Updated: Jan 2
Austin-Travis County Emergency Medical Services (ATCEMS) History of ATCEMS Within the City of Austin and Travis County, the origin of pre-hospital care and transport of the sick and injured seems to have its initial roots in 1957. Brackenridge Hospital was owned and operated by the City of Austin and was the primary receiving hospital for patients. The City Council approved formation of a “zone” system that employed use of Austin PD dispatchers to send “ambulances” to collect sick or injured patients. These transport units responded from funeral homes and mortuaries located throughout the City and were, in fact, hearses. At that time in 1957, these were ideal vehicles because they were long enough to accommodate the crude gurneys that were used to “stretch-out” the patient in the back of the vehicle. For Austin, the process for transporting patients was put to the test on August 1, 1966 when the City experienced the University of Texas clock tower mass shooting, an act of domestic terrorism. An event like this had never occurred in the U.S. and it shocked not only Austin city leaders but also the rest of the nation into addressing the fact that many of the victims could have survived had they been transported to definitive care sooner. In the after-action review of the incident, city leaders were confronted with the reality that they were grossly unprepared to contend with any incident type that inflicted mass casualties. In 1967, the Austin City Council signed a contract with Austin Ambulance Service to provide both emergency and non-emergency transport services throughout the City. This action was shortly followed by City Council signing a franchise agreement with Austin Ambulance Service. Over the period between 1967 and 1973, multiple efforts were undertaken across the nation, including Austin, to put programs and services in place to meet the provisions of the 1966 National Highway Safety Act (NHSA). These actions included the establishment of minimum standards for ambulances as well as development of training curricula for the newly identified position of Emergency Medical Technician (EMT). Between 1970 and 1973, pilot studies were conducted in Los Angeles, Seattle, and Miami to provide Advanced Life Support (ALS) care in the pre-hospital setting. This was the beginning of the Paramedic level of certification. Over the course of 1975, the Austin City Council began forming a standalone municipal department to provide pre-hospital care at the basic life support (BLS) level. It is unclear as to why EMS was not integrated into the Austin Fire Department, as this type of integration existed in the other major metropolitan communities in Texas and in many other U.S. communities. Regardless of this difference, PCG does not believe that combining AFD and ATCEMS field operations is a cost effective or feasible recommendation. However, PCG has identified several program areas where AFD and ATCEMS should consolidate their efforts to gain greater efficiencies, reduce program costs, and improve equitable delivery of services. These recommendations will be discussed in greater detail later in this report. ATCEMS began operating on January 1,1976 with seven ambulances and 32 employees. Even though the City of Austin had a population of over 300,000 residents at the time, Austin EMS only responded to an estimated 5,500 incidents per year. In 1977, Austin EMS executed an interlocal agreement with Travis County to provide EMS response throughout the County. Between 1977 and 1997, Austin EMS employed a tiered response system staffing both BLS and ALS units. This ended in 1997 when Austin EMS converted to an all-advanced life support service (ALS). In 2000, the department rebranded and became known as Austin-Travis County EMS.
Presently, ATCEMS is considered a municipal, third-service EMS pre-hospital provider. It is staffed by ALS personnel with at least one ALS provider and one BLS provider. ATCEMS provides ambulance service to both the City of Austin and throughout Travis County (except TCESD2 service area), covering 1,189 square miles in size and a population of over 2.2 million residents. ATCEMS’s response coverage area also includes portions of Williamson and Hays counties. This service area encompasses an additional 18 cities and 13 emergency service districts (ESDs). ATCEMS is accredited by the Commission on Accreditation of Ambulance Services (CAAS) and its dispatch center achieved Accredited Center of Excellence (ACE) status in 2000 from the International Academies of Emergency Dispatch (IAED). ATCEMS was the first department in Texas to achieve this accreditation. This places ATCEMS and its dispatch operations at the CTECC among the top tier of EMS agencies nationally and internationally. ATCEMS has held these performance accreditations for more than a decade. The FY 2021 approved budget for ATCEMS reflects a substantial increase over the FY 2020 budget of $93,068,228. The FY 2021 budget approved by the City Council is $102,002,968, which is an increase of nearly $9 million over the FY 2020 budget. This change was due to a reduction of the Austin Police Department budget because of the “Reimagine Public Safety” initiative. The increase for ATCEMS will add 14 additional community health paramedic (CHP) personnel, as well as three full-time ambulances with 12 full-time employees (FTEs) per ambulance and three reserve ambulances. Also included in this additional funding are 12 new positions for the Communications Division: four Communications Clinical Specialists and eight Clinical Specialists to support the C4 consult line. One additional Command District Chief that requires five FTEs was also funded. Services Provided The term “third-service” refers to the addition of EMS to the traditional governmental services of police and fire. ATCEMS is classified as a third-service EMS provider, not a fire-based EMS service, private, or forprofit service provider (e.g., Acadian Ambulance, American Medical Response - AMR). Although there are other third-service providers around the country, this model is the least common type of provider. ATCEMS is the designated primary EMS provider for the City of Austin, most of Travis County, and sections of Williamson and Hays Counties. Within the City of Austin, ATCEMS is supported and/or augmented by Austin Fire Department, which is dispatched to ALS-level calls (priority one through three) to ensure more critical patients receive care and treatment as rapidly as possible. AFD responds to these calls with EMTs and provides basic life support (BLS) level care. ATCEMS utilizes an international system known as the Medical Priority Dispatch System™ (MPDS®) to classify and prioritize EMS 911 calls. When a person calls 911 and states they have a medical emergency, the call is transferred to the ATCEMS dispatch center from the Austin Police Department call taker. Once the ATCEMS call taker determines the primary complaint and obtains the address of the incident, emergency response units from ATCEMS are dispatched and, if needed, AFD is also dispatched at the same time. The call taker continues with a series of questions to determine the severity of the problem and additional information gathered regarding the patient is provided to the responders. In Austin and Travis County, EMS calls are prioritized one through five with one being the most critical and five being the least. ATCEMS provides a single-tier response model, meaning that all response units are staffed by ALS providers which are typically certified or licensed paramedics. This means that regardless of the call priority level an ALS unit responds, provides care, and, if necessary, provides transportation to a protocoldesignated hospital, which may include the closest hospital or emergency department facility, or a specialty care center for specific types of patient emergencies.