Alabama Department of Public Health

Office of Emergency Medical Services

2018 Annual Report

January 1, 2018 – December 31, 2018 Alabama Office of Emergency Medical Services 2018 Annual Report

January 1, 2018 – December 31, 2018

State of Alabama Department of Public Health Scott Harris, M.D., M.P.H., State Health Officer

Office of Emergency Medical Services Stephen Wilson, B.S., NRP, Director

Office of Emergency Medical Services Gary Varner, M.P.H., NRP, Senior Epidemiologist

Office of Emergency Medical Services Augustine M. Amenyah, Ed.D., M.P.H., Epidemiologist

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Mission of the Alabama Office of Emergency Medical Services

OVERVIEW The Alabama Office of Emergency Medical Services (OEMS) operates under the Alabama Department of Public Health (ADPH) and is tasked with oversight of emergency medical services in Alabama. The OEMS is responsible for protecting the health, safety, and welfare of the public by assuring that emergency medical response agencies, training entities, and emergency medical services personnel meet or exceed established standards. The mission of the OEMS is to reduce preventable mortality and morbidity caused by trauma and other emergency medical conditions.

FORCE OF LAW The Code of Alabama 1975, §22‐18‐1, set forth the authority of the OEMS to create rules and regulations. The legislation includes mandates for the State Emergency Medical Control Committee (SEMCC), and all regulatory processes (licensure, fees, compliance, operations, etc.) regulated by the OEMS.

ADMINISTRATIVE MISSION The spectrum of tasks that the OEMS implements for the ADPH and Alabama, at large, includes but is not limited to:

 Facilitation of the prehospital component of the Alabama Incident Management System (AIMS), which allows the ADPH to monitor hospitals, nursing homes, and ambulance resources during times of disaster.

 Facilitation of the Emergency Medical Services (EMS) staffing of Medical Needs Shelters for the Center for Emergency Preparedness, during times of disaster.

 Facilitation and administration of Alabama’s electronic patient care reporting (ePCR) entreated by the federal government via the National Emergency Medical Services Information System (NEMSIS). The OEMS provides free software to facilitate licensed EMS provider data reporting. The software, Recording of Emergency Medical Services Calls and Urgent‐care Environment (RESCUE), is compliant with the NEMSIS Version 3 platform for national EMS reporting. Otherwise, third‐party software vendors are supplied upon request with the Alabama NEMSIS Version 3 schematron to enable their Alabama EMS provider service clients’ ePCR process. Data uploaded by EMS provider services is retained in the Alabama NEMSIS repository and further uploaded to the national NEMSIS repository.

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 Facilitation and administration of Alabama’s prehospital EMS provision; including standards, licensure, and compliance oversight for individuals, services, businesses, and departments engaged in provision of emergency medical care and/or transport of the sick and injured; oversight and guidance for universities, colleges, and schools engaged in EMS training; and the responsibility for quality assurance and quality improvement processes for Alabama EMS provider services through periodic inspection of deployed EMS vehicles and equipment and, for individuals and service providers, through definitive complaint investigation and adjudication.

 Facilitation and administration of Alabama’s arrangement with the National Registry of Emergency Medical Technicians (EMT/NREMT) to oversee and guarantee integrity of the National Registry of EMTs examination process. National Registry certification is a prerequisite for licensure at the level of that certification in Alabama.

 Facilitation and administration of Alabama’s Acute Health Systems (AHS) which includes the Alabama Trauma System (ATS) and the Alabama Statewide Stroke System, as well as the Alabama Trauma Registry (ATR), which also closely monitors head and spinal cord injuries. The AHS are also currently developing to include data reporting and management of cardiac data, especially myocardial infarction pathologies. That component of the AHS (the Alabama ST‐Elevation Myocardial Infarction, or STEMI system) is expected to go online within 2 years. Much of the data collection and management for AHS is facilitated through the University of Alabama at Birmingham. In all aspects of the AHS, the OEMS coordinates with area hospitals to facilitate uniform data recording of provided care to enable data follow‐up of patients from the prehospital phase until well into the specialty hospital care process.

 Facilitation and administration of the Alabama EMS Regional Agencies. Alabama counties are assigned to one of six EMS Regions that are tasked by the OEMS with: providing an initial point of contact for EMS issues or concerns, organizing meetings and providing effective communication between local communities and the OEMS, assisting constituent EMS personnel with rules compliance, providing local ongoing credentialing, and functioning as a clearing house for EMS education activities. Each regional agency also assists with coordination and implementation of the AHS components.

 Facilitation and administration of the federally funded Emergency Medical Services for Children (EMSC) Program. The purpose of the EMSC is to prevent and reduce child, youth, and adolescent disability and death resulting from severe illness and injury. To accomplish

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its goal, the program provides education for prehospital providers and ensures that the American Academy of Pediatrics/American College of Emergency Physicians (AAP/ACEP) guideline compliant equipment is available on prehospital emergency vehicles that transport children.

 Provision of EMS data management and analysis for the purposes of quality assurance and improvement, compliance investigations, public health investigations of illness and injury, and research to drive the development of EMS efficacy in Alabama.

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Purpose and Methods

PURPOSE The purpose of this report is to present to our stakeholders a systematic overview of EMS calls occurring in Alabama in 2018. Data for this report was synthesized from the RESCUE database developed by the Center for Public Safety of the University of Alabama in Tuscaloosa based on NEMSIS V2 data standards.

METHODOLOGY RESCUE captures prehospital care through both required and optional reporting elements and data are validated to meet (NEMSIS‐3) standards. RESCUE captures agency information, patient demographics, response times, incident location, prehospital treatment, EMS transport, insurance, and patient disposition.

A total of 812,974 EMS runs were submitted to RESCUE from January 1, 2018, to December 31, 2018, as of February 27, 2019. The OEMS used the 2018 U.S. Census Bureau, Vintage 2018 Population Estimates www.census.gov/programs‐surveys/popest.html figures to calculate EMS runs per 10,000 Alabama residents.

DISCLAIMER Calculations were done using Microsoft Excel 2016.

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Map of Alabama 67 Counties

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Alabama County Population by Rank

Rank County Population Rank County Population Rank County Population

1 Jefferson 659,460 2 Mobile 414,328 3 Madison 353,213

4 Montgomery 227,120 5 Shelby 208,721 6 Tuscaloosa 204,424

7 Baldwin 203,360 8 Lee 156,597 9 Morgan 119,157

10 Calhoun 115,527 11 Houston 104,108 12 Etowah 103,132

13 Marshall 94,738 14 Lauderdale 92,590 15 Limestone 91,695

16 St. Clair 86,937 17 Cullman 81,703 18 Elmore 80,989

19 Talladega 80,888 20 Dekalb 71,194 21 Walker 64,927

22 Russell 58,480 23 Blount 57,667 24 Autauga 55,036

25 Colbert 54,435 26 Jackson 52,326 27 Coffee 51,073

28 Dale 49,393 29 Chilton 43,805 30 Tallapoosa 40,756

31 Dallas 40,755 32 Escambia 37,621 33 Covington 37,519

34 Chambers 33,895 35 Lawrence 33,288 36 Pike 33,287

37 Franklin 31,507 38 Marion 30,058 39 Geneva 26,572

40 Barbour 26,201 41 Cherokee 25,855 42 Clarke 24,625

43 Winston 23,968 44 Bibb 22,580 45 Randolph 22,530

46 Monroe 21,745 47 Pickens 20,170 48 Butler 20,126

49 Marengo 19,743 50 Macon 19,358 51 Henry 17,110

52 Washington 16,746 53 Fayette 16,657 54 Hale 14,995

55 Cleburne 14,939 56 Lamar 14,021 57 Crenshaw 13,866

58 Clay 13,407 59 Choctaw 13,188 60 Sumter 13,084

61 Conecuh 12,649 62 Coosa 10,955 63 Wilcox 10,919

64 Bullock 10,478 65 Lowndes 10,362 66 Perry 9,680

67 Greene 8,533

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2018 Alabama EMS Annual Report Type of Service Requested (Chart 1) 01/01/2018 ‐ 12/31/2018

Type of Service Requested 01/01/2018 ‐ 12/31/2018

911 RESPONSE (SCENE) 600,163

MEDICAL TRANSPORT 146,838

INTERFACILITY TRANSPORT 55,035

PUBLIC ASSISTANCE/OTHER NOT LISTED 5,647

STANDBY 2,955

INTERCEPT 1,619

MUTUAL AID 717

0 100000 200000 300000 400000 500000 600000 700000

Chart 1 shows a breakdown of type of service requested. The predominant was 911 response to scene at 74 percent (n=600,163).

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2018 Alabama EMS Annual Report Chief Complaint Anatomic Location (Chart 2) 01/01/2018 – 12/31/2018

Chief Complaint Anatomic Location: 01/01/2018 ‐ 12/31/2018

ABDOMEN 55,991

BACK 17,887

CHEST 73,647

EXTREMITY‐LOWER 37,208

EXTREMITY‐UPPER 18,231

GENERAL/GLOBAL 417,514

GENITALIA 4,674

HEAD 43,476

NECK 7,247

0 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 Chart 2 shows chief complaint anatomic locations. The predominant was general/global anatomic location complaints at 51 percent (n=417,514).

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2018 Alabama EMS Annual Report Call Volume by EMS Region (Chart 3) 01/01/2018 ‐ 12/31/2018

Call Volume by EMS Region 01/01/2018 ‐ 12/31/2018

199,299

168,241 168,545

125,695

88,515

62,679

BREMSS EAST GULF NORTH (AERO) SOUTHEAST WEST Chart 3 shows call volumes by EMS regions. The predominant was 24 percent (n=199,299) in BREMSS

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2018 Alabama EMS Annual Report CMS Service Level (Chart 4) 01/01/2018 ‐ 12/31/2018

CMS Service Level 01/01/2018 ‐ 12/31/2018

ALS, LEVEL 1 EMERGENCY 134,386

BLS 117,812

ALS, LEVEL 1 74,271

BLS, EMERGENCY 33,118

ALS, LEVEL 2 6,889

SPECIALITY CARE TRANSPORT 3,046

ROTARY WING (HELICOPTER) 1,936

FIXED WING (AIRPLANE) 16

PARAMEDIC INTERCEPT 8

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000

Chart 4 shows CMS service levels. The predominant was ALS, Level 1 Emergency at 36 percent (n=134,386).

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2018 Alabama EMS Annual Report EMS Transport Method (Chart 5) 01/01/2018 ‐ 12/31/2018

2018 Alabama EMS Annual Report EMS Transport Method (Chart 5) 01/01/2018 ‐ 12/31/2018

GROUND‐AMBULANCE 663,788

GROUND‐OTHER NOT LISTED 39,384

AIR MEDICAL‐ROTOR CRAFT 5,067

AIR MEDICAL‐FIXED WING 2,261

GROUND‐BARIATRIC 355

GROUND‐ATV OR RESCUE 180

WATER‐BOAT 75

GROUND‐WHEELCHAIR VAN 9

0 100,000 200,000 300,000 400,000 500,000 600,000 700,000

Chart 5 shows transport methods. The predominant method was ground ambulance at 82 percent (n=663,788).

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2018 Alabama EMS Annual Report EMS Transport Mode to Scene (Chart 6) 01/01/2018 ‐ 12/31/2018

Transport Mode to Scene 01/01/2018 ‐ 12/31/2018

581,361

213,589

15,579 2,445

EMERGENT EMERGENT NON‐EMERGENT NON‐EMERGENT (IMMEDIATE DOWNGRADED UPGRADED RESPONSE) Chart 6 shows transport mode to scene. The predominant mode was Emergent (Immediate Response) at 72 percent (n=581,361).

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2018 Alabama EMS Annual Report EMS Transport Method Mode from Scene (Chart 7) 01/01/2018 ‐ 12/31/2018

Transport Mode from Scene 01/01/2018 ‐ 12/31/2018

463,791

131,106

9,699 2,130

Emergent (Immediate Emergent Non‐Emergent Non‐Emergent Response) Downgraded to Non‐ Upgraded to Emergent Emergent

Chart 7 shows transport mode from scene. The predominant was non‐emergent from the scene at 76 percent (n=463,791).

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2018 Alabama EMS Annual Report EMS Transport Destination State (Chart 8) 01/01/2018 ‐ 12/31/2018

Alabama EMS Transport Destination State 01/01/2018 ‐ 12/31/2018

NORTH CAROLINA 1 NEW YORK 1 MICHIGAN 1 MARYLAND 1 IOWA 1 ARKANSAS 1 OKLAHOMA 2 OHIO 3 INDIANA 4 ILLINOIS 5 SOUTH CAROLINA 7 TEXAS 11 LOUISIANA 43 TENNESSEE 2,012 FLORIDA 2,912 MISSISSIPPI 4,353 GEORGIA 6,743 ALABAMA 585,763

0 100,000 200,000 300,000 400,000 500,000 600,000 700,000

Chart 8 shows transport destination states. The predominant was Alabama with 585,763 transports.

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2018 Alabama EMS Annual Report Patients Gender Category (Chart 9) 01/01/2018 ‐ 12/31/2018

EMS Patients Gender 01/01/2018 ‐ 12/31/2018

Male, 333,775, 46%

Female, 387,863, 54%

Chart 9 shows gender distribution of patients. EMS provided care to 54 percent females (n=387,863) and 46 percent males (n=333,775).

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2018 Alabama EMS Annual Report EMS Patients by Age Group (Chart 10) 01/01/2018 ‐ 12/31/2018

EMS Patients by Age Group 01/01/2018 ‐ 12/31/2018

131,561

116,112 110,973

81,441

62,079 63,121 59,458

43,864

35,890

0‐17 18‐25 26‐35 36‐45 46‐55 56‐65 66‐75 76‐85 >86

Chart 10 shows patients by age groups. The predominant was 16 percent (n=131,561) for age group (66 ‐75).

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2018 Alabama EMS Annual Report EMS Patients by Race (Chart 11) 01/01/2018 ‐ 12/31/2018

Patients by Racial Categories 01/01/2018 ‐ 12/31/2018

466,048

238,383

933 2,403 9,936 813

American Asian Black or Hispanic or Native White Indian or African Latino Hawaiian or Alaska Native American Other Pacific Islander

Chart 11 shows the racial categories of EMS patients. Whites were the predominant group at 57 percent (n=466,048).

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2018 Alabama EMS Annual Report EMS Patients by Age and Gender (Chart 12) 01/01/2018 ‐ 12/31/2018

Female Male Age Female Male Percentage Percentage 0‐17 13,216 13,301 5% 5% 18‐25 8,911 15,737 3% 6% 26‐35 23,343 22,960 8% 9% 36‐45 24,620 24,371 9% 10% 46‐55 33,795 33,179 12% 13% 56‐65 44,775 47,471 16% 19% 66‐75 52,397 48,430 18% 19% 76‐85 49,368 34,703 17% 14% >85 34,088 15,436 12% 6% Total 284,513 255,588 100% 100%

Chart 12 shows age and gender distribution of patients with respective counts and percentages.

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2018 Alabama EMS Annual Report Top 10 Provider’s Primary Impressions (Chart 13) 01/01/2018 ‐ 12/31/2018

Top 10 Provider's Primary Impressions 01/01/2018 ‐ 12/31/2018

GENERAL/OTHER ‐ WEAKNESS 129,351

OTHER CODE 86,407

COGNITIVE FUNCTIONS/AWARENESS ‐ 34,271 ALTERED MENTAL STATUS

NO PATIENT COMPLAINT ‐ ENCOUNTER, 20,027 ADULT, NO FINDINGS OR COMPLAINTS

INJURY, UNSPECIFIED 19,489

RESPIRATORY ‐ RESPIRATORY DISTRESS, 19,037 ACUTE

PAIN ‐ CHEST (CARDIAC) 18,734

GENERAL/OTHER ‐ SYNCOPE AND COLLAPSE 15,561

PAIN ‐ ACUTE PAIN, NOT ELSEWHERE 15,001 CLASSIFIED

PAIN ‐ GENERALIZED ABDOMINAL PAIN 13,954

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000

Chart 13 shows the top 10 provider’s primary impressions. At 35 percent (n=129,351), general/other weakness was the predominant impression.

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2018 Alabama EMS Annual Report Cardiac Arrests by Regions (Chart 14) 01/01/2018 ‐ 12/31/2018 Cardiac Arrests Count by EMS Region 01/01/2018 ‐ 12/31/2018

1,577 1,444

1,253

844

645 643

AERO/North East BREMSS West Southeast Gulf

Chart 14 shows cardiac arrest calls reported by EMS regions. The predominant was 25 percent (n=1,577) in BREMSS region.

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2018 Alabama EMS Annual Report Top 10 Cardiac Arrests by County (Chart 15) 01/01/2018 ‐ 12/31/2018 Top 10 Cardiac Arrests by County 01/01/2018 ‐ 12/31/2018

JEFFERSON 845

MOBILE 723

MADISON 401

BALDWIN 352

TUSCALOOSA 332

SHELBY 229

CULLMAN 186

MARSHALL 175

WALKER 171

ETOWAH 170

0 100 200 300 400 500 600 700 800 900

Chart 15 shows top 10 cardiac arrest calls by county. The predominant cases were recorded in Jefferson County at 24 percent (n=845)

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2018 Alabama EMS Annual Report Naloxone Administration by Gender (Chart 16) 01/01/2018 ‐ 12/31/2018

Naloxone Administration by Gender 01/01/2018 ‐ 12/31/2018

Female, 2,734, 44% Male, 3,490, 56%

Chart 16 shows naloxone administration by gender. The predominant was given to males at 56 percent (n=3,490).

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2018 Alabama EMS Annual Report Naloxone Administration by Regions (Chart 17) 01/01/2018 ‐ 12/31/2018

Naloxone Given by Regions 01/01/2018 ‐ 12/31/2018

2,629

1,324

610 555 588 449

BREMSS EAST GULF NORTH (AERO) SOUTHEAST WEST

Chart 17 shows naloxone administration by EMS regions. The predominant was given in the BREMSS region at 43 percent (n=2,629).

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2018 Alabama EMS Annual Report Top 10 Medications Given (Chart 18) 01/01/2018 ‐ 12/31/2018 Top 10 Medications Given 01/01/2018 ‐ 12/31/2018

OXYGEN 109,877

SODIUM CHLORIDE INFUSION 37,098 SOLUTION

NITROGLYCERIN 18,550

ONDANSETRON 16,559

ASPIRIN 15,540

ALBUTEROL 11,162

FENTANYL 9,198

EPINEPHRINE 1:10,000 6,325

NALOXONE 6,155

D50 (50% DEXTROSE) 4,472

0 20,000 40,000 60,000 80,000 100,000 120,000

Chart 18 presents a breakdown of the top 10 medications given by Alabama EMS. The predominant was oxygen, reported at 47 percent (n=109,877).

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2018 Alabama EMS Annual Report Top 10 Causes of Injury (Chart 19) 01/01/2018 ‐ 12/31/2018 Top 10 Causes of Injury 01/01/2018 ‐ 12/31/2018

MVC, TRAFFIC ‐ CAR 18,224

FALL ‐ SLIP, TRIP, OR STUMBLE 4,810

FALL ‐ OTHER 3,404

FALL ‐ BED 2,653

FALL ‐ CHAIR 2,252

FALL ‐ STAIRS OR STEPS 1,815

INJURY, UNSPECIFIED 1,614

MVC, TRAFFIC ‐ OTHER 1,583

MVC, NON‐TRAFFIC ‐ CAR 1,511

MVC, TRAFFIC ‐ MOTORCYCLE 961

0 2,000 4,000 6,000 8,000 10,00012,00014,000 16,00018,00020,000

Chart 19 shows top 10 causes of injuries. The predominant was MVC, traffic‐car accidents at 47 percent (n=18,224).

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2018 Alabama EMS Annual Report Mechanism of Injury (Chart 20) 01/01/2018 ‐ 12/31/2018

MECHANISM OF INJURY 01/01/2018 ‐ 12/31/2018

Penetrating, 5,254, 4%

Other, 37,254, 33%

Blunt, 70,185, 62%

Burn, 1,134, 1%

Chart 20 shows the mechanisms of injuries of EMS patients. The predominant was blunt force trauma at 62 percent (n=70,185).

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2018 Alabama EMS Annual Report Top 10 Procedures Performed (Chart 21) 01/01/2018 ‐ 12/31/2018

Top 10 Procedures Performed by EMS 01/01/2018 ‐ 12/31/2018

ASSESSMENT ‐ PATIENT ASSESSMENT 486,071

PULSE OXIMETRY (PROCEDURE) 184,147

VASCULAR ACCESS ‐ EXTREMITY VEIN 166,260 CATHETERIZATION

CARDIAC ‐ 12 LEAD ECG OBTAINED 76,682

CARDIAC ‐ 3 LEAD ECG OBTAINED 75,640

EVALUATION PROCEDURE (PROCEDURE) 70,300

CARDIAC MONITORING (REGIME/THERAPY) 58,615

ADULT PAIN ASSESSMENT (PROCEDURE) 51,358

GLUCOSE MEASUREMENT, BLOOD 45,688 (PROCEDURE)

GENERAL ‐ NOT OTHERWISE CLASSIFIED. 41,321

0 100,000 200,000 300,000 400,000 500,000 600,000

Chart 21 shows the breakdown of the top 10 procedures performed. Patient assessment was the predominant at 39 percent (n=486,071).

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2018 Alabama EMS Annual Report Vital Signs Taken (Chart 22) 01/01/2018 ‐ 12/31/2018

Count of Vital Signs Taken by Crew 01/01/2018 ‐ 12/31/2018

615,725

495,407

205,761

114,737 109,506 69,446 44,116 35,513 28,507 19,849 13,768

123405610 OR 789 MORE

Chart 22 shows the number of times vital signs were taken. The predominant was one (1) vital at 35 percent (n=615,725).

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2018 Alabama EMS Annual Report Cardiac Procedures (Chart 23) 01/01/2018 ‐ 12/31/2018

Cardiac Procedures Performed 01/01/2018 ‐ 12/31/2018

76,749 77,377

80 5

Cardiac 3 Lead ECG Cardiac 12 Lead ECG Cardiac 15 Lead ECG Cardiac 18 Lead ECG Obtained Obtained Obtained Obtained

Chart 23 shows cardiac procedures performed. Both Cardiac 3 Lead ECG Obtained and Cardiac 12 Lead ECG Obtained procedures were performed at 50 percent each (n=76,749) and (n=77,377). [Excel calculations].

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2018 Alabama EMS Annual Report Airway‐Basic Procedures (Chart 24) 01/01/2018 ‐ 12/31/2018 Airway‐Basic Procedures 01/01/2018 ‐ 12/31/2018

AIRWAY‐BASIC SUCTION AWAY 3,758

AIRWAY‐BASIC BAGGED VENTILATION VIA 3,172 MASK

AIRWAY‐BASIC CPAP 2,069

AIRWAY‐BASIC NASOPHARYNGEAL AIRWAY 1,079 INSERTION

AIRWAY‐BASIC AIRWAY OPENED 432

AIRWAY‐BASIC ETCO2 COLORIMETRIC 254 DETECTION

AIRWAY‐BASIC BIPAP 127

AIRWAY‐BASIC FOREIGN BODY REMOVAL 73

AIRWAY‐BASIC HEIMLICH MAUEVER 25

0 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

Chart 24 shows airway‐basic procedures performed. The predominant was airway‐basic suction away at 34 percent (n=3,758).

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2018 Alabama EMS Annual Report Airway‐Advanced Procedures (Chart 25) 01/01/2018 ‐ 12/31/2018

Airway‐Advanced Procedures 01/01/2018 ‐ 12/31/2018

AIRWAY‐ADVANCED‐INTUBATION 3,230 (OROTRACHEAL)

AIRWAY‐ADVANCED‐ETCO2 DIGITAL 2,552 CAPNOGRAPHY

AIRWAY‐ADVANCED ‐ INTUBATION 181 (RAPID SEQUENCE)

AIRWAY‐ADVANCED‐CRICOTHYROTOMY 3 NEEDLE

0 500 1000 1500 2000 2500 3000 3500

Chart 25 shows airway‐advanced procedures performed. The predominant procedure was airway‐advanced intubation (Orotracheal) at 54 percent (n=3,230).

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2018 Alabama EMS Annual Report Top 10 Select Procedures Performed (Chart 26) 01/01/2018 ‐ 12/31/2018

Top 10 Select Procedures Performed 01/01/2018 ‐ 12/31/2018

CAPILLARY BLOOD GLUCOSE MEASUREMENT 7,731

INTRAVENOUS/IRRIGATION MONITORING 5,685 (REGIME/THERAPY)

VASCULAR ACCESS‐EXTERNAL JUGULAR VEIN 4,085 CATHERIZATION

CARDIAC ‐CARDIO PULMONARY 3,611 RESUSCITATION (MANUAL)

VASCULAR ACCESS‐VENOUS PUNCTURE FOR 3,265 BLOOD DRAW

MUSCULOSKELETAL‐SPINAL 3,044 IMMOBILIZATION (FULL)

VASCULAR ACCESS‐INTRAOSSEOUS 3,012 CANNULATION

CARDIAC DEFIBRILATION (MANUAL) 2,149

0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

Chart 26 shows select procedures performed. The predominant was capillary blood glucose measurement at 24 percent (n=7,731).

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2018 Alabama EMS Annual Report Top 10 Protocols Used (Chart 27)

01/01/2018 ‐ 12/31/2018

Top 10 Protocols Used

01/01/2018 ‐ 12/31/2018

GENERAL‐UNIVERSAL PATIENT CARE/ 420,382 INITIAL PATIENT CONTACT

GENERAL‐INDIVIDUALIZED PATIENT 65,743 PROTOCOL

GENERAL‐INTERFACILITY TRANSFERS 23,192

MEDICAL‐CARDIAC CHEST PAIN 22,734

MEDICAL‐RESPIRATORY 20,398 DISTRESS/ASTHMA/COPD/REACTIVE …

MEDICAL‐ALTERED MENTAL STATUS 18,826

MEDICAL‐ABDOMINAL PAIN 15,322

MEDICAL‐SEIZURE 8,436

INJURY‐EXTREMITY 7,429

MEDICAL‐STROKE/TIA 6,712

0 100,000 200,000 300,000 400,000

Chart 27 shows top 10 protocols used. The predominant was general‐universal

patient care‐initial patient contact at 69 percent (n=420,382).

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2018 Alabama EMS Annual Report EMS Type of Destination (Chart 28) 01/01/2018 ‐ 12/31/2018

EMS Type of Destination 01/01/2018 ‐ 12/31/2018

HOSPITAL‐EMERGENCY DEPARTMENT 949,296 HOSPITAL‐NON‐EMERGENCY DEPARTMENT BED 270,495

NURSING HOME/ASSISTED LIVING FACILITY 107,850

HOME 64,811

MEDICAL OFFICE/CLINIC 51,456

OTHER 23,316

FREESTANDING EMERGENCY DEPARTMENT 4,442

OTHER EMS RESPONDER (AIR) 5,703

OTHER EMS RESPONDER (GROUND) 1,023

POLICE/JAIL 887

URGENT CARE 490

MORGUE/MORTUARY 530

0 200,000 400,000 600,000 800,000 1,000,000

Chart 28 shows where EMS patients were transported. The predominant destination was hospital emergency departments at 64 percent (n=949,296).

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.

2018 Alabama EMS Annual Report Times Elapsed (Chart 29) 01/01/2018 ‐ 12/31/2018

Time Elapsed Unit Arrived on Scene to Patient Arrived at Destination 01/01/2018 ‐ 12/31/2018

30+ MINUTES TO 45 MINUTES 153,995

20+ MINUTES TO 25 MINUTES 79,665

25+ MINUTES TO 30 MINUTES 75,537

45+ MINUTES TO 1 HOUR 70,071

15+ MINUTES TO 20 MINUTES 68,718

1+ HOUR TO 1.5 HOUR 48,022

10+ MINUTES TO 15 MINUTES 40,928

1.5+ HOUR TO 2 HOURS 15,125

5+ MINUTES TO 10 MINUTES 12,264

MORE THAN 2 HOURS 10,246

1 MINUTE TO 5 MINUTES 2,755

LESS THAN 1 MINUTE 1,514

0 20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 180,000

Chart 29 shows time elapsed from the time unit arrived on scene to the time patient arrived at destination. The predominant time was 30+ minutes to 45 minutes at 27 percent (n=153,995).

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2018 Alabama EMS Annual Report Times Elapsed (Chart 30) 01/01/2018 ‐ 12/31/2018

Time Elapsed Patient Arrived at Destination to Destination Patient Transferred Care 01/01/2018 ‐ 12/31/2018

5+ MINUTES TO 10 MINUTES 101,420

1 MINUTE TO 5 MINUTES 91,503

LESS THAN 1 MINUTE 87,354

10+ MINUTES TO 15 MINUTES 74,435

15+ MINUTES TO 20 MINUTES 51,006

20+ MINUTES TO 25 MINUTES 33,314

30+ MINUTES TO 45 MINUTES 27,702

25+ MINUTES TO 30 MINUTES 21,543

45+ MINUTES TO 1 HOUR 8,985

1+ HOUR TO 1.5 HOUR 6,514

MORE THAN 2 HOURS 2,344

1.5+ HOUR TO 2 HOURS 2,058

0 20,000 40,000 60,000 80,000 100,000 120,000

Chart 30 shows elapsed times between patient’s arrival at destination to time patient received care. The predominant time was 5+ minutes to 10 minutes at 20 percent (n=101,420).

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2018 Alabama EMS Annual Report Out of Chute Times (Chart 31) 01/01/2018 ‐ 12/31/2018

Out of Chute Times 01/01/2018 ‐ 12/31/2018

LESS THAN 7 MINUTES 746,837

7 MINUTES OR GREATER 62,931

NULL VALUE 3,206

0 100,000 200,000 300,000 400,000 500,000 600,000 700,000 800,000

Chart 31 shows out of chute times. The predominant out of chute time was less than 7 minutes recorded at 92 percent (n=746,837).

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2018 Alabama EMS Annual Report Times Elapsed (Chart 32) 01/01/2018 ‐ 12/31/2018

Time Elapsed Time Unit Arrived at Patient to Transfer of EMS Patient Care 01/01/2018 ‐ 12/31/2018

10+ MINUTES TO 15 MINUTES 10,810

15+ MINUTES TO 20 MINUTES 10,268

30+ MINUTES TO 45 MINUTES 8,619

20+ MINUTES TO 25 MINUTES 8,118

5+ MINUTES TO 10 MINUTES 8,090

LESS THAN 1 MINUTE 6,442

25+ MINUTES TO 30 MINUTES 5,531

1 MINUTE TO 5 MINUTES 4,868

45+ MINUTES TO 1 HOUR 3,596

1+ HOUR TO 1.5 HOUR 2,240

MORE THAN 2 HOURS 2,233

1.5+ HOUR TO 2 HOURS 624

0 2,000 4,000 6,000 8,000 10,000 12,000

Chart 32 shows elapsed times that unit arrived at patients to transfer of EMS care. The predominant time was 10+ minutes to 15 minutes at 15 percent (n=10,810).

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2018 Alabama EMS Annual Report Times Elapsed (Chart 33) 01/01/2018 ‐ 12/31/2018

Time Elapsed Unit Arrived on Scene to Unit Left Scene 01/01/2018 ‐ 12/31/2018

10+ MINUTES TO 15 MINUTES 166,596 5+ MINUTES TO 10 MINUTES 142,911 15+ MINUTES TO 20 MINUTES 117,841 20+ MINUTES TO 25 MINUTES 68,925 30+ MINUTES TO 45 MINUTES 42,168 1 MINUTE TO 5 MINUTES 39,484 25+ MINUTES TO 30 MINUTES 38,054 LESS THAN 1 MINUTE 11,990 45+ MINUTES TO 1 HOUR 10,266 1+ HOUR TO 1.5 HOUR 4,816 MORE THAN 2 HOURS 2,159 1.5+ HOUR TO 2 HOURS 1,163

0 20,000 40,000 60,000 80,000 100,000120,000140,000160,000180,000

Chart 33 shows elapsed time from the time unit arrived on scene to the time unit left scene. The predominant time was 10+ minutes to 15 minutes at 26 percent (n=166,596).

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2018 Alabama EMS Annual Report Top 10 Transport Providers (Chart 34) 01/01/2018 ‐ 12/31/2018

Top 10 Transport Providers 01/01/2018 ‐ 12/31/2018

H E M S I 65,423

MOBILE FIRE RESCUE DEPARTMENT 59,246

RPS ‐ JEFFERSON 37,896

LIFEGUARD AMBULANCE SERVICE LLC D/B/A MEDSTAR 27,122

NORTHSTAR PARAMEDIC SERVICES ‐ TUSCALOOSA 25,167

MOBILE COUNTY EMS 23,997

BIRMINGHAM FIRE & RESCUE SERVICE 23,821

LIFEGUARD AMBULANCE SERVICE ‐ MOBILE 19,710

RPS ‐ SHELBY 15,834

RPS ‐ WALKER 15,808

0 10,000 20,000 30,000 40,000 50,000 60,000 70,000

Chart 34 shows the top 10 transport providers in 2018. HEMSI provided the most at 21 percent (n=65,423).

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2019 Alabama EMS Annual Report Patient Drug Use Indicators (Chart 35) 01/01/2018 ‐ 12/31/2018

Patient Drug Use Indicators 01/01/2018 ‐ 12/31/2018

PATIENT ADMITS TO ALCOHOL USE 9,771

PATIENT ADMITS TO DRUG USE 5,816

SMELL OF ALCOHOL ON BREATH 1,541

ALCOHOL CONTAINERS/PARAPHERNALIA AT SCENE 1,370

DRUG PARAPHERNALIA AT SCENE 1,170

POSITIVE LEVEL KNOWN FROM LAW ENFORCEMENT OR HOSPITAL RECORD 848

0 2,000 4,000 6,000 8,000 10,000 12,000

Chart 35 shows EMS patients drug use indicators. The predominant indicator was when patients admitted to alcohol use at 48 percent (n=9,771).

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2018 Alabama EMS Annual Report List of Active EMS Agencies Appendix A (Chart 36) 01/01/2018 ‐ 12/31/2018

Appendix A

List of Active EMS Agencies: 01/01/2018 – 12/31/2018

Provider Name License County Region Level A‐MED AMBULANCE SERVICE ‐ ETOWAH Etowah East ALS1 A‐MED AMBULANCE SERVICE ‐ MARSHALL Marshall North ALS1 ABBEVILLE FIRE RESCUE Henry Southeast ALS1 ADAMSVILLE FIRE AND RESCUE Jefferson BREMSS ALS1 ADVANCED EMS, INC Covington Southeast ALS1 ADVANTAGE EMERGENCY MEDICAL SERVICES LLC Etowah East ALS1 ADVANTAGE EMERGENCY MEDICAL SERVICES, LLC. ‐ JEFFERSON Jefferson BREMSS ALS1 AIR EVAC EMS, INC. ‐ COLBERT Colbert North ALS1 CC AIR EVAC EMS, INC. ‐ CORINTH, MS Out of State Out of State ALS1 CC AIR EVAC EMS, INC. ‐ CULLMAN Cullman North ALS1 CC AIR EVAC EMS, INC. ‐ DEMOPOLIS Marengo West ALS1 CC AIR EVAC EMS, INC. ‐ FAYETTE Fayette West ALS1 CC AIR EVAC EMS, INC. ‐ JACKSON Jackson North ALS1 CC AIR EVAC EMS, INC. ‐ MANCHESTER, TN Out of State Out of State ALS1 CC AIR EVAC EMS, INC. ‐ MARSHALL, TN Out of State Out of State ALS1 CC AIR EVAC EMS, INC. ‐ SAVANNAH, TN Out of State Out of State ALS1 CC AIR EVAC EMS, INC. ‐ WAYNESBORO, TN Out of State Out of State ALS1 CC AIR EVAC LIFETEAM ‐ CARROLLTON, GA Out of State Out of State ALS1 CC AIR EVAC LIFETEAM ‐ LAGRANGE, GA. Out of State Out of State ALS1 CC AIR EVAC LIFETEAM. ‐ LAWRENCEBURG, TN Out of State Out of State ALS1 AIR LIFE GEORGIA ‐ CARROLLTON Out of State Out of State ALS1 CC AIR LIFE GEORGIA ‐ ROME Out of State Out of State ALS1 CC AIRHEART 2 ‐ MARIANNA, FLORIDA Out of State Out of State ALS1 CC ALABAMA FIRE COLLEGE Tuscaloosa West ALS1 ALABASTER FIRE DEPARTMENT Shelby BREMSS ALS1 ALBERTVILLE FIRE & RESCUE Marshall North ALS1 ALEXANDER CITY FIRE DEPARTMENT Tallapoosa East ALS1 ALLGOOD VOLUNTEER FIRE AND RESCUE Blount BREMSS ALS1 AM/NS CALVERT Mobile Gulf ALS1 AMSERV EMS ‐ BIBB Bibb West ALS1 AMSTAR EMERGENCY MEDICAL SERVICES ‐ MARENGO Marengo West ALS1

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AMVAC CHEMICAL CORPORATION Mobile Gulf ALS1 ANNISTON EMERGENCY MEDICAL SERVICES, INC. Calhoun East ALS1 ANNISTON FIRE ‐ RESCUE Calhoun East ALS1 ARAB FIRE RESCUE Marshall North ALS1 ARGO FIRE & RESCUE St. Clair BREMSS ALS1 ARITON RESCUE SQUAD Dale Southeast BLS ARJENNA PARABASIC TRANSPORT LLC Shelby BREMSS BLS ASAP AMBULANCE ‐ ESCAMBIA Escambia Gulf ALS1 ASAP AMBULANCE ‐ WASHINGTON Washington Gulf ALS1 ASAP EMS ‐ CLARKE Clarke Gulf ALS1 ASAP EMS ‐ MONROE Monroe Gulf ALS1 ASAP EMS ‐ PERRY Perry West ALS1 ASAP EMS ‐ SUMTER Sumter West ALS1 ASHFORD AMBULANCE AND RESCUE SQUAD Houston Southeast ALS2 ASHVILLE FIRE & RESCUE St. Clair BREMSS ALS1 ATHENS LIMESTONE EMS Limestone North ALS1 ATMORE AMBULANCE, INC Escambia Gulf ALS1 ATTALLA FIRE & RESCUE Etowah East ALS1 BAKER HILL FIRE / RESCUE Barbour Southeast ALS1 BALDWIN EMERGENCY MEDICAL SERVICES Baldwin Gulf ALS1 BAPTIST LIFEFLIGHT 1 Out of State Out of State ALS1 CC BAPTIST LIFEFLIGHT 3 ‐ CONECUH Butler Southeast ALS1 CC BASF CORPORATION Washington Gulf ALS1 BESSEMER FIRE DEPARTMENT Jefferson BREMSS ALS1 BIRMINGHAM FIRE & RESCUE SERVICE Jefferson BREMSS ALS1 BIRMINGPORT FIRE DEPARTMENT Jefferson BREMSS ALS1 BLOUNT EMS, INC. Blount BREMSS ALS1 BOAZ FIRE / RESCUE Marshall North ALS1 BRANTLEY FIRE & RESCUE Crenshaw Southeast ALS1 BROOKSIDE FIRE RESCUE Jefferson BREMSS ALS2 BROOKWOOD VOLUNTEER FIRE DEPARTMENT Tuscaloosa West ALS1 CAHABA VALLEY FIRE ‐ JEFFERSON Jefferson BREMSS ALS1 CAHABA VALLEY FIRE ‐ SHELBY Shelby BREMSS ALS1 CALERA FIRE DEPARTMENT Shelby BREMSS ALS1 CARE AMBULANCE ‐ AUTAUGA Autauga Southeast ALS1 CARE AMBULANCE ‐ CHILTON Chilton BREMSS ALS1 CARE AMBULANCE ‐ DALLAS Dallas West ALS1 CARE AMBULANCE ‐ LOWNDES Lowndes Southeast ALS1 CARE AMBULANCE ‐ MACON Macon Southeast ALS1 CARE AMBULANCE ‐ MONTGOMERY Montgomery Southeast ALS1 CC CARE AMBULANCE ‐ PERRY Perry West ALS1

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CARE AMBULANCE ‐ RUSSELL Russell Southeast ALS1 CC CENTER POINT FIRE AND RESCUE Jefferson BREMSS ALS1 CHELSEA FIRE & RESCUE Shelby BREMSS ALS1 CHEROKEE EMERGENCY MEDICAL SERVICES, INC Cherokee East ALS1 CHEROKEE RESCUE SQUAD Colbert North ALS1 CHILDERSBURG AMBULANCE SERVICE Talladega East ALS1 CHOCTAW COUNTY AMBULANCE SERVICE Choctaw West ALS1 CITY OF LANETT FIRE AND EMS Chambers East ALS1 CITY OF SLOCOMB EMS Geneva Southeast ALS1 CLANTON FIRE DEPARTMENT Chilton BREMSS ALS1 CLAY COUNTY RESCUE SQUAD Clay East ALS1 CLEBURNE COUNTY EMERGENCY MEDICAL SERVICES Cleburne East ALS1 CLIO RESCUE SQUAD Barbour Southeast BLS COLLINS CHAPEL FIRE & RESCUE Chilton BREMSS ALS1 COLUMBIA AMBULANCE & RESCUE EMERGENCY SQUAD Houston Southeast ALS1 CONCORD FIRE DISTRICT Jefferson BREMSS ALS1 CONECUH COUNTY EMS Conecuh Gulf ALS1 CORDOVA VOLUNTEER FIRE DEPARTMENT Walker BREMSS ALS1 CORNER VOLUNTEER FIRE & RESCUE SERVICE, INC. Jefferson BREMSS ALS1 COTTONWOOD AMBULANCE & RESCUE SQUAD Houston Southeast BLS CRAWFORD VOLUNTEER FIRE DEPARTMENT, INC Russell Southeast ALS1 CROSSVILLE FIRE & RESCUE Lamar West ALS3 CULLMAN EMERGENCY MEDICAL SERVICES Cullman North ALS1 CC CULLMAN FIRE RESCUE Cullman North ALS1 D. W. MCMILLAN EMS Escambia Gulf ALS1 DALE EMS & RESCUE SQUAD INC Dale Southeast ALS2 DALEVILLE POLICE VOLUNTEER RESCUE Dale Southeast ALS2 DAPHNE FIRE DEPARTMENT Baldwin Gulf ALS1 DAUPHIN ISLAND FIRE AND RESCUE Mobile Gulf ALS1 DAVIS LAKE FIRE DISTRICT St. Clair BREMSS ALS2 DECATUR FIRE & RESCUE Morgan North ALS1 DEKALB AMBULANCE SERVICE Dekalb North ALS1 DEMOPOLIS PUBLIC SAFETY D/B/A DEMOPOLIS FIRE/RESCUE DEPT. Marengo West BLS DESOTO RESCUE SQUAD Dekalb North ALS3 DIRECTORATE OF PUBLIC SAFETY, FIRE & EMERGENCY SERVICES DIVISION Dale Southeast ALS1 DOTHAN AMBULANCE SERVICE ‐ HOUSTON Houston Southeast ALS1 DOTHAN FIRE DEPARTMENT Houston Southeast ALS1

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EAST ALABAMA EMERGENCY MEDICAL SERVICES, LLC Lee Southeast ALS1 EAST ALABAMA FIRE DISTRICT Chambers East ALS1 ECHO EMS Dale Southeast ALS1 ECLECTIC FIRE DEPARTMENT EMS Elmore Southeast ALS1 ELITE INDUSTRIAL SERVICES Mobile Gulf ALS1 EMERGENCY MEDICAL TRANSPORT, LLC Randolph East ALS1 EMS CARE AMBULANCE Russell Southeast ALS1 ENTERPRISE FIRE DEPARTMENT Coffee Southeast ALS2 ENTERPRISE RESCUE, INC. Coffee Southeast ALS1 ESCAMBIA COUNTY EMS Out of State Out of State ALS1 EUFAULA RESCUE SQUAD Barbour Southeast ALS1 EXCELSIOR AMBULANCE SERVICE, INC. ‐ MONTGOMERY Montgomery Southeast ALS1 FAIRVIEW VOLUNTEER FIRE & RESCUE Chilton BREMSS ALS1 FAYETTE COUNTY EMS Fayette West ALS1 FIRST RESPONSE ‐ DECATUR Morgan North ALS1 CC FLOYD EMS ‐ CHEROKEE Cherokee East ALS1 FORESTDALE FIRE DISTRICT Jefferson BREMSS ALS1 FORT PAYNE FIRE DEPARTMENT Dekalb North ALS1 FORT RUCKER EMERGENCY MEDICAL SERVICE Dale Southeast ALS1 FULTONDALE FIRE & RESCUE Jefferson BREMSS ALS1 GADSDEN FIRE DEPARTMENT Etowah East ALS1 GALLANT VOLUNTEER FIRE DEPARTMENT Etowah East ALS3 GANTT AREA VOLUNTEER RESCUE SQUAD Covington Southeast BLS GARDENDALE FIRE & RESCUE Jefferson BREMSS ALS1 GEMS AMBULANCE Butler Southeast ALS1 GENEVA RESCUE SQUAD Geneva Southeast ALS1 GOODWATER AMBULANCE SERVICE Coosa East ALS2 GRAYSVILLE FIRE & RESCUE Jefferson BREMSS ALS1 GREEN POND FIRE & RESCUE Bibb West ALS1 GREENE COUNTY EMS Greene West ALS1 GREENVILLE FIRE DEPARTMENT Butler Southeast ALS1 GREG'S AMBULANCE SERVICE Lawrence North ALS1 CC GULF SHORES FIRE RESCUE Baldwin Gulf ALS1 GUNTERSVILLE FIRE & RESCUE Marshall North ALS1 H E M S I Madison North ALS1 HALE COUNTY EMS Hale West ALS1 HALEBURG RESCUE SQUAD Henry Southeast ALS1 HARPERSVILLE FIRE DEPARTMENT Shelby BREMSS ALS1 HARTFORD FIRE RESCUE Geneva Southeast ALS1 HAYNES AMBULANCE ‐ AUTAUGA Autauga Southeast ALS1

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HAYNES AMBULANCE ‐ BULLOCK Bullock Southeast ALS1 HAYNES AMBULANCE ‐ COFFEE COUNTY Coffee Southeast ALS1 HAYNES AMBULANCE ‐ MACON Macon Southeast ALS1 HAYNES AMBULANCE ‐ MONTGOMERY Montgomery Southeast ALS1 HAYNES AMBULANCE OF ELMORE COUNTY, LLC Elmore Southeast ALS1 HAYNES AMBULANCE OF OPP COVINGTON Covington Southeast ALS1 HAYNES AMBULANCE OF TROY, LLC Pike Southeast ALS1 HAYNES LIFE FLIGHT ‐ PIKE COUNTY Pike Southeast ALS1 CC HAYNES LIFE FLIGHT, LLC Elmore Southeast ALS1 CC HEADLAND FIRE RESCUE Henry Southeast ALS1 HELENA FIRE DEPARTMENT Shelby BREMSS ALS1 HIGHLAND HOME VOLUNTEER FIRE & RESCUE DEPARTMENT, INC. Crenshaw Southeast ALS1 HIGHLANDS MEDICAL CENTER AMBULANCE SERVICE Jackson North ALS1 HILLSBORO AREA VOLUNTEER FIRE & RESCUE Lawrence North ALS3 HOMEWOOD FIRE AND RESCUE SERVICE Jefferson BREMSS ALS1 HOOVER FIRE DEPARTMENT ‐ JEFFERSON Jefferson BREMSS ALS1 HOOVER FIRE DEPARTMENT ‐ SHELBY Shelby BREMSS ALS1 HUEYTOWN FIRE & RESCUE Jefferson BREMSS ALS1 HUNTSVILLE FIRE & RESCUE Madison North ALS2 HUNTSVILLE MEDFLIGHT ‐ MADISON Madison North ALS1 CC INDIAN FORD FIRE DISTRICT Jefferson BREMSS ALS1 INTERNATIONAL PAPER Autauga Southeast ALS1 IRONDALE FIRE DEPARTMENT Jefferson BREMSS ALS1 JACKSONVILLE FIRE DEPARTMENT Calhoun East ALS1 JEFFERSON COUNTY SHERIFF'S OFFICE TACTICAL UNIT Jefferson BREMSS ALS2 JEMISON FIRE AND RESCUE Chilton BREMSS ALS1 KELLER EMS ‐ COLBERT Colbert North ALS1 KELLER EMS ‐ FRANKLIN COUNTY Franklin North ALS1 KELLYTON FIRE & RESCUE Coosa East ALS1 KIMBERLY FIRE AND RESCUE Jefferson BREMSS ALS1 LAFAYETTE FIRE AND EMS Chambers East ALS1 LAMAR AMBULANCE SERVICE INC Lamar West ALS1 LEEDS FIRE & RESCUE Jefferson BREMSS ALS1 LIFECARE OF ALABAMA ‐ JEFFERSON Jefferson BREMSS ALS1 LIFECARE OF ALABAMA ‐ TUSCALOOSA Tuscaloosa West ALS1 LIFEGUARD AMBULANCE SERVICE ‐ BALDWIN Baldwin Gulf ALS1 LIFEGUARD AMBULANCE SERVICE ‐ JEFFERSON Jefferson BREMSS ALS1 LIFEGUARD AMBULANCE SERVICE ‐ MOBILE Mobile Gulf ALS1 LIFEGUARD AMBULANCE SERVICE ‐ MORGAN Morgan North ALS1

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LIFEGUARD AMBULANCE SERVICE LLC D/B/A MEDSTAR Baldwin Gulf ALS1 CC LIFEGUARD AMBULANCE SERVICE, LLC D/B/A MEDSTAR/ESCAMBIA Escambia Gulf ALS1 LIFESAVER 2 ‐ ETOWAH Etowah East ALS1 CC LIFESAVER 3 ‐ CHAMBERS Chambers East ALS1 CC LIFESAVER 4 ‐ TALLADEGA Talladega East ALS1 CC LINCOLN FIRE & RESCUE Talladega East ALS1 LITTLEVILLE FIRE & RESCUE Colbert North ALS1 LIVINGSTON FIRE & RESCUE Sumter West ALS1 LOCUST FORK FIRE AND RESCUE Blount BREMSS ALS1 LOUISVILLE FIRE & RESCUE Barbour Southeast BLS LUVERNE RESCUE SQUAD, INC. Crenshaw Southeast ALS1 MADISON FIRE & RESCUE Madison North ALS1 MARION COUNTY EMS Marion West ALS1 MARSHALL MEDICAL CENTER ‐ BOAZ Marshall North ALS1 MCADORY FIRE DEPARTMENT Jefferson BREMSS ALS1 MCCALLA AREA FIRE DISTRICT Jefferson BREMSS ALS1 MED‐TRANS CORP DBA SHANDSCAIR 6 Out of State Out of State ALS1 CC MED‐TRANS CORPORATION D/B/A MEDSTAR AIR CARE Baldwin Gulf ALS1 CC MEDCARE EMERGENCY MEDICAL SERVICE, INC. Wilcox West ALS1 MIDFIELD FIRE DEPARTMENT Jefferson BREMSS ALS1 MIDLAND CITY FIRE RESCUE Dale Southeast BLS MILLBROOK FIRE DEPARTMENT Elmore Southeast ALS1 MINOR HEIGHTS FIRE DISTRICT Jefferson BREMSS ALS1 MOBILE COUNTY EMS Mobile Gulf ALS1 MOBILE FIRE RESCUE DEPARTMENT Mobile Gulf ALS1 MONTEVALLO FIRE & RESCUE SERVICE Shelby BREMSS ALS1 MONTGOMERY FIRE / RESCUE DEPARTMENT Montgomery Southeast ALS1 MOODY FIRE & RESCUE St. Clair BREMSS ALS1 MOUNT OLIVE FIRE AND RESCUE DISTRICT Jefferson BREMSS ALS1 MOUNTAIN BROOK FIRE DEPARTMENT Jefferson BREMSS ALS1 MUD TAVERN VOLUNTEER FIRE RESCUE Morgan North ALS1 NECTAR FIRE DEPARTMENT Blount BREMSS ALS1 NEW SITE VOLUNTEER FIRE AND AMBULANCE SERVICE Tallapoosa East BLS NEWMAN'S MEDICAL SERVICES INC Mobile Gulf ALS1 NIXON CHAPEL VOLUNTEER FIRE DEPARTMENT Marshall North ALS2 NORTH BALDWIN EMS, LLC Baldwin Gulf ALS1 NORTH CHILTON VOLUNTEER FIRE DEPARTMENT Chilton BREMSS ALS1 NORTH LAMAR EMERGENCY MEDICAL SERVICES Lamar West BLS

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NORTH SHELBY FIRE DEPARTMENT Shelby BREMSS ALS1 NORTHPORT FIRE RESCUE Tuscaloosa West ALS1 NORTHSTAR PARAMEDIC SERVICES ‐ JEFFERSON Jefferson BREMSS ALS1 NORTHSTAR PARAMEDIC SERVICES ‐ TALLADEGA Talladega East ALS1 NORTHSTAR PARAMEDIC SERVICES ‐ TUSCALOOSA Tuscaloosa West ALS1 ODENVILLE FIRE & RESCUE St. Clair BREMSS ALS1 OKALOOSA MEDFLIGHT Out of State Out of State ALS1 CC ONEONTA FIRE AND RESCUE Blount BREMSS ALS1 OPELIKA FIRE RESCUE Lee Southeast ALS1 OPPORTUNITY EMS, INC. Covington Southeast ALS1 ORANGE BEACH FIRE RESCUE Baldwin Gulf ALS1 OXFORD EMERGENCY MEDICAL SERVICES, INC. Calhoun East ALS1 OZARK EMS Dale Southeast ALS1 OZARK FIRE DEPARTMENT Dale Southeast ALS1 PALMERDALE FIRE DISTRICT Jefferson BREMSS ALS1 PELHAM FIRE DEPARTMENT Shelby BREMSS ALS1 PELL CITY FIRE & RESCUE SERVICE St. Clair BREMSS ALS1 PHIL CAMPBELL RESCUE SQUAD Franklin North ALS1 PICKENS COUNTY AMBULANCE SERVICE Pickens West ALS1 PIEDMONT RESCUE SQUAD Calhoun East ALS1 PINE MOUNTAIN VOLUNTEER FIRE AND EMS DISTRICT, INC Blount BREMSS ALS1 PINTLALA VOLUNTEER FIRE DEPARTMENT Montgomery Southeast ALS2 PLEASANT GROVE FIRE & RESCUE SERVICE Jefferson BREMSS ALS1 PRATTVILLE FIRE DEPARTMENT Autauga Southeast ALS1 PROGRESSIVEHEALTH, LLC Montgomery Southeast ALS1 RAGLAND RESCUE SERVICE St. Clair BREMSS ALS3 RAINBOW CITY FIRE & RESCUE Etowah East ALS1 RAINSVILLE FIRE & RESCUE Dekalb North ALS2 REGIONAL AIR MEDICAL SERVICES, INC.‐ WALKER Walker BREMSS ALS1 CC REHOBETH VOLUNTEER RESCUE Houston Southeast ALS2 RIVERSIDE FIRE & RESCUE St. Clair BREMSS ALS1 ROCKY RIDGE FIRE DEPARTMENT Jefferson BREMSS ALS1 ROSA VOLUNTEER FIRE & RESCUE Blount BREMSS ALS1 RPS ‐ CHILTON Chilton BREMSS ALS1 RPS ‐ CULLMAN Cullman North ALS1 RPS ‐ JEFFERSON Jefferson BREMSS ALS1 RPS ‐ MARION Marion West ALS1 RPS ‐ SHELBY Shelby BREMSS ALS1 RPS ‐ ST. CLAIR St. Clair BREMSS ALS1 RPS ‐ TALLADEGA Talladega East ALS1

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RPS ‐ WALKER Walker BREMSS ALS1 CC RPS ‐ WINSTON Winston BREMSS ALS1 RUSSELLVILLE FIRE AND RESCUE Franklin North ALS1 SAMARITAN EMS, INC ‐ MORGAN Morgan North ALS1 SAMARITIAN EMS, INC ‐ ARAB Marshall North ALS1 SAMSON VOLUNTEER RESCUE SQUAD Geneva Southeast ALS1 SARALAND FIRE RESCUE DEPARTMENT Mobile Gulf ALS1 SAVES FIRE & RESCUE Morgan North ALS1 SCOTTSBORO FIRE DEPARTMENT Jackson North ALS1 SHOALS AMBULANCE ‐ COLBERT Colbert North ALS1 SHOALS AMBULANCE ‐ JEFFERSON Jefferson BREMSS ALS1 SHOALS AMBULANCE ‐ LAUDERDALE Lauderdale North ALS1 SIMMONS EMS Monroe Gulf ALS1 SKIPPERVILLE VOLUNTEER RESCUE SQUAD Dale Southeast BLS SMITHS STATION FIRE & RESCUE Lee Southeast ALS1 SNEAD FIRE AND RESCUE Blount BREMSS ALS1 SOUTHEAST SHELBY COUNTY RESCUE Shelby BREMSS ALS1 SOUTHERN AMBULANCE TRANSPORT, INC. Randolph East ALS1 SOUTHFLIGHT Mobile Gulf ALS1 CC SOUTHSIDE FIRE DEPARTMENT Etowah East ALS1 SPRINGVILLE FIRE AND RESCUE St. Clair BREMSS ALS1 STEELE FIRE AND RESCUE St. Clair BREMSS ALS1 SUMITON FIRE AND RESCUE SERVICE Walker BREMSS ALS1 SURVIVAL FLIGHT, INC. ‐ HENRY Henry Southeast ALS1 CC SYLACAUGA AMBULANCE SERVICE Talladega East ALS1 SYLVAN SPRINGS FIRE DEPARTMENT Jefferson BREMSS ALS1 TALLAPOOSA EMERGENCY MEDICAL SERVICES Tallapoosa East ALS1 TARRANT FIRE AND RESCUE Jefferson BREMSS ALS1 THORSBY FIRE DEPARTMENT Chilton BREMSS ALS1 TIDE EMS Tuscaloosa West ALS1 TOWN OF CLAYTON ‐ CLAYTON FIRE AND RESCUE Barbour Southeast ALS1 TROY FIRE DEPARTMENT Pike Southeast ALS1 TRUSSVILLE FIRE AND RESCUE Jefferson BREMSS ALS1 TUSCALOOSA COUNTY SHERIFF'S OFFICE Tuscaloosa West ALS1 TUSCALOOSA FIRE & RESCUE SERVICE Tuscaloosa West ALS1 U S STEEL Jefferson BREMSS ALS1 VESTAVIA HILLS FIRE DEPARTMENT Jefferson BREMSS ALS1 VINEMONT PROVIDENCE FIRE DEPARTMENT Cullman North ALS2 VINES AMBULANCE SERVICE Chambers East BLS WARRIOR FIRE DEPARTMENT Jefferson BREMSS ALS1 WEST BLOUNT VOLUNTEER FIRE & RESCUE Blount BREMSS ALS2

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WEST JEFFERSON FIRE & RESCUE Jefferson BREMSS ALS2 WESTOVER MUNICIPAL FIRE DEPARTMENT Shelby BREMSS ALS1 WICKSBURG FIRE RESCUE Houston Southeast ALS1 WINTERBORO VOLUNTEER FIRE AND RESCUE INC Talladega East ALS1

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Appendix B: Map of EMS and Trauma Regions

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