Patrick N. Cobb EMT-P, CEM, ENP
Director of EMS & Emergency Management
Hamilton County Hospital District
Hamilton EMS is the exclusive provider of emergency medical services to the citizens of Hamilton, Mills, San Saba, and Llano counties. The EMS Department began operations in May 1990 with one ambulance and a dedicated team of first responders serving Hamilton County licensed at the Basic Life Support with Mobile Intensive Care capabilities. Today, Hamilton EMS operates a fleet of 10 full-time and 3 reserve Mobile Intensive Care Units, all equipped with the Stryker PowerLoad XTS System (auto-loading stretchers); and licensed at the highest-level of pre-hospital emergency medical care possible in Texas. In addition to 13 MICU ambulances, HEMS manages each county service area with a 24-hour Paramedic Supervisor in a 4x4 Command truck. Each EMS Command truck is equipped and stocked as not only a command vehicle with communications and incident command equipment; but also carries a full complement of medical gear, medications, and equipment in a climate-controlled vehicle. Not only does an EMS Supervisor provide an emergency response to 911 calls in a supervisory capacity; they also routinely assist EMS ambulance crew with complex emergency patient transports and interfacility transfers. This ability to provide two Paramedics in the back of an ambulance performing critical care medicine in real-time while a third drives, truly allows the best possible patient outcome.
Our service area extends from the rolling plains and ranching country of Hamilton and Mills counties south to the Texas Hill Country of San Saba and finally to the Highland Lakes Region of Llano County. To ensure we can access any portion of our service area and provide an effective rapid response, the EMS Department MICU and Command vehicle fleet are all 4x4 vehicles. For Special Operations, the department also owns and operates a Polaris 6x6 Ranger specially equipped for EMS rescue operations in rugged terrain.
With over 80 full-time licensed employees, the EMS Department specializes in rural emergency medicine bringing Mobile Intensive Care to the patient with advanced critical care paramedicine. Using the latest technology and state-of-the-art equipment, medications, and science based clinical practice guidelines; Hamilton EMS brings the hospital to the patient minimizing the delays in life-saving emergency medical care often found in rural environments. Our staff are trained to rapidly assess each patient’s injury or illness, initiate advanced pre-hospital emergency medical care based on a differential diagnosis, and transport to an appropriate hospital, Trauma Center, Burn Center, or other Specialty Care Center that can provide the appropriate level of care to each patient.
In addition to specializing in rural 911 EMS response, Hamilton EMS also supports two Critical Access rural hospitals in both emergency and non-emergency interfacility transfers. Hamilton General Hospital and Llano Mid-Coast Central Hospital are both 50+ miles from any cardiac catheterization facility, Level I or II Trauma Center(s), or Pediatric Specialty Care Center(s). Critically ill or injured patients who are first treated and stabilized at these two rural hospitals often require immediate emergency interfacility transfers to a higher level of care. Critical Care transfers like these are often as much or more stressful and intense than 911 calls can be. It is not uncommon to manage emergency transfer patients that are chemically sedated, intubated and on a ventilator, our cardiac monitor being used as an external heart pacemaker, and on three or more IV drug infusions with various IV pumps in use. Helicopters are often used for these types of patients due to speed and reducing the “out-of-hospital” times for the patient. However, Hamilton EMS is staffed, equipped, and trained to manage these patients regardless of helicopters- air resources are not always available. Weather and/or aircraft availability cannot always guarantee a critical patient can be flown. With these considerations in mind, HEMS ensures any critically ill or injured patient requiring emergency interfacility transport receives the same or higher level of out-of-hospital care in our ambulances as they would in any aircraft.
Every ambulance, EMS Command Vehicle, and Special Operations apparatus is equipped with a LifePak 15 Cardiac Monitor/Defibrillator capable of treating any cardiac related emergency such as defibrillation (re-starting a heart not pumping) and electrical cardioversion (shocking a heart beating incorrectly) to pacing a patient’s heart that is not beating fast enough to sustain life. Our cardiac monitors are also connected to the internet and cellular phone networks that allow Paramedics to transmit ECG’s and other vital information to receiving hospital emergency rooms, cardiac catheterization facilities, and comprehensive stroke centers to ensure each receiving facility is ready and prepared to continue high-quality critical care when you arrive. To compliment our cardiac care program, each apparatus is also equipped with the Lucas Device (version 3.1). Mechanical CPR has been the gold standard in cardiac arrest treatment for nearly two decades. The Lucas Device delivers consistent high-quality mechanical chest compressions to patients in cardiac arrest greatly increasing each patient’s chance of survival when compared to traditional “hands-on chest compressions”. Not only is mechanical CPR markedly better than “hands-on chest compressions” for the patient, it is also much safer for the EMS crew and first responders providing patient care while travelling in an ambulance. Lucas Device provided CPR allows the EMS crew to remain seated and restrained in the back of an ambulance; whereas traditional CPR requires the EMS crew to be unrestrained and “out of their seat” while transporting patients increasing the chance of serious injury or death if involved in a collision.
Hamilton EMS carries and administers traditional cardiac medications such as oxygen, baby aspirin, morphine, and sublingual nitroglycerin tablets. However, due to the rural nature of our service areas and long transport distances; we go far beyond traditional medications and routinely administer such drugs as Plavix and Lovenox as well. These medications are usually only found in hospital settings and used to prevent blood clots from forming or help dissolve or “break-up” blood clots already formed that are causing the chest pain or “heart attack”. HEMS is able to immediately diagnose a patient’s “heart attack” and bring the ICU to the patient and begin emergency hospital level care in the field reducing treatment delays due to time and distance.
In addition to advanced cardiac care, each apparatus is equipped to provide immediate life-saving emergency airway management through the use of MacGrath Video Laryngoscopy devices and Hamilton T1 Transport Ventilators. Video Laryngoscopy allows paramedics visualization of a person's airway via LED lighting and camera equipment placed in a patient's airway, to facilitate the placement of a breathing tube into the lungs of patients, of all ages successfully.
Our transport ventilators are high-tech and digitally automated allowing us to successfully provide CPAP and BiPAP pressurized oxygen and medications to conscious patients. This equipment also provides traditional ventilator care to patients who are unconscious or not breathing through a breathing tube that our paramedics have inserted into the patient's lungs. Once placed, this equipment can sustain life during long-distance emergency transports to any trauma center, burn center, heart center, or comprehensive stroke center that can provide definitive care to an emergency patient. HEMS utilizes advanced airway management techniques such as Delayed Sequence Intubation (DSI) or Pharmacological Assisted Intubation (PAI) to facilitate initial and sustained airway management procedures.
Hamilton EMS covers hundreds of miles of high-speed state and federal highways, over 4,000 square miles of rural ranch, farming, and hunting areas; and finally, hundreds of miles of river and highland lakes water ways. All of which are scenes of major traumatic accidents involving motor vehicles, farm equipment, firearms, boats, jet skis, and other water borne emergencies. The EMS Department has a robust trauma care program with aggressive pain management protocols to include procedural analgesia (conscious sedation). In addition, each MICU is equipped to treat any traumatic injury from hip fractures with pelvic binders to collapsed lungs with chest decompression kits to large wounds with hemostatic gauze (blood clotting gauze), tourniquets, and Doppler units to detect blood circulation in injured limbs where pulses (heart beats) or blood circulation may be questionable or absent.
Quality Assurance and Education
The EMS Department is licensed by the Texas Department of State Health Services to provide EMS Education to licensed EMS and First Responder personnel. HEMS also provides emergency medical education programs to the communities served. Our EMS instructors administer classes such as CPR, Stop-the-Bleed and EMS specific programs in advanced cardiology, respiratory and airway management, internal medicine, adult and pediatric trauma, infectious diseases and hazardous materials. The Department has full-time staff dedicated to CQI Programs and developing clinical education programs ensuring continuous quality improvement of pre-hospital emergency medical care.
For over 30 years, Hamilton EMS has served the citizens of Central Texas delivering high quality pre-hospital emergency medical care. In January 2020, Hamilton EMS became the first EMS agency in Texas to be recognized by the Centers for Medicare and Medicaid (CMS) as a “Critical Access” EMS Provider. Traditionally, EMS is considered a Medicare Part B EMS Supplier and reimbursed for Medicare patient treatment and transport from a standardized fee schedule which averages about 30% of cost. However, by achieving the designation of being a Critical Access EMS Provider, HEMS is now a Part A EMS Provider and receives 101% of Medicare costs.
The patients served by Hamilton EMS ultimately benefit from this business model because the level of customer service we are able to provide is uncommon even in urban areas with high call volume and large taxpayer funded systems; and practically unheard of in rural areas. Hamilton Healthcare is proud of the achievements of our EMS System and the ability to pass these benefits onto our patients.