| Wildfires tore across Texas in the late spring and summer of 2012, scorching tens of thousands of acres and forcing residents to evacuate rapidly. Firefighters battling the wildfires needed medical attention. The situation could have been overwhelming, but Texans put their newest emergency response resource into action—multi-patient vehicles, more commonly known as ambuses |
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Staffed by EMS personnel, an ambus responded with a primary mission tasking to evacuate area nursing homes if needed and a secondary tasking to provide force protection and rehab, medical assessments and care for hundreds of firefighters each day. Because an ambus remained at the wildfire site for the duration of the emergency and brought basic medical care close to the scene, firefighters could remain on-site. Receiving medical care nearby provided rapid relief for the firefighting crews, which are required to rotate work-and-rest cycles for firefighter safety.
An ambus is a special EMS unit that can transport or care for up to 20 patients at once, at least ten times as many patients as a standard ambulance. The vehicles are equipped like ambulances, including patient ventilators, wireless vital signs monitoring, suction devices and other life-saving equipment. The ambuses have additional emergency response capability that has proven valuable when a Texas nursing home lost both its main and backup power due to a vehicle accident which interrupted their normal power supply. Two of the new ambuses were able to serve as a backup generator for the nursing home. Each ambus is equipped with five air conditioners as well, which allowed nursing home residents to shelter in place in the ambus instead of having to be evacuated. Another nursing home used an ambus to evacuate patients to safety after a severe storm.
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Over the past year, Texas purchased 13 ambuses using funds from the Hospital Preparedness Program and other grant programs and has placed at least one ambus in each of the state’s eight EMTF regions. The ambuses are available to be deployed during state-tasked missions and fulfill vital roles in the day-to-day response needs of local communities. In a disaster, these 13 ambuses could transport up to 260 patients simultaneously and then return to the emergency for more.
This new ambus capacity came in handy in September as a small Texas community responded to a school bus accident in which eleven children and one adult suffered injuries. The community did not have enough ambulances to transport all the injured passengers quickly to the hospital, so the town enlisted one of the EMTF ambuses to assist in the response.
The ambuses are staffed by personnel from an EMS host agency within each EMTF region, usually a local fire department or local EMS department. To qualify to receive an ambus, the host agency must enter into a written agreement with the state, specifying their intent and capacity to respond to state emergencies. The EMTF program allows and encourages the host agencies to utilize the ambuses for local responses, as day to day use increases familiarity for the EMS crews and ensures the vehicles are in safe, optimal working order.
State agency representatives note that routinely using the emergency medical task force for local emergencies also serves as continuous training for other emergency responders across the state. As they improve their knowledge and incorporate lessons learned from day-to-day deployment of the task force, they become better prepared for major disasters for many years to come.
The big picture
The idea for ambuses emerged in 2008 after the state responded to four major storms, including Hurricane Ike. The experience demonstrated the need for more state-based emergency resources including ambulances and medical teams.
To address the problem, an emergency preparedness committee made formal recommendations to state emergency management and public health agencies to develop the Emergency Medical Trask Force program. Using Hospital Preparedness Program funds, the trauma regional advisory councils, which serve as regional healthcare coalitions in Texas, developed and executed the Emergency Medical Task Force program. The program encompasses the ambuses, as well as field hospital trailers, called mobile medical units, 40 ambulance strike teams to augment EMS departments across the state, and nurse strike teams to augment or relieve local hospital staff during a major disaster.
The ambulance and nurse strike teams volunteer to participate and go through an extensive interview and enrollment process to be a part of the program. When activated, team members are paid by their employers who are reimbursed by the state. By working with the employers, the program ensures that these health care providers hold the appropriate medical credentials and competencies.
The Texas Department of State Health Services partners with selected hospitals and health care systems to maintain custody and manage integrity of the pharmacy caches even while a cache is deployed. After an emergency, the unused portion of the cache returns to the hospital or health care system and the state receives an invoice for cache supplies that were used while the cache was deployed.
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All of the emergency medical task force resources follow the National Incident Management System and apply standard operating procedures statewide, employing a “one team, one fight” motto. State agencies, hospitals, and EMS departments statewide maintain visibility on emergency medical task force resources through a web-based secure application called WebEOC. Texas implemented a statewide WebEOC Interoperability Project, also funded through the Hospital Preparedness Program. The software connects state WebEOC servers with 53 local jurisdictions’ servers and FEMA Region 6. FEMA headquarters recently selected WebEOC as their crisis information management software and chose the Texas-FEMA Assistance Request Process as the model for the nation.
All of the task force elements hopped into action as quickly as they came online. The state placed two nurse strike teams, the mobile medical unit and six ambuses on standby during tornadoes and storms, including Hurricane Isaac, this summer.
The mobile medical unit also served as a temporary medical facility for approximately 700 patients who sought medical attention for illness and injury during the annual Bataan Memorial Death March in New Mexico. Texas lent the unit to its neighboring state for the 26-mile march through the high desert terrain of the White Sands Missile Range in New Mexico near El Paso, Texas. Approximately 6,300 participants marched this year in honor of the military service members who defended the Philippine Islands during World War II.
