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Unpublished journal report finds strains in local Austin/Travis County EMS

Monday, July 15, 2013 by Michael Kanin

An academic report set to run in the September edition of the Journal of Emergency Medical Services concludes that, while the Austin/Travis County Emergency Medical Service is not broken, there are clear strains on the system.


Former A/TCEMS employee turned Ph. D and consultant Dave Williams wrote the piece. Williams told In Fact Daily that he could not share a draft of it. However, he agreed to lay out key points in his study. “There are real problems…but does (that) make it broken?…Is the system on the verge of collapse?” Williams asked. “It’s a very long way from broken.”


Further, Williams worries that narrowly focused concerns threaten the current set-up of the A/TCEMS system. “I was seeing a lot of movement in a direction that concerned me; that someone might change directions…without understanding what they were doing.”


There has been no small amount of concern over the interlocal agreement that governs how the City of Austin and Travis County partner to run the region’s EMS system. Representatives of leadership on both sides insist that such issues have been put to rest. (See In Fact Daily, July 10.)


Williams, who emphasized that he used only publicly available information in his work, says that he analyzed the A/TCEMS system with six criteria from a study he produced for the International City/County Management Association and five “hallmarks” used by the American Ambulance Association. He noted that he is after an objective view of the Austin system.


According to Williams, the A/TCEMS system has been highly regarded thanks to the fact that it is “one of the most well-funded,” that its focus is on clinical practice, and the efforts of former system Medical Director Ed Racht. However, he adds, “Austin is not known at all for (demonstrable) results” – something that Williams says is not at all uncommon in the EMS world.


The first six criteria – the set developed by Williams – examine whether there is “(a)n increase in (Media or official) inquiries because of service complaints, deaths, crashes, hospitals being unavailable, poor care, or poor response times; and whether there is “a pattern of response-time inequities between different areas in a community…failure to properly monitor or report response times.” They also look for “labor strife, ineffective leadership and development, sexual harassment complaints, inequities in compensation or workload, or difficulty recruiting or retaining workers”; “turf battles,” a “lack of accountability and transparency,” and financial distress.


In each of these categories, Williams says one could argue that there is “an example of each distress factor in place” with regard to the A/TCEMS system. For Williams, this includes recent Audits of the service and the many concerns from Public Safety Commissioner Mike Levy about system management.


The remaining five criteria ask similar questions from a different perspective: They look to “hold the emergency ambulance service accountable,” “establish an independent oversight committee,” “account for all service costs,” “require system features that ensure economic efficiency,” and “ensure long-term high performance.”


Williams says that the paper will offer a set of recommendations to city and county officials. Chief among these will be a suggestion that the county clarify its relationship with the city. From Williams’ perspective, Travis County needs to decide whether it wants to be the city’s partner or its customer. Currently, Williams says, the interlocal agreement makes the County out to be a partner “but they are not operating this way.”


Offered the chance at the last word, Williams was frank. “The system is not broken…I wish people would take a step back.”


Williams continued to call for more calm. “We just need to look at (the picture) in a way that helps us figure out how to make the improvements.”


For his part, A/TCEMS Employee Association head Tony Marquardt said that he’s known Williams for a long time. He adds, “if Dave is pointing out objective information and his conclusion is that we are not beyond salvage…I have no problem (with the study).”


A/TCEMS chief Ernie Rodriguez told In Fact Daily that he had seen a draft of the study. He cites a number of steps that the system has taken or will take, including best practice studies (and visits), a recent accreditation, and a new strategic plan, now linked – for the first time – to the system’s budget.


Rodriguez says he hasn’t seen Williams’ findings, but adds that he does not think they will surprise him. “I’m sure that…he’s going to find some characteristics that we need to improve upon,” Rodriguez says, adding that he will likely agree with some of these and disagree with others.

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