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Finding New Venues of Support for EMS


Facing severe budget deficits, many state, regional and local governments are slashing money from programs that support EMS. With limited ability to raise additional funds on their own, some EMS agencies are finding welcome assistance from unlikely sources.

Several years ago, the loss of critical state funding for EMS, trauma and acute care drove a diverse group of Texas healthcare professionals to join forces. Recognizing that they could no longer expect the state to fully support their programs, they decided to create a unique network of EMS and hospital professionals.

The result is the Texas EMS, Trauma and Acute Care Foundation (TETAF), a thriving nonprofit that not only picked up the slack for the state but also, according to Edward M. Racht, MD, chief medical officer at American Medical Response, has proved a successful rallying point for EMS. The venue, he says, just like the national healthcare discussion, has brought together professionals who, historically have not talked to each other. “Surgeons have to talk to CEOs, hospitals have to talk to EMS, nurses have to talk to paramedics and everyone is charged with focusing on the patient,” he says. “This is so critically important.”

The original vision for the Foundation was to create an entity without the kinds of restrictions that typically hamstring state agencies. In addition to the formerly held state functions, it could provide an advisory role and offer educational opportunities, for example. “The idea blossomed from there,” he says.
Racht, who chaired the State EMS & Trauma Advisory Council during the discussions of establishing a Foundation, now serves on the board as the EMS committee chair after relocating back to Texas. However, he is quick to point out that this was, and continues to be, a “communal process.”

Getting Started
The impetus for the Foundation began in 2003 when Texas legislators, looking to reduce a $10 billion budget deficit, restructured Health and Human Services by eliminating services that could be provided by other entities. One of those services was the accreditation for trauma centers.

The state of Texas determined that since the American College of Surgeons (ACS) conducted such surveys, they were equipped could take over the process. What seemed like a good idea on paper was more problematic in practice. Part of the issue is that the ACS rarely surveys the level 3 or 4 trauma centers commonly found in large portions of rural Texas. Just as challenging was the fact that the survey fees the state collected, helped to fund much of the trauma and emergency healthcare services, including EMS.

Although the associated agencies could see the problem and agreed that collaborating was the answer, it took the hard work of Jorie Klein, RN, director of trauma and disaster preparedness for Parkland Health and Hospital System in Dallas to bring EMS and the hospitals to the table and create the Foundation.
“I attribute all that has been done here to her professional style,” Racht says of Klein’s exceptional ability to bring together groups with wildly disparate opinions. “She’d be a great marriage counselor,” he says. Klein continues to serve as the Foundation’s board chair, and presumably, chief relationship-builder.

Establishing Goals
As a collaborative effort, the process of establishing the Foundation was a lengthy one. According to TETAF Chief Executive Officer Dinah Welsh, it took five years from the initial idea to the final structure was established. In 2007, the Foundation was approved as a nonprofit. A year later, the state officially recognized it as a verified surveyor of level 3 and 4 trauma centers.

Welsh and another employee, Brenda Putz, RN, became the first employees when they were hired in 2009. Since then, TETAF has hired a third employee to attend to initiatives at the State Department of State and Health Services, as they relate to trauma and EMS. To focus efforts, the Foundation created seven divisions: EMS; Acute Care; Injury Prevention; Pediatrics; Professional Education; Regional Advisory Council (RAC) and Disaster; and Trauma.

The overall goals of the Foundation are the following:

• Afford resources and educational programs to providers and agencies;
• Promote systems development throughout the state;
• Support public education programs;
• Review system outcomes measures to define areas of improvement; and
• Provide research opportunities to all agencies.

“It’s essentially our own little ACO (accountable care organization) club,” Racht says. By cross-pollinating professionals from different disciplines, the TETAF has been able to improve relationships and generate innovative ideas. “Hospitals hear EMS issues and vice versa,” he says.

In 2010, TETAF was approved by the state to conduct accreditation surveys for stroke centers in Texas. In the education arena, the Foundation developed an EMS Medical Director course that it offers throughout the state and is working on a data management course. It also coordinates with affiliate hospitals and EMS agencies to promote educational events. In an effort to expand communications, it recently began web-casting the quarterly Governor’s EMS and Trauma Advisory Council meetings.

Seed money for the project came from the 22 Regional Advisory Councils (RACs) that are responsible for EMS across Texas. Additional funding came from state and federal grants.

Survey fees, educational fees and private donations support daily operations. Success breeds success. “We’ve had a number of private donors come on board in the past year,” Welsh says. She hopes to expand the Foundation’s reach in 2012 with an aggressive grant writing effort. “We’re finally at a point where we need more financial resources to do more,” she says. “Fasten our seatbelts!”

Keys to Success
Racht says that the structure of the foundation allows it to go beyond the traditional scope of similar, state-run agencies, allowing for educational and outreach programs that not only can be developed in a more collaborative way, but can also be sponsored and maintained by the same organization. “There’s a synergy that might not necessarily happen from one or the other,” he says. “It’s not an imitator, as other structures can be.”  A large part of TETAF’s success is that it provides an inclusive atmosphere for EMS providers regardless of whether they’re fire-based, private, third-service or volunteer. Collectively, they determine hot topics and, once determined, address them in a meaningful way.

Racht hopes that this collaboration continues to grow. He believes that by blurring the lines, the Foundation can develop novel approaches to outreach programs, similar to Mothers Against Drunk Driving (MADD) and the Heart Association. “There is a tremendous opportunity to interface with the general public who are not yet our patients,” he says. “It’s like a co-op of talent.”

The Future
Welsh admits that 2009 was a difficult time to kick off the endeavor, but so far, the Foundation has weathered a difficult economic time. She sees big thing ahead. “We are well-positioned to maintain and grow the trauma system in Texas,” she says. “Nothing is guaranteed, but we’re on the right side of the climb.”


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