Medic One System Description & Budget
In the beginning...
Thurston County's Medic One / Emergency Medical Services (EMS) System was established in 1974. It was the first public, county-wide, tiered response, EMS system in the United States.
- The Medic One/EMS System provides a fire services based basic and advanced life support emergency medical and trauma care and transport to over 281,700 residents within the county's 727 square miles.
- The EMS System responded to 34,401 EMS calls with paramedics responding to 10,192 calls and transporting over 3,562 life critical patients during 2018.
- The Medic One System’s paramedic units responded with a countywide average response time of 6.86 minutes.
- The paramedic units accomplished an overall 94% county-wide response goal achievement for response goals of 10 minutes urban, 20 minutes suburban and 30 minutes rural classified areas.
The approach is to involve all jurisdictional entities as participants in the system rather than a sole provider approach.
- Twelve fire departments/districts are providers of Basic Life Support (BLS) and are certified at First Responder or Emergency Medical Technician (EMT) levels.
- All Fire/EMS agencies function with one or more Aid vehicle (55 BLS units provide countywide coverage), averaging 6.75 minutes countywide.
- All BLS agencies have been auto-defibrillation capable since 1986 and carry epinephrine for severe allergic reactions.
- Most fire agencies are primarily volunteer with the exceptions of the larger municipal departments.
- Olympia, Tumwater and Lacey Fire District # 3 are integrated as county-wide providers of Advanced Life Support (ALS) staffing seven units.
- Paramedic transport units are dual-role (EMS and fire services) personnel and staffed with two paramedics.
- Two private ambulance companies, Olympic Ambulance and American Medical Response (AMR), provide basic life support EMS and inter-facility transport.
- Private ambulance companies provide four full-time BLS transport units and additional for peak load times.
- The System is further supported by a private non-profit EMS helicopter service, AirLift Northwest, stationed at the Olympia Airport.
A Timeline of how we got there
- 1998 - The System enhanced paramedic services by adding a Single Paramedic Rapid Intervention Non Transport (SPRINT) Unit to the south western county area.
- 2000 - A second SPRINT unit was added to address paramedic response times to west Olympia and northwest Thurston County.
- The goal of the SPRINT unit is to improve ALS level response time and paramedic transport unit availability.
- 2002 - SPRINT unit #10 north western county was upgraded to a full dual staffed paramedic transport unit after the 2001 Nisqually Earthquake due to accessibility issues with northwest county and west portion of Olympia.
- 2006 - Medic unit #10 (formerly SPRINT unit #10) - managed by Olympia Fire Department - was a peak hour, dual paramedic staffed ALS transport unit.
- 2006 - The Medic 6 unit is stationed in the Hawks Prairie/northeast county area to respond to growth in the Lacey Urban Growth Boundary area and is managed by Lacey Fire District #3.
- 2010 - SPRINT #14 unit was stationed at Grand Mound, had simultaneous response with the Tumwater ALS transport unit and both units are managed by Tumwater Fire Department.
- SPRINT 14 was later upgraded to half time full paramedic transport unit at the same location.
- 2012 - The final phased transition was completed to a full time dual paramedic staffed Medic 14.
- 2012 - Medic 6 began phase up to a 24 hour dual paramedic unit by adding staff in each year, full staffing was completed in 2014.
- 2015 - Protocols were updated to add Pulse Oximetry and Blood Glucose assessment to BLS skillset.
How the 911 process works
- Medical communications is over cellular phone and/or HEAR (Hospital Emergency Administrative Radio).
- Two hospitals are designated to receive EMS patients, Providence St. Peter Hospital and Capital Medical Center.
- Both hospitals and TCOMM have compatible radio equipment to insure greater than 90% communication coverage county-wide.
- The Thurston County EMS System participates in a state wide Trauma Center system.
- In 2012, Thurston County implemented a program to be included in a statewide Cardiac and Stroke center system.
- Cardiac and Stroke patients meeting state criteria may be transported to cardiac and stroke specialty centers.
- Implemented in 2005, was an in-vehicle data system linking ALS units with the Dispatch center and county hospitals via digital radio modem.
- Private ambulances are capable of hospital and system communication.
- Disaster situations are coordinated on a designated VHF (very high frequency) band.
- Washington Hospital Emergency Radio System (WHERS) capability was added to all medic units for additional communication capability.
- Disaster situations are coordinated through pre-plans, fire Incident Command System, TCOMM, and Thurston County Department of Emergency Management.
- The EMS System maintains pre-positioned disaster resource trailers that can respond to the site with additional disaster medical supplies and equipment.
- Medic One is capable of immediately placing additional fully equipped Medic Units in service by calling back paramedic staff.
Continuing Education and Training
- All initial and specialized county-wide BLS training and over 125 required EMS continuing education classes are provided through the Medic One office.
- Implemented in 2008, the Basic Life Support (BLS) online training was added to the hands on training and evaluation program (OTEP).
- Monthly ALS continuing education, run reviews and quality management are provided by the Medic One system.
- Paramedics spend in-service training time at the Base Station for skill maintenance, patient follow-up and continuing education.
- Paramedic employment and county-wide EMS personnel certification testing are provided through the Medic One office.
Emergency Medical Program Director (EMPD)
- The Emergency Medical Program Director (EMPD) is staffed and paid by the Medic One office.
- The EMPD provides medical direction and authorization for system function.
- Prehospital standing orders/protocols, dispatch protocols, certification, training, testing standards, medical quality assurance and medical disciplinary actions are the EMPD's responsibility.
- In 2012, EMPD medical support was initiated to Thurston County SWAT.
Documentation and Reporting
- ALS & BLS agencies use a county designed Medical Incident Reporting (MIR) form to document all EMS patient care.
- MIR’s may be internally reviewed at the Medic One office for quality assurance and quality improvement under a state approved QI plan.
- ALS reports are input on a central, mobile, electronic data processing system.
- The Medic One system is developing a pilot for integration of ALS and BLS systems to electronically process all EMS reports by 2019.
The Thurston County EMS Council
- The policy making body is the Thurston County Board of County Commissioners (BoCC).
- Advisory to the BoCC and the Medic One office is the Thurston County EMS Council.
- The EMS Council is made up of 16 members:
- three citizens-at-large
- one citizen-at-large countywide physician
- a BoCC representative
- three Fire Commissioner representatives
- a City of Olympia representative
- a City of Lacey representative
- a City of Tumwater representative
- a Fire District # 3 representative
- a south county Mayors representative for suburban/rural cities
- an emeritus position
- and non-voting members; the Chair of Operations Committee and the EMPD
About the Medic One Office
The Medic One office staff is responsible for developing and implementing system policies and procedures, recommended by the EMS Council and authorized by the Board of County Commissioners.
- The Medic One office is responsible for county-wide:
- system coordination
- county to region system integration
- equipment/supply purchase
- staff support to the EMS Council/committees
- EMS provider initial BLS training
- EMS continuing medical education
- system quality management (QM)
- ambulance licensing
- system financial administration
- The office provides county-wide citizen CPR training and system education.
- In 2018, CPR Training was provided to 4,177 citizens.
- In 2011, Public Access Defibrillator (PAD) training was added to the citizen CPR classes.
- The CPR program was enhanced in 2013 to add High School CPR training.
- PAD trains citizens how to use a public automatic external defibrillator (AED) as part of the CPR programs.
- In 2007, the Medic One system implemented a county-wide SafeKids (national childhood trauma prevention program) by partnering with Thurston Child Care Action Council.
- SafeKids provides child car seat fitting/education, bicycle helmet fitting/education, water safety education and other child trauma prevention programs.
Medic One Office Staff
The full-time Medic One staff is composed of:
- BLS Program Manager
- BLS Training Coordinator
- Medic One Training Assistant
- ALS Program Manager
- Business Applications Administrator
- Fiscal Manager
- Administrative Supervisor
- Medic One Purchasing Specialist
- Senior Office Assistant
The part-time Medic One staff includes:
- Emergency Medical Program Director
- CPR Outreach Coordinator & Instructors
- Cardiac Arrest Review Coordinator
- EMT/OTEP Instructors
The 2019 Medic One/EMS System is funded by:
- $11 million county-wide regular EMS levy
- rate @ 31.6 cents/$1,000 assessed value
- this covers the county-wide EMS program
The funding is used across the System with emphasis on full-time paid paramedic response and transport coverage.
The current Medic One/EMS program budget is dispersed as follows:
- 79% to Advanced Life Support (ALS) activities
- 15% Basic Life Support (BLS) activities
- 4.9% to administration
- 1.1% for CPR/public information activities