Hospital district hosts first regional EMS solution workshop, as Valentine EMS seeks recruits

TRI-COUNTY — County judges, city officials and local EMS directors met this week to begin formally discussing the potential creation of a regional EMS entity to serve the entire tri-county area. 

The talks are kicking off as a Valentine resident launches efforts to bring emergency services to the tiny town, where locals now find themselves waiting 40 minutes for an ambulance.

The workshop, the first of many, was facilitated by the Big Bend Regional Hospital District and focused on whether a regional EMS model could provide more efficient, higher quality services for tri-county residents, as opposed to the current model in which each community runs its own operation. Staffing and funding are two of the main obstacles affecting the area’s EMS providers who work to respond to 911 calls across the vast Big Bend region.

“This is a very unique region. It’s going to be a very unique solution. But we really need to understand what everybody’s challenges are. We also need to understand how everybody feels about pursuing this regional model,” said JD Newsom, executive director for BBRHD. 

Newsom said medical professionals and political leaders were spurred to start seriously assessing the option of a regional EMS solution after the sudden passing of Alpine EMS Director Michael Scudder this past December. In the months following Scudder’s death, Brewster County leaders faced the daunting task of quickly securing a new EMS provider to prevent a gap in services. At that time a regional solution was considered, but ultimately ruled out due to the expedited timeline. 

“That really demonstrated the fragility of a lot of our EMS providers and everything was great until it wasn’t,” said Newsom. “There’s not a lot of depth to our bench of medical providers, so when something happens to one critical person, everything kind of falls apart.”  

Greg Henington, chief of Terlingua Fire and EMS, whose organization stepped in to run 911 calls in North Brewster County while county officials sought a more permanent solution, said he was going into the initial brainstorming session with an open mind, understanding each EMS provider has its nuances and issues of how to retain local autonomy and cost sharing needed to be fleshed out.

“I think it’s good that all of us that are running first responder organizations are getting together in a room for probably the first time in many, many years,” said Henington. 

The tri-county area consists of six total EMS providers which vary in organizational and funding structure. Some, like Marfa and Presidio EMS, are city-run; others, like that of North Brewster County, are run by a private company, Emergent Air, and Terlingua Fire and EMS is a nonprofit organization. All EMS agencies receive some form of subsidies, whether from cities, counties or, in Terlingua Fire and EMS and Jeff Davis County’s case, an emergency services district (ESD) designation which allows them to funnel sales tax revenue into emergency services.

“All the pieces of the puzzle, we’re all jagged edged, and none of them match because we’re all running different operations with different pay scales and different levels of experience,” said Henington. 

Henington said in general he supports the regional EMS idea as a possible solution to ongoing staffing and funding issues taking place across the board. Attracting new EMS directors as longtime leaders leave their roles has been a challenge as of late — he himself is seeking a replacement — and financially speaking, running EMS services is costly. Each provider maintains equipment, medications, ambulances and more. Pooling resources might help cut down on repetitive spending and processes, said Newsom. For example, one central location for medication supplies could allow for buying in bulk and managing expiration dates in one spot, saving money and time, said Newsom. 

“The capital costs for running EMS can be really expensive and ambulances [cost] $300,000. I think the idea would be that you could station those capital costs and those ambulances in a more effective manner. I think there’s a number of areas that could be more efficient with a regional operation.” 

Newsom said adopting a regional model could also help local training and recruiting efforts for medics and paramedics in the future. The tri-county area is competing for staff with nearby Reeves County, for example, whose ESD is currently offering $35 an hour for paramedics — higher wages than exist locally. And not all tri-county EMS providers are able to offer health insurance to their employees, something that could be remedied with a larger operation, said Newsom. 

“By scaling and consolidating operations, we might be able to help with the recruitment of folks when we’ve got a little bit bigger organization to be able to fund and train and recruit personnel,” said Newsom. 

Jeff Davis County EMS is the only volunteer-run operation and faces the task of recruiting and maintaining adequate levels of volunteer medics to keep their service running. Terlingua Ranch is also recruiting EMS volunteers to help provide immediate care while ambulances are on route. Each EMS operation is also required to be overseen by a medical director, and in many cases those roles have been filled by doctors willing to donate their time, a practice that will soon fall by the wayside, said Newsom. A regional solution could allow for the hiring of one medical director, as opposed to the multiple currently required to keep each entity in compliance. 

Jeff Davis County EMS currently services Valentine, but the remoteness of the town means dangerously long wait times for such services to arrive — because of this, ambulances are often dispatched from Marfa, which is closer in proximity than Fort Davis, but it’s still a considerable distance to travel. 

This is the problem Kyle LaFerriere is working to address. The Valentine local is currently looking to recruit volunteers who will be trained by Jeff Davis County EMS as either emergency medical responders — who, with 28 hours of training, can administer basic services like CPR and can stop bleeding — and higher tiers of emergency medical technicians, who can actually drive an ambulance and transport patients with between 80 and 120 hours of training. Jeff Davis County, which is anticipating the arrival of a new ambulance, will then allocate its retired emergency vehicle to Valentine. 

“My dad, who is elderly with a pacemaker, can’t even come down to [visit] me because if something happens, it’s 40 minutes for someone to respond and 40 minutes to get to the hospital,” said LaFerriere. His neighbor in Valentine, he added, is a disabled veteran on full-time oxygen.

“I’ve been thinking about it and have been concerned about it as long as I have been in Valentine, and trying to figure out how I can help with the revitalization of this town of 100 people,” he said.

LaFerriere said he has already heard from a number of people interested in training, plus folks who are already trained in some capacity who want to offer their services. Training is slated to begin in the fall, he said.

LaFerriere said that while he couldn’t be in town for the inaugural discussion, he is in touch with Newsom and is interested in talks of a regional solution. 

On the regional front, the idea to develop a homegrown workforce of local medical personnel by recruiting local high school students or creating a training program in partnership with Sul Ross State University has been floated in the past. Newsom said he is in conversations with the university, but while the school is under new leadership — Carlos Hernandez is acting as interim president after the resignation of Pete Gallego — operations are still stabilizing and no major updates can be provided. BBRHD has supported Sul Ross’ nursing program in the past by helping purchase equipment for a simulation lab with the intention that the lab would also be open for EMS provider training, said Newsom.

“There are some little bits and pieces that we are working into the fabric of Sul Ross to support our EMS, but it’s kind of it’s kind of piecemeal,” said Newsom. 

Other regional EMS operations the tri-county area might glean some insight from include MedStar, based out of Tarrant County, which serves a total of 14 communities around the Fort Worth area, and Hamilton County Hospital District, which serves a handful of counties in Central Texas, said Newsom. 

The creation of an ESD will likely be considered, as will the possibility of the hospital district running regional EMS. An ESD would likely be funded from property taxes and would need to be voted on by local residents. ESDs also typically include fire in their overall emergency services operations. 

A precise timeline for the initiative, schedule of regional EMS meetings and plans for public involvement have yet to be established. The hospital district is actively collecting data, performing a budget analysis to get a better idea of how much a regional EMS operation would cost, and has a public health intern researching the topic.

Newsom said in order to have an informed discussion with the public, more research and discussion needed to take place with industry and governmental representatives, but in the future he anticipates town halls or other public forums will be held to garner public feedback about a regional EMS system.

“Because this initiative impacts the whole region and it involves a really critical service, I’m definitely going to be urging quite a bit of public participation and input into the process,” said Newsom. “We want something that’s going to be sustainable for the next generation of folks living out here.”