Excellence in Public Service since 1974
Thurston County's Medic One / Emergency Medical Services (EMS) System was established in 1974, completing 40 years of public EMS service. It was the first public, county-wide, tiered response, EMS system in the United States. The Medic One/EMS System provides a fire services based basic and advanced life support emergency medical and trauma care and transport to over 265,851 residents within the county's 727 square miles. The EMS System responded to 28,630 EMS calls with paramedics responding to 8,622 calls and transporting over 3,562 life critical patients during 2014. The Medic One System’s paramedic units responded with a countywide average response time of 7.0 minutes. The paramedic units accomplished an overall 94% county-wide response goal achievement for response goals of 10 minutes urban, 20 minutes suburban and 30 minutes rural classified areas.
The approach is to involve all jurisdictional entities as participants in the system rather than a sole provider approach. Fourteen fire departments/districts are providers of Basic Life Support (BLS) and are certified at First Responder or Emergency Medical Technician (EMT) levels. All Fire/EMS agencies function with one or more Aid vehicles (55 BLS units provide countywide coverage), averaging 6.7 minutes countywide. Protocols were updated 2015 to add Pulse Oximetry and Blood Glucose assessment to BLS skillset. All BLS agencies have been auto-defibrillation capable since 1986 and EpiPen qualified (epinephrine for severe allergic reactions) since year 2000. Most fire agencies are primarily volunteer with the exceptions of the larger municipal departments. Olympia, Tumwater and Lacey Fire District # 3 are integrated as county-wide providers of Advanced Life Support (ALS) staffing seven units. Paramedic transport units are dual-role (EMS and fire services) personnel and staffed with two paramedics. The System enhanced paramedic services by adding a Single Paramedic Rapid Intervention Non Transport (SPRINT) Unit to the south western county area on July 1, 1998. A second SPRINT unit was added July 1, 2000 to address paramedic response times to west Olympia and northwest Thurston County. The goal of the SPRINT unit is to improve ALS level response time and paramedic transport unit availability. SPRINT #14 unit was stationed at Grand Mound, had simultaneous response with the Tumwater ALS transport unit and both units are managed by Tumwater Fire Department. In January 2010, SPRINT 14 was upgraded to half time full paramedic transport unit at the same location. In 2012, the final phased transition was completed to a full time dual paramedic staffed Medic 14. SPRINT unit #10 north western county was upgraded in 2002 to a full dual staffed paramedic transport unit after the 2001 Nisqually Earthquake due to accessibility issues with northwest county and west portion of Olympia. Medic unit #10 (formerly SPRINT unit #10) is managed by Olympia Fire Department. Implemented in 2006, was a peak hour, dual paramedic staffed ALS transport unit, Medic unit # 6. The Medic 6 unit is stationed in the Hawks Prairie/northeast county area to respond to growth in the Lacey Urban Growth Boundary area and is managed by Lacey Fire District #3. In 2012, Medic 6 began phase up to a 24 hour dual paramedic unit by adding staff in each year, full staffing was completed in 2014. Two private ambulance companies, Olympic and American Medical Response (AMR), provide basic life support EMS and inter-facility transport. Private ambulance companies provide four full-time BLS transport units and additional for peak load times. The System is further supported by a private non-profit EMS helicopter service, AirLift Northwest, stationed at the Olympia Airport.
The EMS System is activated by the public through an enhanced 9-1-1 (E 9-1-1) phone system to a central dispatch center. Thurston 9-1-1/Communications (TCOMM) receives 9-1-1 calls and dispatches county-wide police, fire and EMS assistance. On January 1, 2011 CAPCOM became an independent PSAP/Dispatch agency and is now Thurston 9-1-1 Communications (TCOMM). The entire radio system was converted to narrow band in 2012/2013. NextGen 9-1-1 is in the process of being implemented 2014/2015. Fire/EMS units are dispatched on a single frequency with frequency assignment to one of several response/operational frequencies. Dispatchers use predetermined questions to decide the type and level of unit to dispatch. In 2011, TCOMM and Medic One implemented a pilot Automatic Vehicle Locator (AVL) system to test Geographic Information System (GIS) dynamic map based dispatching module to assist locating closest Medic One ALS units to the call. The AVL pilot was terminated in 2012 for dispatch software incompatibility. Dispatchers are trained to give pre-arrival aid instructions to citizens awaiting arrival of EMS units. The System converted to a three level response system of Criteria Based Dispatch (CBD) on July 1, 1998. The Dispatch system implemented a fourth “Telephone” subcategory of the non-emergency response level on June 1, 2001. The dispatch system routes the “Telephone” category of non-emergency calls to a 24 hour nurse HealthLine, 166 calls in 2014 were routed to HealthLine. The nurse HealthLine provides a better level of medical care to 9-1-1 callers not needing an emergency unit response. In 2009, the System implemented a process for on scene personnel to access the HealthLine. Medic Units respond with BLS units on any potentially life-threatening situations. The first BLS units to arrive on the scene communicate with the incoming Medic Unit. Medic Units may communicate care instructions or when medically appropriate the Medic Unit may be canceled. Medic Units handle all prehospital ALS, life-critical transports. When Medic Unit response times are extended, BLS agencies may transport and rendezvous with responding Medic Units. The paramedics operate from both "standing orders/protocols" and on-line communication with the Base Station hospital at Providence St. Peter. The Base Station determines the medical priority needs of the patient. The Base Station may authorize ALS transport, BLS transport or cancellation of EMS care. Private ambulances transport most non-life threatened BLS patients.
Medical communications is over cellular phone and/or HEAR (Hospital Emergency Administrative Radio). Two hospitals are designated to receive EMS patients, St. Peter Hospital and Capital Medical Center. Both hospitals and TCOMM have compatible radio equipment to insure > 90 % communication coverage county-wide. The Thurston County EMS System participates in a state wide Trauma Center system. In 2012, Thurston County implemented a program to be included in a statewide Cardiac and Stroke center system. Cardiac and Stroke patients meeting state criteria may be transported to cardiac and stroke specialty centers. Implemented in 2005, was an in-vehicle data systems linking ALS units with the Dispatch center and county hospitals via digital radio modem. Private ambulances are capable of hospital and system communication. Disaster situations are coordinated on a designated VHF (very high frequency) band. Washington Hospital Emergency Radio System (WHERS) capability was added to all medic units for additional communication capability.
Disaster situations are coordinated through pre-plans, fire Incident Command System, TCOMM, and Thurston County Department of Emergency Management. The EMS System maintains pre-positioned disaster resource trailers that can respond to the site with additional disaster medical supplies and equipment. Medic One is capable of immediately placing, additional fully equipped Medic Units in service by calling back paramedic staff.
All initial and specialized county-wide BLS training and over 125 required EMS continuing education classes are provided through the Medic One office. Implemented in 2008, is a BLS on-line, on-going training and evaluation program (OTEP) being provided through contract with King County Medic One. Monthly ALS continuing education, run reviews and quality management are provided by the Medic One system. Paramedics spend in-service training time at the Base Station for skill maintenance, patient follow-up and continuing education. Paramedic employment and county-wide EMS personnel certification testing are provided through the Medic One office.
The Emergency Medical Program Director (EMPD) is staffed and paid by the Medic One office. The EMPD provides medical direction and authorization for system function. Prehospital standing orders/protocols, dispatch protocols, certification, training, testing standards, medical quality assurance and medical disciplinary actions are the EMPD's responsibility. An Assistant MPD was added to the EMS System in 2012 to supplement EMPD training and Quality Improvement functions. In 2012, EMPD medical support was initiated to Thurston County SWAT. EMS protocols were converted to a smart phone app in 2012.
BLS agencies use a county designed Medical Incident Reporting (MIR) form to document all EMS patient care. MIR’s may be reviewed at the Medic One office for quality assurance and quality improvement under a state approved QI plan. ALS reports are input on a central, in-vehicle, electronic data processing system. The Medic One system is developing a pilot for integration of ALS and BLS systems to electronically process all EMS reports by 2015.
The policy making body is the Thurston County Board of County Commissioners (BoCC). Advisory to the BoCC and the Medic One office is the Thurston County EMS Council. The EMS Council was modified in 2014 and is made up of 15 members: three citizens-at-large, one citizen-at-large countywide physician, a BoCC representative, three Fire Commissioner representatives, a City of Olympia representative, a City of Lacey representative, a City of Tumwater representative, a Fire District # 3 representative, a south county Mayors representative for suburban/rural cities, and non-voting members the Chair of Operations Committee and the EMPD.
The Medic One office staff is responsible for developing and implementing system policies and procedures, recommended by the EMS Council and authorized by the Board of County Commissioners. The Medic One office is responsible for county-wide: system coordination, county to region system integration, equipment/supply purchase, staff support to the EMS Council/committees, EMS provider initial BLS training, EMS continuing medical education, system quality management (QM), ambulance licensing and system financial administration. The office provides county-wide citizen CPR training and system education. In 2014, CPR Training was provided to 3,289 citizens in 286 classes. In 2011, Public Access Defibrillator (PAD) training was added to the citizen CPR classes. The CPR program was enhanced in 2013 to add High School CPR training with 1,491 high school students trained in 55 classes during 2014. PAD trains citizens how to use a public automatic external defibrillator (AED) as part of the CPR programs. In 2007, the Medic One system implemented a county-wide SafeKids (national childhood trauma prevention program) by partnering with Thurston Child Care Action Council. SafeKids provides child car seat fitting/education, bicycle helmet fitting/education, water safety education and other child trauma prevention programs.
The full-time Medic One staff is composed of: administrator, administrative assistant, BLS training/QM supervisor, BLS training coordinator, ALS training/QM supervisor, Information Systems technician, purchasing/CPR coordinator, data entry/receptionist. The part-time Medic One staff includes: Emergency Medical Program Director, assistant EMPD, training support and CPR outreach coordinator. CPR and continuing education instructors are part-time or contract personnel.
The 2015 Medic One/EMS System is funded by a $9.9 million county-wide regular EMS levy (rate @ 37.1 cents/$1,000 assessed value) for the county-wide EMS program. The funding is used across the System with emphasis on full-time paid paramedic response and transport coverage. The current Medic One/EMS program budget is dispersed as follows: 79% to ALS activities, 14.5% BLS activities, 4.5% to administration, 2% for CPR/public information activities.
2703 Pacific Avenue SE , Suite C
Phone: 360 - 704 - 2780 (voice)
360 - 704 - 2781 (FAX)
Home Page: www.TCMedicOne.org