2019 EMS State of the State

Welcome back to the South Carolina Bureau of EMS and Trauma contribution area of this edition of Carolina Fire Rescue EMS Magazine.

As we go to press we just returned from one of, if not the best, EMS Symposium in a few decades at the ever-accommodating Kingston Plantation in Myrtle Beach. There were a large number of renowned speakers covering a plethora of topics attending this year’s symposium, many of whom had never presented at our conference before. I stepped into several rooms for a few minutes here and there and most were packed to the gunnels.


On top of 100 hours of continuing education, the annual paramedic competition was held and annual awards were presented on Saturday night at the annual closing dinner. If you missed the closing ceremonies, the awards, and presentation by Lancaster County EMS’ Honor Guard, you truly missed an event. There were goosebumps and eyes filled for almost the whole event from nearly 250 attendees; and that was just at the dinner.

The last report we received was more than 570 people attended this year, which makes it the most attended in several decades, if not ever. Nearly the entire Bureau of EMS and Trauma was onsite the entire conference attending meetings, providing training and staffing our booth in the PACKED exhibit hall. Many of you came up and said “Hey,” bought a new state patch, or got your new ForEver ID card. We even got a few new ideas from you on how we can make things better for you and for EMS in South Carolina; we are listening.

A Year in Review

Each year the SC EMS Network graciously allows me an hour to deliver an EMS “State of the State” address during the opening ceremonies. It is an honor and privilege to present to you where we are, what we’ve been doing, and where we’d like to head in the coming year(s). Sometimes we throw some things out there to start a conversation or to float an idea that has been presented to us. I have a great time preparing and delivering the address, and we always have a great turnout, nearly 300 this year sat in. For that I thank you all. I also blatantly grovel for twitter followers and tags while we’re in there together.

This year I’m proud to announce that all your tweets and tags actually had @SCEMS1 trending for about an hour in South Carolina; my work here is done! Seriously though, thanks to those that follow me on Twitter and who tagged the Twitter feed.

I’m also happy to let you know the state of EMS in South Carolina is “healthy, advanced and getting noticed.”

Where We Are

Currently in South Carolina we have 276 licensed transport and non-transport agencies, that’s down about five percent from last year. We have 1634 permitted ambulances and 45 helicopters ready to answer the call. Those agencies generated more than 1,280,000 ePCRs in 2018. We have stayed flat or had decreases in EMS personnel that are active in South Carolina as well as general roster numbers over the last five years. Happily, those things are changing. We are up nearly two percent in overall personnel that are active in South Carolina, 8400 versus 8100 last year. Since we only credentialed and added 202 net new EMS workers to the roles, that means we had about 178 folks come back into the workforce over the last year that weren’t working in EMS in 2017. That’s awesome.

All levels of EMTs had increases as well this year, with paramedic numbers jumping by 100 or 2.5 percent over last year. Why are these numbers going up? Thank your EMS programs and your EMS agencies that are adding personnel. We heard a report out from one of the EMS regions that they had TWELVE concurrent EMT classes going on currently. I’ve never heard those large of numbers before from just a single educational institution. Keep up the good work. According to our records we should be adding at least two new paramedic program institutions this year as well, so there will be even more seats open to start producing medics in the midlands and upstate.

We’ve actually added almost one FTE in the bureau this year as well in training and certifications and they are also getting it done. This week alone I’ve been monitoring output and complete applications that are received have a one-day turnaround, yes one day. Make sure you send us a complete application for new folks and that you have a photo in Continuum. If you’re renewing, make sure you upload legible copies of your CPR/ACLS cards into the online system and you’ll also experience one day turnarounds if your background check has hit the system. We’re very pleased to be able to offer this kind of speed; most of us can remember when it would be several weeks to get our paperwork turned around.

Where We Are

We talked about numbers a bit. I won’t give you everything, you’ll need to come to the symposium to hear it all, but we are quite busy in SC EMS. We ran more than 1,280,000 calls last year, more than 827,000 were 911; 366,000 were medical transports and 75,000 were interfacility calls. Over 720,000 were listed as ALS or BLS, so that leaves about 100,000 or so refusals and cancelled calls a year for 911 agencies. You continue to get better with scene times; there was a 24 percent increase in urban systems in those call where you spent less than 15 minutes on scene with a trauma. There was a 15 percent increase in the number of calls where you got off the scene in less than 15 minutes with a stroke in rural areas. We continue to see numbers of attempts of BIADs going up; nearly 200 this past year. Conversely, we are also seeing the number of failed attempts increasing each year by about four percent over the last two years alone. We’re working to make a first attempt our best attempt with ET intubation and BIADs. More on that in a minute.

We are about the same in narcotics administrations across the state as we were in 2017 with 9707 patients receiving IV/IO narcotics. Unfortunately, we are also seeing an increase annually in the amount of Narcan being given by EMS agencies, up 37 percent since 2015 to almost 8000 this year vs. 5,000 in 2015 to opioid overdose patients. Our LEON officers have given Narcan more than 700 times since we started training and outfitting them. More than 8343 officers are trained and carrying Narcan. Twenty-eight percent of the time they arrive before EMS CPR is in progress and the LEON program has a 97 percent success rate in reviving patients. Amazing work.

Last year the department performed more than 870 ambulance, fire engine and helicopter inspections. Most of those were on ambulances. We reviewed the Top 10 hits we saw and they aren’t pretty, folks. Again, you gotta buy a ticket come to the show to see them all but you should concentrate your efforts on making sure all required equipment is”

  1. On the truck
  2. Working
  3.  Not expired
  4. Your O2 tanks are full (or at least there)

A new onsite “ticket” program is coming from the bureau to see if we may be able to better assist you with compliance. After all, we’re from the government and we’re here to help.

We introduced a new patch this year after a fierce competition. Seventy percent of you chose the winner. Most of you like them, some don’t, but we did sell out of the ones we brought with us to the booth so that says something.

We survived another near miss by a major hurricane that had us evacuate the coastal areas, at least five hospitals, 100 other medical facilities and about 5900 patients. The bureau facilitated more than 400 transports to our special medical needs shelters. This was the most ever moved by you as state EMS and us as a bureau. You should be proud, not one single request for an EMS resource went unanswered. Bravo.

More than 18,000 Stop the Bleed Kits were distributed to every school district in South Carolina and more than 6,700 nurses were trained in their use and 10,000 other staff members as well. The EMS for Children Program has a new Peds Ready ER program in place and certified three hospitals as Peds-Ready in 2018. Keep your eyes open for Pre-Hospital Peds Care Coordinator certifications as well as Peds Ready EMS Designations, too. Who wants to be the first Peds Ready EMS Agency in South Carolina? Let’s see who wants it.

SC FAST had more than 50 deployments last year, should receive their funding again this year from the general assembly which is fantastic news. SC FAST, SC DHEC, and the SC EMS Association sponsored the first ever ETLS classes East of the Rockies in 2018 and hope to do so again soon. Speaking of the SC EMS Association, haven’t they done a remarkable job pulling all their forces together into a formidable group working to better EMS and move the profession forward?

In case you missed the speech, you should ask around about how they pretty much single-handedly provided the legislature with information on what we do, how we do it, what’s required, and why a particular bill; while well intentioned, wasn’t needed. That single bill had the ability to impact every agency in the state and would have lifted caps on damages to whatever a jury wanted to award in EMS-related gross negligence cases. Not a member yet? Give Henry, Tater, or even David a call. They can fill you in on all the benefits of being a member. They have had a super year, and even greater things are coming.

Where Do We Want to Go?

As I start to run out of space, I need to mention some of the directions we are going, or at least things that have been brought to us to consider. Nope, not touching the “Paramedics need a degree” fight this time around, you mostly know where I stand anyway. We are still working with The Duke Endowment to try to get video laryngoscopes to those agencies that don’t have them yet. We feel really good about the support and feedback we’ve gotten from TDE and we should have a final answer on funding here by May at the latest. Keep your fingers crossed.

Speaking of education, the only way to get and keep EMTs in South Carolina is to home-grow them. It’s been proven time and again, if you grew up here, you’re likely to stay here. If you came down to visit from Cleveland or Chicago for a couple years to gain some experience, you’re probably gone in just a few years. To that end, we are open to any suggestions on EMS education models that you want to try that are within our purview.

You’ve already proven hybrid classes can work, and work well. We’d love to see more high schools and tech schools start EMS programs. Some have suggested a SC EMS Academy is a solution. Although different than a police or fire academy, there are those that feel it might work. Maybe, maybe not, but until someone brings forth a plan and executes it, we will not know.

During this year’s pre-conference NAEMT PEPL course, a discussion started about protocols. Someone said “state-wide protocols” and my ears perked up. We took an informal poll and every student, from about 18 agencies, raised their hands when asked if we should consider them. The argument? Well, someone who works in Myrtle Beach full time may have a protocol for 0.5 mgs of epi for anaphylaxis for an adult, when they go part time to Georgetown it might be 0.3 mgs, and at Midway Fire on their weekend job it may be .01 mgs/kg. Give the “wrong” dose in the wrong job and you’ve just violated an order. While we aren’t for or against them in the office, we will be bringing this topic forward for discussion because YOU asked us to.

As I close, I mention probably our heaviest lift for the coming year, the South Carolina State EMS Plan. We are required by statute to develop and adjust a State EMS Plan. What is a state EMS plan? Ask someone who’s been in EMS since before 1996 because that’s the last time one was generated. That’s both good and bad. Bad in that we have to start from scratch, but also good in that we can start from scratch, take your input, mold it and craft it into a living and working document and really set a course for the future here in South Carolina with EMS.

If you came to the symposium and enjoyed yourself, let a colleague know and get them to come next year. If you’re wondering just how much you learned from this column, it’s less than half of what was discussed. If you want the full show, “ya gotta” get a ticket and show up folks.

Be safe.

Rob Wronski is the South Carolina Department of Health and Environmental Control (SC DHEC) Bureau Chief of EMS. He has served in many roles since becoming a firefighter paramedic in 1991, culminating with his selection as Chief of EMS for the state where he has served for nearly three years. He has held several executive positions including Assistant Chief of the St. Andrews Fire Department in Charleston, Medical Officer of the Mt. Pleasant Fire Department, and a Shift Commander in the Beach Park (IL) Fire Department. His experience includes working in fire-based EMS, including ALS and BLS first response as well as fire based and county based ALS transport.

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