Saying they lack a voice in policy decisions, all but one of Travis County’s 11 fire departments operated by emergency services districts will split from the medical director they share with the city of Austin by October.
The medical director is the physician who oversees the clinical side of an EMS program and sets certain medical protocols, such as how to treat someone with shortness of breath. In Austin and Travis County, which partner through an interlocal agreement, that person is Dr. Mark Escott.
Chiefs Robert Abbott of ESD 6 and Ken Bailey of ESD 11 told county commissioners at a meeting Feb. 27 that they feel they have a limited ability to give input on how the EMS program runs under Escott.
Commissioners in March heard their concerns and decided on a 3-2 vote, with Commissioners Brigid Shea and Jeff Travillion against, to approve a $508,000 program under STAR Flight’s medical director, Dr. James Kempema, that is set to begin in October.
Travis County Fire Rescue (ESD 11), which already contracts with Kempema, the Oak Hill Fire Department (ESD 3), Lake Travis Fire and Rescue, (ESD 6), the Pedernales Fire Department (ESD 8), the Westlake Fire Department (ESD 9), the Ce-Bar Fire Department (ESD 10) and the Volente Fire Department (ESD 14) have said they want to participate. Travis County Parks emergency medical technicians will also join.
Aside from ESD 11, three other districts have also parted ways with Escott and pay for their own directors: ESD 1 in North Lake Travis contracts with Dr. Robert Hancock, ESD 2 in Pflugerville and ESD 5 in Manchaca contract with Dr. Michael Zimmerman.
Just one district will remain under the city’s medical direction: ESD 12 in Manor.
“Eighty percent of what we do is EMS,” Bailey said at the February meeting. “We occasionally go to fires. And we think that this program … allows us the flexibility and allows us to be the voice of our community to meet the needs of our community.”
One of the main areas of contention, Bailey said, was Escott’s credentialing process, which paramedics, emergency medical technicians and others have to go through to be approved to work for Austin-Travis County Emergency Medical Services.
Bailey said many of the chiefs found the process too slow and burdensome, infringing on their ability to make hires.
Escott said he learned of the chiefs’ concerns when he took on the role about 18 months ago. He said he met with each chief and developed proposals to address their concerns, including making changes to the credentialing process and creating a committee that could give them input on implementing clinical changes.
Escott stood by the credentialing program, which launched in 2015, saying that other EMS systems require lengthier training, sometimes seven to 16 months. His advanced life support program takes about four months.
“Paramedics provide a higher level of care … necessitating a more extensive process for credentialing,” Escott said. “This process has ensured a high quality of care for patients across the city of Austin and Travis County.”
The county currently pays for medical direction through its interlocal agreement with the city. That led Shea and Travillion to question the program cost at the February meeting.
“It just doesn’t make sense to me to volunteer to pay this additional money for a redundant system, which I don’t think is going to result in overall better service for the entire community,” Shea said before voting no March 20.
But Josh Davies, the county’s executive of emergency services, said the funding for the program is readily available from cost savings elsewhere in the budget. Plus, Davies said, the interlocal cost potentially could be negotiated down to account for the loss of medical direction from the city.
Escott said his office was designed to be a “unified lead agency to maintain a single standard of care in the EMS medical practice.”
“I am concerned about last week’s decision, which may further fragment our world-class EMS system,” Escott said. “Concerns have also been raised about the potential impact on the patients we care for in the field. Despite this, my focus will continue to be on ensuring high quality and evidence-based clinical care to people in need in our community.”
While it would be ideal for all to operate under a single medical director, Davies said, Austin-Travis County EMS already works with multiple directors, and plenty of Texas counties do so.
Commissioner Gerald Daugherty and County Judge Sarah Eckhardt said they voted for the program because it was what the majority of districts said they wanted.
“Having the majority of those entities receiving clinical direction from Dr. Kempema puts us in a higher probability of getting us to a countywide system that’s unified,” Eckhardt said.
The option the county chose includes an exit clause that says if less than 75 percent of the ESDs that indicated they would enter into the agreement, or fewer than five ESDs, decide to abandon the county-funded medical direction, the county can end the program. The clause is effective in October 2019.
CORRECTION: This article has been updated from an earlier version to reflect that ESD 5 in Manchaca will be contracting with Dr. Michael Zimmerman as of April 1 and will not remain with the city.