For Travis County residents in areas such as Bee Cave, Lakeway and Westlake, emergency medical responses are typically slower and met at a lower standard than for residents within the city of Austin. In life-threatening incidents, emergencies within the city of Austin must be met with a response time that is 2 minutes shorter than elsewhere in the county—9 minutes, 59 seconds compared with 11 minutes, 59 seconds—nine times out of 10. August data shows that Austin-Travis County Emergency Medical Services responses within the city of Austin exceed the standard response time 94.4 percent of the time, but emergency responses in the county met the response time standard 88.59 percent of the time. “The folks moving [outside the city] want the same service and response times they have in the city of Austin,” said Mike Elliott, fire chief for the Westlake Fire Department, also known as Emergency Services District 9. “An ESD cannot provide that if there aren’t enough stations or transports and ambulances to meet the demand.” One ESD is taking matters into its own hands. After experiencing explosive growth similar to the Lake Travis area over the past 15 years, the Pflugerville Fire Department, or ESD 2, purchased its own ambulances this spring and expanded its fleet again in October to better response times within the district. However, as a cost-saving measure, ESD 2 could soon decide to stop using Travis County’s dispatch services, instead seeking help from outside the county. That could also result in ESD 2 leaving the county’s automatic-aid agreement by default. Currently the automatic-aid agreement between the 15 Travis County ESDs and the Austin Fire Department requires the closest available fire rescue or medical unit to respond to a call regardless of jurisdiction, said Robert Abbott, Lake Travis Fire Rescue, or ESD 6, fire chief. “You are basically operating as a single fire department or a single EMS department,” said Josh Davies, Travis County’s executive of emergency services. “This is because whoever calls shouldn’t have to worry about who is responding.” ESD 2 Assistant Fire Chief Kevin Croegaert said that by owning its own ambulances, ESD 2 is able to provide a level of service he believes is not available with the ATCEMS interlocal agreement. Abbott said ESD 6 is always monitoring area response times and, in the past, has looked at running an ambulance service in conjunction with ATCEMS, although there are no plans to pursue units at this time. Finding an equitable solution Davies said he is trying to narrow the gap in response times and demand a higher quality of service for all of Travis County. This could help ESDs who are a part of the automatic-aid agreement. Abbott said due to overall growth and recent development in Travis County, some aspects of emergency response that have been in place for years may need to change in the future. “Over time these systems evolve,” he said. “As departments grow they may be able to do things that they weren’t able to do for themselves 10-15 years ago. Whatever system an individual ESD follows has to be beneficial to their community first and foremost.” The current interlocal agreement between the county and city is set to expire at the end of September 2018. Although Davies said he expects some parts of the agreement to change, he believes the city-county partnership will remain. A new method developed by Davies to measure ATCEMS performance and response times was implemented Oct. 1 and will be used to set new standards and aspects of the expected future agreement. “Today services are going down, and costs are going up,” he said. “We’re OK with costs going up if the service is going up. The focus of this amendment to measure performance [is to see if] the ATCEMS can come up on performance.”   The new performance-based model would adjust expected standard response times based on population density, not whether an incident occurred inside or outside the city. ATCEMS would be required to meet a 90 percent success rate on all incidents, regardless of location. “The performance model will work; there is no doubt about it,” Davies said. “Because you will only pay or continue the arrangement if whoever is providing the [emergency medical] service is meeting the performance standards, and that is not happening today.” Depending on price and results, he said private EMS services could be added to future agreements. EMS Operations in Travis County Prior to ESD 2’s decision to purchase ambulances, ATCEMS was the sole operator of ambulances in the area. With a fleet of 11 ambulance units for the county and 26 for the city of Austin, Travis County and city officials determined the optimal locations to position units in order to best serve the community. Although some ESDs, such as the Westlake Fire Department, service areas that ATCEMS can easily access using the city of Austin’s fleet, other rural ESDs near the outskirts of the county see longer response times, Elliot said. “For ESDs [that are] on the borders of Travis County, when an ambulance has to pick up a patient and take them to a hospital, it can be 30 minutes or longer before that ambulance is back in service,” he said. “We’re surrounded by ambulances in Westlake, but I would be looking at [adding ambulance service] if I faced waiting 20 minutes or more to get one.” Currently two ambulances are located within Lake Travis Fire Rescue’s jurisdiction: one at Baylor Scott & White Medical Center-Lakeway and a second between Bee Cave and Spicewood, Abbott said. “Based on the proximity to population density, it makes sense to have units in this general vicinity,” he said. “However, Travis County has final say on where ambulances are stationed and could decide to move them or add more units in the future. Maybe one day there are more ambulances out here, but that’s really up to county to decide.” The importance of automatic aid The automatic-aid agreement’s objective is to allow those in Travis County to receive fair, equitable and fast responses to emergencies, regardless of where the emergency is located, Abbott said. It also helps integrate the policies of all area departments, assuring that each agency follows the same practices. “Dispatch technology makes it where [ESDs and ATCEMS] can track each other’s units better than we ever could before,” he said. “Now we can check a screen and see which units are available in half a second. It has allowed auto-aid to be extremely user-friendly.” Abbott said automatic aid is a two-way street: ESD 6 benefits when there are multiple incidents in the area or incidents closer to Austin, and ESD 6 responds to calls in Austin when its units are closest to the event. “There are moments we are receiving aid, and there are moments that are going to help [other ESDs or the AFD],” he said. “I don’t know of any losers in auto aid, and I think collectively county and ESD 6 residents benefit from the service.” Elliott said if the Pflugerville Fire Department leaves the dispatch system, his department likely would not feel much of a direct impact, although Pflugerville's neighboring ESDs may. “It doesn’t happen very often that Pflugerville would assist us because we are so far away from them, but on a major incident like a large forest fire they could help,” he said. “[ESD 2 leaving automatic aid] might mean we would have to get that additional assistance from another source on large fires.” However, he said ESD 9 does respond to calls and receive help from the AFD; the Oak Hill Fire Department, or ESD 3; the CE-Bar Fire Department, or ESD 10; and ESD 6 on close to a daily basis because of automatic aid. Elliott said he does not believe ESD 2 potentially leaving both automatic aid and Travis County’s dispatch system will encourage other ESDs to follow suit. Pflugerville’s large call volume, increasing population, and close proximity to dispatch centers in Williamson County and the city of Georgetown make it one of only a few ESDs that could viably switch to a different service without seeing a negative impact to its residents, he said. For other ESDs farther from the center of the county, Elliott said Travis County and the city of Austin are still likely the most accessible resources. “For a group like ESD 11, their closest alternatives are Bastrop or Caldwell counties, and those areas are not well-developed,” he said. “I can’t see them leaving the dispatch center or ATCEMS because of their demographics and location.”