Brazos Valley Regional Advisory Council
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Challenges Facing EMS and Trauma Systems in Texas

Texas: A Big State with Large Rural/Frontier Areas

The health care system in Texas provides care to one of the largest and most diverse populations in the country, bordering four states and Mexico. Texas has a population total of about 25 million people, making up almost 8 percent of the total population of the United States. Additionally, Texas has approximately 3.2 million people residing within its rural and frontier counties.

Recruitment/Retention Challenges:

Lower salaries

Salaries for EMS personnel are low in comparison with other health care fields, especially in rural and frontier areas. At the same time, the cost and time required to meet educational requirements can be high. Each individual interested in attending an EMS course must take into account the necessary steps to become certified, and balance the possible hardships, including the financial and time burdens. Especially in rural and frontier areas, these burdens can deter individuals from pursuing EMS as a career.

Reliance on volunteers in rural/frontier areas Because call volume and city/county income can be very low in sparsely populated areas, many areas in rural and frontier Texas rely on volunteer personnel to provide EMS, and recruitment can be especially difficult.

Training may be costly or difficult to access Specific to rural and frontier Texas, problems such as the lack of initial training, especially advanced training, and fewer opportunities for continuing education can hamper local efforts to train EMS crews and keep certifications current.

Over-use in urban areas

Challenges to employee recruitment and retention in urban areas include high call volumes, rapid job burnout and a high turnover rate of employees. Daily traffic congestion and related transportation problems getting to and during a shift make it easy to understand how a career in urban areas can be as challenging as one in rural areas.

EMS/Trauma Systems Are Costly:

Staff training

Providing staff training can be a costly, though vital, part of operating an EMS organization. Although initial training is typically paid for by the individual employee, many providers offer continuing education as a way to ensure their employees remain fully qualified. For those who choose to renew certifications via continuing education, specific hours must be earned every four years in a variety of subjects. ECAs must complete 36 hours, EMT-Basics must complete 72 hours, EMT-Intermediates must complete 108 hours, and EMTParamedics and licensed paramedics must complete 108 hours.In addition, designated trauma and stroke facility personnel are required to maintain certain certifications such as Advanced Trauma Life Support.

Maintaining Equipment

Many ambulances are old, and costs to repair them are prohibitive for smaller departments. In addition, hospitals must provide certain equipment to maintain trauma and stroke designations.

Reliance on city/county/state funding

The need for adequate funding affects EMS and trauma systems across the state regardless of location. All EMS providers and trauma facilities have seen an increased demand for services in the last few years, usually without an increase in funding. As outlined in the Funding section, EMS providers depend mostly on local funding, and the trauma system, including the designated trauma facilities, depends mostly on state disbursed funds. Changes in the budgets for cities, counties and the state frequently have a direct impact on the levels of service Texas citizens can expect.