A regional emergency routing system in Alabama has been recognized as a model for the rest of the nation for its ability to handle emergencies from the smallest scale to a mass casualty incident. The Birmingham Regional Emergency Medical Services System (BREMSS) recently won the prestigious Mitretek Innovations Award in Homeland Security, which has been established to identify best practices among public-private partnerships nationwide that collaborate across jurisdictions to improve national security.

BREMSS operates a trauma, stroke and cardiac divert system and a bioterrorism divert system in seven counties — Jefferson, St. Clair, Shelby, Walker, Winston, Blount and Chilton — to ensure that patients are always routed to the closest hospital available to treat their particular emergency.

"In the past, we took patients to any hospital in an emergency, but that's not true today," said Joe Acker, executive director of BREMSS. "Every hospital has issues with capacity and physician and device availability at times, so sometimes that hospital is not the right one for a patient with specific needs."

The Mitretek award committee liked the fact that the system, which operates daily, can be ramped up easily for a mass disaster. "We work with the system every day, so if we have to handle a mass casualty incident, we're doing what we do everyday, just on a larger scale," Acker said. The committee also cited the system's ability to conduct syndromic surveillance, which can use health-related data to detect outbreaks associated with bioterrorism.

BREMSS serves a total population of 1.5 million people currently, and the system includes 1,500 paramedics, 1,000 emergency medical technicians, 180 Emergency Medical Service agencies, 19 hospitals and more than 20 different call centers. The system combines electronic communication with a human paramedic interface. When a medic calls the trauma communications center (TCC) the BREMSS staff coordinates the real-time availability of area hospitals with the patient's unique needs using the LifeTrac system, a state-of-the-art technology that assesses the ability of emergency departments, trauma services and stroke centers to accept and care for patients.

"We will match a patient with an acute need with a hospital that has real-time available resources to treat the problem," Acker said. "It allows hospitals the maximum economic flexibility to determine when resources are available. If resources are not there, we will deliver the patient to another facility."

Acker pointed out that the system has helped rural hospitals that don't have the resources to treat severely ill or injured patients. "The system assures them that they will not receive a patient they can't treat because of resource or capacity limitations," he said.
Through a partnership with BlueCross BlueShield of Alabama, Acker said that unconscious patients now can share medical information with medics if they have registered with the BlueCross Emergency Patient Information system (EPI).

"The system is electronically connected to the TCC which can share a patient's medical information with a receiving hospital even before the patient arrives," Acker said.

He added that BREMSS also interfaces with OnStar® and in the case of an automobile accident, it can immediately determine the exact location of the wreck, the point of impact on the vehicle and the number of passengers involved. "We can identify the trauma victims right away and go ahead and plug them into the system," said Acker.

Since the inception of BREMSS, the fatality rate from injury in the region has decreased about 12 percent, according to Dr. Loring Rue III, chief of trauma, burns, and surgical care at UAB Hospital. "The remaining counties in the state have not experienced that same decrease," he said.

Acker said that even with BREMSS as a model, few other systems like it exist in the nation today. "First, you have to get multiple teams together to make the system work. We are fortunate in Birmingham to have the involvement to be successful," he said. "Also, there are no state or federal funds available so all monies must be raised locally."

While BREMSS currently is confined to helping people in one region of Alabama, Mitretek award officials said they hope the best traits of this program will be replicated as a best practice in Homeland Security and adopted in communities around the country. "The front lines are in our communities, and the solution begins and ends there as well," the officials cited. "BREMSS meets those criteria."



June 2007