EMS investments paid off during deadly storm

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EMS Captain Selena Xie stands next to her ambulance, which was stuck in the snow and ice during the big winter strorm.

City Council orders review to improve future disaster response

When a failure of the Texas electric grid shut down power in swathes of Austin during the night of February 15-16, there weren’t enough ambulances to respond to every 9-1-1 call.

Selena Xie

“At a certain point we were only sending an ambulance to our high priority calls, and even then we didn’t have enough,” said Captain Selena Xie, Austin EMS Association president, in an interview.

Many of the first calls were for patients dependent on oxygen or dialysis. But with the roads partially impassable, even they didn’t have any guarantee of immediate assistance.

On her first shift of the day, Xie was with a crew trying to get up a hill in West Austin. They were trying to evacuate a man with lung disease whose oxygen had gone out. “We lost traction and our ambulance started sliding. Once it started sliding we lost control.”

A half foot of snow had fallen overnight, topping a layer of ice. Some roads were strewn with abandoned vehicles. It would be another three days before the mercury rose above freezing and power started to be restored.

Xie’s ambulance slid off the road and got stuck “for a few hours.” The medics called firefighters to assist. An Austin Fire crew in a four-wheel drive vehicle managed to get up the hill to extricate the patient and bring him down to the ambulance. “This patient was critically ill by the time we got to him with oxygen levels at like half what they should be,” Xie said. “I was concerned that he was going to die.”

Elsewhere, medics commandeered a Bobcat (a compact tractor) to get to a patient after their ambulance got stuck in a ditch. Austin Travis County EMS (ATCEMS) used its four-wheel drive command vehicles and special events vehicles to extract ambulances when they got stuck. Medics tried to get to some patients on foot, but even walking was treacherous. Xie said, “We have quite a few medics who fell. I fell on my butt many times.”

For the next two days, the city’s EMS service, which has more than 30 ambulances, ran at full steam around the clock. “During the ice storm, those three days, every single ambulance was basically on calls, driving to calls, or at the hospital for 24 hours straight.”

That’s highly unusual. “A real safe level of ambulances, you want them to be in use about 30 percent of the time,” Xie said. “On our normal day we have probably up to 10 ambulances that are generally out for a majority of the day.”

After the oxygen calls, medics started getting more cold-related calls. Xie said she transported a man from a nursing home simply because he couldn’t stop shivering.

Then came the carbon monoxide calls. That’s a poisonous gas that’s produced when someone runs a car inside a garage, heats a home with an oven, burns charcoal indoors, or runs a generator without proper ventilation.

In all, ATCEMS says it received 6,058 calls for service from February 14 through 19, including 187 environmental exposures, 519 falls, 115 traffic collisions with injuries, and 86 carbon monoxide poisonings.

Xie believes that Austin EMS or other emergency responders “made it to everybody who critically needed EMS. However, I think that there were some people who did die, potentially, because we couldn’t get there fast enough.”

“I know that there was one dialysis patient who did end up dying. Those things are kind of hard to quantify. If you’re calling us because you’re actually dying, even if we resuscitate you and get you to the hospital it still doesn’t mean that you’re going to live.”

New investments made a difference

A couple of recent investments helped prepare EMS for the winter storm. Perhaps the most impactful was a call-in service, known as a clinical consult line. That helped EMS to more effectively triage patients, preventing ambulances from going out on unnecessary errands. The consult line is similar to the sort of nurse hotline that’s offered by insurers or healthcare providers, except that it’s staffed by paramedics.

“Our triage line was really helpful in making sure the appropriate resource was sent when we have such a severe lack of resources,” Xie said. For instance, “If you have an eye stye you don’t need an ambulance, you just need a ride to the hospital. Or if you fall and cut yourself and need stitches, we can actually send out our mobile doctors…and give you stitches so that you’re not taking up ambulance resources.”

A complementary resource was the hiring of a full-time physician’s assistant who could do mobile healthcare in the field. The physician’s assistant can perform minor procedures like sutures or cutting an abscess, without the need to bring an ambulance.

Finally, this year’s budget included funding for three new ambulances and crews, though only one was in place when the storm hit. If not for the COVID-19 pandemic, one more ambulance would have been online, but illnesses and quarantines related to the outbreak delayed its deployment. The third new crew and vehicle wasn’t scheduled to be ready until July.

In all, there are 776.5 EMS staff positions in the city’s current budget, up from 704.5 last year. That includes 41 new sworn staff for ambulance crews, paramedics for the consult line, a new command unit, five new administrative positions, and 14 community health paramedics.

Xie told the Bulldog that the new community health paramedics were able to provide assistance at the city’s warming centers during the February storm, to check on the homeless when other service providers weren’t able to do so, and to respond to mental health calls of persons not coping well with the cold and stress of the week’s events.

The city’s total EMS budget this year is $102 million, which is a substantial increase from the $93.1 million operating budget last year. Much of the new spending, about $6.5 million, came from diverted funds from the Austin Police Department as part of the Reimagining Public Safety process launched by the council last year, according to budget documents.

Council orders disaster planning

Despite the new investments, the Austin EMS Association would like to see additional investments in the coming years. “By the end of this fiscal year we will have 40 full-time ambulances and seven part-time ambulances. If we have five more ambulances I think that would be a good level for us to be staffed at for the next few years,” Xie said.

Staffing that many new ambulances would require as many as 60 new hires. That could be a big ask if the budget next year involves belt-tightening. In the wake of the pandemic, the dust hasn’t really settled on property values, making it difficult to forecast property tax revenues. It’s also unclear how rapidly tourism and business travel will revive, which could cut into sales tax revenue. However, a $350 billion chunk of the federal stimulus plan being discussed in Congress is expected to go to municipal governments, which could offset those impacts.

For now, the City Council seems willing to splurge on EMS. At a special meeting February 25, it waived fees for people who received help from ATCEMS during the winter storm. That will cost the city $300,000, according to a fiscal note published alongside the council agenda for the day.

Looking ahead, some lifesaving measures might not actually cost all that much to implement. For instance, Xie testified to the council, “We failed to maintain winter boxes—containing extra blankets, hand warmers, chains to attach to boots for walking on ice, deicer for windshield wipers, and field additives to keep the bio diesel from freezing—or to put chains on our ambulances.” None of those fixes are particularly costly.

Likewise, some EMS stations lost power during the storm and were unable to charge lifesaving equipment. Small backup generators would help in that regard.

Mackenzie Kelly

A resolution passed by the council February 25 directed the city manager to “report on recommended actions related to disaster relief.” Under an amendment introduced by Council Member Mackenzie Kelly, the resolution also required a review of “first responder response to the disaster including a review of how staffing levels were maintained and a comparison to other municipal equivalent responses in Texas.”

Alison Alter

Council Member Alison Alter, who backed the idea of a resource study of that kind, said, “I know that for AFD and EMS there were resources that were stretched very thin, from not having chains (on vehicles) to having to deal with roads that TxDOT didn’t close down. There are all sorts of things that we definitely have much to learn from for the first responders.”

Kathie Tovo

In addition to the staff-led review, Council Member Kathy Tovo proposed “a deliberative process that helps inform recommendations going forward,” including potentially a series of council work sessions that would feature invited testimony from city staff and other stakeholders.

“I would like to see this accompanied by a community task force that is hearing directly from the public about elements of the response that worked well and where there were gaps,” Tovo said.

Greg Casar

Ahead of the vote on the resolution, which passed unanimously, Council Member Greg Casar thanked the city’s employees and volunteers who helped out during the storm. “I don’t think we can say enough to thank the line workers at Austin Energy who were in the wind and ice and snow getting power back on; the Austin Water staff who worked all day and all night to get water working in our pipes; the public safety employees who pulled folks out of stranded cars and put out fires, and got people to the hospital; the staff who ran our shelters and the volunteers that pulled people out from under bridges and got them into hotels.”

“Really, our public employees and the caring members of the public were the heroes of this crisis.”