When both the Journal of Emergency Medical Services and the local alternative weekly newspaper, the Austin Chronicle, run stories on purported issues with the local EMS system, there’s something seriously wrong.   ATCEMS may not truly meet the definition of an EMS system in crisis as defined by the International City/County Management Association, but there’s two indicators to me of trouble. One, the union’s push for civil service, from my sources and own observations, stems from a core lack of trust in leadership’s decisions, particularly in promotions. Second, I remember when this was an EMS system that attracted paramedics from across the country.  Not so much these days, despite being one of the better paying EMS systems.

I don’t have the answers to chic everything or else I’d be a highly paid EMS consultant. But I can start with two suggestions.  One, cut out the paramilitary training academy and FTO process that turns off experienced medics.  Two, bring in some outside people into middle and upper management.  ATCEMS’s operational and clinical management has become too much of an echo chamber of itself.  New ideas never hurt any organization, especially one that’s sadly stagnating. 

As for the issues with the rivalries and turf wars with Travis County, I have a simple solution.  Honesty.  I have no issues with the medical director allowing — or not allowing — first responder agencies to provide patient care above the EMT level.  But if you’re going to allow it, provide for a fair, transparent credentialing process.  If it’s not going to be allowed, just say so rather than hiding behind a vague concept of credentialing that hides the ball from everyone.

I’ve had many great experiences with Austin EMS, both as an EMT first responder and as a family member of patients.  I’ve also been disgruntled by some of their management decisions.  But as a resident of Austin, I truly do hope that we can have a great EMS system again rather than an EMS system that used to be great.