wants the best care available — even if the equipment and supplies are costly.

"With decreasing government reimbursement, and increasing technological advances, Americans want the very best for everybody, so it puts some real tensions on us," said Williamson.

Williamson sees more changes ahead for EMS care. One revolutionary new step could be a means for getting patients the appropriate care without toting them to emergency rooms.

"There are a lot of things we get called on that could be handled the next day. Through technology, we could set up appointments for them rather than transport them to the hospital," he said.

In rural areas, individual paramedics with specially equipped vehicles could serve as first responders while transportation is awaited. Consolidation of services could provide some help in some rural areas.

"The thing that is so important is advocacy — making the point about how EMS figures into a municipality's plan for survival, whether it's ice storms or manmade disasters," said Williamson. "Unfortunately, over our history, we've had floods, the Murrah Building bombing, tornadoes. ... You have to be prepared, equipped and educated."

Janet Pearson, 581-8328
janet.pearson@tulsaworld.com By JANET PEARSON Associate Editor

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FF, Tulsa (11/9/2008 8:14:42 AM)

Wow Janet. Your opinion piece sounds like your comments were written for you by Mr. Williamson or the EMSA PR person. Why no mention of the Tulsa Fire Department? It's a fact that EMSA's success in Tulsa is due in large part on it's heavy reliance on the EMS services provided by firefighters. Another fact is the Public Utility Model that is EMSA's structure is being dismantled in other communities, (KC, MO) because a better service can be had through Fire Based EMS.

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