Heart of Texas Regional Advisory
Council (HOTRAC)
Trauma Service Area (TSA) - M
Regional STEMI Plan
Heart of Texas Regional Advisory Council (HOTRAC)
405 Londonderry, Suite 201
Waco, Texas 76712
Email: info@heartoftexasrac.org
For the service delivery area including
Bosque, Falls, Hill, Limestone, and McLennan Counties.
Phone: (254) 761-7890
Fax: (254) 761-7895
HOTRAC Regional STEMI Plan
March 2011
Page 1
Table of Contents
Introduction
Organization
Service Area/ Facilities
Regional Plan
TSA M – EMS Providers (Ground)
TSA M – Air Medical Providers
TSA M – Acute Care Facilities
System Participation
System Access
Communications
Regional Pre-hospital Medical Oversight & Control
Pre-hospital Triage
Helicopter Activation
Facility Diversion
Facility Bypass
Facility Triage Criteria
Inter-hospital Transfers
Regional STEMI Form
System Performance Improvement
Statement of Confidentiality
HOTRAC Regional STEMI Plan
March 2011
3
3
3
4
5
9
18
19
20
20
27
28
28
29
29
30
30
33
34
36
Page 2
Introduction
Organization and Service Area
Organization
The Heart of Texas Regional Advisory Council (HOTRAC) is comprised of the Central Texas counties of Bosque, Falls, Hill,
Limestone, and McLennan. The HOTRAC was organized and completed the incorporation process in 1994, and became
an approved 501 (c) (3) organization in 1995.
The HOTRAC Vision Statement is be a lead Regional Advisory Council in the State of Texas that achieves improved quality
of life by reducing morbidity/mortality for emergency healthcare conditions within our Trauma Service Area. The mission is
to reduce death/disability related to acute illness and injury by providing infrastructure and leadership necessary to sustain
an inclusive acute care, trauma, emergency medical, and disaster system in all phases within our Trauma Service Area.
Service Area/Facilities
The HOTRAC Service Area is comprised of four rural counties (Bosque, Falls, Hill, and Limestone) and one suburban
county (McLennan). The terrain in this region is primarily Black-land prairie with rolling hills located in the Bosque county
area. Interstate 35, a heavily traveled transportation artery, transects McLennan and Hill Counties and is the source of
many multi-vehicular crashes annually. Also heavily traveled State Highway 6 traverses McLennan, Falls and Bosque
counties, while Limestone counties transportation primarily occurs via farm-to-market roads.
Bosque County encompasses 989.3 square miles and has a population of 17,631 lives. Goodall-Witcher Healthcare
Foundation is a 40-bed acute care facility located in Clifton, Texas. Goodall-Witcher has surgical capability. One EMS
service provides 9-1-1 service in Bosque County.
Falls County is located in the southern most part of this Region and encompasses 769 square miles. The county population
is 16,782. Falls Community Hospital in Marlin is a 44 bed facility and is centrally located. There is one EMS service that
provides 9-1-1 service in Falls County.
Hill County is located in the northern portion of the region and encompasses 962 square miles. The county population is
35,840 persons. Hill Regional Hospital is a 92-bed acute care facility with surgical capability. A second facility is Lake
Whitney Medical Center which is located in the western portion of the county. Lake Whitney Medical Center is a 49-bed
acute care facility. Three EMS providers provide 9-1-1 services in Hill County.
Located in the eastern-most portion of the region, Limestone County includes 909 square miles of primarily farm and ranch
land. The population in Limestone County is 22,287 persons. Parkview Regional Hospital is a 77-bed acute care facility
with surgical capability. Limestone Medical Center is a 20-bed acute care facility (which does not have surgical capability).
Three EMS providers provide 9-1-1 service in Limestone County.
McLennan County is the only suburban county in the region and covers 1041.9 square miles of Central Texas and has a
total population of 233,378 persons. Waco is the largest city in the county (population approximately 121,496) and contains
two acute care hospitals: Hillcrest Baptist Medical Center and Providence Health Center. Both facilities are capable of
providing Percutaneous Coronary Intervention (PCI) care. Providence Health Center is a 230-bed acute care facility with
surgical capability. Hillcrest Baptist Medical Center is a 393-bed acute care facility with surgical capability. The other
hospitals located in Waco are psychiatric facilities. These facilities are Central Texas Veterans Healthcare System – Waco
Campus and Waco Center for Youth. There are five EMS services that provide 9-1-1 services in McLennan County.
HOTRAC Regional STEMI Plan
March 2011
Page 3
Regional Plan
This Plan has been developed in accordance with generally accepted STEMI guidelines and procedures for implementation
of a comprehensive Emergency Medical Services (EMS) and STEMI System plan. This plan does not establish a legal
standard of care, but rather is intended as an aid to decision-making in general patient care scenarios. It is not intended to
supersede the physician’s prerogative to order treatment.
Due to the rural areas in this Region, the HOTRAC promotes and supports First Responder Organizations (FRO) and
Volunteer Fire Departments (VFD) in order to help ensure expedited pre-hospital emergency care for its residents.
STEMI Patient
The classification of STEMI patients is based on a standard definition of “the STEMI patient” which is applied in a consistent
manner in both the pre-hospital and hospital setting.
The STEMI Patient - In TSA-M, the STEMI patient is defined as any patient presenting with symptoms of an acute
myocardial infarction and/or left bundle branch blockage and/or 1mm of ST-elevation in two contiguous EKG leads.
HOTRAC Regional STEMI Plan
March 2011
Page 4
HOTRAC – TSA M
EMS 9-1-1 PROVIDERS (Ground)
(see attached map on page 8 of this document for service areas)
CareFlite
Jan Cody –
(
Fax –
Dispatch –
Level of Service –
Medical Director –
Number of Vehicles –
Central Texas EMS
Jason Haisler - Manager
Marlin, TX
(254)
Fax – (254)
Dispatch –
Level of Service –
Medical Director – Dr. Steven Ellerbe
Number of Vehicles - 3
Crawford EMS
Marilyn Judy – President
P.O. Box 341
Crawford, Texas 76638
(254) 486-2101
Fax – (254) 486-2198
Dispatch – McGregor Police Department (254) 840-2855
Level of Service - BLS
Medical Director – Dr. George Smith
Number of Vehicles - 1
Hillsboro Fire Dept. & EMS
Chief Tony Cain – Director of Public Safety
P.O. Box 568
Hillsboro, Texas 76645
(254) 582-2401
Fax – (254) 582-9155
Dispatch – City of Hillsboro (254) 582-2141
Level of Service – BLS with ALS capabilities
Medical Director – Dr. Richard Jackson
Number of Vehicles – 2
HOTRAC Regional STEMI Plan
March 2011
Page 5
ETMC – EMS
Dale Yates – Regional Director
1501 Hogan Lane, Ste. H
Waco, TX 76705
(254) 799-7718
Fax – (254) 799-2363
Dispatch – EMTC Tyler (800) 255-2011
Level of Service – MICU
Medical Director – Dr. William Moore
Number of vehicles – 13
Lake Whitney Medical Center EMS
Jimmy Hoskins – Director
103 N. Colorado Street
Whitney, Texas 76692
(254) 694-9706
Fax – (254) 694-9708
Dispatch –
Level of Service - BLS with MICU capabilities
Medical Director – Dr. Richard Jackson
Number of Vehicles - 3
Limestone Medical Center EMS
Shelton Chapman - Director
701 McClintic Dr.
Groesbeck, Texas 76642
(254) 729-3097
Fax – (254) 729-3532
Dispatch – Limestone County Sheriff’s Office (254) 729-3278
Level of Service – BLS with MICU capabilities
Medical Director – Dr. Mark Hoeschele
Number of Vehicles - 3
McGregor EMS
William Heath – President
PO Box 237
McGregor, Texas 76657
(254) 840-2528
Fax – (254) 840-2528
Dispatch – McGregor Police Department (254) 840-2855
Level of Service – BLS with MICU capabilities
Medical Director – Dr. Jon Daniell
Number of Vehicles - 2
Mart EMS
James Fullner – President
P.O. Box 335
Mart, Texas 76664
(254) 876-3322
HOTRAC Regional STEMI Plan
March 2011
Page 6
Fax – (254) 876-3332
Dispatch – McLennan County Sheriff’s Office (254) 757-5222
Level of Service - MICU
Medical Director – Dr. Jon Daniell
Number of Vehicles - 2
Mexia Fire Dept & EMS
Mike Clements – EMS Director
P.O. Box 207
Mexia, Texas 76667
(254) 562-4188
Fax – (254) 562-2569
Dispatch – Mexia Fire Department (254) 562-4150
Level of Service – BLS with MICU capabilities
Medical Director – Dr. Yong Chin
Number of Vehicles – 3 Ambulances
North Bosque EMS
Linda Catena – EMS Director
P.O. Box 119
Meridian, Texas 76665
(254) 435-2070
Fax – (254) 435-2560
Dispatch – Bosque County Sheriff’s Office (254) 435-2362
Level of Service – BLS with MICU capabilities
Medical Director – Dr. Kevin Blanton
Number of Vehicles – 3
Scott & White EMS
2401 S. 31st Street
Temple, TX 76508
(254) 724-8080
Fax – (254) 724-0019
Dispatch – via MedCom
Level of Service – BLS with MICU capabilities
Medical Director – Dr. Robert Greenberg
Number of vehicles- 16 (total)
West Volunteer Ambulance Service
Tom Marek – Supervisor
P.O. Box 461
West, Texas 76691
(254) 826-3779
Fax – (254) 826-3231
Dispatch – (254) 826-3778
Level of Service – BLS with MICU capabilities
Medical Director – Dr. George Smith
Number of Vehicles - 3
HOTRAC Regional STEMI Plan
March 2011
Page 7
HOTRAC – TSA M
EMS 9-1-1 PROVIDERS (Ground)
HOTRAC Regional STEMI Plan
March 2011
Page 8
HOTRAC – TSA M
EMS 9-1-1 PROVIDERS (Air)
(see maps on next pages of this document for service areas)
Air Evac LifeTeam – West (AEL 51)
Steven Clinkscales, Regional Manager
Cell (417) 293-2626
405 Meadow Drive
West, TX 76691
Base – (254) 826-0521
Fax – (254) 826-0520
Dispatch – 800-247-8322
Medical Director – Dr. Brian Price
Air Evac LifeTeam – Killeen (AEL )
2407 S. Creek Clear Road
Killeen, TX 76549
Base – (254) 628-1275
Fax – (254) 628-2710
Dispatch – (800) 247-3822 or (800)568-6806
Medical Director – Dr. Philip Chapa
Air Evac LifeTeam – Fairfield (AEL 53)
160 S IH 45
Fairfield, TX 75840
Base – (903) 389-7266
Fax – (903) 389-7352
Dispatch – 800-247-8322
Medical Director – Dr. Brian Price
Air Evac LifeTeam – Ennis (AEL 74)
3004 West Ennis Ave.
Ennis, TX 75119
Base – (972) 875-8216
Fax – (972) 875-6963
Dispatch – 800-247-8322
Medical Director – Dr. Frank Chappa
Cell – (417) 274-8722
Base – (817) 579-2031
Fax – (817) 579-2034
Dispatch – (800) 247-3822 or (800)568-6806
Medical Director – Dr. Philip Chapa
PHI STAT Air 1 – Killen Skylark Field
Brittany Misercola, Business Relations Supervisor
Jeff Brown, Base Supervisor
Base - (254) 680-3644
Fax – (254) 680-3573
Dispatch – 800-456-7477
Medical Director – Dr. Jeff Jarvis
PHI Air Medical 6 – Corsicana
Lora Murphy, Flight Nurse
(214) 395-6033
9000 Old Navarro Road
Corsicana, TX 75109
Fax – (903) 872-0201
Dispatch – 877-435-9744
Medical Director – Dr. Roy Yamada
PHI Air Medical 12 – Bryan
Billy Rice, Base Supervisor
Base (936)
Fax –
Dispatch –
Medical Director – Dr.
Air Evac LifeTeam – Granbury (AEL 69)
Martha Headrick, Base Manager
HOTRAC Regional STEMI Plan
March 2011
Page 9
Air Evac LifeTeam – 51 (West)
HOTRAC Regional STEMI Plan
March 2011
Page 10
Air Evac LifeTeam –
HOTRAC Regional STEMI Plan
March 2011
(Killeen)
Page 11
Air Evac LifeTeam – 53 (Fairfield)
HOTRAC Regional STEMI Plan
March 2011
Page 12
Air Evac LifeTeam – 74 (Ennis)
HOTRAC Regional STEMI Plan
March 2011
Page 13
Air Evac LifeTeam – 69 (Granbury)
HOTRAC Regional STEMI Plan
March 2011
Page 14
PHI STAT Air 1 (Killeen Skylark Airfield)
*divide the air miles by 2 for approximate ETA in minutes (i.e., 30 miles = 15 min ETA).
HOTRAC Regional STEMI Plan
March 2011
Page 15
PHI Air Medical 6 (Corsicana)
*divide the air miles by 2 for approximate ETA in minutes (i.e., 30 miles = 15 min ETA).
HOTRAC Regional STEMI Plan
March 2011
Page 16
PHI Air Medical 12 (Bryan)
*divide the air miles by 2 for approximate ETA in minutes (i.e., 30 miles = 15 min ETA).
HOTRAC Regional STEMI Plan
March 2011
Page 17
Heart of Texas Regional Advisory Council – TSA M
TSA-M Acute Care Facilities
Facility
Falls Community Hospital
(254) 803-3561
Fax (254) 803-6066
Goodall-Witcher
Healthcare Foundation
(254) 675-8322
FAX- (254) 675-8964
Hill Regional Hospital
(254) 582-8500
FAX- (254) 582-2144
Hillcrest Baptist Medical
Center
(254) 202-2000
FAX-(254) 202-6605
Lake Whitney Medical
Center
(254) 694-3165
FAX-(254) 694-3299
Limestone
Medical Center
(254) 729-3281
FAX-(254) 729-3080
Parkview Regional Hospital
(254) 562-5332
FAX-(254) 562-9279
Providence Health Center
(254) 751-4000
Fax: (254) 751-4769
HOTRAC Regional STEMI Plan
March 2011
Location
PO Box 60
Marlin, TX 76661
Falls County
44 beds
PO Box 549
101 South Ave. T
Clifton, TX 76634
Bosque County
40 Beds
101 Circle Drive
Hillsboro, Texas 76645
Hill County
92 Beds
100 Hillcrest Blvd
Waco, Texas 76706
McLennan County
393 Beds
PO Box 468
Whitney, Texas 76692
Hill County
49 Beds
701 McClintic
Groesbeck, TX 76642
Limestone County
20 Beds
600 S Bonham
Mexia, Texas 76667
Limestone County
59 Beds
6901 Medical Parkway
Waco, TX 76712
McLennan County
230 beds
AVERAGE
DAILY
CENSUS
HOSPITAL-BASED
EMS SERVICE
ED
DIRECTOR
Administrator
15-20
No
Tammy Samford,
RN
Willis Reese
CEO
12-15
No
Joyce McDowell,
RN
Clarence Fields
President & CEO
30
No
Annie Tucker, RN
Jan McClure
CEO
175
No
Tamra Acierni, RN
Glenn A. Robinson
President & CEO
10-15
Yes
10-12
Yes
George Black, RN
Penny Gray
CEO
30
No
Marcy McFarland,
RN, BSN
vacant
CEO
175
No
Eileen Bohannon,
RN
Kent Keahey
President & CEO
Ruth Ann Crow
Administration
Page 18
System Participation
All HOTRAC General Assembly meetings are open to any interested persons. Meeting notices and reminders are emailed
to the membership well in advance of all meetings, and meeting notices are posted on the HOTRAC website. Minutes of all
meetings are emailed and provided at each meeting, along with a meeting agenda. Active Participation in the RAC is
defined as the following:
A.
EMS Provider Agencies
1.
2.
3.
4.
5.
6.
7.
B.
Hospital Members
1.
2.
3.
4.
5.
6.
7.
8.
9.
C.
Will have representation at 75% of General Assembly Meetings.
Will participate in a minimum of one (1) standing committee and will have representation at
75% of that committee meetings.
Will submit information into the Trauma Registry and attend any meeting when the agency
has a referral on the agenda.
Will demonstrate participation in at least one HOTRAC sanctioned prevention activity
annually and submit documentation of such.
Will submit required Performance Improvement data upon request.
Will have physician representation at 75% of the Physician Advisory Committee meetings.
Will participate in one community disaster preparedness drill per year.
Will have representation at 75% of General Assembly Meetings.
Will participate in a minimum of one (1) standing committee and will have representation at
75% of that committee meetings.
If applicable, will have Trauma Coordinator attend at least 75% of the Hospital Care &
Management Committee as well as participate in the Trauma System Plan development.
If applicable, will have Stroke Coordinator attend at least 75% of the Stroke Committee as
well as participate in the Stroke System Plan development.
Will have physician representation at 75% of Physician Advisory Committee Meetings.
Will demonstrate participation in at least one HOTRAC sanctioned prevention activity
annually and submit documentation of such.
Will submit information into the Trauma Registry and attend any meeting when the agency
has a referral on the agenda.
Will participate in 75% of scheduled preparedness activities.
In the event of emergency healthcare activations, will participate as required by the Health
& Medical Annex of the County Emergency Operations Plans and/or the Health & Medical
Appendix of the Regional Response Plan.
Non-EMS/Hospital Entities
1.
2.
3.
Will have representation at 75% of General Assembly Meetings.
Will participate in a minimum of one (1) standing committee and will have representation at
75% of that committee meetings.
Will participate in at least one (1) scheduled regional preparedness activity.
Meeting attendance may be met in person, via conference call, or via webinar.
D.
Each member entity will complete an annual Regional Needs Assessment by the 1st of March of
each year.
HOTRAC Regional STEMI Plan
March 2011
Page 19
E.
Membership Dues must be paid in full by each member by the 1 st of March of each year.
Membership dues is charged as follows:
Hospitals - $500.00
9-1-1 EMS Providers (including Air Medical) - $250.00
Other Members (i.e., FROs, Emergency Management, etc.) - $50.00
Individuals - $25.00
Participation from each organization is encouraged. The Bylaws are reviewed each year and revised as appropriate. Each
component of the Regional STEMI Plan is presented, discussed, and approved by the HOTRAC General Assembly, Board
of Directors, and Physicians Advisory Committee. All revisions are reviewed and approved through the same process. Once
approved, complete copies of the Regional Trauma Plan will be distributed to the HOTRAC membership.
System Access via 9-1-1
Goal
The Goal for System Access within TSA-M is two-fold. First, rapid access to notification of the need for emergency cardiac
care at any location within TSA-M must be available to all persons in the Region. Second, Emergency Medical Services
(EMS) must be rapidly available to provide quality health care to injured or ill persons in each HOTRAC Community. In
portions of this Region, First Responder Organizations (FRO) may provide initial treatment pending EMS arrival.
Objectives
1. To ensure that all persons located in Trauma Service Area M will have the availability to access Emergency Dispatch
for EMS services.
2. To ensure emergency healthcare providers have communication equipment available.
3. To strive to maintain an adequate number of first responders and EMS providers that have the knowledge, skills, and
equipment needed to provide emergency care to persons requesting assistance within the Region.
Discussion
The 9-1-1 communications system provides a dedicated phone line allowing direct routing of emergency calls through a
telephone company central office to a Public Safety Answering Point (PSAP). Routing is based on the specific telephone
exchange area rather than municipal boundaries. Enhanced 9-1-1 includes Automatic Number Identification (ANI) and/or
Automatic Location Identification (ALI). Enhanced 9-1-1 also automatically routes emergency calls to a pre-selected
answering point based upon the geographical location from which the call originated. Each of the five HOTRAC counties
has enhanced 9-1-1 with ANI/ALI capability.
The 9-1-1 Advisory Committee of the Heart of Texas Council of Governments is responsible for the development,
performance evaluation, and administration of the 9-1-1 system in rural HOTRAC counties. Representatives from each
county meet on a regular basis to discuss system problems, plan educational activities, and work cooperatively to develop
and implement the 9-1-1 Strategic Plan. In McLennan County, the McLennan County 9-1-1 District provides the same
services to the entire McLennan County area.
There is free public access to 9-1-1 throughout TSA-M. Public education programs such as the Red E. Fox program are
used to educate consumers. Training sessions are provided at community health fairs, schools, auxiliaries, hospitals,
Sheriff’s departments, and EMS providers.
HOTRAC Regional STEMI Plan
March 2011
Page 20
Communications
Goal
The Goal for Communications within TSA-M is to ensure communication capability between EMS providers, medical control,
receiving facilities; and other First Responders entities. Rapid dispatch and notification of the need for emergency cardiac
care at any location within TSA-M must be available to all persons in the region.
Objectives
1. To facilitate regional communications, all EMS & first responder units as well as hospital emergency personnel will have
a list of the communication devices & operating frequencies of the EMS and emergency care providers operating in the
HOTRAC region.
2. To ensure that all EMS providers, First Responders, and hospital facilities in the HOTRAC region have functional
communications equipment in order to communicate information related to the patient’s condition, the need for medical,
EMS, or helicopter back-up, and to receive and communicate information related to patient care and disposition.
3. To ensure that emergency dispatch within the HOTRAC region is accomplished by persons who have the knowledge,
skills, and equipment necessary to rapidly mobilize the appropriate level of emergency care to persons requesting
assistance throughout the region.
Discussion
The communications network in TSA-M is comprised of UHF, VHF, and 800 MHz radio devices combined with telephone
links, both cellular and base site. In some instances individual EMS providers utilize UHF, VHF, 800 MHz, and cellular
phones to ensure communications capability. The use of multiple communications systems ensures regional
communications are maintained between public and private EMS agencies, police, fire, and hospital entities.
Dispatch - Emergency dispatch in each of the five HOTRAC counties is accomplished through various methods (i.e.,
sheriff’s office, local police department, or county 911 services).
Pre-hospital Care Providers – Most of the EMS Providers utilize the VHF frequency while ETMC-EMS in McLennan County
utilizes 800 MHz.
Hospital Care Providers - All HOTRAC hospital facilities maintain communications capability with pre-hospital care providers
through the use of UHF emergency radios, cellular phones, or standard phone lines. Cellular phones are the primary
means of communications between EMS Providers and Hospitals. HOTRAC purchased each facility a HAM radio that is
programmed as follows:
HAM Radio Frequencies:
CH
Location
Type Service
0
Alpha/Numeric
W5BEC - ????
147.140
147.740
123.0
Bell
Amateur
1
W5BCR - Clifton
147.180
147.780
123.0
Bosque
Amateur
2
KC5QHO - Comanche
146.680
146.080
110.9
Comanche
Amateur
3
N5DDR - Gatesville
146.960
146.360
Coryell
Amateur
4
WD5DDH - Waxahachie
145.410
144.810
Ellis
Amateur
5
KB5TPP - Stephenville
147.360
147.960
110.9
Erath
Amateur
6
WB5YJL - Fairfield
145.110
144.510
146.2
Freestone
Amateur
7
WM5L - Hillsboro
146.780
146.180
123.0
Hill
Amateur
8
WD5GIC - Granbury
147.080
147.680
110.9
Hood
Amateur
9
KC5PGV - Cleburne
145.490
144.890
88.5
Johnson
Amateur
HOTRAC Regional STEMI Plan
March 2011
Out
In
Tone
Page 21
10
W5ZMI - Mexia
145.390
144.790
146.2
Limestone
Amateur
11
W5ZDN - Hewitt
146.890
146.290
123.0
McLennan
Amateur
12
W5ZDN - Moody
145.150
144.550
123.0
McLennan
Amateur
13
AA5RT - Waco
146.660
146.060
123.0
McLennan
Amateur
14
W5ZDN - Waco
146.880
146.280
123.0
McLennan
Amateur
15
WA5BU - Waco
147.160
147.760
McLennan
Amateur
16
AA5RT - Waco
147.360
147.960
123.0
McLennan
Amateur
17
N5DDC -Corsicana
145.290
144.690
146.2
Navarro
Amateur
18
WD5GND - Glen Rose
145.270
144.670
110.9
Somervell
Amateur
19
WD5GIC - Glen Rose
147.020
147.620
110.9
Somervell
Amateur
25
Simplex Point to Point
146.400
Amateur
26
Simplex Point to Point
146.410
Amateur
27
Simplex Point to Point
146.420
Amateur
28
Simplex Point to Point
146.430
Amateur
29
Simplex Point to Point
146.440
Amateur
30
Simplex Point to Point
146.450
Amateur
31
Simplex Point to Point
146.460
Amateur
32
Simplex Point to Point
146.470
Amateur
33
Simplex Point to Point
147.480
Amateur
34
Simplex Point to Point
146.490
Amateur
35
Simplex Point to Point
146.500
Amateur
36
Simplex Point to Point
146.510
Amateur
37
National Calling Frequency
146.520
Amateur
38
Simplex Point to Point
146.530
Amateur
39
Simplex Point to Point
146.540
Amateur
40
Simplex Point to Point
146.550
Amateur
41
Simplex Point to Point
146.560
Amateur
42
Simplex Point to Point
146.570
Amateur
43
Simplex Point to Point
146.580
Amateur
CH
Alpha/Numeric
20
24
Out
In
Tone
Location
Type Service
49
50
Simplex Point to Point
147.420
Amateur
51
Simplex Point to Point
147.430
Amateur
52
Simplex Point to Point
147.440
Amateur
53
Simplex Point to Point
147.450
Amateur
54
Simplex Point to Point
147.460
Amateur
55
Simplex Point to Point
147.470
Amateur
56
Simplex Point to Point
147.480
Amateur
57
Simplex Point to Point
147.490
Amateur
58
Simplex Point to Point
147.500
Amateur
59
Simplex Point to Point
147.510
Amateur
60
Simplex Point to Point
147.520
Amateur
61
Simplex Point to Point
147.530
Amateur
62
Simplex Point to Point
147.540
Amateur
63
Simplex Point to Point
147.550
Amateur
64
Simplex Point to Point
147.560
Amateur
65
Simplex Point to Point
147.570
Amateur
66
85
86
TX Fire 3
HOTRAC Regional STEMI Plan
March 2011
154.2950
NOTE: Receive only
Public Service
Page 22
87
TX Fire 2
154.2650
88
TX Fire 1
154.2800
on Public Service Bands
Public Service
89
TX Air 2
151.3850
90
TX Med 1
155.3400
Public Service
91
TX Law 3
155.4750
Public Service
92
TX Law 2
155.3700
Public Service
93
TX Law 1
154.9500
Public Service
94
Freestone EOC
155.7975
Public Service
95
Limestone EOC
155.9325
Public Service
96
Falls EOC
154.0025
Public Service
97
McLennan EOC
158.7750
Public Service
98
Hill EOC
155.6925
Public Service
99
Bosque EOC
155.8875
Public Service
Public Service
127.3
Public Service
HOTRAC is an active participant in the interoperability planning efforts being address by the Heart of Texas Council of
Governments. HOTRAC strives to remain at Level 4 interoperability. HOTRAC follows the HOTCOG Regional
Communications Plan. Please see that specific plan for additional detailed information regarding communications in the
Region.
Regional Pre-hospital Medical Oversight & Control
Goal
The goal for Regional Medical Control in TSA-M is multifaceted.
- To ensure strong physician leadership and supervision for pre-hospital care providers in both on-line and off-line
functions.
- To secure medical involvement in regional planning and educational program development.
- Provide for the development and implementation of regional treatment guidelines and system plan components, as
well as in systems evaluation.
.
Objectives
1. To evaluate regional cardiac care from a systems perspective, under the direction of representatives of HOTRAC
medical staff throughout the Region.
2. To involve HOTRAC medical staff in all phases and at all levels of the leadership and planning activities of regional
development.
3. To ensure appropriate medical oversight of all pre-hospital care providers through a Performance Improvement (PI)
process and other administrative processes.
4. To identify and educate regional medical control resources, standardize treatment protocols, and analyze
accessibility of medical control resources.
5. To identify and educate HOTRAC EMS providers and sources of on-line and off-line medical control.
Discussion
The HOTRAC Region includes both rural and suburban hospital and emergency care providers with varying levels of
medical capability. There is not a single EMS medical director for all EMS providers in the HOTRAC Region. All EMS
medical directors are members of the HOTRAC Physician Advisory Committee, which meets on a quarterly basis.
Physician Involvement in Regional Plan Development - The Physician Advisory Committee meets on a quarterly basis to
conduct its usual business and to review and approve regional planning components, policies, and treatment guidelines
HOTRAC Regional STEMI Plan
March 2011
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related to medical care. Each EMS medical director and at least one physician from each HOTRAC hospital has
representation on this standing committee. Any interested HOTRAC physician is invited to attend committee meetings.
Medical Direction of Pre-hospital Care Providers - In accordance with DSHS guidelines, all HOTRAC pre-hospital care
providers function under medical control. Regional EMS treatment guidelines are printed and distributed to all EMS
providers for incorporation into local protocols. Periodic reviews and updates are completed and upon approval are
distributed as necessary. These treatment guidelines serve as a baseline and individual Medical Directors may adapt for
their local community.
Regional Performance Improvement - The Physician Advisory Committee meets quarterly to conduct its usual business and
to carry out regional performance improvement (PI) activities. The ED Directors/EMS Providers meet in conjunction with the
Physician Advisory Committee to review patient care and evaluate outcomes from a systems perspective. PI indicators
include a review of all STEMI patients. (Please see System PI section for more details).
Pre-hospital Triage
Goal
Patients will be identified, rapidly and accurately assessed, and based on identification of their actual or suspected onset of
symptoms, will be transported to the nearest appropriate TSA-M facility.
Purpose
In order to ensure the prompt availability of medical resources needed for optimal patient care, each patient will be
assessed for the presence of abnormal vital signs; concurrent disease/predisposing factors; and abnormal EKG or 12-lead if
available.
System Triage




If a provider is unable to complete an EKG or 12-lead, suspected cardiac patient should be taken to the nearest
acute care facility within TSA M.
If a provider suspects a STEMI (confirm by 12-lead), the patient should be taken directly to a PCI Facility within TSA
M.
If a provider is unable to provide MICU care to the suspected cardiac patient, paramedic intercept should be
considered. Paramedic intercept may be by ground or air.
If transport by ground to the nearest appropriate facility is more than 20 minutes, consider helicopter activation.
Helicopter Activation
Goal
TSA-M regional air transport resources will be appropriately utilized in order to reduce delays in providing optimal cardiac
care.
Decision Criteria
HOTRAC Regional STEMI Plan
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1. Helicopter activation/scene response should be considered when it can reduce transportation time for patients with:
 Pulmonary edema
 Altered Mental Status
 Hypotension
OR
 A PCI Facility is more than 20 minutes away by ground.
Should there be any question whether or not to activate TSA-M regional air transport resources, on-line medical control
should be consulted for the final decision.
2. Patients transported via helicopter should be taken to the nearest PCI Facility within TSA M.
Facility Diversion
Goal
TSA-M facilities will communicate “facility diversion” status promptly and clearly to regional EMS and other facilities through
EMSystem in order to ensure that STEMI patients are transported to the nearest appropriate facility.
System Objectives
1. To ensure that STEMI patients will be transported to the nearest appropriate TSA-M facility.
2. To develop system treatment guidelines for regional facility and STEMI diversion status (see EMSystem guidelines
and protocols):
 Situations which would require the facility to go on diversion
 Notification/activation of facility diversion status
 Procedure for termination of diversion status
3. Regional cardiac care problems associated with facility diversion will be assessed through the Physician Advisory
Committee PI process.
4. All facilities and pre-hospital providers will use EMSystem to notify and track diversion status.
Facility Bypass
Goal
Suspected STEMI patients will be safely and rapidly transported to the nearest appropriate facility within TSA M.
Decision Criteria
Regional transport treatment guidelines ensure that patients who meet the triage criteria for activation of the TSA-M
Regional STEMI Plan will be transported directly to the nearest appropriate PCI Facility rather than to the nearest hospital
except under the following circumstances:
HOTRAC Regional STEMI Plan
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1. If unable to establish and/or maintain an adequate airway, the patient should be taken to the nearest acute care
facility for stabilization.
2. Medical Control may wish to order bypass when a facility is unable to meet hospital resource criteria or when there
are patients in need of specialty care.
3. If expected transport time to the nearest appropriate PCI Facility is excessive (> 20 minutes), medical control or the
EMS crew on scene should consider activating air transportation resources.
4. Additionally, should the patient or their cardiologist choose to bypass a PCI Facility, their request should be followed
when possible.
Note: Should there be any question regarding whether or not to bypass a facility, the receiving facility should be consulted.
Facility Triage Criteria
Goal
The goal of establishing and implementing facility triage criteria in TSA-M is to ensure that all regional hospitals use
standard definitions to classify STEMI patients in order to ensure uniform patient reporting and facilitate inter-hospital
transfer decisions.
Objectives
1. To ensure that each STEMI patient is identified, rapidly and accurately assessed, and based on identification and
classification of their actual or suspected onset of symptoms, transferred to the nearest appropriate TSA-M facility.
2. To ensure the prompt availability of medical resources needed for optimal patient care at the receiving facility.
3. To develop and implement a system of standardized STEMI patient classification definitions.
Discussion


After a confirmed STEMI, a patient should be transferred immediately to the nearest PCI Facility within TSA M.
If a PCI Facility receives and confirms a 12-lead, the PCI Facility should activate the facility’s Code STEMI protocol.
Inter-Hospital Transfers
Goal
The goal for establishing and implementing inter-hospital transfer criteria in TSA-M is to ensure that those STEMI patients
requiring additional or specialized care and treatment beyond a facility’s capability are identified and transferred to a PCI
Facility as soon as possible.
HOTRAC Regional STEMI Plan
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Objectives
1. To ensure that all regional hospitals make transfer decisions based on standard definitions which classify STEMI
patients according to TSA-M criteria.
2. To identify cardiac treatment and specialty facilities within and adjacent to TSA-M.
3. To establish treatment and stabilization criteria and time guidelines for TSA-M patient care facilities.
Discussion
The level of cardiac care resources required for STEMI patients is outlined in the TSA-M facility triage criteria and prehospital triage criteria. When a suspected STEMI patient is identified activation of a Code STEMI should be initiated. A
transferring facility should state that the patient is a “Code STEMI” when calling EMS and the accepting PCI Facility within
TSA M.
These criterions (see attached Regional STEMI Form) are monitored through the regional PI program.
Identification of STEMI Patients & STEMI Transfers - STEMI patients and their treatment requirements for optimal care are
identified in the TSA-M facility triage criteria and pre-hospital triage criteria. Written transfer agreements are available
between all TSA-M hospital facilities, and hospital facilities in adjacent regions. STEMI patients with special needs may be
initially transferred to a PCI Facility for assessment and treatment. When resources beyond its capability are needed,
transfer to another facility outside TSA M should be expedited. The TSA-M initial-receiving hospitals may also choose to
transfer patients with special needs directly to these facilities, bypassing the TSA M facilities when appropriate.
STEMI Patient Transport - STEMI patients in TSA-M are transported according to patient need, availability of air transport
resources, and environmental conditions. Many of the EMS Providers in the HOTRAC Region are MICU capable.
Additionally, this Region has several air medical services that may be utilized.
HOTRAC Regional STEMI Plan
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HOTRAC Regional STEMI Alert Form
Date________
Symptom Onset Time: _________ Patient Name: _____________ DOB: ____________
Regional Goal: 90 minutes or less from initial medical contact to balloon inflation.
□ Male □ Female
EMS to complete this section
EMS Provider: ________________________
□ Patient contact time:___________
□ 12-lead administered Time: _____________
□ 12-lead transmitted to facility Time: ___________
□ O2 _____ Lpm, via _____________
□ Started IV w/ ______ gauge
□ 4 chewable baby aspirin (or equivalent) PO, unless
contraindicated Time: __________
□ NTG 0.4 mg SL q 5 minutes x 3, unless contraindicated
Time: __________ __________ __________
□ Other Treatment: _______________________________
_____________________________________________
Medic Name (Printed): ________________________
Signature: ___________________________________
RURAL HOSPITAL to complete this section
□
□
□
Patient arrived at ________________ ED Time: _________
Activate Code STEMI
Time: ____________
STAT EKG & continuous cardiac monitoring. Notify ED
Physician: ________________________ Time: __________
□ O2 _____ Lpm, via ____________
□ Ensure 2 IV lines
□ STAT lab: CBC, CMP, PT/PTT, CK, CKMB, Troponin I
□ Chest Xray completed Time: ____________
□ 4 chewable baby aspirin (or equivalent) PO, unless
contraindicated Time: __________
□ NTG 0.4 mg SL q 5 minutes x 3, unless contraindicated
Time: _________ __________ ___________
□ Other Treatment: _______________________________
_____________________________________________
□ IF STEMI or left bundle branch block, call for acceptance of
CODE STEMI Time Called: ______ Accept rec’vd: _________
□ Hillcrest □ Providence □ Other: __________________
□ Thrombolytics given
Drug/Dose:____________________
Route: __________________ Time: ________________
□ Contact EMS (ground or air) for priority transfer
Provider: ____________________ Time called: ___________
□ EMS arrived Time: _______ Patient leaves ED Time: _______
□ Call Cardiologist when patient has left facility.
Nurse Name (Printed): ________________________
Signature: ___________________________________
TRANSFER – TRANSPORTING AGENCY: _____________________
□ Other Treatment: _____________________________________
___________________________________________________
□ Status Change(s): ____________________________________
__________________________________________________
Signature: ____________________________________________
CATH LAB to complete this section
□ Patient arrives in Cath Lab:______
□ Arrival of Interventionalist: ______
□ First Lesion Access:______
□ Reperfusion time/intervention complete: ______/______
□ ICU Notified for Room:______
□ Patient leaves Cath Lab: ______
Nurse Name (Printed): ________________________
Signature: ___________________________________
HOTRAC Regional STEMI Plan
March 2011
STEMI FACILITY to complete this section
□
□
□
Patient arrived at _________________ ED Time: ________
Activate Code STEMI
Time: ____________
STAT EKG Time: ______ & continuous cardiac monitoring.
Notify Cardiologist: ________________________
Time called: _________ Time Arrived: __________
□ O2 _____ Lpm, via ___________
□ Ensure 2 IV lines
□ STAT lab: CBC, CMP, PT/PTT, AMIP
□ Chest Xray completed Time: ___________
□ 4 chewable baby aspirin (or equivalent) PO, unless
contraindicated Time: __________
□ NTG 0.4 mg SL q 5 minutes x 3, unless contraindicated
Time: _________ __________ ___________
□ Other Treatment: _______________________________
_____________________________________________
□ Thrombolytics given
Drug/Dose:____________________
Route: __________________ Time: ________________
□ Prep Patient for Cath:
o Remove all patient’s clothes; hospital gown only
o Name/allergy bands on patient
o IV x 2 with extension tubing
o IV: NS at KVO rate for primary line
o Clip patient’s groin bilaterally
o Place radiotransparent defibrillation pads at the right subclavicular and the left axillary areas (NOT over heart)
o Connect patient to the portable monitor
o Portable O2 tank on stretcher
o Place consent on chart; ensure patient has signed consent
after explanation from cardiologist
o Place label on front of chart and ensure appropriate paper is
included.
□ Patient leaves ED for Cath Lab. Time: _________
Nurse Name (Printed): ________________________
Signature: ___________________________________
Place patient label here
Page 28
Heart of Texas Regional Advisory Council
STEMI Alert Form
Standard Usage Guidelines
Each facility within the HOTRAC Region will maintain copies of the HOTRAC Regional STEMI Alert Form in the Emergency
Department.
The HOTRAC Regional STEMI Alert Form will be completed on any patient with a suspected STEMI or Left Bundle Branch Blockage.
For the purposes of this program the ‘STEMI patient’ shall be defined as any patient presenting with symptoms of an acute
myocardial infarction and/or left bundle branch blockage and/or 1mm of ST-elevation in two contiguous EKG leads (STEMI).
The HOTRAC Regional STEMI Alert Form is intended to document required information for the regional STEMI facilities as well as
serve as the tool for the regional STEMI quality improvement process.
When a suspected STEMI patient presents in the ED of a HOTRAC facility, that facility will initiate the HOTRAC Regional STEMI Alert
Form by completing the top portion of the STEMI Alert Form.
Initial EMS Provider
 The EMS provider will obtain a STEMI Alert form from the facility and complete the top portion of the form titled “EMS to
complete this section”.
 The EMS provider shall complete the section fully.
 The EMS provider shall attach a copy of the initial 12 lead. The 12 lead shall be noted with the patient’s name and date of
birth.
 If additional documentation is required, a copy of the run sheet may be attached to the EMS copy and forwarded to
HOTRAC. HOTRAC will forward copies of additional documentation as appropriate.
 The paramedic/flight nurse must sign the completed section.
 Upon signature, the bottom copy shall be removed by EMS provider and maintained by the provider as part of their records
for QI purposes.
 Once the EMS copy is removed, the form shall be given to the facility.
Rural HOTRAC Facility
 When the patient arrives at a rural HOTRAC facility, the rural facility shall complete the section titled “Rural Facility to
complete this section”.
 If the patient presents directly at the facility by his/her own means, the facility shall mark “N/A” across the EMS Section.
 The attending nurse must sign the completed section.
 Upon signature, the bottom copy shall be removed by the rural facility; a patient label is placed at bottom of the facility’s
copy, and maintained by the facility as part of their records.
 Once the rural facility has removed its copy, the form shall follow the patient to the PCI Facility.
Transferring EMS Provider
 When the patient is transferred from a rural facility to a regional PCI Facility, the transferring EMS provider (ground or air
medical) shall complete the section titled “Transfer-Transporting Agency”.
 If additional documentation is required, a copy of the run sheet shall be attached to the EMS copy and forwarded to
HOTRAC to be attached to the regional copy. HOTRAC will forward copies of additional documentation as appropriate.
 The paramedic/flight nurse must sign the completed section.
 Upon signature, the bottom copy shall be removed by EMS provider and maintained by the provider as part of their records
for QI purposes.
 Once the EMS copy is removed, the form shall be given to the PCI Facility.
HOTRAC PCI Facility
 When the patient arrives at a regional PCI Facility, the PCI Facility shall complete the section titled “PCI Facility to complete
this section”.
 If the patient presents directly at the facility by his/her own means, the facility shall mark “N/A” across the EMS, Rural
Facility, and Transfer Section.
 The attending nurse must sign the completed section and place a patient label at the bottom of the form.
HOTRAC Regional STEMI Plan
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Page 29

Upon signature, the form shall follow the patient to the cath lab.
Cath Lab
 Once the patient arrives in the cath lab, the section titled “Cath Lab to complete this section” shall be completed by cath lab
staff.
 The attending nurse must sign the completed section.
 Upon signature, the RAC copy shall be forwarded to HOTRAC upon completion for the regional quality improvement
process.
The PCI Facility shall maintain the original (top) sheet as part of the facility’s record.
System Performance Improvement
Goal
The goals for system performance improvement in TSA-M are to establish a method for monitoring and evaluating system
performance over time and to assess the impact of STEMI system development.
Objectives
1. To provide a multidisciplinary forum for STEMI care providers to evaluate STEMI patient outcomes from a system
perspective and to assure the optimal delivery of cardiac care.
2. To facilitate the sharing of information, knowledge, and scientific data.
3. To provide a process for medical oversight of regional STEMI and EMS operations.
Discussion
In order to assess the impact of regional STEMI development, system performance must be monitored and evaluated from
an outcomes perspective. A plan for the evaluation of operations is needed to determine if system development is meeting
its stated goals.
Authority - The authority and responsibility for regional quality improvement rests with the Regional Advisory Council. This
will be accomplished in a comprehensive, integrated manner through the work of the Physician Advisory, Cardiac, and Prehospital Committees.
Scope & Process - The Physician Advisory Committee serves as the oversight committee for regional performance
improvement. Referrals for follow-up and feedback to & from the Committee and providers ensure system-wide,
multidisciplinary performance improvement.
The Cardiac Committee will develop the type of data and manner of collection, set the agenda for the PI process within the
regularly-scheduled meetings of the committee, and identify the events and indicators to be evaluated and monitored.
Indicator identification will be based on high risk, high volume, and problem prone parameters. Indicators will be objective,
measurable markers that reflect STEMI resources, procedural/patient care techniques, and or systems/process outcomes.
The Physician Advisory Committee will have final approve of the PI process.
Occurrences will be evaluated from a system, outcomes prospective and sentinel events will be evaluated on a case by
case basis. Activities and educational offerings will be presented to address knowledge deficits and case presentations or
other appropriate mediums will be designed to address systems and behavioral problems. All actions will focus on the
opportunity to improve patient care and systems operation. The results from committee activities will be summarized and
HOTRAC Regional STEMI Plan
March 2011
Page 30
communicated to the RAC membership. Problems identified that require further action will be shared with the persons and
entities involved, for follow-up and loop closure. Committee follow-up and outcome reports will be communicated on a
standard format (please see attached).
The functions and effectiveness of the HOTRAC Performance Improvement Process will be evaluated on an annual basis in
conjunction with the annual evaluation of the HOTRAC Regional STEMI Plan. All PI activities and committee proceedings
are strictly confidential. Individuals involved in performance activities will not be asked to review cases in which they are
professionally involved, but will be given the opportunity to participate in the review process.
Data Collection - PI data will be collected by the Cardiac Coordinator. PI forms and summary reports are submitted by each
HOTRAC hospital facility and EMS provider to HOTRAC Staff. Sentinel events will be used to focus attention on specific
situations/occurrences of major significance to patient care outcomes.
Confidentiality - All information and materials provided and/or presented during PI meetings are strictly confidential. See
attached form.
HOTRAC facility and EMS provider data related to the following PI indicators are reviewed during the quarterly Physician
Advisory meetings. The STEMI Alert Form is reviewed and updated annually.
Reporting Quarters.
HOTRAC regional PI data-reporting quarters are as follows:
First Quarter:
Second Quarter:
Third Quarter:
Fourth quarter:
HOTRAC Regional STEMI Plan
March 2011
Jan-Feb-Mar
April-May-June
July-August-Sep
Oct-Nov-Dec
Reporting at:
Reporting at:
Reporting at:
Reporting at:
May meeting
August meeting
December meeting
February meeting
Page 31
HOTRAC Regional Performance Improvement
Statement of Confidentiality
Medical Performance Improvement provides an objective mechanism to evaluate trauma and emergency care, facilitates the sharing of
information, knowledge, and scientific data, and provides a forum for medical directors and other physicians to review the performance
of the regional systems to assure the optimal delivery of trauma and emergency care. The direction of the committee comes from the
Texas EMS Rules: Section 157.124 Regional EMS Trauma Systems: (3) (k) of the EMS Rules (effective 2/17/92) requires the
development of a “performance management program that evaluates outcome from a system perspective”
Committee members engaged in medical care review have protection from disclosure of proceedings, under Section 773.095
RECORDS OF PROCEEDINGS CONFIDENTIAL of the Texas Health and Safety Code as follows:
(a) The proceedings and records of organized committees of hospitals, medical societies, emergency medical service
providers, or first responder organizations relating to the review, evaluation, or improvement of an emergency medical
services provider, a first responder organization, or emergency medical services personnel are confidential and not
subject to disclosure by court subpoena or otherwise.
(b) The records and proceedings may be used by the committee only in exercise of proper committee functions.
(c) This section does not apply to records made or maintained in the regular course of business by an emergency medical
services provider, a first responder organization, or emergency medical services personnel.
Section 773.096 IMMUNITY FOR COMMITTEE MEMBERS
“A member of an organized committee under Section 773.095 is not liable for damages to a person for an action taken or
recommendation made within the scope of the functions of the committee if the committee member acts without malice and in the
reasonable belief that the action or recommendation is warranted by the facts known to the committee member.”
CONFIDENTIALITY
As a participant in this HOTRAC regional performance improvement process, I understand and agree that all information and materials
provided and/or presented during the meeting are strictly confidential.
Meeting & Date: Physicians Advisory Meeting –
HOTRAC Regional STEMI Plan
March 2011
Page 32