GEORGIA DEPARTMENT OF HUMAN RESOURCES, DIVISION OF PUBLIC HEALTH OFFICE OF EMERGENCY MEDICAL SERVICES/TRAUMA OPERATING REPORT Aligning people, processes and technology Georgia Department of Human Resources, Division of Public Health OFFICE OF EMERGENCY MEDICAL SERVICES/TRAUMA (OEMS/T) ABSTRACT This document provides an operating report, organization description and basic statistical characterization of Emergency Medical Services (EMS) in Georgia. The contents of this report are based upon the regulatory records of the Georgia Office of Emergency Medical Services/Trauma, Division of Public Health, Department of Human Resources. The statistical tables are taken from an analysis of statewide Patient Care Reports and other operating data from 2000 through 2005. The statistics in this document provide a baseline for the continuing examination, comparison and improvement of Georgia statewide EMS operations. DOCUMENT ORGANIZATION Emergency Medical Services in Georgia is best-understood if sequentially read; however, each section stands on its own as a substantive description of EMS operations in Georgia. PREFACE A Message from the Director 3 OEMS/T Mission, Vision and Values 4 First EMS Operating Report 4 A Message from the State Office Of Emergency Medical Services/Trauma (OEMS/T) 5 Publication Objectives 5 Trauma in Georgia: A Call to Action 6 EMERGENCY MEDICAL SERVICES (EMS) What is EMS? 8 History of EMS in Georgia 10 The OEMS/T 11 OEMS/T Organizational Mandates 12 OEMS/T Organization 12 EMS Regulated Components 14 EMT Personnel and Instructor Certification 14 Requirements for Georgia EMS Personnel 15 Licensing and Compliance 16 Ground and Air Ambulance 17 AED Licensing 17 Summary 17 In an economy of reduced public spending, the publication of this information directly supports initiatives to understand and improve statewide EMS operations. PREFACE Emergency Medical Services in Georgia Operating Report P R E FAC E G E O RG I A' S E M S R E G I O N S A Diverse Population with Diverse EMS Needs 18 Georgia Demographics 18 State Overview Map of EMS Regions 19 EMS Region 1 20 EMS Region 2 22 EMS Region 3 24 EMS Region 4 26 EMS Region 5 28 EMS Region 6 30 EMS Region 7 32 EMS Region 8 34 EMS Region 9 36 EMS Region 10 38 G E O RG I A' S E M S C O U N C I L S EMS Advisory Council (EMSAC) 40 EMS Medical Directors Advisory Council (EMSMDAC) 41 LO O K I N G TOWA R D S T H E F U T U R E Future Strategic Focus 42 EMS Development is a State Responsibility 42 Ability to Secure Grant Funding 43 The Future of EMS is Information 44 National EMS Information System (NEMSIS) Participation 44 Keeping Pace with Technology to Benefit Stakeholders 44 References 45 APPENDICES Appendix A: GEMSIS Goals 47 Appendix B: EMSAC Membership 48 Appendix C: EMSMDAC Membership 49 Appendix D: Georgia Fast Facts 50 Appendix E: Georgia Prehospital General Reports 51 Acknowledgements Inside back cover PREFACE A Message From the Director Stuart T. Brown, MD Director, Division of Public Health Georgia Department of Human Resources The Georgia Division of Public Health (GDPH) is the lead agency entrusted by the people of the state of Georgia with the ultimate responsibility for the health of communities and the entire population. Our vision is a Georgia with healthy people, families, and communities, where all sectors unite by pooling their assets and strengths to promote health for all. We bring to all Georgians a commitment to improving health status through community leadership, expertise in health information and surveillance, and assurance of a safer environment. Our mission is to promote and protect the health of people in Georgia wherever they live, work, and play. Accordingly, a strong and vibrant Emergency Medical Services capability is essential to public health in Georgia. I am pleased to make available this first year's publication of Georgia's Office of Emergency Medical Services/Trauma Operating Report. The collection and publication of EMS operating data marks a major milestone in the development of objective information to support EMS system development in Georgia. While these data are largely descriptive, they enable us to begin to have the capability to link EMS data with other public health information sources. With this information, Georgia begins to possess a distinct ability to identify risk factors, foster interventions to prevent injuries and understand how the integrated delivery of EMS resources can further benefit patient outcomes. We are grateful to the National Highway Transportation Safety Administration (NHTSA) Emergency Medical Services for Children (EMSC) program for their grant funding to support this publication. Stuart T. Brown, M.D., has had a distinguished career in the field of medicine and public health. After receiving his A.B. from Dartmouth College, he received his M.D. degree from Cornell Medical School. In 1971, Dr. Brown served as Chief of Outpatient Clinics at the U.S. Army Hospital in Bangkok, Thailand. On assignment by the Centers for Disease Control and Prevention (CDC), he worked with the Seattle Health Department for two years before accepting a position with the Neighborhood Union Health Center in Atlanta, where he served for four years. A second CDC assignment took him to Geneva, Switzerland, as a medical officer with the World Health Organization. From 1980 to 1984, Dr. Brown worked as an Associate Director at the CDC, directing international projects which focused on sexually transmitted diseases. Remaining within the CDC, he was appointed director of the Division of Injury Epidemiology and Control in 1984, where he continued until 1989. A third CDC assignment brought him to the DeKalb County Board of Health, where he served as director of the STD/HIV program for three years; he subsequently served as the medical director for the DeKalb County Board of Health. In March 2004, he was appointed Interim Director of the DeKalb County Board of Health. In January 2005, Dr. Brown was named Acting Director of the Division of Public Health, Georgia Department of Human Resources and has served since June 2005 in his current position as Director of the Division of Public Health. 3 OEMS/T Mission To encourage, foster, and promote the continued development of an optimal system of emergency medical and trauma care, which provides the best possible patient outcome. Vision By promoting excellence, providing uniform statewide regulation, and promoting healthy communities, we seek to be valued by those we serve. An important by product of regulation is value-added information for emergency preparedness, public health, EMS research, and strategic governance. By managing knowledge, EMS can improve public health in Georgia. Values Excellence: We promote excellence, achieve and maintain quality results. Integrity: We are committed to honesty, fairness, and trustworthiness in the best interests of the citizens of Georgia and those that represent state government. Teamwork: We encourage active collaboration to solve problems, avoid conflict, make decisions, and achieve common goals. 4 Ej Dailey, Acting Director, OEMS/T The Georgia OEMS/T builds public health infrastructure through strong strategic planning, teamwork, and coordination among the ten EMS Regions. In 2005, EMS significantly improved its ability to communicate data as an integrated component of Georgia's overall healthcare system. First EMS Operating Report The publication of this document marks a strategic milestone for the OEMS/T. This is the first time in Georgia's history that statewide EMS data has been formally aggregated, cleaned, analyzed, summarized and reported. The publication of Georgia's EMS operating information marks a major milestone in the evolution of the statewide EMS system.1 1 Mr. Frederic J. Grant IV, PhD (Cand), MBA, CDP is the Principal Investigator and author of this publication, and the Manager of the Operations Analysis & Research of OEMS/T. PREFACE A Message from the State Office of Emergency Medical Services/Trauma (OEMS/T) Strategic development starts with knowledge of the past, an assessment of the present, and a desire for higher performance in the future. Strategic change can be defined as a change in the form, quality or state over time in the overall pattern of alignment of an organization with its environment.2 The purpose of this operating report is to present information regarding EMS in Georgia--its past, present and future. In 2005, the Georgia State Office of Emergency Medical Services/Trauma, made significant strides in its regulatory capabilities. These improvements were based upon the alignment of people, processes and technology to strategically support the statewide needs of the EMS community. From the people perspective, a statewide survey of EMS services was completed. A publication is available which summarizes the survey results. The survey primarily investigated the question: Is there a shortage of EMS professionals in Georgia? The results indicated that all groups and categories of EMS providers in all regions of the state perceived a shortage of EMS professionals. Other findings are summarized regarding trends in EMS pay, benefits, hours worked and certain aspects of EMS operations. Several of these findings have potential implications for statewide emergency preparedness.3 From the process perspective, new Rules and Regulations went into effect, March 17, 2005. From the technology perspective, publication of the GEMSIS Strategic Plan provides a roadmap for EMS system-wide improvement based upon the use of hard data. This coupled with the acquisition of web-based software significantly improved the data processing capabilities of the OEMS/T. A contract was awarded to ImageTrend to provide the OEMS/T a web-based system to support the receipt and analysis of Georgia Patient Care Report (PCR) data. The base system installation has been completed; the system is operating in a test mode. The system resides at Skyland Drive. PCR data from 2000 through 2005 is being converted into the NEMSIS data standard. Pilot operations for the new system will begin in the first few months of 2006. For Georgia EMS to advance, a shared vision is required. This shared vision must be tangibly based upon our history, where we are today and where we must be tomorrow in order to be meeting the dynamic needs of the State of Georgia. Publication Objectives: Provide an overview of the State Office of Emergency Medical Services/Trauma regulatory and programmatic areas. Establish a context for understanding the strategic public health significance of EMS operations in Georgia. Present a preliminary statistical characterization of statewide EMS and trauma programs based upon available programmatic data from 20002005. 2 Rajagopalan & Spreitzer, 1996, p. 51 5 3 http://www.legis.state.ga.us/legis/2005_06/fulltext/hr830.htm PREFACE Trauma in Georgia: A Call to Action Trauma is a physical injury or wound caused by external force or violence. In Georgia, motor vehicle crashes and falls are the most frequent incidents that produce traumatic injury. Trauma is the number four killer in the U.S. today behind cardiovascular disease, stroke, and cancer. It is the leading killer of persons under age 44.4 Traumatic injury is producing in excess of $170 million of uncompensated hospital care annually in this state. This uncompensated care is being provided by a healthcare system that is very fragile fiscally and in danger of collapse. According to recent statistics, approximately two-thirds of Georgia's hospitals are operating in the red. The recent economic downturn has accentuated an already-significant problem for Dr. J. Patrick O'Neal, State EMS Medical Director, OEMS/T Trauma in Georgia is a significant Public Health Problem. Traumatic injuries are the leading cause of death for Georgians between the ages of 1 and 44--very productive years. On an annual basis, over 50,000 Georgia citizens experience traumatic injury; 8-9% die as a result of their injuries. In most counties in Georgia, the rate of death from injuries is significantly higher than the U.S. rate. A call to action is needed... hospitals. The tremendous increase in uninsured patients, the reductions in Medicare/Medicaid reimbursement, the increasing penetration of managed care, and the escalating costs of malpractice coverage both for hospitals and for individual practitioners are bringing about the closure of some hospitals and significant reduction in services in others. The malpractice crisis, itself, is causing a significant number of essential surgical sub-specialists to relocate to states with a more favorable malpractice climate. In 2005, Georgia took a major step forward through several actions: (1) legislation to cap malpractice claims, (2) the publication of its trauma system data, and (3) continued participation in the NTDB (National Trauma Data Bank). These actions marked forward progression in the development of statewide trauma system. In Georgia, because we currently lack a statewide, inclusive system, our ability to provide optimal care is constrained. We are working diligently to address this situation; however, no single organization or agency can create a solution to this problem. A call to action is needed. 6 4 Bledsoe, Porter & Cherry, 2003, p. 815 PREFACE Areas of the U.S., which have established trauma systems, show dramatic reductions in death and disability from traumatic injury--as much as 2040%. If the Georgia traumatic death rate were just equal to the national average, we could likely save an additional 700+ lives per year. Emergency Medical Services and trauma care cannot and should not be separated. The reasons for this have to do with time and access to optimal care facilities. Trauma literature often addresses the golden hour. This hour refers to the short window of opportunity during which one may successfully treat major traumatic injuries. The clock for the golden hour begins to tick at the point the traumatic event occurs. Depending on where the victim is located in the state, the pre-hospital response may require from 3 to 45 minutes. There may be an additional 10 to 60 minutes before the patient reaches a medical facility--and then not necessarily the appropriate facility. Factor in to this timeline that the patient may have needed on-scene extrication or transfer from one facility to another, and an additional 8 to 10 hours may elapse before the appropriate level of care is being rendered. There are still many areas of the state that do not have rapid access to trauma centers. And, although many hospitals do render quality care to injured patients, the standard of care is not uniform--a situation that could be corrected through participation in an organized, statewide system. In 2005, data indicate that trauma is a serious problem in Georgia; a call to action is needed. Georgia must take steps to recognize that trauma is a major health hazard. Ignoring this problem will only intensify it. We have an ethical obligation to provide a comprehensive trauma care system that will prevent trauma when possible but will guarantee rapid access and high quality trauma care when injury occurs. Additionally, it is increasingly apparent that an effective trauma system is an essential ingredient for Homeland Security. As we have moved into this new age where terrorism is no longer isolated to other lands, an effective trauma system needs to be part of the foundation for our emergency preparedness efforts. In Georgia, because we currently lack a statewide, inclusive system, our ability to provide optimal care is constrained. 7 EMERGENCY MEDICAL SERVICES What is EMS? Emergency Medical Services (EMS) is a comprehensive network of personnel, equipment, and resources established to deliver aid and emergency medical care to the community.5 EMS is an umbrella term for a continuum of prehospital care activities involving personnel, equipment, procedures, systems and community programs.6 In everyday terms, emergency medical services centers on rapid response, initial treatment, and safe transport of a patient to an acute care hospital facility. While precise numbers are not available, EMS on a nationwide basis treats and transports approximately 25 to 30 million patients per year. In Georgia, EMS received an estimated 940,000 calls in 2005. As an important point of entry into the healthcare system, EMS is in a unique position to favorably impact patient outcomes. EMS in Georgia is principally about the care of sick and injured patients by qualified, licensed providers and their rapid and safe transport to an appropriate health care facility. Every ambulance in the State of Georgia must contain the proper equipment and medications and be licensed. Appropriately qualified and licensed medical personnel must staff every licensed EMS vehicle. EMS providers must retain a medical director a physician who is legally responsible for all clinical and patient-care aspects of treatment. Appropriate medical care protocols must be in-place and utilized; and, the initial care provided must be properly transitioned to a definitive health care facility. The quality of Georgia's prehospital care is assured though the licensing of both personnel and equipment, and the assurance of appropriate medical control during patient care processes. Licensed medics use approved medical protocols to care for sick and injured patients while rapidly and safely transporting them to hospitals and other health care facilities where they can be treated and recover. In Georgia, EMS represents a broad and complex collection of private, community and governmental organizations, services and environments providing prehospital health care related services. Accordingly, EMS regulation covers the full spectrum of emergency care from recognition of the emergency, prehospital medical treatment, and patient transportation through patient receipt at a hospital or definitive care facility. Collectively, these services and programs comprise the EMS gateway to health care and certain types of medical emergency preparedness for state citizens and visitors. 8 5 Bledsoe et al. (2003, p. 9) 6 GAO (2001, p. 4) EMS also includes a number of specialized topical areas including: Paramedic and Emergency Medical Technician (EMT) training and licensing. Ground and air ambulances and specialized equipment including Automated External Defibrillators (AEDs). The planning of medical responses to disasters including disease out-break. The planning for the provision of medical coverage at mass gatherings. Emergency preparedness including bioterrorism planning. Interfacility transfers of patients. Community health care (prevention) education. Emergency medical services for children (EMSC). The longitudinal study of trauma from incident to outcome. While the concept of EMS centers on rapid response, initial treatment, and safe transport of a patient to a health care facility; it is now generally recognized that EMS also plays a role in improving community health and takes planning actions that result in better and more appropriate uses of acute health care resources. Additionally, EMS also provides an essential strategic element for homeland security, bioterrorism preparedness and preparedness against other threats, which require the mobilization of significant emergency medical resources.7 In everyday terms, emergency medical services centers on rapid response, initial treatment, and safe transport of a patient to a health care facility. 7 EMS Agenda for the Future, 2000, p. 5 9 EMERGENCY MEDICAL SERVICES History of EMS in Georgia EMS in Georgia is over thirty years old. Emergency medical care has developed significantly in the past 30 years; Georgia can be proud of the role that many of its professionals have played in furthering EMS as a medical discipline. In the not-so-distant past, local Georgia funeral homes were the primary ambulance providers and patient care did not begin until arrival at a hospital. Since that time, EMS has grown increasingly sophisticated in recognition that what happens to a sick or injured person before they reach a hospital is of critical importance. Initially, medics were trained in basic life support (BLS) including basic airway management, CPR, and skills for managing serious cardiovascular problems. Today, most of the procedures that Georgia medics employ to management cardiovascular emergencies fall into the category of advanced life support (ALS). In the not-so-distant past, local Georgia funeral homes were the primary ambulance providers and patient care did not begin until arrival at a hospital. Basic Life Support (BLS): The basic level of care provided by first responders and emergency medical technicians (EMTs). Care includes basic airway management, care of choking victims, oxygen administration, hemorrhage control, splinting fractures, CPR, automated defibrillation and immobilization of spinal injuries. Advanced Life Support (ALS): Includes the services of basic life support (BLS) and advanced emergency care. ALS personnel provide intravenous therapy, endotracheal intubation, PASG application (considering new protocols), cardiac monitoring (ECG), cardiac defibrillation and external pacing, drug therapy, relief of pneumothorax, and other invasive procedures and services. Personnel respond in either a transportcapable ambulance vehicle or in a non-transporting vehicle such as a fire department engine or separate response vehicle. Although more advanced services are provided by ALS personnel, both BLS and ALS provide crucial life saving procedures in time of need. 10 EMERGENCY MEDICAL SERVICES The Office of Emergency Medical Services/Trauma (OEMS/T) A Brief History In the late 1950's, the effectiveness of mouth-to-mouth ventilation and closed cardiac massage led to the realization that rapid response of trained persons to cardiac emergencies could help improve outcome.8 The introduction of these techniques into the public consciousness provided the foundation on which the concepts of Emergency Medical Services, BLS and then ALS could be built. In the early 1970's, at the federal level, Congress passed the Emergency Medical Services Act in 1974. This act established the necessity for managing EMS communications, transportation and certain related public health functions. Concurrently, the Georgia General Assembly recognized that EMS was a substantial matter of importance to the people of the State of Georgia. Through legislation, which ultimately became known as Title 31, Chapter 11 of the Official Code of Georgia Annotated--the Georgia legislature established the functions in law that are administered by the OEMS/T. The first statewide EMS plan for Georgia was prepared in 1974. This document evolved in the 1980's and substantial revisions occurred to the plan in the mid and late 1990's. In general, the evolution of statewide plans coincides with the progression of federal legislation and block grants, state government stakeholder interactions, as well as through the activities of a professional and dedicated staff. In 1996, a group of representatives from private and public emergency medical services, the State Office of Emergency Medical Services & Preparedness and the ten affiliated district EMS offices was convened as a State EMS Planning Task Force for the purpose of determining the long range goals of Georgia's EMS system and to create a new State EMS plan. This group was charged with the responsibility of examining where we are now vs. where do we want to go. Once these goals were developed, the committee was then charged with the responsibility of determining a path of least resistance for attaining this direction. These efforts resulted in the publication of the State EMS Plan, dated 1998. In 2003, three stakeholder committees comprised of EMS professionals representing all of the ten EMS Regions of the state participated in the development of the Georgia EMS Information System (GEMSIS) plan. These committees were: Infrastructure, Data, and Reporting. Each of these committees had specific deliverables within broad areas of responsibility. The inputs from each committee represented the summarization of years of EMS/Trauma and EMSC experience. The areas of infrastructure, data, and reporting can be conceptualized as interlocking spheres of knowledge that when integrated provide coherence to statewide EMS activities. The GEMSIS plan was published in 2004 and now guides EMS strategic development plans through 2007. The goals of the GEMSIS plan are summarized in Appendix A. 8 DOT, 1999, p. 3. 11 State Office of EMS/T Organizational Mandates Beyond regulatory responsibilities, the State Office of Emergency Medical Services/Trauma is responsible for a broad set of goals. The objectives for the EMS and Trauma related areas are stated as follows: To provide and maintain support for regional planning, development, expansion and improvement to each of the ten EMS regions. To provide statewide coordination of training programs. To provide technical support within each EMS region for the establishment of regionwide medical control of the EMS system. To provide for annual assessment of regional planning and development of each EMS region. To assure continued system development and quality improvement. To incorporate the special needs of children in EMS system development. To provide an integrated EMS Information System for local, regional and state planning and evaluation of system development. Accordingly, as indicated above, the Office of Emergency Medical Services/Trauma functions in many roles and on several levels. Through its Regional Office locations, it is in touch with the communities that it serves. State Office of EMS/T Organization The State Office of EMS & Trauma is an important part of Georgia's overall health care system. The organizational chart on the next page illustrates the placement of the Office of Emergency Medical Services/Trauma as an operating component within state government. Specifically, the State Office of Emergency Medical Services/Trauma is part of the Department of Human Resources Division of Public Health, and a branch of Environmental Health and Injury Prevention. The State Office of Emergency Medical Services organization corresponds to its regulatory and functional responsibilities. The following diagram displays the major programmatic areas in which the State Office of Emergency Medical Services/Trauma is involved and reflects its statewide activity charter. Fred Grant, Operations Analysis Manager, OEMS/T An important by-product of regulatory activities is value-added information for EMS stakeholders and Georgia's citizens. Information, education, research, and strategic action underlie the foundation for emergency preparedness and directly support the future of EMS in Georgia. 12 EMERGENCY MEDICAL SERVICES Executive Secretary EMS Director EMS-Trauma Medical Director Emergency Preparedness Coordinator Hospital Preparedness Coordinator Emergency Preparedness Coordinator Deputy EMS Director Trauma Systems SNS/Chempack Manager Coordinator Admin. Assistant Prof. Healthcare Worker Healthcare Director Emergency Logistics Coord. Program Operations Specialist Emergency Preparedness Coordinator Exercise Coordinator Exercise Coordinator Exercise Coordinator Eight Regional EMS Program Directors PHSO Program Director Pharmacy Manager Administrative Assistant Program Evaluator EMSC Program Manager Contracts Manager Operations Support Coordinator Program Associate Trauma Systems Data Registrar Operations Analysis Manager Program Assistant EMS License Compliance Officer Agency Licenses Program Assistant EMS Data Registrar Statistical Analyst Personnel Licenses Program Assistant 13 EMERGENCY MEDICAL SERVICES EMS Regulated Components The Georgia EMS system is comprised of the following regulated components: Licensed Prehospital Emergency Care Personnel and Instructors Trauma System Facility Designation, Redesignation. Ground Ambulance Services. Medical First Responder Services Neonatal Transport Services AED's (Automatic External Defibrillators). Currently excluded from regulation are medical dispatch personnel and medical first responder personnel. EMT Personnel and Instructor Certification As summarized in the table below, the State of Georgia currently has records for valid certifications for 13,927 EMT practitioners, including 421 EMT-Basics, 8,349 EMT-Intermediates, and 5,063 EMT-Paramedics. There are also 94 Cardiac Technicians. Of the 13,927 EMTs in the state, 1.8% are EMT-Basic personnel. 62.9% are at the EMT-Intermediate level and 34.5% are EMT-Paramedics. EMT Professional Certification Summary Active Medics by EMS Region of Residence* EMS Cardiac EMT Region Tech Basic 1 17 48 2 3 20 3 13 88 4 9 28 5 14 12 6 4 35 7 2 18 8 13 11 9 15 45 10 4 18 Out of state or unknown 98 GA Total 94 421 *As of 12/20/05 EMT Paramedic Total Intermediate Medics 1,230 615 2,309 1,081 518 514 180 459 618 609 216 8,349 687 424 968 637 363 219 120 448 522 327 348 5,063 1,982 1,062 3,378 1,755 907 772 320 931 1,200 958 662 13,927 14 Statewide EMS also includes thousands of first responders--these include local, county, or state police and fire services. There are over 450 certified EMT instructors. EMS can be delivered by either paid or volunteer personnel at a stand-alone local government EMS agency, fire department, hospital, for-profit or non-profit private company, or by other less common ways, such as a police department or an integrated public safety department. According to a 2004 Journal of Emergency Medical Services study, 44.89 percent of EMS systems are fire-based and 55.11 percent are hospital-based, private, stand-alone government agency or another type of EMS organization.9 9 Mistovich, Hafen & Karren, 2000, p. 3 EMERGENCY MEDICAL SERVICES Georgia's 13,927 EMS personnel are trained, generally speaking, to either the basic level (EMT-Basic), intermediate (EMT-Intermediate or advanced level (EMT-Paramedic).10 EMT-Basics can assess and stabilize patients' immediate needs, whereas paramedics provide additional interventions, such as intravenous medication delivery, cardiac monitoring and defibrillation, and advanced airway procedures. Many EMS providers also have specialized training in the areas of patient extrication and rescue, incident command, hazardous materials response, crisis intervention, mass casualty response and injury prevention.11 Each state sets its own requirements though the EMT-Basic, EMT-Intermediate and Paramedic curricula are based upon a national standard developed by the National Highway Traffic Safety Administration (NHTSA). The sidebar on the right indicates the requirements for becoming a licensed medic in Georgia. Regardless of the delivery method or level of training, EMS strives to quickly respond to, care for and transport the sick and injured during their time of need. Such emergency assistance is required for the thousands of heart attacks, automobile collisions and other everyday emergencies. But there is also a significant need for EMS response for high-consequence crises, such as natural disasters or terrorist acts. EMS must therefore be adequately prepared for both the ordinary and extraordinary events. 10 http://www.legis.state.ga.us/legis/2005_06/fulltext/hr830.htm 11 National EMS Research Agenda, 2001, p. 11 Education and Training Requirements for Georgia EMS Personnel EMT-BASIC Skills include: Those taught in the DOT EMT-Basic course updated in 1994. Hours of training: 130 minimum (including a 12 hour Georgia specific module) and clinical of 8 hours and 5 patient contacts to include all clinical objectives. Licensure requirements: In addition to successful completion of a DHR approved EMT Course, the student is required to successfully pass the National Registry EMT Basic written and practical exams. License renewal requirements: Must complete at least 40 hours of continuing education requirements in a 2 year cycle in addition to CPR training. Fees: $25 for initial licensure and license renewal. EMT-INTERMEDIATE Skills include: Those taught in the DOT EMT Basic course updated in 1994 as well as those in the DOT EMT Intermediate 1985 course, plus D50, Epi Pen, and intraosseous placement (pediatric patients). Does not include endotracheal intubation. Hours of training: Completion of the EMT Basic Curricula Objectives and Requirements plus 8 additional modules and required clinical for a minimum of 192 additional hours. A minimum of 16 hours clinical and 5 patient contacts to complete all the clinical objectives are in addition to the EMT Basic clinical objectives. Licensure requirements: Upon successful completion of a DHR approved EMT-Intermediate course, the student is required to successfully pass the National Registry I-85 written and practical exams. License renewal requirements: Must complete at least 40 hours of continuing education requirements in a 2 year cycle in addition to CPR training. Fees: $50 for initial licensure and license renewal. EMT-PARAMEDIC Skills include: Those taught in the DOT Paramedic course updated in 2000. Hours of training: Licensure as an EMTBasic or EMT-Intermediate by Georgia, another state, or the National Registry of EMTs plus an additional 824 hours of Paramedic curriculum objectives (which includes 320 hours of clinical time) Clinical experience is very specific to objectives in the care of medical and trauma patients. Licensure requirements: Upon successful completion of a DHR approved EMT-Paramedic course, the student is required to successfully pass the National Registry Paramedic written and practical exams. License renewal requirements: Must complete at least 40 hours of continuing education requirements in a 2 year cycle in addition to CPR and ACLS training. Fees: $75 for initial licensure and license renewal. As of 12/05 these are minimum standards subject to modification as needed. 15 EMERGENCY MEDICAL SERVICES Licensing and Compliance Emergency Medical Services is an organized system that provides licensed personnel, vehicles and equipment for the effective and coordinated delivery of prehospital care within specific geographical areas. An effective and well-regulated EMS system involves many different persons, agencies and organizations working together to provide rapid emergency medical response, treatment and transport to those in need of immediate medical attention. The basis for this coordination is strong regional EMS direction. In Georgia, the agencies licensed to provide EMS include air (not in place yet)and ground ambulance service providers, fire departments, hospitals and similar organizations. These agencies can be owned by private individuals, corporations, cities or counties. (See charts) Effective regulation begins at the local level through Regional EMS Offices which are coordinated in concert with state policies. As shown in the chart across from this discussion, EMS contains many areas which can directly affect quality of patient care and patient outcomes. The ultimate goals of EMS regulation is the safeguarding of patients and communities. Additionally, EMS rules and regulations must be enforced statewide on a uniform basis. The OEMS/T seeks to continually streamline regulatory processes. The use of objective data to support regulatory efficiency is also a strategic mandate--regulatory data can also be used to suggest areas for systematic improvement. Summary of State and Regional Regulatory Activities Licensing of EMS Ground Services, Medical First Responder Services, Neonatal Transport Services, AED Programs, and soon to be added Air Ambulance. Conducting a program of regulatory inspection of licensed EMS equipment. Approving and monitoring of EMS educational programs and continuing education. Licensing of EMS personnel, including instructors and practitioners. Enforcing of statutes, Rules and Regulation and EMS Procedures for medical control of the EMS system. Establishment and review of the exclusive operating areas (zones) for the regulation of ambulance services. Developing, implementing and monitoring procedures for the designation, redesignation and de-designation of trauma centers. Planning and coordinating disaster medical response. Russ McGee, State EMS Licensing and Compliance Officer The purpose of EMS regulation is to assure public safety, uniform standard of patient care, and provide a coordinated system of statewide prehospital medical care. Georgia's new rules and regulations strengthen the ability to insure that all of Georgia's citizens and visitors receive medically appropriate prehospital care from qualified and licensed EMS providers. 16 EMERGENCY MEDICAL SERVICES Ground and Air Ambulance In Georgia, 82 percent of the patients EMS transported to trauma centers were transported by ground ambulances. The table below summarizes the ground ambulance service operations from a statistical standpoint. In 2005, Georgia has a total of 282 ambulance service providers and about 1,739 licensed ground ambulance vehicles. These service providers encompass an important portion of the regulatory activities that are overseen by the OEMS/T. OEMS/Trauma regulatory activities of ambulance services include, but are not limited to, ensuring vehicles are properly equipped and all instrumentation and equipment are functional and that the EMS vehicles themselves are in good running order. In addition, regulation by the OEMS/T ensures that EMS personnel are appropriately licensed and vehicles are correctly manned. The regulation of ground ambulance service providers is an essential critical function provided by the OEMS/T. Air ambulance services play a major role in pre-hospital trauma care in getting trauma and other patients with life threatening conditions to help quickly. Five air ambulance services are based in Georgia including Air Med in Augusta, Life Star One in Savannah, and Children's Response Air, Emory Flight/LifeNet Georgia, and Rescue Air in the Atlanta area. A number of areas in Georgia are not covered by air ambulance services. At the time of writing this document, air ambulance services are not regulated by the state. Ground Ambulances* EMS Region 1 2 3 4 5 *As of 9/28/05 EMS Vehicles 176 108 673 129 143 EMS Region EMS Vehicles 6 77 7 63 8 157 9 158 10 55 AED Licensing The state also licenses Automated External Defibrillators (AED) programs that respond to the public for assistance in cardiac arrest situations. AEDs are devices that deliver electric shocks to restore heart rhythm and can be used by relatively untrained personnel. AED program licensing is a separate process from the licensing process of ground ambulances and their equipment. Summary Since 1976, the OEMS/T has played a strategic role in (a) developing the infrastructure of emergency medical care, (b) fulfilling a legally mandated regulatory role to oversee statewide ambulance services to safeguard the public interest, and (c) providing education and certification of emergency medical personnel. With the rapid introduction of computer technology beginning in the 1990's, the OEMS/T is now increasingly called upon to be an information clearing-house and provide a unified planning and continuous quality improvement direction for the collection and analysis of EMS data for both rural and urban areas. At the Georgia state government level, pressures to reduce or eliminate costs are real and require the utmost in careful planning. The OEMS/T is continuously seeking greater efficiency in the evolution of prehospital care regulatory services. These efforts include channeling regulatory data to support roles in education, prevention and research; and, the use of better technology to drive the elimination of cost. The strategic management of people, process, and technology form the basis for systemwide EMS improvements in prehospital care services. 17 G E O RG I A' S E M S R E G I O N S A Diverse Population with Diverse EMS Needs The OEMS/T fulfills its regulatory mission through ten EMS Regions. A state-level EMS agency is required to provide leadership to local jurisdictions.12 Accordingly, OEMS/T aggressively undertakes its mandated roles to regulate, enforce rules and regulations, provide strategic leadership, produce information, define elements of statewide continuous quality improvement programs, education, the publication of information, and research support to the ten EMS Regions in Georgia. This later role in using regulatory data to produce value added information is increasing important in fulfilling this mission. Georgia Demographics Georgia is located on the southeast coast of the U.S. Atlanta is the state capitol. Georgia has 159 counties. These 159 are grouped into 10 geographical EMS Regions. Among the 50 states, Georgia ranks 24th in size, covering 59,441 square miles. Based upon the 2000 U.S. Census, Georgia was the 10th most populous state. Georgia's population is projected to increase by 17.2 percent through 2010. Between 1990 and 2000, the population of metropolitan Atlanta increased by over one million, from 2.9 to 4.1 millionthe largest gain of any large metropolitan area in the nation.13 Georgia's Need for EMS In Georgia, it is estimated that in 2005, statewide EMS received about 940,000 calls for assistance. This call estimate suggests the magnitude of EMS services demands is much greater than the public is generally aware of. In fact, this call estimate may underestimate overall EMS related services provided statewide. While statistics indicate that during any one year EMS may provide assistance to the equivalent of 8 to 10% of Georgia's population, these call estimates do not include the many activities supporting the many educational, preventative, and community programs that public and private EMS agencies initiate and the importance of regulatory (safety and preventative) activities conducted within virtually every community in the state. 12Mistovich, Hafen & Karren, 2000, p. 3 13 http://nnlm.gov/sea/state/ga.html REGION 1 POPULATION 950,936 18 32.1% UNDER AGE 20 REGION 2 POPULATION 529,598 28% UNDER AGE 20 REGION 3 POPULATION 3,375,475 29.2% UNDER AGE 20 REGION 4 POPULATION 706,546 29.5% UNDER AGE 20 REGION 5 POPULATION 637,356 28.6% UNDER AGE 20 G E O RG I A' S E M S R E G I O N S 5,482 TOTAL SQUARE MILE AREA 2,343 TOTAL SQUARE MILE AREA 3,848 TOTAL SQUARE MILE AREA 8,560 TOTAL SQUARE MILE AREA 4,143 TOTAL SQUARE MILE AREA 3,516 TOTAL SQUARE MILE AREA 3,006 TOTAL SQUARE MILE AREA 5,323 TOTAL SQUARE MILE AREA 10,670 TOTAL SQUARE MILE AREA 12,533 TOTAL SQUARE MILE AREA REGION 6 POPULATION 434,314 30.3% UNDER AGE 20 REGION 7 POPULATION 284,226 30.4% UNDER AGE 20 REGION 8 POPULATION 660,926 29.9% UNDER AGE 20 REGION 9 POPULATION 844,775 29.9% UNDER AGE 20 REGION 10 POPULATION 405,231 27.6% UNDER AGE 20 19 G E O RG I A' S E M S R E G I O N S EMS REGION 1 Dade Catoosa Walker Whitfield Fannin Murray Gilmer Chattooga Gordon Pickens Floyd Bartow Cherokee Northwest Georgia Region 1 EMS Northwest Georgia Regional Hospital 1305 Redmond Circle - Building 614 Rome, GA 30165-1391 David Loftin, EMS Program Director cdloftin@dhr.state.ga.us Linda Avery, Executive Administrative Assistant lfavery@dhr.state.ga.us James Cutcher, EMS Training Specialist jlcutcher@dhr.state.ga.us 20 EMS in Georgia Polk Paulding Haralson UUrrbbaan Overview Region 1 is in the uppermost northwestern corner of Georgia. It stretches from the mountains of Dade County in the north to Cherokee County at the edges of Atlanta and from the forests of Polk County to the rivers of Haralson County. It is made up of 16 diverse counties. Although many counties in this region are classified as rural there are also many counties that are exurban and suburban. In fact three distinct cities impact this region. Rome directly in Region 1, Atlanta toward the southwest and Chattanooga, Tennessee in the north. Operating Highlights Region 1 serves the 950,936 people in the 5,482 total square mile area with 31 licensed ambulance services and 176 vehicles. It has 15 general hospitals and has 1,944 licensed medics living in its counties. Region 1 is served by Floyd Medical Center and Hamilton Medical Center both Level 2 Trauma Centers. Each county within Region 1 faces unique challenges, in every case the challenge is to provide the best possible care. For many of the counties that challenge is compounded by increased demand due to rapidly expanding population and often severe weather conditions on difficult terrain. From 2000 to 2004 there have been 136,742 motor vehicle crashes resulting in 64,967 injuries and 932 fatalities in Region 1. Almost one out of three of the people are under the age of 20 making it one of the youngest regions. Region 1 has one of the highest ratios of persons per physicians in Georgia. FAST FACTS 31 licensed ambulance services with 176 vehicles 1,944 licensed medics live in this Region 173 persons per total square mile area 12 percent increase in population from 2000 to 2004 902 people per physician 3.2 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 1 EMS REGION 1 COUNCIL MEMBERS Larry Ballew Director Murray County EMS Tony Cooper Paramedic Rome, GA Johnny Cowart R.N./Paramedic Murray County EMS Matthew Crumpton Director of Hospital Disaster Preparedness Hamilton Medical Ctr. Herbert Dodd Director Chattooga Co. EMS Lana Duff Paramedic/Operations Officer Angel EMS Clark Far Firefighter Bremen Fire Dept. Clarence Ford Private Citizen Cedartown, GA Sandra Gray Supervisor Hutcheson Medical Ctr. EMS Danny Hall Supervisor Floyd EMS John Hitchens Director Whitfield EMS Steve Lawson Paramedic/Firefighter Walker Co. ES Robin Logan Paramedic Paulding County Fire Rescue Gregg Lord EMS Coordinator Cherokee Co. Fire & ES Dr. Jill Mabley Physician Canton, GA Harry McConnell Director Gilmer County EMS Jean Miller R.N./Director of Marketing Redmond Regional EMS Craig Norton Director Ambucare, Inc. Kevin Nowicki Paramedic/Firefighter Walker Co. ES Lonnie Oliver Director Fannin Co. EMS Bud Owens Director Gordon County EMS Larry Owens Deputy Director Bartow Co. EMS *Council Chairman **Council Vice-Chairman Darrell Payne Director of Emergency Services Fannin Co. EMS Joey Pelfrey Firefighter Paulding County Fire Rescue Jeff Putnam GEMA Calhoun, GA Don Starnes** Director Bartow County EMS Phillip Tucker Director Redmond Regional EMS Curtis Vincent* Director Polk County EMS Leroy Wilson Director/Owner W. L. Wilson & Sons Funeral Home Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 Total 44,154 17,658 6,974 2,012 609 42 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Floyd Medical Center Other Not Specified Hamilton Medical Center Redmond Regional Medical Center Hutchenson Medical Center Cartersville Medical Center Number 9,789 7,762 7,285 5,197 4,727 4,453 Data Sources Population: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database Bartow Catoosa Chattooga Cherokee EMS in Georgia Dade Fannin Floyd Gilmer COUNTIES SERVED Gordon Haralson Murray Paulding Office of Emergency Medical Services/Trauma Pickens Polk Walker Whitfield 21 EMS Region 1 G E O RG I A' S E M S R E G I O N S EMS REGION 2 Union Towns Rabun Habersham Lumpkin White Stephens Dawson Forsyth Franklin Hall Banks Hart North Georgia Region 2 EMS 1280 Athens Street Gainesville, GA 30507-7000 Urban Urban Overview Region 2 is in the uppermost northeastern corner of Georgia. Its thirteen counties stretch from the mountains of Union County in the north to Forsyth County at the edges of Atlanta and from Dawson County in the east to Hart County at the edge of South Carolina. Like many of the EMS Regions, its counties are strikingly diverse. Many of its northern counties are covered with parks, forests or preserves compared with the more southern counties that are covered with urban development areas. Earl McGrotha, EMS Program Director ehmcgrotha@gdph.state.ga.us Sandy Jolliff, Secretary sljoliff@dhr.state.ga.us B. Jack Mundy, EMS Training Specialist bjmundy1@dhr.state.ga.us Operating Highlights Region 2 serves the 529,598 people in the 3,516 total square mile area with 21 licensed ambulance services and 108 vehicles. It has 10 general hospitals and has 1,046 licensed medics living inside its borders. Region 2 does not have a designated Trauma Center. In addition to all of the challenges in providing the best possible care with existing resources, Region 2 faces difficult mountainous terrain in the north and traffic congestion in the south. The contrast goes beyond geographic challenges to the exploding population in Forsyth, Dawson and White compared with limited growth in Hart and Towns counties. From 2000 to 2004 there have been 83,055 motor vehicle crashes resulting in 35,686 injuries and 605 fatalities in Region 2. It also has one of the highest ratios of persons per physicians in Georgia. FAST FACTS 21 licensed ambulance services with 108 vehicles 1,046 licensed medics live in this Region 151 persons per total square mile area 15 percent increase in population from 2000 to 2004 827 people per physician 3.1 EMS vehicles per 100 total square mile area 22 EMS in Georgia Office of Emergency Medical Services/Trauma EMS Region 2 EMS REGION 2 COUNCIL MEMBERS Joe Anderson Director EMA Roxanne Barrett Nurse Manager Towns County Health Department Danny Bowman Chief Forsyth County Fire & EMS Craig Bryant Commissioner White County Mike Carnes Director Rabun County EMS Robert Carpenter Member at Large Barry Church Director Habersham County EMA Joe Lane Cox Mayor Dawsonville John Creasy Paramedic Banks County Fire & EMS Perry Dalton Chief Banks County Fire & EMS Joey Dorsey Chairman Hart County Board of Commissioners *Council Chairman **Council Vice-Chairman Banks Dawson Forsythe Franklin EMS in Georgia David Dyer Director Union County Ambulance Service Richard C. Hamilton Captain Forsyth County Fire Department Terry Harris Director Franklin County EMS Sandy Jolliff Secretary EMS Advisory Council Will Lockwood Member at Large Scott Masters Director Med. Transport-NE GA. Primary Care Rickey Mathis Director Towns County EMS Matt McRee Dir. Of Development Ty Cobb Healthcare Jack Moody** Director Habersham County EMS Terrell Partain Director Hart County EMS/EMA Tim Peebles EMS Director Hall County EMS Bill Scandrett Director White County EMS Don Seabolt* Director Lumpkin County EMS Lanier Swafford EMS Director Dawson County EMS Billy Thurmond Emergency Services Coordinator Dawson County EMS Randall Townley Member at Large Bond Tyner Director American Red Cross, NE GA. Chapter Ann Wigley EMT Lumpkin County EMS Ray Willis Director Stephens County EMS Jerry Wise Administrator Hart County Hospital Charles Worden Director Union County EMA Dan Yeargin FTO GEMA Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 10,907 3,305 1,147 371 228 22 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 North East Georgia Medical Center Other Not Specified Union General Hospital Not Applicable Lanier Park Hospital Habersham County Medical Center Number 7,350 4,024 1,656 1,483 1,116 1,098 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database COUNTIES SERVED Habersham Hall Hart Lumpkin Rabun Stephens Towns Union White Office of Emergency Medical Services/Trauma 23 EMS Region 2 G E O RG I A' S E M S R E G I O N S EMS REGION 3 Cobb Gwinnett Douglas Fulton Dekalb Clayton Rockdale Newton Region 3 EMS 2600 Skyland Drive, Upper Level Atlanta, GA 30319 Marty Billings, EMS Program Director wmbillings@dhr.state.ga.us Christine, Ellington, Administrative Assistant cellington@dhr.state.ga.us Bobbi Gulley, EMS Training Specialist bhgulley@dhr.state.ga.us 24 EMS in Georgia Urban Urban Overview Region 3 in the central northwestern midsection of Georgia encompasses many of the most populous counties of the Atlanta metropolitan area. Its eight county area includes Fulton, DeKalb, Cobb, Clayton and Gwinnett as well as the suburban counties of Douglas, Newton and Rockdale. Although all counties are densely populated each county has pockets of small rural areas and narrow rural roads. Even within this urban region there are striking differences. The populations of Douglas, Gwinnett and Newton are growing rapidly while DeKalb and Fulton have seen growth of less than 1 percent from 2000 to 2004. Operating Highlights Region 3 serves the 3,375,475 people in the 2,343 total square mile area with 68 licensed ambulance services and 673 vehicles. It has 30 general hospitals and has 3,285 licensed medics living inside its borders. Region 3 is served by multiple Trauma Centers: three Level 2 Trauma Centers, one level 3, two Level 2 Pediatric Trauma Centers and one Level 1 Trauma Center. EMS Region 3 is continually faced with increased need due to expanding populations and traffic congestion complicates the ability to quickly respond to calls. From 2000 to 2004 there have been 765,811 motor vehicle crashes resulting in 273,813 injuries and 1,995 fatalities in Region 3. FAST FACTS 68 licensed ambulance 1,441 persons per total services with 673 vehicles square mile area 3,285 licensed medics live 7 percent increase in in this Region population from 2000 to 2004 411 people per physician 29 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 3 EMS REGION 3 COUNCIL MEMBERS Pete Quinones Metro Atlanta Ambulance Service David Daniels Chief Fulton County Fire/EMS Lee Mitchell Chief Gwinnett County EMS Carmelita Ferrone Deputy Chief Clayton County EMS Raffi Standifer Captain Douglas County Fire Dr. Earl Grubbs Paragon Emergency Physicians Chuck Baird Division Chief Cobb County Fire/EMS David Foster Chief DeKalb County Fire/EMS Kon-Tiki Jabaley Smyna Fire Mike Luna Newton General Hospital Benny Atkins National EMS Angela D. Conley Communications Manager Gwinnett County Police Alfred Moore Fulton County Emergency Services John Harvey Fulton County Dr. Reggie Latimer Lieutenant Atlanta Fire/EMS Dr. Authur Yancey II Fulton County Dr. Bob Gisness Cobb County Medical Trauma Cardiac OB/GYN Psych Neonate PRIMARY CLINICAL AREA Reported to State in 2004 38,668 14,111 3,984 1,804 1,078 135 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Dekalb Medical Center Grady Memorial Hospital - Atlanta Rockdale Medical Center Other Not Specified Kennestone Hospital Emory University Hospital Number 11,434 5,620 5,209 4,901 2,513 2,470 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database Clayton Cobb EMS in Georgia Dekalb Douglas COUNTIES SERVED Fulton Gwinnett Newton Rockdale Office of Emergency Medical Services/Trauma 25 EMS Region 3 G E O RG I A' S E M S R E G I O N S EMS REGION 4 Carroll Heard Coweta Troup Fayette Henry Spalding Butts Pike Lamar Meriwether West Georgia Region 4 EMS 122 Gordon Commercial Dr. Suite A LaGrange, GA 30240-5740 Billy Watson, EMS Program Director brwatson@dhr.state.ga.us Craig Stubbs, EMS Training Specialist cstubbs@dhr.state.ga.us 26 EMS in Georgia Upson Urban Urban Overview Region 4 is in the northwestern midsection of Georgia. Bordering Alabama it stretches from the rolling hills and streams of Carroll County in the north to Upson County in the southeast. Although its twelve county area includes many rural counties it contains the cities of Carrollton and Newnan and many emerging Atlanta suburban communities. The counties of Henry and Coweta have seen double digit population expansion reflecting their proximity to Atlanta. Operating Highlights Region 4 serves 706,546 people in the 3,848 total square mile area with 28 licensed ambulance services and 129 vehicles. It has 11 general hospitals and has 1,831 licensed medics living inside its borders. EMS Region 4 has one of the fastest growing populations in Georgia and the challenge is to provide services in the face of massive population growth and continual increased traffic congestion. Region 4 has one of the highest ratios of persons per physicians in Georgia and does not have a designated Trauma Center. From 2000 to 2004 there have been 115,172 motor vehicle crashes resulting in 52,456 injuries and 640 fatalities in Region 4. FAST FACTS 28 licensed ambulance services with 129 vehicles 1,731 licensed medics live in this Region 184 persons per total square mile area 13.9 percent increase in population from 2000 to 2004 809 people per physician 3.4 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 4 EMS REGION 4 COUNCIL MEMBERS Steve Adams Owner/Director West Georgia EMS Steve Andrews Fire Chief Lamar County Anne Austin Captain Training Division Henry County Fire & EMS Jimmy Bearden Fire Chief Carrollton City Scott Blue Chief Heard County Fire & EMS Michael Brewer Director Butts County 911 Randy Cash West Georgia Medical Center Thomas Chapman Assistant EMS Director Meriwether County Robert Cox M.D. E.R. Doctor Upson Regional Medical Center Jeff Denny Captain/Paramedic Coweta County Fire Chris Eden, M.D. E.R. Doctor Upson Regional Medical Center *Council Chairman **Council Vice-Chairman Butts Carroll Coweta EMS in Georgia Steve Folden Captain Fayette County Fire & Emergency Services Woody Francis M.D. Medical Director Henry County Fire & EMS Chipper Gardner Chief Spalding County Fire Ron Gause Consumer Dennis Hammond Chief Coweta County Fire Jerry Heard Chief Troup County Fire Zach Holmes Director Spalding Regional Hospital EMS Melvin Hunter Owner/Director Coweta County EMS & Vital Care EMS Brad Johnson Deputy Chief Henry County Fire & EMS Tommy Jones Griffin City Fire Department Richard Lee Interim Director Upson Region Medical Center EMS Allen McCollough* Chief Fayette County Fire & Emergency Services Trudy McDevitt Director Spalding County 911 Bobby Mitchell, M.D. E.R. Doctor Tanner Memorial David Newberry Chief Butts County Fire &EMS Peki Prince** Director of EMS Operations Peachtree City Fire &EMS Chris Smith Chief LaGrange City Fire Milton Smith Chief West Point City Fire & EMS Phillip Spradlin Battalion Chief Heard County Fire & EMS Troop Sutherland EMT/P, Vol. Fire Chief Pike County Fire Gary Thomas Fire Chief Carroll County Jimmy Totten R.N. Spalding Regional Hospital Sandra Whitlock EMA-EMS Director to Meriwether County Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 32,196 14,858 4,952 1,169 600 63 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Other Not Specified Spalding Regional Hospital Peachtree Regional Hospital Henry General Hospital Tanner Medical Center - Carrol West Georgia Medical Center Number 13,769 6,798 6,677 4,537 4,002 3,656 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database Fayette Heard Henry COUNTIES SERVED Lamar Meriwether Pike Spalding Troup Upson Office of Emergency Medical Services/Trauma 27 EMS Region 4 G E O RG I A' S E M S R E G I O N S EMS REGION 5 Central Georgia Region 5 EMS 158-1 Sammons Industrial Pkwy. Eatonton, GA 31024 Chris W. Threlkeld, EMS Program Director cwthrelkeld@dhr.state.ga.us Danny Bessinger, EMS Training Specialist dbessinger@dhr.state.ga.us 28 EMS in Georgia Jasper Putnam Hancock Jones Baldwin Monroe Washington Bibb Wilkinson Crawford Twiggs Johnson Peach Houston Bleckley Laurens Treutlen Pulaski Dodge Wheeler Wilcox Telfair Montgomery Urban Overview Region 5 is in the center of Georgia. Its large 23 county area covers Jasper and Putnam Counties in the north to Telfair County in the south. Its gently rolling hills and streams cover rich farmland and small towns. Although predominately rural it contains the city of Macon. Population growth has been relatively stable however the counties of Jasper, Johnson, Jones and Houston have each seen over 10 percent growth from 2000 to 2004. Operating Highlights Region 5 serves 637,356 people in the 8,560 total square mile area with 26 licensed ambulance services and 143 vehicles. It has 17 general hospitals and has 884 licensed medics living inside its borders. Region 5 is served by the Medical Center of Central Georgia a Level 1 Trauma Center in Macon. EMS Region 5 is challenged by the very large area served that poses logistic difficulties as well as by increased demand from many growing townships, the city of Macon and its surrounding communities. From 2000 to 2004 there have been 104,272 motor vehicle crashes resulting in 50,139 injuries and 806 fatalities in Region 5. FAST FACTS 26 licensed ambulance services with 143 vehicles 884 licensed medics live in this Region 74 persons per total square mile area 5 percent increase in population from 2000 to 2004 536 people per physician 1.7 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 5 EMS REGION 5 COUNCIL MEMBERS Dr. Gihan Abdel-Samed ER Physician Oconee Regional Medical Center Jimmy Braddy Deputy EMA Director Montgomery Co. EMA Deputy Dir./Higgston VFD-Firech Wendell Brantley Paramedic Johnson County EMS Gary Brown Deputy EMA Director Wilkinson County EMA Don Bryant EMA Director Laurens County EMA Patricia Chandler Director Crawford County EMS Greg Chapman Paramedic Houston EMS W. J. (Bill) Cheek Owner & Director Heartland EMS, Wilkinson, Wheeler Terry Cobb Director Laurens County EMS Randy Coker Director Wilcox County EMS Rickie Coleman Paramedic Dodge County EMS Robert Coulter Jones County EMA & Rescue Lawton Davis, M.D. District Health Director South Central Health District *Council Chairman **Council Vice-Chairman Baldwin Beckley Bibb Crawford Dodge Hancock EMS in Georgia Donald Floyd EMA Director Twiggs County EMA Alfonzo Ford Director Peach County EMS Allan Green EMA Director Jones County EMA James Gregory Director Putnam County EMS Dr. Ralph Griffin Physician MCCG James Harden Citizen Dr. James F. Hatcher, Jr. Physician Region V EMS Medical Director Shane Hill Asst. Director Putnam County EMS Ben Hinson** President Mid Georgia Ambulance Service Annette Huff Director Dodge County EMS Barbara Kassner Citizen Alvin Keith Lewis Paramedic Peach County EMS Dan Maddock CEO Taylor Regional Hospital Bill McNair Realtor McNair Realty Co. Inc. Lee Oliver* Director MCCG, Inc. Dr. Robert Polglase Physician Washington County Lisa Pope Paramedic Jasper Emergency Services Marvin Riggins Chief Fire Department Macon-Bibb Fire Department Joe Robinson Chief Operating Officer Mid Georgia Ambulance Service Kimberly Ross Paramedic Monroe County EMS Jeff Soles Director Washington County EMS Joseph Swartwout, M.D. District Health Director North Central Health District Vicki Thompson GEMA Area 4 Field Coordinator Monroe County David Ward EMS Supervisor Houston Medical Center Richard Warren Director Hancock County EMS Carla Weese RN & Director Houston Medical Center Jennifer Williamson Director Telfair County EMS Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 2,769 1,219 557 93 71 5 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Memorial Hospital of Washington Medical Center of Central Georgia Inc Monroe County Hospital Houston Medical Center Taylor Regional Hospital Medical Office/clinic Number 1,200 1,032 883 878 719 613 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database COUNTIES SERVED Houston Jasper Johnson Jones Laurens Monroe Montgomery Peach Pulaski Putnaml Telfair Treutlen Office of Emergency Medical Services/Trauma Twiggs Washington Wheeler Wilcox Wilkinson 29 EMS Region 5 G E O RG I A' S E M S R E G I O N S EMS REGION 6 Wilkes Lincoln TaliafWerraorrenMcDuffieColumbia Glascock Richmond Jefferson Burke East Central Georgia Region 6 EMS 1916 North Leg Road Augusta, GA 30909-4402 Lawanna Mercer-Cobb, EMS Program Director lmcobb@dhr.state.ga.us Karen Winburn, EMS Program Assistant kwinburn@dhr.state.ga.us Wes Simonds, EMS Training Specialist wgsimonds@dhr.state.ga.us 30 EMS in Georgia Jenkins Screven Emanuel Urban Overview Region 6 is in the eastern midsection of Georgia bordered in the west by South Carolina. It covers a thirteen county narrow section running from Wilkes County in the north to Screven County in the south. It is characterized by gently undulating slopes and streams with rich farms. Although predominately rural, it contains the city of Augusta in Richmond county at the edge of South Carolina. Operating Highlights Region 6 serves 434,314 people in the 5,323 total square mile area with 17 licensed ambulance services and 77 vehicles. Region 6 has 11 general hospitals and has 759 licensed medics living inside its borders. It is served by the Medical College of Georgia Health System in Augusta as a Level 1 Trauma Center. As with other primarily rural regions Region 6 must respond across long distances to reach communities in the north and south. The suburban county of Columbia just north of Augusta has seen over 10 percent growth in population from 2000 to 2004 adding an increased need for services. Along with Region 3, it has a better than average ratio of persons to physicians. From 2000 to 2004, there have been 81,527 motor vehicle crashes resulting in 31,290 injuries and 454 fatalities in Region 6. FAST FACTS 17 licensed ambulance services with 77 vehicles 759 licensed medics live in this Region 82 persons per total square mile area 2 percent increase in population from 2000 to 2004 323 people per physician 1.5 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 6 EMS REGION 6 COUNCIL MEMBERS Rich Bias* Senior VP Of Ambulatory & Network Services MCG Health, Inc. Glenn Bridges, MD Online Medical Director University Hospital ER Casey Broom Paramedic Lincoln County EMS Debbie Burch, APRN Nurse Practitioner Burke Medical Center Brad Carani EMA Director Deputy Sheriff Taliaferro County Sheriff's Office Ernie Doss Area General Manager Rural/Metro Ambulance James Finney Crawfordville, GA Martha Garner Director of Emergency, Critical Care, and Diagnostic Nursing Doctors Hospital, ED John Graham Chairman Warren County Board of Commissioners Donna Hardy County Commissioner Wilkes County Michael Hawkins, MD Chief of Trauma, Critical Care and Surgery Augusta, GA *Council Chairman **Council Vice-Chairman David Herrin Operations Manager Chief of Rural Air Operations Transport One/Screven County EMS Gail J. Thornton, RN Quality Management Coordinator Emanuel Medical Center Kathleen Kosmoski Executive Director American Red Cross Nona Lord, RN Facility Administrator/ Nurse Manager Glascock Co Health Dept. Walker T. Norman Chairman Lincoln County Board of Commission Dianne Rabun Secretary Glascock Co Health Dept. Cliff Richardson Paramedic Millen, GA Jane Rogers EMS Director McDuffie County EMS John F. Salazar, MDFACC Cardiovascular Associates Rusty Sanders EMA Director (EMS and Fire) Burke County EMA Tom Schneider Director, CEO Gold Cross EMS Richard Schwartz, MD Chairman and Associate Professor of Emergency Medicine MCG-AF 2058 Chris Sheppard, MD Wrens Physicians' Health Group Bruce Tanner EMA Director McDuffie County EMA Courtney Terwilliger EMS Director Emanuel County EMS Blake Thompson** EMS Director Wilkes County EMS Elaine Timmerman Director of Inpatient Services Acting Chief Nursing Officer St. Joseph Hospital Pam Tucker Emergency Services Director Columbia County EMA Phillip Wasson Augusta/Richmond 911 Director Augusta 911 Center Howard Willis Chief Augusta-Richmond County Fire Dept. Tommy Wolfe EMS Director Warren County EMS Connie Wammock Director of Nursing Screven County Hospital Henry Young EMS Director Jenkins County EMS Phillip L. Coule, MD Director Center of Operational Medicine Medical College of Georgia Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 13,917 4,352 1,585 342 274 85 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Other Not Specified Medical College of Ga Hospital University Hospital - Augusta Doctors Hospital - Augusta Nursing Homes McDuffie County Hospital Number 7,971 4,534 4,073 1,832 1,118 943 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database COUNTIES SERVED Burke Columbia Emanuel Glascock EMS in Georgia Jefferson Jenkins Lincoln McDuffie Richmond Screven Office of Emergency Medical Services/Trauma Taliaferro Warren Wilkes 31 EMS Region 6 G E O RG I A' S E M S R E G I O N S EMS REGION 7 West Central Georgia Region 7 EMS 2100 Comer Avenue Post Office Box 2299 Columbus, GA 31902-2299 Sam R. Cunningham, EMS Program Director srcunningham@dhr.state.ga.us Glenda Morish, Program Assistant gjmorish@dhr.state.ga.us Darrell R. Enfinger, EMS Training Specialist drenfinger@dhr.state.ga.us 32 EMS in Georgia Harris Talbot Muscogee Taylor Chatta- Marion hoochee Schley Stewart Quitman Webster Randolph Macon Clay Urban Overview Region 7 is in the southwestern midsection of Georgia with rapid streams and low hills. Its thirteen county area is bordered in the west by Alabama and stretches to Macon County in the east and Harris County in the north to Clay county in the south. Although predominately rural with productive farms and small communities it contains the city of Columbus in Muscogee County just at the edge of Alabama. Operating Highlights Region 7 serves 284,226 people in the 4,143 total square mile area with 17 licensed ambulance services and 63 vehicles. It has seven general hospitals and has 314 licensed medics living inside its borders. Region 7 is served by The Medical Center a Level 2 Trauma Center in Columbus. The challenge is to provide the best possible care with existing resources. Harris County just north of Columbus has seen over 12 percent growth in population from 2000 to 2004 adding an increased need for services. As with other primarily rural regions, Region 7 must respond across long distances to reach communities. From 2000 to 2004 there have been 49,735 motor vehicle crashes resulting in 19,496 injuries and 235 fatalities in Region 7. FAST FACTS 17 licensed ambulance services with 63 vehicles 314 licensed medics live in this Region 82 persons per total square mile area 1 percent decrease in population from 2000 to 2004 546 people per physician 1.5 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 7 EMS REGION 7 COUNCIL MEMBERS Ivy Belflower EMT/Consumer Ron Brown Director Clay County EMS Jimmy Carver* Assistant Director Harris County EMS Michael Charles Program Director Columbus Technical College Dr. Richard Chase Medical Director Macon County EMS Ellice Ann Fancher Assistant Director Middle Flint Regional E-911 Center Johnny Floyd Acting Director Chattahoochee Emergency Management Agency Robert Futrell Deputy Chief Columbus Fire and EMS Gary Gill EMT Schley County EMS Dr. R. Scott Hannay Chief of Trauma Columbus Regional Medical Center Jay Hazen Operations Manager Care Ambulance Service Sandra Higginbotham Clerk Talbot County Board of Commissioners *Council Chairman **Council Vice-Chairman Chattahoochee Clay Harris Macon EMS in Georgia Mike Higgins Division Chief Columbus Fire and EMS Darrell Holbrook Chief Webster County Fire/EMS Dallas Jankowski Consumer Former State EMS Director Dr. Charles Kelly EMT Talbot County EMS Shirley Kisor EMT/RN Webster County Fire/EMS Jimmy Lee Commissioner Stewart County Board of Commissioners Gary Lowe Director Taylor County EMS/EMA Ben Lunsford EMT Randolph County EMS Cathy Maxwell Trauma Manager Columbus Regional Medical Center David McCall Director Harris County EMS Joanne W. McDaniel Consumer Mini Maid of Columbus Dell Miller EMT-P / RN Doctors Hospital Ryne Ming Firefighter Quitman County Volunteer Fire Department Duane Montgomery Director Schley County EMS Judson Montgomery EMT/Police Officer Taylor County EMS/ Reynolds Police Department Brian Moseley Operations Manager/ Columbus Mid Georgia Ambulance Service Frank Perez EMT-P LifeNet Air Medical Service Max Pittman Director Randolph County Emergency Management Agency Terry Roberts EMT-P Marion County EMS Joe Robinson Chief Operating Officer Mid Georgia Ambulance Service Greg Stewart** Director Stewart County EMS Terry Whaley Director Marion County EMS Andy Windham Director Macon County EMS Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 13,583 4,794 1,552 733 387 33 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 The Medical Center - Columbus St. Francis Hospital - Columbus Other Not Specified Doctors Hospital - Columbus Medical Office/clinic (Air) Other EMS Responder Number 5,842 3,859 1,886 1,679 1,526 1,445 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database COUNTIES SERVED Marion Muscogee Quitman Randolph Schley Stewart Talbot Taylor Webster Office of Emergency Medical Services/Trauma 33 EMS Region 7 G E O RG I A' S E M S R E G I O N S EMS REGION 8 Southwest Georgia Region 8 EMS Post Office Box 3637 319 North Main St. Moultrie, GA 31776-3637 Robert D. Vick, EMS Program Director rdvick@dhr.state.ga.us Jamie Crowe, Program Assistant jcrowe@dhr.state.ga.us John Vickers, EMS Training Specialists jtvickers@dhr.state.ga.us 34 EMS in Georgia Sumter Terrell Lee Dooly Crisp Turner Ben Hill Calhoun Dougherty Worth Irwin Tift Early Baker Berrien Miller Mitchell Colquitt Cook Seminole Decatur Grady Thomas Brooks Lanier Lowndes Echols Urban Overview Region 8 is in the southwestern section of Georgia. Its large 27 county area reaches in the east from Echols County at the very edges of the Okefenokee Swamp through rich farmland to Early County bordering Alabama. Region 8 covers a massive area. I-75 runs almost straight through it from the city of Cordele in the north through Tifton to Valdosta in Lowndes County bordering Florida in the south. Although predominately rural it contains many small and medium size towns including the city of Albany. Operating Highlights Region 8 serves 660,926 people in the 10,670 total square mile area with 35 licensed ambulance services and 157 vehicles. It has 23 general hospitals and has 917 licensed medics living inside its borders. Region 8 is served by the Archbold Memorial Hospital a Level 2 Trauma Center in Thomasville. The large area served poses logistic difficulties, as does increased demand from growing townships and communities. Although many counties in Region 8 are seeing stable or slightly declining populations, Dougherty County the home of Albany has seen a 20 percent increase in population from 2000 to 2004. From 2000 to 2004, there have been 88,051 motor vehicle crashes resulting in 46,925 injuries and 880 fatalities in Region 8. FAST FACTS 35 licensed ambulance services with 157 vehicles 917 licensed medics live in this Region 69 persons per total square mile area 2 percent increase in population from 2000 to 2004 598 people per physician 1.5 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 8 EMS REGION 8 COUNCIL MEMBERS Jack Bass County Commissioner Worth County Dexter Beard Director Calhoun Mem. Hosp. EMS Andy Belinc Director Baker County EMS Cathy Bishop Director Ben Hill County EMS Tim Brogdon Director So. GA Med. Center EMS Dana Brown Director Seminole County EMS Andrea P.F. Brooks County Comm. Sumter County Paul Bynum Director Colquitt County EMS Danny Connell Chief of Operations Regional EMS Danny Edwards Director of wound care Tift Regional Hospital David Edwards Director Crisp County EMS *Council Chairman **Council Vice-Chairman Baker Ben Hill Berrien Brooks Calhoun Colquitt Cook EMS in Georgia Jerry Edwards Director Irwin County EMS James C. Hamby Director Terrell County EMS Tony Heath Director Dooly County EMS Bill Hogan Director Decatur County EMS Melburn Kelly Director Thomas County EMS Ann Lamb Director Mitchell County EMS Randy Lancaster Paramedic Berrien County EMS Arch McNeill, M. D. Emergency physician Archbold Mem. Hosp./Trauma Center Thomasville Stanley Mobley* retired PH Howard Moore Director Lanier County EMS Ken Morey Supervisor Mid. Ga Ambulance Svc. Billy Rathel Director Miller County EMS Gary Rice Field Rep. GEMA Mark Swicord RN, EMT-P ED Director Archbold Mem Hosp/ Trauma Center Thomasville Bobby Tripp** Director Vice-Chair Dougherty Co. EMS Bobby Watkins Director Lee County EMS Randall Whiddon Director Turner County EMS Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 44,332 20,474 5,776 1,658 1,066 277 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Other Not Specified Phoebe Putney Memorial Hospital Not Applicable South Georgia Medical Center John D Archbold Memorial Hospital Tift Regional Medical Center Number 17,950 11,300 7,026 6,792 5,099 4,788 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database COUNTIES SERVED Crisp Decatur Dooley Dougherty Early Echols Grady Irwin Lanier Lee Lowndes Miller Mitchell Seminole Office of Emergency Medical Services/Trauma Sumter Terrell Thomas Tift Turner Worth 35 EMS Region 8 G E O RG I A' S E M S R E G I O N S EMS REGION 9 Effingham Candler Bulloch Toombs Evans Bryan Chatham Tattnall Jeff Davis Liberty Appling Long Coffee Bacon Wayne McIntosh Atkinson Pierce Glynn Ware Brantley Clinch Camden Charlton Southeast Georgia Region 9 EMS P.O. Box 1877 Brunswick , GA 31521 Urban Overview Region 9 is in the southeastern section of Georgia. Bordered by the Atlantic Ocean in the east it stretches through the 660 square miles of the Okefenokee Swamp to the hills of Coffee County in the west. On the Atlantic side going south from Savannah marshes dot the coast along with barrier islands. Although predominately rural, it contains the city of Savannah and its suburban counties within its 24 county area. Shirley Starling, Interim EMS Program Director sdstarling@dhr.state.ga.us Linda Wright, Administrative Assistant lwright@dhr.state.ga.us Operating Highlights Region 9 serves 844,775 people in the 12,533 total square mile area with 34 licensed ambulance services and 158 vehicles. It has 20 general hospitals and has 1,175 licensed medics living inside its borders. Region 9 is served by the Memorial Health University Medical Center a Level 1 Trauma Center. An increased demand for services combined with the large area to be served pose challenges to Region 9. Effingham County just north of Savannah, has seen over 18 percent growth in population from 2000 to 2004 adding an increased need for services. As with other primarily rural regions, Region 9 must respond across long distances and swampland and marshes add to the challenge. From 2000 to 2004, there have been 136,684 motor vehicle crashes resulting in 62,404 injuries and 979 fatalities in Region 9. 34 licensed ambulance services with 158 vehicles 1,175 licensed medics live in this Region FAST FACTS 67 persons per total square mile area 5 percent increase in population from 2000 to 2004 561 people per physician 1.3 EMS vehicles per 100 total square mile area 36 EMS in Georgia Office of Emergency Medical Services/Trauma EMS Region 9 EMS REGION 9 COUNCIL MEMBERS Tony Cabiness, EMT-P Jeff Davis County EMS Charles Carter Director Alma-Bacon Co. Ambulance Service Susan Clark Director Bryan County EMS Tim Crews Director Brantley County EMS Carol Crockett, NREMT-P Rescue Training, Inc. Lee Eckles** Director Bulloch County EMS Dennis Gailey Interim Fire Chief Camden County Fire Rescue Paul Genest Director Evans County EMS Tim Genest* Director Southside Fire/Mercy Amb. Service Brian Hendrix-NREMT-P Pembroke, GA 31321 David Herrin Chief of Operations MedStarOne *Council Chairman **Council Vice-Chairman Wallace Hodge Director Clinch County EMS Teresa Howard RN Southeast GA Reg. Med. Systems Ken Justice Director Peirce County EMS John Keanon Director Atkinson Co. Amb. Service Sheila Keck-Deverger Director Mclntosh County EMS Bob Kicklighter Wayne County EMS Sgt. Clay Kicklighter Georgia State Patrol William Mann Director East Coast EMS David Moore Director Candler Hospital/EMS Larry NeSmith Director Appling County Ambulance Service Walter Nichols Director Fort Stewart EMS Mark Palmer Coordinator Bioterrorism/Emerg. Preparedness Southeast Health Unit Jim Phillips Director Office of Emergency Preparedness Coastal Health Unit Rick Shores Director MedStarOne Zach Shuman Director Chatham County EMS Cecil Stephens Director Kingsland Fire Rescue Al Thomas Chief Glynn County Fire Dept Steve Towne Director Charlton EMS James Turk Director Coffee Regional Med. Center/EMS Jim Turner Director Liberty Regional Med. Center/EMS Mark Walker Director Ware County EMS Medical Trauma Cardiac Psych OB/GYN Neonate PRIMARY CLINICAL AREA Reported to State in 2004 36,520 18,598 5,256 2,380 950 108 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Other Not Specified Memorial Health University Medical Center Candler Hospital (Savannah) Coffee Regional Medical Center Satilla Regional Medical Center East GA Regional Medical Center Number 13,856 12,511 5,731 4,630 2,874 2,873 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database Appling Atkinson Bacon Brantley Bryan Bulloch EMS in Georgia COUNTIES SERVED Camden Candler Charlton Chatham Clinch Coffee Effingham Evans Glynn Jeff Davis Liberty Long Office of Emergency Medical Services/Trauma Mcintosh Pierce Tattnall Toombs Ware Wayne 37 EMS Region 9 G E O RG I A' S E M S R E G I O N S EMS REGION 10 Jackson Madison Elbert Barrow Walton Clarke Oconee Oglethorpe Morgan Greene Northeast Georgia Region 10 EMS 1551 Jennings Mill Road Bogart, GA 30622-2565 Earl McGrotha, EMS Program Director ehmcgrotha@dhr.state.ga.us Kathy Stocum, Administrative Assistant kathyskat@aol.com B. Jack Mundy, EMS Training Specialist bjmundy1@dhr.state.ga.us 38 EMS in Georgia Urban Overview Region 10 is in the northeastern section of Georgia. It is composed of 10 counties stretching from Walton County near Atlanta in the west to the hills of Elbert County in the east touching South Carolina. Although it includes some rural counties, it contains the city of Athens, its suburban counties and many emerging Atlanta suburban communities. Stark population contrasts exist between counties with some having less than 20,000 compared with Clarke County with a population just over 100,000. Operating Highlights Region 10 serves 405,231 people in the 3,006 total square mile area with 13 licensed ambulance services and 58 vehicles. It has 10 general hospitals and has 941 licensed medics living inside its borders. Region 10 is served by the Morgan Memorial Hospital a Level 4 Trauma Center. Region 10 faces unique challenges but for all counties the challenge is to provide the best possible care with existing resources. For many of the counties that challenge is compounded by increased demand due to rapidly expanding population. Barrow, Jackson and Walton counties have all seen a greater than 15 percent increase in population from 2000 to 2004. Region 10 has one of the highest ratios of persons per physicians in Georgia and is one of the fastest growing regions in Georgia. From 2000 to 2004, there have been 67,624 motor vehicle crashes resulting in 28,883 injuries and 461 fatalities in Region 10. FAST FACTS 13 licensed ambulance services with 58 vehicles 941 licensed medics live in this Region 135 persons per total square mile area 10 percent increase in population from 2000 to 2004 757 people per physician 1.8 EMS vehicles per 100 total square mile area Office of Emergency Medical Services/Trauma EMS Region 10 EMS REGION 10 COUNCIL MEMBERS Steve Akery Walton County Chuck Almond EMS Director Elbert County Huey Atkins EMS Director Morgan County Dr. Zeb Burrell Jr., M.D.** EMS Medical Director Elbert County Don Cargile EMS Director Athens Regional Medical Center Nancy Couch EMS Director Walton County Julie Cronic EMS Division Chief Barrow County James Dove* Director NEGA Regional Development Center *Council Chairman **Council Vice-Chairman Barrow Clarke Elbert EMS in Georgia Iby George Fire Chief Athens-Clarke County Fire Department Wayne Jackson Clerk City of Union Point Farris T. Johnson, M.D. Physician Family Practice Center Mitch Kitchens EMS Director Barrow County James Mathews EMS Director Oglethorpe County Dwayne Patton EMS Director Madison County Gwen Ruark EMS Director Morgan County Howard Sanders Assistant EMS Director Oglethorpe County Steve Shirley, M.D. Surgeon NE Georgia Surgical Consultants, PC Henry Slocum Public Relations & Marketing Director BJC Hospital Jeff Smith EMS Director Greene County Jeff Sosby Paramedic St. Mary's Hospital Quinton Still Director of Emergency Services Oconee County Bruce Thaxton Fire Chief Oconee County Brett Atchley, M.D. ER Physician Athens Regional Medical Center Medical Trauma Cardiac OB/GYN Psych Neonate PRIMARY CLINICAL AREA Reported to State in 2004 1,089 446 164 25 17 2 TTOOPP 55 TTRRAANNSSPPOORRTT DDEESSTTIINNAATTIIOONNSS Reported to State in 2004 Other Not Specified Athens Regional Medical Center Elbert Memorial Hospital Barrow Medical Center St. Marys Hospital - Athens Minnie G Boswell Memorial Hospital Number 2,525 1,638 1,626 945 409 326 Data SourcesPopulation: U.S. Census Bureau, Population Division; Square Miles of Land Area: U.S. Census Bureau, Census 2000; Number of physicians: Georgia Physician Surveys, 1992-2002, Composite State Board of Medical Examiners, and Georgia Board for Physician Workforce; Environmental Causes and Destinations: OEMS Patient Care Report (PCR) Database; Trauma Centers: Georgia Trauma Database; Medics and EMS Vehicles: OEMS Database Greene Jackson Madison COUNTIES SERVED Morgan Oconee Office of Emergency Medical Services/Trauma Oglethorpe Walton 39 EMS Region 10 G E O RG I A' S E M S C O U N C I L S Emergency Medical Adv isor y Council (EMSAC) Open interchange with the statewide EMS community is an essential factor in planning and development initiatives. Established in 1973, EMSAC provides a fundamentally important role in advising the strategic growth of EMS in Georgia. In connection with this, Georgia is fortunate to have assembled a distinguished statewide advisory board. The membership of this advisory board is shown in Appendix B. Health District and GEMA Interactions In the case of the State Office of Emergency Medical Services/Trauma, the formal and informal interactions of the Health District program managers, the environmental interchanges with the Emergency Medical Services Advisory Council, interactions with the parent organization, the Division of Public Health (DPH), as well as, potentially, the Human Resources Board of Directors and legislators require significant analysis from an open systems perspective. 40 G E O RG I A' S E M S C O U N C I L S EMS Medical Directors Adv isor y Council (EMSMDAC) The recognition that medical direction is a significant and necessary component of EMS has existed since the 1970's; however, Georgia is still in the process of formalizing this recognition. Each licensed EMS service must retain a medical director--a physician who is legally responsible for all clinical and patient-care aspects of its operation. The prehospital medical care provided by medics is considered an extension of the medical director's license. In Georgia, the Medical Director's Role is to: Provide medical oversight and guidance. Develop, review, approve and monitor clinical protocols in cooperation with expert EMS personnel. Participate in quality improvement and problem resolution. Advocate within the medical community. Interface between the EMS system, public health, and other public and private health-care agencies. Support the strategic development of the statewide EMS system. EMSMDAC was created in 1997, by Region 7 EMS Program Director, Sam Cunningham when he was state EMS Director. Dr. J. Patrick O'Neal was the initial chair of EMSMDAC. In 1997, Dr. Phillip Coule, Director of the Center of Operational Medicine, Medical College of Georgia became the chair. Dr. Coule served as chair from 1997 through 2004. On November 2004, Dr. Jill Mabley was then elected as chair. When oversight of paramedics passed from the Composite Board of Medical Examiners to the Office of EMS/T a couple of years ago, formalization of EMSMDAC became more essential. In 2004, legislation was introduced to formally recognize EMSMDAC and conveying upon it certain powers. The bill passed both legislative bodies but did not become law. 41 LO O K I N G TOWA R D S T H E F U T U R E Future Strategic Focus Looking towards the future, the OEMS/T believes that a well-articulated mission and vision, a formal strategic plan, well-defined operational processes, written formal procedures, and frequent interactions with statewide stakeholders groups can drive improvements in statewide EMS regulation as well as regional organizational performance. OEMS/T recognizes that a customer service orientation, a focus on quality coupled with the flexibility to adapt to local operating conditions are also keys to success. While uniformity is sought and desired, there is no cookie cutter approach to statewide operational effectiveness. Going into the future the OEMS/T will continue to develop its role focused on regulating the processes of delivering prehospital care. The strategy of the OEMS/T is to embed in its regulatory mission mechanisms that will enable systemic evolution through the production of high quality information--value-added information is a by-product of objective and uniform regulation. EMS Development is a State Responsibility In 2005, no single federal agency has lead responsibility for EMS activities. No federal agency collects data on EMS responses--a major shortcoming that undercuts the EMS community's ability to conduct research to improve itself, or help justify its mission. In 2005, a number of different federal agencies are involved in supporting and promoting EMS improvements, including the National Highway Traffic Safety Administration, (NHTSA) the Department of Health & Human Services, and several others. None of these agencies imposes standards or enforces requirements on how state EMS systems should operate. Instead, the federal agencies undertake activities such as providing technical consulting support and guidance, providing funding for EMS initiatives through various grant programs to states, and exploring avenues for developing a consensus among EMS providers on policy needs and changes.14 Each state has control of its own EMS system, independent of the federal government. Of the federal agencies mentioned above, NHTSA has provided a set of recommended standards called the Technical Assistance Program Assessment Standards for EMS. NHTSA prescribed standards are to insure that (a) the public has access to the EMS system through a communications mechanism (e.g., 911, e-911), (b) patients are provided with safe, reliable transportation by ground or air ambulance, (c) EMS personnel are appropriately educated and in-turn provide public education on the prevention of injury, (d) EMS has appropriate medical direction, (e) each state develops a system of specialized care for trauma patients; and (f) each state has a quality improvement program for the continuous evaluation and upgrading of the system. In conformance with these standards, each state must have laws, regulations, policies and procedures that govern it's EMS system.15 To provide this governance objective, statewide information is needed. EMS is 42 14 GAOT 2001, p. 1112 15 GAO, 1999, p. 6 LO O K I N G TOWA R D S T H E F U T U R E becoming increasingly complex and information driven. In the absence of information, uncertainty may drive inappropriate policy determination. In past years, it has been possible to obtain certain types of information from federal sources. Today, however, because of the need for state-specific information, this ability to tap federal information is no longer a responsive option. The development of an excellent statewide EMS system is solely Georgia's responsibility. The ability to produce and disseminate statewide information provides an essential service need for policy development and the outcomes-based objectives to improve statewide EMS and trauma system effectiveness. EMS information additionally supports statewide emergency preparedness. Going into the future, the OEMS/T must organizationally be able to plan, prescribe, react and evolve in response to the internal and external forces that may manifest themselves in each of these areas. To react to these changes, the OEMS/T has revised its rules and regulations, shed bureaucracy and taken steps to enhance its regulatory capabilities based upon improved alignments of people, process and technology. Ability to Secure Grant Funding The Emergency Medical Services for Children (EMSC) Program is a national initiative designed to reduce child and youth disability and death due to severe illness and injury. Medical personnel, parents and volunteers, community groups and businesses, and national organizations and foundations all contribute to the effort. HRSA administers the program in partnership with the U.S. Department of Transportation's National Highway Traffic Safety Administration. Through the efforts led by the Deputy DirectorOEMS/T working closely with the EMS Regions and partnering with other state and federal agencies, the OEMS/T has been able to obtain and effectively utilize grant monies to improve aspects of Georgia's public health infrastructure. Since its establishment in 1984, the EMSC program has improved the availability of child-appropriate equipment in ambulances and emergency departments. It has initiated hundreds of programs to prevent injuries, and has provided thousands of hours of training to EMTs, paramedics and other emergency medical care providers. Based upon a demonstration of need, EMSC grants fund States and U.S. Territories to improve existing emergency medical services systems and to develop and evaluate improved procedures and protocols for treating children. The EMSC program is the only federal program that focuses specifically on improving the quality of children's emergency care. Georgia gratefully acknowledges the funding it has received from this valuable program. The Office of EMS/Trauma has also been able to secure grant funding from other federal agencies. In 2005, major programs were completed involving grant funds from the Office of Rural Health Services as well as the Health and Human Services Administration (HRSA). These grants were also competitive and were based upon Georgia's ability to provide data and appropriate justifications. 43 LO O K I N G TOWA R D S T H E F U T U R E The Future of EMS is Information With the introduction of computer technology beginning in the 1990's, the OEMS/T has been increasing called upon to be an information clearing house and provide a unified planning and continuous quality improvement direction for the collection and analysis of EMS, EMSC and trauma data for both rural and urban areas. It is now generally recognized that the analysis and production of meaningful EMS data is a core function central to supporting EMS regulation and system wide medical improvement. In order for Georgia to fulfill its regulatory mission, new ways to collect and analyze EMS data must be rapidly developed. Infrastructure development is continuously required such that the building blocks can be put into place to support these needed capabilities. In 2005, emergency medical services is still all about rapid response, initial treatment, and safe transport of a patient to a health care facility; however, it is now increasingly recognized that EMS also plays a role in data collection and analysis for prevention, education, and planning for improving community public health. NEMSIS Participation In 2004, Georgia signed a letter of intent to support and participate in the NEMSIS (National EMS Information System) data standard. Georgia recognizes that participation in NEMSIS and related activities provides relationships essential to develop a statewide EMS training curricula, CQI program and the development of EMS system indicators. Additionally, Georgia believes that the NEMSIS effort will (a) facilitate research efforts, (b) assist in providing information on fee schedules and reimbursement rates, (c) address resources for disaster and domestic preparedness, and (d) provide valuable information on other issues or areas of need related to EMS care. Keeping Pace with Technology to Benefit Stakeholders The OEMS/T is committed to keeping pace with rapidly changing technology to benefit our stakeholders. Dramatic technological change will reshape society and its institutions in the next five to ten years. The pace of this change is increasing. The Internet and other information and communications technologies are changing the way EMS works, learns, communicates, and the way EMS will do business. The Internet is shaping EMS in the same way that the steam engine and electricity defined the Industrial Age. Used creatively, the Internet and information technology can be a powerful tool for tackling some of our toughest challenges in improving statewide EMS. It can let us share information, make it easier to acquire new skills, and improve our ability to support our statewide regulatory mission. For the OEMS/T, the long-term, strategic importance of anywhere access to information through an improved statewide EMS infrastructure--perhaps more than any other element--underpins the 10 GEMSIS goals outlined in Appendix A. A movement to web-based technologies over the next several years will make the OEMS/T more effective in carrying out its mission. The ability to produce and disseminate unique information provides an essential service and promotes more efficiency in governmental services. 44 REFERENCES American College of Surgeons. (1999). Resources for Optimal Care of the Injured Patient: 1999. As retrieved September 22, 2003 from www.acs.com Chicago, IL, American College of Surgeons, 1999. 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Academy of Management Journal, 45, (1). 163179. United States General Accounting Office Report (GAO) to Congressional Requesters (October, 2001). Emergency Medical Services: Reported Needs are Wide-Ranging, With a Growing Focus on Lack of Data (GAO-02-28). U. S. General Accounting Office, Washington, D. C. 46 Appendix A Summary of GEMSIS Programmatic Goals Strategic Area EMS Strategy Development. Comprehensive EMS Data Collection. Published EMS Information Baseline. Formalized EMS Benchmarks. Standardized EMS Data Utilization. Objective Establish the strategy, organizational structure, standard operating procedures, and funding necessary for the implementation and maintenance of a statewide EMS data collection, evaluation and improvement process. Establish a comprehensive data collection system capable of gathering, integrating, and reporting pertinent, timely and accurate data from all state EMS system participants, and provide data linkages with other state and federal agencies and organizations as appropriate. Establish a mechanism(s) to ensure feedback of data reports to all contributing agencies while maintaining confidentiality and security of data. This process will include a mechanism for prehospital personnel to receive timely feedback on the diagnosis and disposition of their patients. Establish standardized definitions, indicators, and benchmarks, include the consideration of all national EMS datasets to facilitate comparative analysis of local EMS system performance, quality of patient care, customer satisfaction, and system cost on a state and national level. Establish a mechanism(s) to ensure data is utilized at the state, local and provider level for continuous quality improvement aimed at improving EMS services and quality of patient care decreasing death and disability, and reducing costs. EMS CQI. EMS Training Curriculum Evolution. EMS Research. Define EMS CQI programmatic needs and goals. Establish communication linkage(s) with EMS training and prevention programs to ensure needs identified through the evaluation process are integrated into the EMS training curriculum and prevention programs. Establish system evaluation training for all levels of EMS personnel to ensure proper documentation, data entry, analysis utilization of data and an understanding of the principles of research. Establish agenda, guidelines and support mechanisms for conducting and funding Georgia-relevant EMS research. Uniform Rules & Regulations Administration. Ensure immunity for medical control and quality improvement processes and discovery protection for all local and state EMS quality improvement efforts to ensure cooperation and participation of all EMS participants in patient care and EMS service evaluation. EMS Regulatory Operations Review. Establish a mechanism(s) for the periodic performance evaluation of the state's EMS regulatory agency. 47 Appendix B EMS Advisory Council (EMSAC) Membership Steve Adams Owner West Georgia Ambulance Service Wright Alcorn Vice President Patient Services Piedmont Hospital James Benny Atkins Chief Operating Officer National EMS, Inc. Don T. Cargile Director of Emergency Medical Services Athens Regional Medical Center Robert Cox, M. D. Spalding Regional Hospital Department of Emergency Medicine Ernie Doss Regional Director of Patient Account Rural Metro Ambulance Service Danny Edwards Program Director Tift Regional Medical Center Wound Care Center Jane Garbisch Paul Genest Director Evans County EMS Timothy L Genest EMS Director - Assistant Chief Mercy Ambulance Service Inc., DBA Southside Fire/EMS John Harvey, M. D. Ben Hinson Owner Mid Georgia Ambulance Service John Hitchens Director Whitfield County EMS Zachery Holmes Director Spalding Regional Hospital EMS Debra Kitchens Trauma Program Manger Medical Center of Central Georgia Ann Lamb Director EMA and GEMA Mitchell County EMS Jeff F. Linzer, M.D., MICP, FAAP, FACEP Assistant Professor, Pediatric Emergency Medicine Emory University School of Medicine EMSC Coordinator, Division of Pediatric Emergency Medicine Scott Masters Director of Emergency Medical Transportation Northeast Georgia Health System M. Allen McCullough Deputy Director Fayette County Department of Fire and Emergency Services Lee Mitchell Retired (Consultant) Gwinnett Fire and Emergency Services Suzanne K. Nieman Associate Legislative Director for Health and Human Services Lee Percy Oliver III Director Emergency Medical Services The Medical Center of Central Georgia Pete Quinones President & CEO Metro Atlanta Ambulance Service Gary Rice Georgia Emergency Management Agency Marvin Riggins Chief Macon Bibb County Fire Department Jeannie Riner Technical Instructor Swainsboro Technical College Richard Roberts Training Supervisor Dougherty County EMS Joe Robinson Chief Operating Officer Mid Georgia Ambulance Service Thomas R. Schneider CEO Gold Cross Emergency Medical Service Courtney Terwilliger Director Emanuel County EMS 48 Appendix C EMS Medical Directors Advisory Council (EMSMDAC) Membership Dr. Brett Atchley Emergency Medicine Physician Dr. Michael Brackett EMS Medical Director Elbert County Dr. Zeb L. Burrell, JR. EMS Advisor Dr. Phillip L. Coule Director Center of Operational Medicine, Medical College of Georgia Dr. Robert J. Cox Region IV EMS Medical Director Dr. David H. Fagin Pediatric Emergency Medicine, Children's Healthcare of Atlanta Dr. Raymond L. Fowler Medical Director of Mid Georgia Ambulance Service & Douglas County Fire Department Dr. Virginia G. Galvin Metro Atlanta Ambulance Service, Inc. Dr. Charles B. Gillespie EMS Advisor Dr. Earl Grubbs Paragon Emergency Physicians Dr. Michael D. Hagues West Central Georgia Region 7 EMS Medical Director Dr. John S. Harvey General Surgery Dr. James F. Hatcher, Jr. Central Georgia Region 5 EMS Medical Director Dr. Michael L. Hawkins Surgery, Medical College of Georgia Dr. Stephen E. Holbrook Emergency Medicine Physician, Dekalb Medical Center Dr. George S. Houlditch North Georgia Region 2 EMS Medical Director Dr. Alex Isakov Emory Flight Dr. Spencer King Dr. Jeffrey F. Linzer Pediatric Medicine, Children's Healthcare of Atlanta Dr. Bryan McNally Emory University School of Medicine Dr. Arch McNeill Emergency Medicine Physician, Archbold Memorial Hospital Dr. Jill Mabley Emergency Medicine Physician Dr. Mims Gage Ochsner, Jr. General Surgery, Trauma, and Surgical/Critical Care, Memorial Medical Center, Inc. Dr. Eric W. Ossmann Medical Director Grady Emergency Medical Service Dr. James Patrick O'Neal State EMS Medical Director, OEMS/T Dr. Dee William Pettigrew, III Emergency Medicine Physician, Athens Regional Medical Center Dr. Henry J. Siegelson Emergency Medicine/ Disaster Medicine, Emory University School of Medicine Dr. Eli Warnock Dr. Arthur H. Yancey, II Associate Professor Department of Emergency Medicine, Emory University School of Medicine 49 Appendix D Georgia Fast Facts Population, 2004 estimate Population, percent change, April 1, 2000 to July 1, 2003 Population, 2000 Population, percent change, 1990 to 2000 Persons under 5 years old, percent, 2000 Persons under 18 years old, percent, 2000 Persons 65 years old and over, percent, 2000 Female persons, percent, 2000 White persons, percent, 2000 (a) Black or African American persons, percent, 2000 (a) American Indian and Alaska Native persons, percent, 2000 (a) Asian persons, percent, 2000 (a) Native Hawaiian and Other Pacific Islander, percent, 2000 (a) Persons reporting some other race, percent, 2000 (a) Persons reporting two or more races, percent, 2000 White persons, not of Hispanic/Latino origin, percent, 2000 Persons of Hispanic or Latino origin, percent, 2000 (b) Living in same house in 1995 and 2000', pct age 5+, 2000 Foreign born persons, percent, 2000 Language other than English spoken at home, pct age 5+, 2000 High school graduates, percent of persons age 25+, 2000 Bachelor's degree or higher, pct of persons age 25+, 2000 Persons with a disability, age 5+, 2000 Mean travel time to work (minutes), workers age 16+, 2000 Housing units, 2002 Homeownership rate, 2000 Housing units in multi-unit structures, percent, 2000 Median value of owner-occupied housing units, 2000 Households, 2000 Persons per household, 2000 Median household income, 1999 Per capita money income, 1999 Persons below poverty, percent, 1999 U.S. Census Bureau 50 Georgia 8,829,383 6.1% 8,186,453 26.4% 7.3% 26.5% 9.6% 50.8% 65.1% 28.7% 0.3% 2.1% 0.1% 2.4% 1.4% 62.6% 5.3% 49.2% 7.1% 9.9% 78.6% 24.3% 1,456,812 27.7 3,487,088 67.5% 20.8% $111,200 3,006,369 2.65 $42,433 $21,154 13.0% U. S. 293,655,404 3.3% 281,421,906 13.1% 6.8% 25.7% 12.4% 50.9% 75.1% 12.3% 0.9% 3.6% 0.1% 5.5% 2.4% 69.1% 12.5% 54.1% 11.1% 17.9% 80.4% 24.4% 49,746,248 25.5 119,302,132 66.2% 26.4% $119,600 105,480,101 2.59 $41,994 $21,587 12.4% Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 429,538 No Red Lights and Sirens 197,781 Downgraded 961 Walk-in/Drive-up Upgraded 13,154 395 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 175,885 30,725 5,054 6,522 53,265 82,824 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 274,538 19,109 38,073 501 101,89 61,071 431 921 89,543 7,112 41,359 2,447 5,550 Year 2000 Total: 645,682 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 7,578 1,040 14,188 1,075 18,762 6,869 382,668 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 2,991 858 13 137 1,454 170 12,228 69,869 3,471 1,090 1,144 259 1,182 538 1,123 788 655 507 45,017 439 53 2,201 47,277 115 1,460 1,049 66 208 14,885 Destination Choice: Closest Law Enforcement Speciality Pt/Family Choice Managed Care On-Line Medical Control Pt Physician Protocol Diversion Trauma Center Other 116,457 6,351 6,015 327,407 6,126 1,528 66,779 12,568 1,902 2 6,889 Incident/Patient Disposition: Treated And Transported 387,432 No Patient Found 825 Treated Transferred Care 12,523 False Call Treated Transferred POV 3,034 6,121 Refused All 0 Treated And Released Assist At Home 12,150 3,332 Treated And Refused Trans 39,788 Dead At Scene 5,508 Transport Only 0 No Treatment Required Cancelled 12,461 25,715 N/A 28,017 Female Male Unknown African American 111,266 85,954 636 Asian 1,734 1,316 12 Calls By Race And Gender Caucasian Hispanic 189,233 155,484 1,046 4,901 7,160 83 Native American 250 193 2 Other 2,290 2,407 34 Unknown 15,501 12,582 49,583 51 Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 384,591 No Red Lights and Sirens 167,100 Downgraded 1,119 Walk-in/Drive-up Upgraded 4,476 285 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 278,970 42,123 8,363 10,726 38,077 128,957 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 252,154 17,291 12,295 453 88,598 50,394 175 2,605 71,184 5,465 37,810 1,642 4,855 Year 2001 Total: 560,989 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 4,445 1,021 11,021 1,061 6,162 7,903 360,356 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 1,430 624 10 133 1,421 143 10,846 60,738 3,001 867 996 200 1,035 461 1,000 288 446 602 38,902 418 37 1,443 43,064 1,258 1,477 1,003 40 205 68,049 Destination Choice: Closest Law Enforcement Speciality Pt/Family Choice Managed Care On-Line Medical Control Pt Physician Protocol Diversion Trauma Center Other 98,536 5,544 3,654 325,440 2,754 1,160 48,569 11,966 1,902 32 6,067 Incident/Patient Disposition: Treated And Transported 355,032 No Patient Found 4,969 Treated Transferred Care 8,591 False Call Treated Transferred POV 2,536 5,039 Refused All 0 Treated And Released Assist At Home 10,044 2,815 Treated And Refused Trans 35,628 Dead At Scene 4,976 Transport Only 0 No Treatment Required Cancelled 8,482 18,965 N/A 15,977 Female Male Unknown African American 106,439 82,692 381 Asian 1,588 1,238 21 Calls By Race And Gender Caucasian Hispanic 162,440 133,632 574 4,408 6,365 39 Native American 108 104 2 Other 1,337 1,425 14 Unknown 8,609 7,569 28,760 52 Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 266,543 No Red Lights and Sirens 103,187 Downgraded 818 Walk-in/Drive-up 974 Upgraded 212 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 205,802 33,289 5,447 7,882 1,964 92,636 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 171,840 11,444 14,440 441 58,411 6,803 51 8,171 48,862 3,156 12,089 1,208 2,828 Year 2002 Total: 379,538 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 3,325 489 3,699 2,176 764 95,726 139,501 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 801 344 3 816 896 92 6,675 39,135 1,750 506 540 115 576 268 655 285 259 199 24,741 267 26 671 18,353 128 955 585 28 168 53,989 Destination Choice: Closest Law Enforcement Speciality Pt/Family Choice Managed Care On-Line Medical Control Pt Physician Protocol Diversion Trauma Center Other 69,372 3,250 2,738 197,472 1,834 680 36,331 6,951 1,166 3 2,518 Incident/Patient Disposition: Treated And Transported 228,585 No Patient Found 4,675 Treated Transferred Care 5,702 False Call Treated Transferred POV 1,527 4,809 Refused All 0 Treated And Released Assist At Home 8,315 2,581 Treated And Refused Trans 23,687 Dead At Scene 3,380 Transport Only 0 No Treatment Required Cancelled 6,220 10,100 N/A 4,171 Female Male Unknown African American 70,512 54,558 37 Asian 886 778 2 Calls By Race And Gender Caucasian Hispanic 110,442 90,472 77 745 1,046 5 Native American 121 126 1 Other 157 175 3 Unknown 4,397 4,141 1,987 53 Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 233,485 No Red Lights and Sirens 93,490 Downgraded 526 Walk-in/Drive-up 811 Upgraded 197 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 185,622 27,021 4,201 7,082 630 78,538 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 152,382 9,136 21,092 350 48,965 355 44 9,345 42,373 5,727 4,224 1,280 2,189 Year 2003 Total: 337,085 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 2,564 406 3,031 3,709 604 80,306 85,636 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 540 278 4 62 919 67 5,549 32,871 1,606 368 389 100 523 272 547 107 176 189 21,465 254 26 486 11,612 41 813 467 21 119 33,412 Destination Choice: Closest Law Enforcement Speciality Pt/Family Choice Managed Care On-Line Medical Control Pt Physician Protocol Diversion Trauma Center Other 56,707 2,982 2,450 176,574 2,185 405 32,785 7,715 817 63 3,993 Incident/Patient Disposition: Treated And Transported 205,588 No Patient Found 4,334 Treated Transferred Care 6,415 False Call Treated Transferred POV 1,365 1,937 Refused All 0 Treated And Released Assist At Home 4,393 2,682 Treated And Refused Trans 22,992 Dead At Scene 3,231 Transport Only 0 No Treatment Required Cancelled 5,741 7,790 N/A 5,673 Female Male Unknown African American 63,180 49,445 33 Asian 761 578 6 Calls By Race And Gender Caucasian Hispanic 102,182 204 82,695 336 86 0 Native American 89 80 0 Other 32 20 129 Unknown 3,564 3,253 1,516 54 Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 306,034 No Red Lights and Sirens 102,813 Downgraded 764 Walk-in/Drive-up 861 Upgraded 212 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 241,160 32,487 6,057 10,019 816 100,934 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 199,779 10,801 29,780 454 64,906 464 67 15,922 48,112 3,606 3,792 448 2,789 Year 2004 Total: 425,452 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 3,100 471 3,431 1,580 459 85,123 61,758 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 656 375 4 72 1,193 137 6,910 41,748 1,614 477 503 109 665 260 630 75 207 216 25,905 297 29 559 15,261 42 788 636 25 121 70,565 Destination Choice: Closest Law Enforcement Speciality Pt/Family Choice Managed Care On-Line Medical Control Pt Physician Protocol Diversion Trauma Center Other 69,281 3,555 3,412 218,861 1,801 439 36,725 11,087 1,070 165 5,163 Incident/Patient Disposition: Treated And Transported 260,596 No Patient Found 5,343 Treated Transferred Care 8,849 False Call Treated Transferred POV 1,762 1,805 Refused All 0 Treated And Released Assist At Home 11,851 2,691 Treated And Refused Trans 26,367 Dead At Scene 3,800 Transport Only 0 No Treatment Required Cancelled 10,573 13,209 N/A 5,703 Female Male Unknown African American 80,948 61,491 64 Asian 1,061 741 7 Calls By Race And Gender Caucasian Hispanic 117,142 145 96,006 207 133 5 Native American 237 161 7 Other 29 36 444 Unknown 1,645 1,660 2,097 55 Appendix E Georgia Prehospital General Reports Response Mode to Scene: Red Lights And Sirens 312,472 No Red Lights and Sirens 121,704 Downgraded 781 Walk-in/Drive-up 977 Upgraded 333 Primary Clinical Area: Medical Cardiac OB/Gyn Psych Neonate Trauma 264,183 33,581 5,873 11,401 793 101,111 Location Of Call: Home/Residence Physician/Clinic Other Location Farm Street/Highway Unspecified Location Mine/Quarry Public Building Hospital Industrial Residential Educational Institution Recreation/Sporting 209,406 12,715 29,197 448 64,780 1,195 56 16,442 58,340 3,330 4,246 514 2,789 Year 2005 Total: 459,850 Environmental Causes: Abuse Neglect Alcohol Nutrition Housing Substance Not Applicable 2,499 393 2,919 1,313 398 73,295 79,670 Mechanism Of Injury: Accidentally Hit Machinery Radiation Aircraft Motorcycle Rape Assault Motor Vehicle Crash RX Overdose Bicycle GSW Assault Smoke Bite GSW Self-Inflicted Stabbing Electrical Heat Exposure Stings Falls Off Road Vehicle Suffocation Falling Objects Other Watercraft Fire Pedestrian Lightning GSW Accidental Unknown 581 482 5 58 1,406 111 6,436 38,806 1,692 464 461 82 720 270 566 66 213 173 25,828 408 36 541 14,758 41 756 676 23 135 63,883 Incident/Patient Disposition: Treated And Transported 261,189 No Patient Found 5,086 Treated Transferred Care 11,383 False Call Treated Transferred POV 1,860 1,295 Refused All Treated And Released Assist At Home 0 9,611 2,595 Treated And Refused Trans 22,906 Dead At Scene 3,564 Transport Only 0 No Treatment Required Cancelled 12,913 13,258 N/A 6,183 Female Male Unknown African American 74,618 57,242 40 Asian 953 687 3 Calls By Race And Gender Caucasian Hispanic 125,157 269 100,642 338 99 10 Native American 133 140 0 Other 36 37 832 Unknown 938 1,018 4,950 56 ACKNOWLEDGEMENTS No publication of this scope, complexity or magnitude could have been completed without the hard work and selfless contributions of numerous persons. No attempt to recognize or thank all of those who participated in the development of this publication is adequate. Many who provided their thoughts and experience will remain unnamed; however, all who participated are playing a strategic role in EMS in Georgia. Particular thanks goes to the each of the EMS Regional Program Directors and their dedicated staffs. Thank you. Georgia Department of Human Resources, Division of Public Health OFFICE OF EMERGENCY MEDICAL SERVICES/TRAUMA OFFICE OF EMERGENCY MEDICAL SERVICES/TRAUMA GEORGIA DEPARTMENT OF HUMAN RESOURCES, DIVISION OF PUBLIC HEALTH For additional information or copies of this publication, please write to: The Department of Human Resources, Division of Public Health Office of Emergency Medical Services and Trauma, Operations, Analysis, and Research Section 2600 Skyland Drive, Lower Level, Atlanta, Georgia 30319 The Georgia Emergency Medical Services Information System (GEMSIS) is supported in part by grant H33 Mc00125 from the Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. DPH 06/077HW