Brazos Valley Regional Advisory Council
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EMS Roles and Funding

There are five levels of certification and licensure for individual EMS personnel. A ground ambulance, therefore, can be staffed with many combinations of technicians and medics.

ECA

An Emergency Care Attendant is certified by DSHS in the most basic emergency medical response, including a minimum of 40 hours of training in CPR, splinting, oxygen delivery and control of bleeding.

EMT Basic

An Emergency Medical Technician-Basic is certified by DSHS as minimally proficient to perform emergency prehospital care that is necessary for basic life support, which includes the control of hemorrhaging (bleeding) and CPR. EMT-Basics receive no less than 140 hours of specialized training and must pass the National Registry test prior to certification.

EMT Intermediate

An EMT-Intermediate is certified by DSHS as minimally proficient in performing skills required to provide emergency prehospital or interfacility care by initiating and maintaining, under medical supervision, certain procedures that include intravenous (IV) therapy and endotracheal and/or esophageal intubation. EMTIntermediates receive no less than 160 hours of specialized training and must pass the National Registry test prior to certification.
EMT-Paramedic An EMT-Paramedic is certified by DSHS as minimally proficient in providing emergency prehospital or interfacility care by providing advanced life support that includes initiationand maintenance, under medical supervision, of certain procedures that include IV therapy, endotracheal and/or esophageal intubation, electrical cardiac defibrillation and cardioversion, and drug therapy. EMT-Paramedics receive no less than 624 hours of specialized training and must pass the National Registry test prior to certification.

Licensed Paramedic

In addition to being certified by DSHS as proficient in the same skills as a certified paramedic, a licensed paramedic has an associate’s degree in EMS or a bachelor’s or postgraduate degree from an accredited educational institution.

EMS Ground Transport

The medical director for each licensed EMS provider is responsible for determining the service’s scope of practice and thus the levels of ambulances the service will provide. Each level of ambulance is determined by the personnel working on the ambulance. Six levels of care can be provided by EMS
ground crews.

BLS (Basic Life Support)

When response-ready or in-service, authorized EMS vehicles operating at the BLS level shall be staffed at a minimum with two emergency care attendants (ECAs).

ALS (Advance Life Support)

When response-ready or in-service, authorized EMS vehicles operating at the ALS level shall be staffed at a minimum with one EMT-Basic and one EMT-Intermediate.

MICU (Mobile Intensive Care Unit)

When response-ready or inservice, authorized EMS vehicles operating at the MICU level shall be staffed at a minimum with one EMT-Basic and one EMT-Paramedic.

BLS with ALS capability

When response-ready or in-service below ALS, staff will include at least two ECAs. Full ALS status becomes active when staffed by at least an EMT-Basic and an EMTIntermediate.

BLS with MICU capability

When response-ready or in-service below MICU, staff will include at least two ECAs. Full MICU status becomes active when staffed by at least an EMT-Basic and a certified or licensed paramedic.

ALS with MICU capability

When response-ready or in-service below MICU, staff will include at least one EMT-Basic and one EMTIntermediate. Full MICU status becomes active when staffed by at least an EMT-Basic and a certified or licensed paramedic.

EMS Air Transport

Air medical transport is provided by two means—fixed wing (airplanes) and rotor wing (helicopters). Patients being transported longer distances usually go by fixed wing aircraft, which are faster and can fly farther. Rotor-wing aircraft can go directly to a scene and land, then transport the patient to the nearest appropriate facility. Typically, rotor wing aircraft don’t transport great distances, but are used for shorter inter-facility transports, as well as on-scene flights. The medical crew aboard either type of aircraft usually includes a registered nurse with EMS certification and a paramedic. Additional medical staff may be incorporated as needed, including respiratory technicians, specialty nurses or doctors. Any hospital located near an airport or a landing strip has access to fixed-wing transport. Rotor-wing services are typically located in or near cities with a higher concentration of people and may fly out to treat patients in rural areas.

First Responder Organizations

A first responder organization (FRO), formally, is a group or association of certified emergency medical services personnel that does not transport patients but works in cooperation with a licensed emergency medical services provider to: routinely respond to medical emergency situations; utilize personnel who are EMS-certified by DSHS; and provide on-scene patient care to the ill and injured. In practice, FROs are most commonly created where geography or the needs of the local population demand a supplement for the designated EMS provider. An FRO can be established by a person or organization able to respond to a specific area quickly. The personnel must hold at least ECA certification and be directly affiliated with a licensed EMS provider. An FRO does not transport patients but is able to give care appropriate to the provider’s certification level until EMS arrives. For example, if a small town in a large rural county determines that the nearest base for the county EMS provider is too far away to give immediate care, the town may establish its volunteer fire department as an FRO.

EMS Funding


EMS providers


County/City department

An EMS provider may be funded by the county or city with tax money from the general budget and the revenue it generates. Staffing may be paid, volunteer, or a combination; 9-1-1 service is typically the main function of the department, although some patient transfer services may also be offered.

Private, for-profit company

Private EMS companies can contract with a county or city to provide services and may receive a subsidy from the county or city or both. They are staffed by paid personnel. A private EMS company may be contracted to provide 9-1-1 service or it may exist only as a patient transfer service (non-emergency delivery to a care facility or transfers between care facilities).

Hospital-based

An EMS provider may be funded by hospitals or hospital districts and the revenue they generate, and may receive additional tax funding. Staffing may be paid, volunteer, or a combination.

Emergency service districts

Created by local voters, emergency service districts (fire and/or EMS) are funded by a dedicated tax. The ESD tax rate is set by the voters up to a statutory maximum. Staffing may be paid, volunteer, or a combination. The funds may be used to contract with an existing nearby service or may be used to create a new local service.

State grant programs

Three grant programs administered by DSHS serve EMS; each is dependent on funding from the Legislature for each biennium. The DSHS Local Projects Grant Program distributes $2.6 million per biennium to pay for EMS personnel certification training; specialty training related to prehospital health care management; communication equipment; patient care equipment, including ambulances and non-disposable supplies; injury-prevention projects and continuing education programs. The Extraordinary Emergency Fund helps EMS, hospitals, and first responder organizations recover if unforeseeable events severely reduce or incapacitate emergency response capability. Finally, DSHS distributes $50,000 per year to sponsor ECA training in rural and frontier areas.