EMERGENCY MEDICINE

This is the first part of a

two-part series on REMSA.

In 1986, multiple ambulance companies in Washoe County competed for patients and had no public accountability. The chaotic service resulted in poor patient care and sent two ambulance companies into bankruptcy.

In response, a blue-ribbon commission that included representation from Washoe County and the cities of Reno and Sparks created REMSA, which stands for Regional Emergency Medical Services Authority.

This year, REMSA turns 30. The non-profit, integrated healthcare system provides multiple programs including Care Flight, which celebrates 35 years this year.

REMSA operates solely on user fees with no tax support.

In 1986, REMSA employed 50 people. In 2016 it has 500 in five program divisions.

REMSA’s Care Flight division has four helicopters and bases in Reno, Truckee, Gardnerville, Fallon and a new base in Beckworth, east of Portola.

REMSA’s ground division includes 43 paramedic-level equipped ambulances. On busy days, there may be 20 to 23 ambulances in the field. Slower days, 17 to 18 are deployed.

The software system that directs it all, as well as modern equipment, helps the Communications Center’s emergency medical dispatchers to efficiently and quickly answer 911 calls and dispatch the appropriate transport.

“It’s totally amazing to me even after 41 years,” said REMSA President and CEO Dean Dow, a veteran in emergency medical services with experience that ranges from emergency medical technician to hospital administration and time spent in ground and air ambulances. Dow replaced retiring Jim Gubbels in March.

“We have a robust software program that everyone is monitoring,” Dow said. “It covers multiple years of monitoring (activity) to determine how many and where to send them.

“It’s not a static system. (The ambulances) aren’t parked at bases. We move them around constantly depending on the number of calls at a particular time. It’s constantly in motion.”

The maneuverability of the system reduces response times. Paramedic units must respond to emergencies within eight minutes, at least 90 percent of the time. REMSA consistently surpasses that goal, according to its website.

REMSA is much more than ambulances and helicopters.

Its Tactical Emergency Medical Support (TEMS) division works with law enforcement SWAT members. This team is comprised of eight specially trained, tactical paramedics and nurses, as well as a team leader and team commander. The team provides advanced emergency medical care during police activities to injured officers, hostages, suspects, and the general public.

Begun in 1997, the TEMS team has responded to 96 call outs and participated in 190 trainings in the past two years, according to its website. Equipped with special medical gear, TEMS team members work and train alongside SWAT and are required to maintain the same excellent physical condition as all other SWAT team members.

REMSA also includes a extensive education division.

The REMSA Training Center is a private, Nevada-licensed post-secondary educational institution that offers courses for the public, first responders, EMT, advanced EMT, paramedics, nurses, physicians, and businesses.

“It’s literally almost like running our own junior college to take someone who’s wanting to get into emergency medicine and train them,” Dow said.

It’s also recognized as one of the best in the nation, he said.

The training center comes in handy when it’s time to find new hires.

Each REMSA ambulance is staffed either by a paramedic or EMS-RN plus an intermediate level EMT. Care Flight helicopters carry a flight nurse and a flight paramedic.

Dow said that, although it’s hard to judge whether an applicant has the ability to quickly think on his or her feet, what they look for in an emergency medical services applicant is compassion, understanding, good common sense and someone who can be a quality representative of the organization and the community.

“Whether in an ambulance or a helicopter, they’re actually being asked to take on a lot of decision making on their own,” Dow said. “They follow policies and procedures, but we’re placing them in very serious settings, clinical and stressful settings and they’re required to think through and solve issues in a short period of time.”

The elements that make REMSA what it is today create an emergency medical service organization that sets Washoe County apart.

“When you look at our organization, we’re nationally unique,” Dow said.

All its major divisions are nationally accredited, he said. Plus the community health program is known as one of the best in the nation.

Most emergency medical systems provide one aspect, such as just paramedics, that might be accredited.

“An organization that has all the components under one roof and is accredited nationally, is unique, then couple that with the fact that we’re not for profit.”

A lot has changed in the 30 years since the creation of REMSA, and the years since Dow began his career in emergency medical services.

“Radios, medical technology, IT, computers, all those things are light years away from what we were doing 40 years ago,” he said.

“Being able to support those clinicians and deliver the right amount of medical care, that part hasn’t changed in 40 years.”

Next week: REMSA prepares for the future.