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Overview of Birmingham Regional Emergency Medical Services System

(BREMSS)

Text Box: The Birmingham Regional Emergency Medical Services System (BREMSS) is administratively a component of the University of Alabama at Birmingham (Health System) with policy direction provided by a Board made up of representation of local governments, hospitals, physicians, nurses, emergency medical technicians (EMTs), and other EMS provider groups from throughout a seven-county region. This seven-county region is located in central Alabama and encompasses the counties of Blount, Chilton, Jefferson, St. Clair, Shelby, Walker and Winston. BREMSS is responsible for overall coordination of and improvements in the pre-hospital emergency medical care system within these seven counties and the subsequent city jurisdictions. BREMSS works with all components of the Emergency Medical Services System, which is inclusive of over 180 Emergency Medical Services (EMS organizations), 18 hospitals, over 2500 Emergency Medical Technicians, 10 trauma centers, 12 stroke center hospitals, over 80 different municipalities, and over 20 different 911 agencies. BREMSS, to achieve this overall coordination, must be effective in creating collaborative arrangements and agreements between differing components of the Emergency Medical Services System and local governments. In addition, BREMSS must provide vision and leadership to guide system improvements to increase the quality and quantity of services and improved patient outcomes of emergency medical patients within the region. BREMSS is responsible for medical direction aspects, equipment grant funding, EMS agency improvements from Basic Life Support to Advanced Life Support functions, an EMS communication system, the Trauma System, the Stroke System, as well as coordination of mass casualty incidents and quality improvement activities. Central to this focus of BREMSS is the ability to carry forward the vision and knowledge of world-class medical centers and to apply the expertise to improve the Emergency Medical Services within the seven-county region. In addition, BREMSS also contracts with the Alabama Department of Postsecondary Education and the Alabama Department of Public Health to provide certain functions.


The BREMSS programs have been extraordinarily successful in improving the quality of care, not only within this seven-county region, but statewide.  Initial in this thrust was the enabling of Emergency Medical Technicians, both Intermediates and Paramedics, to provide pre-hospital emergency medical care on the basis of protocols rather than calling a physician for orders on each emergency patient.  This change was driven by studies done by BREMSS in the early 1990’s that compared cardiac arrest patient outcomes before a limited protocol intervention and after a limited protocol intervention.  Cardiac arrest survivorship moved from no survivors in December 1990 to a 17% survivor rate by December of 1993.  This is comparable with the current National average.

 

The BREMSS-implemented Mass Casualty Incident program has been successful in handling mass casualty incidents within the seven counties.  Examples are a multiple bus crash on Interstate 65 with more than 60 pediatric patients transported to regional hospitals, the New Woman All Women Health Care Clinic bombing, and the April 8, 1998, F5 tornado.

 

The BREMSS-administered Equipment Grant Program has, in the past, assisted many volunteer, public, and private regional EMS agencies to improve their equipment so as to be able to improve patient care and outcomes.  This program is supported by County Health Care Authorities or Community Foundations in four of the seven counties.  In addition to this, BREMSS over the past five years has been instrumental in the movement to add more than 40 new agencies to provide Advanced Life Support rather than Basic Life Support.

 

A state-of-the-art communications system that ties all hospitals as well as all major EMS transport agencies is an example of regional cooperation, planning, and implementation.  This EMS communications system, which was implemented at no initial cost to hospitals, is a unique partnership between a commercial provider (Southern LINC), local governments, commercial ambulance services, hospitals, 911 centers, emergency management agencies, and fire services.  BREMSS was able to envision the system and through continual work implement a region-wide system and, ultimately, implementation of a statewide EMS Communication System is possible.

 

The BREMSS developed, implemented, and operated Trauma System has made significant changes in the quality and quantity of trauma care available to patients within this seven-county region.  It is also to be used as a template for development of a statewide trauma program.  The BREMSS Trauma System has also resulted in excess of $6,000,000 in grant awards to assist in the development of trauma and other research opportunities in trauma.  This program has been extraordinarily successful and has changed patient outcomes dramatically.

 

The BREMSS Stroke System is a model for stroke care for not only the United States, but also the world.  The development of the Stroke Plan was by a multi-disciplinary/jurisdictional group convened by the American Heart/Stroke Association.  BREMSS was chosen as the implementing agency.  The Stroke Plan follows the BREMSS Trauma Plan in allowing for the real-time matching of patients with on-line resources available within hospitals.  The System assists hospitals to make determinations of what services are economically and administratively feasible for them to operate at certain times of the day without being penalized and required to have these costly services available at all times.  The Stroke System and Trauma System result in optimal patient care with substantially reduced costs.  Hospital capacity is also considered by this system.


BREMSS, through its administrative relationship with the University of Alabama at Birmingham, and programmatic relationship with all the components of the Emergency Medical Services System and local governments throughout this seven-county region, is an example of the University of Alabama at Birmingham in its finest hour.  It provides the expertise and the framework for development of pre-hospital emergency medical care systems, which clearly improve patient outcomes with little cost to the counties and to the patient.  In fact, many of these programs have a realized capacity of lowering actual patient care cost for the hospitals, as well as third party payors. BREMSS was chosen as the Mitretek / Harvard Innovations Award for Homeland Security in 2006.

 

 

 

The Birmingham Regional Emergency Medical Services System was selected as the winner of the prestigious Mitretek Innovations Award in Homeland Security as announced by Mitretek Systems and the Ash Institute for Democratic Governance and Innovation at Harvard’s prestigious John F. Kennedy School.  The Award was bestowed in Birmingham, Alabama, at the University of Alabama Birmingham (UAB) by Mitretek President and CEO Dr. Lydia Thomas and Director of the Ash Institute for Democratic Governance Dr. Gowher Rizvi.

 

In making the award presentation, Dr. Thomas said, “We at Mitretek are proud to recognize the Birmingham Regional Emergency Medical Services System as the winner of a rigorous national competition of good ideas and innovation in homeland security.  This award program is about discovering and sharing great ideas from around the country and learning how they are put into action.”

 

UAB President Dr. Carol Z. Garrison said, “BREMSS represents not only a unique system of emergency medical care in the state of Alabama, but now is recognized as a model for the rest of the nation.  We are proud that UAB plays a major role in the system’s development and that its concept will be extended.”

 

Birmingham Regional Emergency Medical Services System

 

The Birmingham Regional Emergency Medical Services System (BREMSS) operates a regional trauma, stroke, divert, and bio-chem terrorism monitoring system.  BREMSS is a national model for how trauma and mass casualty victims can be routed to the closest emergency rooms equipped and ready to treat them on an immediate basis.  BREMSS operates in a network of 14 hospitals that serve north central Alabama and are linked through a wide-area network built around a unique software solution called LifeTrac.  This system manages minute-by-minute life saving data, real time information updates every thirty seconds, and provides for air and ground ambulance routing to the nearest care site.

 

 

                                                    Watch BREMSS Mitretek Award video

 

 

The Mitretek Innovations Award in Homeland Security seeks to identify, explore, and highlight creative and effective government and public-private partnership solutions - and the leaders behind them - to the nation’s homeland security concerns.  The criteria for this award assume that the “best practices” to be adopted in the future are emerging from practitioners operating in the field today.  The recipient of the Mitretek Innovations Award in Homeland Security is determined by a distinguished national panel of experts in the field of homeland security, chaired by Judge William H. Webster.  From a broad field of national applicants, five finalists for the Award are selected and subjected to a site evaluation and representatives of each finalist program make presentations to the national selection committee at Harvard.

 

The Mitretek Innovations Award in Homeland Security represents an important collaboration between Mitretek Systems, a nonprofit scientific research and engineering corporation that operates in the public interest, and the Ash Institute for Democratic Governance and Innovation at Harvard University’s John F. Kennedy School for Government, sponsor of the Innovations in American Government Swards.

 

Mitretek Systems is a nonprofit, 501c(3), scientific research and engineering corporation that operates in the public interest.  Mitretek applies expertise in conjunction with objectivity and independence to address challenges of national significance in areas such as homeland and national security, healthcare, energy and environment, and transportation.

 

The Ash Institute for Democratic Governance and Innovation at Harvard University’s John F. Kennedy School of Government fosters excellence in government around the world in order to generate and strengthen democracy.  Through its awards program, research, publications curriculum support, and global network, the Institute champions critical milestones and effective governance and democratic practice.

 

 

 

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