Episode 43| FirstNet: Meeting the Needs of a Texas Rural Emergency Medical Service
Thomas Randall, FirstNet Authority Senior Public Safety Advisor
Chad Edgar, Firefighter and Paramedic, Sacred Cross EMS, Denton, Texas
Narrator: You're listening to Public Safety First, a podcast to help you learn about the First Responder Network Authority and how you can be part of the future of public safety technology.
And now, your host.
Thomas Randall: Welcome to the Public Safety First podcast. I’m Thomas Randall, and I serve as a Senior Public Safety Advisor with the First Responder Network Authority. I’m joined today by Chad Edgar, a firefighter and a paramedic from Sacred Cross EMS in Denton, Texas. Sacred Cross EMS has been on FirstNet for about a year now. I had the pleasure of working with Chad and the team from Sacred Cross EMS at the Texas EMS Conference in Fort Worth several months ago, and we had a great conversation about the positive experiences that their team has had with FirstNet. We’re pleased that he could join us today. Welcome to the podcast, Chad.
Chad Edgar: Thank you, Tom.
Thomas Randall: Great. Well, tell us a little bit about yourself, a little bit about Sacred Cross EMS, and I want you to talk to us a little bit about the unique challenges you all face in north Texas.
Chad Edgar: Okay. My name is Chad Edgar. I’ve been involved in the fire service since 1996. I put in a year volunteering for Frisco Fire Department, and then was hired on full-time with Flower Mound Fire Department, where I did 22 years of service and recently retired from there. I’ve been involved with Sacred Cross now, which started in April of 2008. The owner was a friend of mine and I started helping him out with it, and after my retirement, I made the merge over here, and I was already functioning as basically like a part-time clinical manager and doing special events and helping out with wherever I could, and after my retirement, I merged full-time. I’m the clinical manager, the designated infectious control officer, and I handle all of the special events for the company, including the one we’re going to talk about here shortly – Rednecks with Paychecks, which we’ve heavily utilized FirstNet and their services for.
Thomas Randall: Great, great. Well, you talked a little bit about Charles Hinkle, the owner. What do you and Charles see as some challenges you guys have in rural Texas, up in the north part of the state?
Chad Edgar: So, we have two divisions. We have our typical private ambulance transfer division that’s out of Denton. It’s pretty much our flagship, runs the heaviest portion of our call volume. And, we don’t have major issues here – we do have some areas where we have poor service, and our radio system is also limited because of that, as well. So, we fall back on it for that. Our 9-1-1 division is out of Palo Pinto County, around the area of Possum Kingdom Lake, and it has multiple areas of poor coverage, or no coverage, for cell and for radio, and it’s been a challenge for us out there logistically, safety-wise, all that stuff, because our crews can go out there and run calls and be in an area where they need to call for secondary services, whether it be the sheriff’s department, the law enforcement side, whether it be calling for air medical assistance to air evac a patient to a trauma center or more capable hospital that gives a higher level of care for STEMIs and strokes, or if they just need to call for assistance from the fire department for even something as simple as a lift assist, they just need some more manpower to help get somebody up or get them moved somewhere they need to help those citizens out, and they have limited areas where they can talk.
In addition to that, the way the county is set up with its infrastructure, the roads out there are not conducive to responses, because pretty much, the center of county is 100% encompassed by large ranches, farms, and hunting properties and stuff, so if you need to travel north to south or east to west, there’s only really one way, and east to west is right through the middle of it, and there’s one up top, and then you have I-20 down in the bottom of the county, and then to go north to south, there’s only two roads, really, that cover it completely north to south, and you have to go to the far sides of the county east to west to travel those. So, depending on where we have calls coming out of, we have to move trucks around so that we can still provide the highest level of coverage for those citizens. And with the infrastructure the way it is, it makes it difficult, and then trying to coordinate it, through all the dead cell service areas and dead radio areas, it drastically hampers the operation, and sometimes we get two trucks in one place that don’t need to be there because they couldn’t communicate and they are both trying to do the right thing.
Thomas Randall: Does the communications infrastructure match like what your population base looks like, where you’ve got more coverage in the city, but your rural parts of the county are lacking?
Chad Edgar: Yeah, and, I mean, predominately, the whole county is rural. The county seat is actually a small town called Palo Pinto, which is a very small town. The only decent sized town they have there is, a city called Mineral Wells, which is pretty much the dead center on the eastern edge of it, and the rest of it is, I would say 95% rural, very sparsely populated area. There’s a lot of large ranches and farms and hunting properties and stuff out there. So, from a radio perspective for our trucks, and from a cell perspective, it doesn’t have the priority for top service. I’ve experienced some of it. Several years back, they had a major wildfire out there, and between all the residents that were still there and all the emergency services that were in there, it completely shut down the entire cellular network.
Thomas Randall: So, last year or so, Sacred Cross EMS joined FirstNet. How does the organization use the network as part of your everyday operations?
Chad Edgar: So, currently we’re using it primarily and only, solely just for the cellular portion of it – communicating amongst crews, communicating with dispatch centers and stuff like that. Moving forward, we’re looking at expanding it to all phases of it, you know. We’re in the process currently right now of purchasing new cardiac monitors that are truly the next generation of cardiac monitors, and that was one of the first questions we asked them, because they do have telemedicine capabilities on them, and the first question I asked was, “are you all Band 14?” and it took, like, three or four engineers before they could figure out whether they were or not, and the answer came back yes they are, and they could accept the FirstNet.
We got tablets that were Band 14 capable so we could use those for our ePCR [electronic patient care reporting] reporting. We’ve seen a lot less drops in service and a lot more functionality out of them, where our crews could continue documenting and working to run reports the entire time they’re on the call, and not depending on having to be back at the station and under WiFi or, you know, better service area, in order to get their documentation, so, we can see more accurate documentation out of it, as well.
Thomas Randall: Right. So, with Sacred Cross EMS, it’s not just a cellular connection, or a cell phone – you’re looking at your tablets, your devices, and you’re looking really at telemedicine and trying to expand that in north Texas also, correct?
Chad Edgar: Exactly. I mean, it’s just – the technology is there, and, you know, it’s time to embrace it and quit trying to run from it. We need to progress with the technology that’s out there and use that so we can truly be patient advocates and do all that we can for our patients, you know, versus the old days where you call in on radio, or, as it progressed, you could call in on cell phone to your medical director and get some orders based on a report. Well, now we actually have, if we go with this cardiac monitor, we have a monitor we can pick up and we can do video teleconferencing, and the physician can actually see the patient, can interact with the patient, and get treatments on board that we previously may not have been able to because that physician can be more involved in it from the get-go.
Thomas Randall: I can see where there’s a lot of benefit there for a rural agency like yourself, being able to do things of that nature, especially when you’re out in some of the far reaches of the county.
Chad Edgar: Absolutely. I mean, our 9-1-1 division is truly rural EMS. You know, as a standard, they see anywhere from 25 to 40-minute transport times for patients, whether that be critical, non-critical, and, when it gets down to it with the critical patients, if a helicopter can’t fly, they’re looking at anywhere from an hour, hour and a half transport times to trauma centers or more capable, higher levels of care facilities back into Fort Worth. So, you know, we’ve recently, I’ve recently went through and updated all of our protocols, and I would say we probably have some of the most aggressive protocols in the state of Texas, based on the need that those guys have out there for their time of treatment, and that we needed to get them more treatment capabilities in order to deliver the service to the citizens out there that they need because of the length of time that it’s going to take to get them to a hospital ER with a physician and all that. And I think the telemedicine aspect of it coming up and stuff could dramatically improve that even more, because we could expand those capabilities even further with utilizing that tool, and basically have that physician in the back of the ambulance with you.
Thomas Randall: That’s great. I’m glad you guys are being proactive in moving things forward for your agency and for that region. I want to talk a little bit about the events that you guys have up there. So, twice a year, you guys get thousands of folks that come to Saint Jo, Texas, to have some off-road fun, out in the mud with their ATVs [all-terrain vehicles], their 4x4 trucks. Can you tell us about the Rednecks with Paychecks event, the role that you guys at Sacred Cross EMS play, and how you all used FirstNet in the last event?
Chad Edgar: So, we’ve been doing Rednecks with Paychecks since 2011. Like you said, it’s an off-road event. It’s what I would call a residency event. It lasts for four days, and during that four-day time period, 24/7, we’re providing EMS service out there, just like a 9-1-1 service would. The biggest difference to it is, is it is an off-road park with mud, bumps, horrible roads, all that stuff, and it only gets worse as the participants get out there and start tearing them up even more. So, you know, we have to change up our tactics, and we’ve steadily changed them over the years to adapt to it so we can provide better service. So, when we’re on property out there, we run four MICU [mobile intensive care unit] ambulances that are staged at the front of the property because it’s not safe or conducive to drive those ambulances out there in that element. And then we have two UTV [utility vehicle] side-by-sides, Kawasaki Mules, outfitted with a patient transport on the back of them, and we call those our rescues, which are staffed with two firefighter paramedics that are also trained in rope rescue, extrication, and all that stuff. And then our primary medic gets on there with them, and they will respond out to where the incidents are, mitigate that incident there, and then bring them back out to the front of the park where our ambulances are staged, load them into the ambulance, and then go from there.
In addition to that, we also have a designated landing zone site on property that we utilize in conjunction with the air medical partner of ours, and during peak hours, or our busiest hours, if conditions allow for it, they have a helicopter on site that we can utilize because we do get, we get quite a bit of trauma out of there that we see on a pretty regular basis. It has drastically improved over the years, but with that, we have anywhere from 10 to 15,000 people on site, and you still get the medical conditions and all that stuff, as well, because we have a population anywhere from 18 up into the 60s. The majority of the people are probably 20s to 30s, but we have seen heart attacks, we’ve seen strokes, we’ve seen seizure disorders, we’ve seen other metabolic conditions out there.
Thomas Randall: Alright. So, what other public safety agencies are you in communications with during the event, and why is the interoperability with them so critical?
Chad Edgar: So, we get calls basically three different ways. We get people that come up to either ourselves, other members of the Rednecks with Paychecks staff, whatnot and say, “Hey, there’s been a wreck over here,” “Hey, somebody’s sick over here.” We have people that will actually drive all the way to our campsite and tell us, and then we also have people that will utilize 9-1-1. So, the Montague County Sheriff’s Office dispatch center, over the past about four events, we’ve become more integrated with them, and making it a more streamlined, simpler way of them getting the call to us rather than sending it out through the county. So, we talk to them on a regular basis. We coordinate with them. The law enforcement element out there – DPS [Department of Public Safety], state troopers, game warden, but the heaviest portion of it is a private security company that we work very well with and they’ve been out there for many years, and they’re all cross-trained with fire, EMS, and law enforcement. They assist us with our needs. We assist them, as well. And, the ability to talk back and forth, get assistance to where you need it, is just, it’s a have to, in order to serve the population out there and mitigate whatever events may go down, and through a unified command with them and with Montague County Sheriff’s Office improved responses and capabilities out there dramatically over the years, and I would say we’re almost a single functioning at unit this time, and the communications are paramount for it. And, with the addition of the FirstNet SatCOLT that we had out there at the previous event, it made communications night and day, because we all have radios that we use, and that helped some, but sometimes you just, a radio’s not enough. You need to make a phone call or send a text or any of that stuff, and the ability to do that out there, where previously the cell network out there was completely shut down by that many people in that small, dense of an area, it just, there’s no way it could keep up.
Thomas Randall: Great. Well, that segues into the question I was going to ask about the connection from FirstNet and how that provides you seamless communications, and did it show that you were able to decrease your response times based on your FirstNet connectivity?
Chad Edgar: Absolutely. Especially with the calls that we get coming in through the Montague County Sheriff’s Office, there was always a delay there with them getting a hold of us, being able to relay good information to us, which is limited with any dispatch system, because you’re depending on a layperson, and these people out here, it’s not, there on an area that they’re not as familiar with as we are, so they don’t always know exactly how to tell you where they’re at, or know the nicknames for different areas like we do. So, it’s helped dramatically with that. And in addition to that, the ability for us to communicate with the two local hospitals so that we can triage patients through there and not overwhelm one facility, and, you know, disperse out any surges and transports and stuff like that, so that once the patients physically get to the hospital, they can get what they need. They’re not being set aside because they have too many patients at one facility – we can better disperse patients through communications with the hospital to allow them to function with their jobs and their abilities and still get the patients what they need.
Thomas Randall: So, you touched on the SatCOLT a minute ago. Talk a little bit more about how the FirstNet SatCOLT supported the operations of the event compared to your previous years’ events.
Chad Edgar: So, our first event that we got to use it in was last fall, and it was mentioned to us by Trevlin Pitner that that’s an option that we have if we wanted to look at it to bring out there, and we jumped all over the opportunity, hoping for the best, didn’t know what we were going to get out of it. And pretty much from a cellular wireless network, and even from the ability to use the internet, we pretty much went from being completely in the dark to having unlimited capabilities. I mean, as the incident commander out there, I was able to utilize my cell phone to contact hospitals, contact crews, contact other agencies, talk to the hospitals, talk to the air medical helicopters coming in, going out – all that. Talk to the event coordinators out there that run the event from the Rednecks with Paychecks side and I was able to do it just like I was sitting in my living room at home with my WiFi. Never, I mean there was no lag time, whether I needed to get on the internet and look something up, you know, to get the landing zone coordinates or anything. There was no lag time whatsoever. Never had an issue one time getting a cell phone call out, where as before, we had to do like the commercial, walking around with the phone to the ear saying, “Can you hear me now?” until we could find a spot that you had service, and that was even limited previously. So, the ability to have that communication tool and make the contacts and the phone calls and the use of the internet and all that stuff was just amazing. It made my job go from difficult and frustrating to very functional and as easy as it could be.
Thomas Randall: Can you tell me a little about the level of support that you received from the First Responder Network Authority team leading up to the event and event itself?
Chad Edgar: Absolutely. They said they’d bring it out there and set it up, and it had a generator with it. So, we made plans, we figured, you know, well, we’re going to fill up the fuel on it every day, just like we do with our generators and our equipment that we bring out there. They came out there – the original site that we planned for it but they made a recommendation to move it to a different area that was a better site for it. Every morning from 7:30 to 8 o’clock, the gentleman from FirstNet was there. He checked out all the equipment on the truck, he refilled the generator, he came over and asked if there was anything else we needed, if there was any issues with it, everything. Helped us get set up on it from when they brought it out and dropped it off, and then, unfortunately, due to the weather, when they went to remove it, it took a bulldozer to pull the truck and the generator out of the area where it was at due to heavy rain and lots of mud. But, the service was truly first to none. I mean, it was very surprising.
Thomas Randall: Well, sounds to me that it was a success, and I’m really happy that the FirstNet Authority and AT&T FirstNet were able to provide you all a secure and reliable connection. So, as we close out the podcast, we wanted to ask you if you have any advice for any other EMS departments about joining the network. What would you tell them?
Chad Edgar: I’ve told multiple departments about the SatCOLT. I told them, I said, “Y’all got to get one of these and utilize it.” I said, you know, “It makes things so much easier and so much better.” It’s an emerging technology that everyone needs to embrace, and it can only improve with the more people that embrace it and utilize it, it becomes more functional, more demand for it, and with the demands comes the improvements.
Thomas Randall: Great. Well, thank you for joining us today, Chad, and thanks to Charles Hinkle and the entire team at Sacred Cross EMS for working with us on this, and we hope to visit with you all again soon.
Chad Edgar: Thank y’all very much. We appreciate y’alls assistance and what y’all have brought to us.
Narrator: Thanks for listening today. We're excited to have you join our podcast community. Make sure to subscribe on iTunes, SoundCloud, and YouTube. You can learn more about the First Responder Network Authority at FirstNet.gov and learn about FirstNet products and services at FirstNet.com.