A Decade of Growth and Innovation

The third decade of the Tidewater EMS Council (1994–2004) began and ended much the same – the organization reorganized to address the changing landscape of EMS. In between, new medical devices, preparedness, terrorism, quality improvement, and ambulance diversion were major themes.

Leadership and Committee Changes

As the third decade began, under the leadership of President Donald A. Haupt, Jr., the council modified and added several new committees. Notably, the Mobile Intensive Care (MIC) Committee, which had served the council since the 1970s and fostered the development of advanced life support (ALS) in the region, was changed to the Prehospital Care Committee. This change reflected the organization’s desire to emphasize a greater range of system components such as resources, public education, disaster, leadership, research, and dispatch. That committee also began annual meetings with the emergency department nurse managers from throughout the region.

Increase in EMS Agencies and ALS Provision

The number of EMS agencies and ALS provision in the region jumped at the beginning of the third decade. Between 1989 and 1994, the number of EMS agencies in the region increased from 49 to 61. At the same time, the number of agencies providing cardiac or paramedic level ALS care increased from 20 to 32. This increase in ALS was mainly in Western Tidewater and the Eastern Shore.

Trauma Patient Destination and Triage

Trauma patient destination took on new meaning. What began as a general discussion of the best destination for trauma patients during the early part of the council’s third decade gave way to a full-blown state legislative requirement for trauma triage, formal regional trauma triage plans, and quality improvement processes. The region’s first trauma triage QI committee met in 2001.

EMS Staffing and Support

Western Tidewater EMS Council

Daytime staffing was the main topic for the new Western Tidewater EMS Council, chaired by Charles Darden, which formed in 1994 as a subcouncil under TEMS using the Eastern Shore EMS Council model. After several years of discussions and proposals to Southampton and Isle of Wight Counties, both counties adopted strategies for staffing. In 2000, Isle of Wight County began hiring paid EMS workers to support the county’s two EMS agencies. In 2001, Southampton County sought proposals for daytime EMS coverage and awarded a contract to Medical Transport. The Western Tidewater EMS Council went dormant soon after.

EMS Family Picnic and Community Engagement

The council continued its annual EMS family picnic and awards program, which grew to around 600 attendees at Chesapeake City Park. In 2001, the picnic moved to the Virginia Zoo in Norfolk, where attendance grew to around 900 in 2004. Other promotional activities during the decade included multi-agency EMS Week mall displays, wrecked car displays encouraging seat belt usage, mass CPR training, Rotary Club and other community presentations, and EMS Night at Harbor Park.

Emergency Medical Dispatch

An Emergency Medical Dispatch (EMD) committee developed a standard curriculum for the region’s 9‐1‐1 communication centers and during the decade most localities adopted some version of EMD. The committee helped teach EMD classes and also created a standard instructor‐trainer curriculum.

The Tidewater Regional Technical Rescue Team held annual heavy and technical rescue schools and celebrated its 10th school in 1994. By the end of the decade, FEMA support enabled construction of a much improved training site at the Virginia Beach Fire Training facility.

State-Level Developments

EMS and Fire Department Consolidation Proposal

During the council’s third decade, there was a proposal to incorporate EMS and fire into a Department of Public Safety. After public hearings and outcries, EMS was later withdrawn from the proposal. The 1994 Virginia EMS Symposium held in Norfolk was attended by 1300 registrants and staff and by 1997 the number hit 1500 and continued to grow.

EMS Advancements and Legislative Changes

In 1995, Virginia rolled out the new assessment-based national standard EMT-Basic curriculum and the EVOC requirement began. In 1996, longtime state EMS director Susan McHenry retired, and consolidated EMS test sites were created. In 1997, Gary R. Brown was appointed state EMS director. Numerous attempts to increase the $2‐for‐life state EMS funding to either $3 or $4‐for‐life were tried and failed before $4‐for‐life finally passed the General Assembly and signed by the Governor in 2003.

EMSSTAR Regional Council Study

A large statewide study of regional EMS councils by EMSSTAR in 1998 reaffirmed the need for regional councils but encouraged accountability and changes to promote sharing of best practices. Also in 1998 the state EMS for Children program began. In 1999 the state began to look at using the national EMT‐I in place of the cardiac tech program, and the future of the shock trauma program was in question.

Making Progress

By 2000 EMS data reporting was required either by submission of paper reports or electronic data. In 2003 Virginia Office of EMS moved from its suburban Glen Allen location to the health department building in downtown Richmond. The EMS community was concerned with parking and access. In 2004 the General Assembly’s JLARC completed a comprehensive statewide EMS study. A process to regulate and re‐designate regional EMS councils started in 2004.

Preparedness and Terrorism

Mass Casualty Trailers and Regional Disaster Response

Perhaps with a bit of foresight, in 1994 the council obtained a state RSAF grant to purchase 10 mass casualty trailers, one for each locality. The acquisition was rocky as the original vendor defaulted after building 6 of the trailers, and their quality was questionable. However, during 1995, a second vendor completed the project. Chesapeake Fire Department led the way and designed the original interior layout and stocking plan that was adopted by all. By 1997 five trailers were stocked and in service; others followed.

Terrorism and Major Events

The council’s third decade was also the time our nation became all too familiar with terrorism and mass shootings, including the 1993 World Trade Center bombing, the 1995 Oklahoma City bombing, the 1999 Columbine High School shooting, and the 9/11 attacks on America in 2001.

Ambulance Diversion

Addressing Emergency Department Overcrowding

In 2002, it appeared emergency department overcrowding and ambulance diversion was at its worst. Attempting to address the issues, a “round robin” patient distribution concept was added to the existing ambulance diversion policy, and TEMS joined several other EMS councils in the utilization of EMSystem, a web-based ambulance diversion/hospital bed status program. Into 2003 the diversion problems continued but were better documented using the web‐based system and this enabled a certain amount of “peer pressure” on the hospitals indicating highest amounts of diversions. EMS and ED leadership were in unison that the issues needed to be addressed at hospital corporate levels. This eventually led to a major regional fact‐based diversion meeting in 2004.

Formation of the Governance and EMS Committee

A new Governance Committee was added by the Board of Directors as a result of a consultant’s study showing the need to improve governance, board diversity and board development. Also, a new main EMS committee was formed: the EMS Medical Operations Committee representing the EMS leadership throughout the region and other stakeholders such as hospital pharmacists, public health, ED nurses and special operations.

VA DMAT-1

Virginia‐1 Disaster Medical Assistance Team formed in 1974 as a partnership between Norfolk Fire‐Rescue, York County Department of Life Safety and the Virginia Office of EMS, with TEMS providing a home base and administrative support. Sentara Norfolk General and Riverside Regional Medical Center were designated as Regional Healthcare Coordinating Centers (RHCC), as part of a new federal Hospital Preparedness Program, with roles to be refined in the coming years.

Sadness and Tragedy

Loss of Key Figures

The regional EMS system was saddened by the passing of two well-known figures: Frank M. Yeiser, Jr., MD, who died in 1995, and James M. Wagenbach, who died in 2003. Wagenbach was the long-time Franklin City fire chief who retired in 1998 after 33 years of city service. He was an original EMS steering committee member which eventually became the TEMS Council, and was a TEMS charter director who served for 28 years. He was recognized near and far as an EMS instructor and for his contributions to the American Heart Association as a BLS instructor, instructor trainer and affiliate faculty. In 1995 he was named to the AHA Hall of Fame. Following his death, the TEMS board renamed its annual EMS instructor award in Wagenbach’s honor.

Firefighter Line of Duty Deaths

In 1996, two firefighter line of duty deaths occurred in Chesapeake. There was an outpouring of sympathy and support from the region’s public safety community and numerous interventions by the critical incident stress debriefing team. The tragic event led to improvements to the city’s radio communications and building inspection practices. That year also marked the 10th anniversary of the regional CISM team and the Tidewater Regional Technical Rescue Team. The council’s third decade was also the time our nation became all too familiar with terrorism and mass shootings.

Other Notable Events

1994:

• Rose 1, a converted golf cart, is used for special event patient movement.
• "Rusty" Blow is named as operations manager for Medical Transport.
• Multiple volunteer fire departments in Suffolk are licensed as first responders to improve EMS response times.
• 2,300 attend the annual VAVRS convention in Virginia Beach.

1995:

• FLSA issues emerge.
• Accomack County tells its fire/EMS employees to stop volunteering in the county.
• TRTRT suspends training due to FLSA issues.

1996:

• TEMS obtains a regional CLIA waiver for glucose monitoring devices for 9-1-1 EMS agencies.
• Norfolk purchases the Tabernacle Church on Granby Street and will convert it into a fire/EMS training center (dedicated in 1998).
• Norfolk Southern donates $12,000 to help equip MCI trailers.

1997:

• Stewart Martin, MD, succeeds Donald Haupt as council president.
• Rob Glover is hired as the first public safety director for Accomack County.
• Federal anti-kickback issues arise related to ambulance restocking by hospitals.
• Northampton-Accomack Memorial Hospital opens a new emergency department.
• Don Haupt is named fire chief for Norfolk.
• Long-time Virginia Beach fire chief Harry Diesel and Chesapeake Fire Chief Michael Bolac retire.
• DePaul Hospital installs hyperbaric chambers.
• Steve Cover succeeds Chase Sargent as commander of the Tidewater Regional Technical Rescue Team.

1998:

• Sentara Leigh Hospital installs hyperbaric chambers.
• TEMS publishes a Bereavement booklet modeled after a similar publication at Sentara.
• Eastern Shore EMS Council establishes an areawide infection control committee.
• Chincoteague separates 9-1-1 from the rest of the Eastern Shore and establishes its own communication center.
• Region begins development of a template ambulance restocking agreement in cooperation with other EMS regions, the Virginia Hospital Association, and the Attorney General’s office. The effort concludes in 1999, and all TEMS hospitals and EMS agencies sign the agreement.
• Year 2000 (Y2K) concerns develop: Will EMS medical equipment be impacted?
• The Internet domain vaems.org is secured for use by the EMS councils.

1999:

• TEMS celebrates its 25th anniversary.
• Atlantic Communications awarded a contract to replace all HEAR base stations and antennas at the region’s hospitals.
• Several North Carolina EMS agencies adopt TEMS protocols.
• Philip G. Leavy, Jr., MD, a TEMS charter director, steps down after serving 25 years on the TEMS board.
• Portsmouth Naval opens a new hospital.
• The two rescue squads in Suffolk obtain funding to purchase "Andy the Ambulance" for public education.
• Sentara adopts a new logo.
• Operation Measured Response Hampton Roads tests some 700 responders.

2000:

• The Y2K computer meltdown is avoided.
• The Tidewater EMS council reviews its structure and services, consolidating several committees to avoid fragmented decisions.
• Kenneth R. Murphy, long-time EMS director in Chesapeake, retires.
• A regional ALS preceptor program is developed.
• Norfolk Fire Chief Don Haupt relocates to Coral Springs, Florida.
• Network Medical Systems graduates its first paramedic class.
• Nansemond-Suffolk VRS celebrates its 40th anniversary.

2001:

• Nansemond-Suffolk places an ambulance and crew at the Chuckatuck fire station to improve response times.
• The Eastern Shore EMS Council holds an art auction.
• Norfolk unveils a GIS system linked to fire and EMS calls, zoning, census information, inspections, photography, and maps.
• Child safety seats are required in ambulances.

2002:

• Sentara Obici opens a replacement hospital in Suffolk.
• On move day, 63 patients are transported using 27 ambulances and 104 EMS providers.
• Maryann Fitchett succeeds Scott R. Chandler after 21 years as president of the Eastern Shore EMS Council.
• The new website (www.woocommerce-1221446-4353955.cloudwaysapps.com) is implemented.
• Norfolk Fire-Rescue adopts its new name.
• A regional EMS Quality Improvement committee is established, mirroring the success of the Trauma Triage QI committee.

2003:

• EMS Pioneer James O. Page is a guest speaker at the Virginia Beach Emergency Coronary Care Program’s 30th Anniversary.
• Hurricane Isabel causes substantial damage throughout Hampton Roads and beyond.

2004:

• The council’s program and staff outgrow the donated offices at Eastern Virginia Medical School, prompting a search for new space.

Originally published in the Tidewater EMS Council RESPONSE newsletter, March/April 2014.

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