The EMS System in Columbia is a mature system, having been established since the early 1970s. The State is divided into three EMS regions that align with the Emergency Management and State Police regions. The regional offices are staffed with five positions to support coordination and implementation of State programs. The regional offices coordinate the EMS assembly of region-wide resources for inter-state mutual aid and will assist in the coordination of intra-state mutual aid as needed.

The State of Columbia licenses all EMS air and ground ambulances to include government-operated ambulances and services as well as those that are operated by non-government agencies or volunteers. EMS personnel are licensed as Emergency Medical Responders (EMR), Emergency Medical Technicians (EMT), Advanced Emergency Medical Technicians (AEMT) and Paramedics. Physicians and nurses who are EMS personnel are also licensed at the State level as EMS Physicians, EMS Medical Directors, Air Medical Transport Nurses, and Pre-Hospital Registered Nurses.

Provider agencies, personnel, and ambulances must meet minimum State standards. State of Columbia ambulances must be staffed by at least two emergency medical technicians. Licensed ambulances operating at ALS levels must be staffed by at least one paramedic and one emergency medical technician. Ambulances are typed according to the State and FEMA typing guidance. Personnel who deploy as staff of the EMS resource for the pre-designated inter- and intra-state mutual aid response meet the minimum criteria identified by the State EMS Office and the FEMA credentialing guidance found in the FEMA Job Title Qualifications.

Ground ambulances are licensed as either Basic Life Support (BLS), Advanced Life Support (ALS), or as Specialty Care Transport (SCT). Almost all BLS ambulances are State/FEMA Type IV Ambulances (Ground), i.e., without specialized HAZMAT operational capability; and almost all ALS ambulances are State/FEMA Type II (without specialized hazmat operational capability). A small number of Type 1 Ambulances (ALS with hazmat capability) and BLS Type III (BLS with hazmat capability) exist within the largest cities. Approximately 200 BLS and 300 ALS ground ambulances are licensed in the State of Columbia. The majority of the ambulance resources are in the private sector. A small number are based in industry; those in hazardous material environments are Type I.

Specialty care transport by ground ambulances are also licensed by the State Department of Health and must meet the requirements as defined in the State EMS Act and regulations. These requirements are the same as those listed for FEMA typing of Specialty Care Transport (Ground). Most of the specialty care transport resources are operated by hospitals since they primarily respond to inter-facility transport needs. They can be used during disaster responses and are integrated into most of the emergency response plans at county levels. The air ambulances all meet the FEMA Type I typing criteria.

Nine rotary-wing air ambulances are licensed by the State and located throughout the State at the major population centers. All are operated by hospitals. No fixed-wing air ambulances exist in the State. The air ambulances all meet the State/FEMA Type I. Air Ambulances are used primarily for inter-facility transport of critically ill or injured patients but are capable of responding to scenes and other sites for disaster response if supporting infrastructure is available, e.g., landing zone and safe environment for aviation operations.

Emergency Medical Services (EMS) throughout Liberty County, including in Central City, is provided under the authority and oversight of the County Public Health Department Director. The Liberty County/Central City/Roaring River Indian Community integrated EMS system operates under a uniform set of protocols approved by a Medical Control Board. These protocols are applied through a licensed physician medical director (serving as the contracted EMS Medical Director for all city and county system paramedics) and a Tribal Health Services EMS Medical Director (providing medical direction for EMS within the Roaring River Indian Community [RRIC]). EMS services in Liberty County that are not city or county operated, e.g., private EMS services, contract for their medical director with Central City Hospital; Noble Hospital in Fisherville is an exception to contracting because it owns and operates its own EMS services and provides medical direction through the emergency department physician group. The EMS medical director from the city/county EMS system, Tribal Health Services, Central Hospital contract, and Noble Hospital each are members of the Medical Control Board. Liberty County EMS has adopted the National Incident Management System (NIMS) to respond to emergencies/disasters.

Currently the city/county EMS Medical Director is a board-certified emergency physician who works at the emergency department at Central City Hospital. In his absence, his designee must also be a board-certified emergency physician. The RRIC EMS Medical Director is a board–certified trauma surgeon provided through the United States Public Health Service (USPHS), Roaring River Health Services.

The city/county EMS agency head is the EMS Director and holds a rank of chief officer. The EMS Office is located at the Nelson Center, FF and 11th Streets, Central City. The Nelson Center also contains the offices of the Liberty County Public Health Department, the Liberty County Department of Human Services, and the Liberty County Medical Examiner’s office. The RRTC EMS agency head is also known as an EMS Director and holds a rank of chief officer. The RRIC EMS office is located at the Tribal Health Service Hospital in Big Rock.

The State EMS system has organized disaster response capability using Ambulance Groups in each of the State EMS Regions 1–3 composed of ALS Strike Teams (Types I and II), BLS Strike Teams (Types III and IV), and EMS Task Forces of mixed EMS resources to include rotary–wing air ambulances. The ambulance strike teams and EMS task forces are preplanned and provided from across the State in such a way that no community experiences an unsafe level of EMS response capability during deployments. All personnel who are assigned to staff the regional EMS groups meet the credentialing criteria for FEMA Type 1 EMS personnel. The strike teams and task forces are configured from EMS resources in the private sector and were organized with the support of the State ambulance association. The EMS services co-located with the fire departments remain in place to continue response to the communities for 9-1-1 calls.

Each Ambulance Group consists of one Type I ALS Strike Team (5 ALS ground ambulances and a supervisor with vehicle), one Type II ALS Strike Team, one Type III BLS Strike Team (5 BLS ground ambulances and a supervisor with vehicle), one Type IV BLS Strike Team, and one Emergency Medical Task Force (one BLS ground ambulance, one ALS ground ambulance, two air ambulances, and a supervisor with a vehicle). The EMS strike teams and task forces are organized to meet the requirements of State FEMA Resource Typing.

Mass Casualty Support Vehicles (MCSV), stocked with supplies to support large or extended responses, are positioned in most communities in numbers and types to support the planned response to assessed threats and hazards. The vehicles are managed by the EMS ambulance services, which have been provided State grant funds to maintain the supply inventory required to meet the level of typing (I, II, or III) each is designated. Approximately 30 Mass Casualty Support Vehicles are distributed across the State.

When a State emergency is declared, the EMS Groups, Strike Teams, Task Forces, and Mass Casualty Support Vehicles can be requested through the State EOC; the request is managed by the Department of Health liaison at the ESF8 desk. If needed for personnel protection, Liberty County first responders may access ChemPack emergently through the county ChemPack Point of Contact, who is the EMS Director or designee.

Mutual–aid requests can be made for a single EMS Strike Team or Task Force or any combination that will match the need. The resources are available for response within the State or for interstate mutual–aid requests through processes such as EMAC. When responding to EMAC requests, the EMS resources become agents of the State of Columbia through the State’s emergency management agency, assisted by the State Department of Health’s Office of EMS.

Several counties and cities have purchased bus conversion kits for mass casualty response and patient evacuations. The kits permit the conversion of buses available through the school districts or bus transportation companies and provide a resource that meets the State/FEMA Type III Multi-Casualty Transport Vehicle definition and can be requested through the State EOC when a State disaster is declared.

The Columbia National Guard owns EMS-related assets but these assets are not routinely available for response due to recent deployments and the personnel being employed in critical and essential civilian sectors when not deployed. The Military Support to Civilian Authorities office in the State National Guard Headquarters is activated during all state emergencies to coordinate requests for EMS assets should they be available.

The Federal Customs and Border Patrol (CBP) has an active presence on the northern and southern international borders and also have EMS-related resources. Like military organizations, the CBP can provide rapid response for life threatening events needing immediate intervention until the arrival of other responders. Resources that may be available include:

• Uniformed law enforcement officers; canine teams for detection of humans, cadavers, drugs, and explosives; horse-mounted units; and tracking teams.
• Rapid-Response Special Operations Units capable of short-notice nationwide deployment to include Border Patrol Tactical Unit (BORTAC); Border Patrol Search, Trauma, and Rescue (BORSTAR) Teams including pre-hospital ALS air ambulance evacuation; law enforcement Search and Rescue personnel; regional Special Response Teams (SRTs); Search and Recovery divers; and law enforcement medical personnel.
• Assets including fixed-wing and rotary-wing aircraft, command and control aircraft, command and control vehicles, mobile communications repeaters, marine vessels, detainee transport vehicles, and special purpose vehicles (e.g., 4X4s, ATVs, sand rails, snowmobiles).

Most emergency medical technicians (EMTs) and paramedics work 24-hour shifts, utilizing the same work schedule as the fire department, and are co-located at the fire stations. Other ambulances and staff are assigned to augment the basic operational EMS system during periods of high demand; these resources typically work 8, 10, or 12-hour shifts. Services are generally provided through a geographic deployment method using ground ambulances to deliver Basic Life Support (BLS) and Advanced Life Support (ALS). Ground ambulances are co-located at area fire stations. These geographically dispersed ambulances are deployed and assigned at peak times throughout Central City using a process called system status management. Ambulances are activated during seasonal times in Bayport, Fisherville, Gish Island, and other local areas as special situations warrant.

Central City Hospital is designated as the base hospital, i.e., the hospital that provides medical direction and medical command in Central City.

Central City’s EMS ground ambulances respond to all emergency medical requests made through the 9-1-1 system within the city limits and to certain adjoining Liberty County areas that do not have an EMS system in place.

RRIC EMS ambulances respond to all emergency medical requests within the reservation and to certain adjoining Liberty County areas when needed.

Fisherville, Harvest Junction, Kingston, Bayport, Apple Valley, Gish Island, Blue Water, and Liberty International Airport ambulances respond to all emergency medical requests within their limits and to adjoining Liberty County areas.

One rotary-wing air ambulance is located at Central City Hospital. The air ambulance in Liberty County is used primarily for interfacility specialty care transport missions but may respond to scenes if dispatched by the Liberty County 9-1-1 Center. A nearby air ambulance is located in Green County at the airport in Monroe City.

The EMS dispatcher, located at the Liberty County 911 Center, dispatches all EMS units including Central City ambulance units and units from Fisherville, Harvest Junction, Kingston, Bayport, Apple Valley, Gish Island, Blue Water, and Liberty International Airport over the Liberty County public safety trunked radio system. The dispatcher may, under agreement with all units in the county, dispatch or move up any units, provided that required coverage exists in each city. Each city requires at least one ambulance to remain assigned at all times within its jurisdiction, and the RRIC requires at least four units.

Routine requests for single-ambulance mutual–aid requests that occur almost daily are made directly by the ambulance needing the assistance. Requests for mutual-aid assistance during major events such as disasters or mass casualty incidents into Liberty County from other counties is routed through the EMS Director or the EMS Supervisor in the absence of the Director to the county from which the request is being made. Although mutual-aid agreements are in place, nothing is automatic at time of need. Responders must keep in mind the time elements for EMS resources provided through mutual aid, such as preparation time, assembly, and travel time to Central City.