For MedStar Mobile Healthcare, the high-performance, public utility model EMS system serving Fort Worth and 14 other cities in North Texas, delivering patient-centered care, effective response and maintaining economic efficiency is their mission. However, achieving that mission for a special district of MedStar’s service area during peak times was becoming increasingly difficult during the summer of 2018.
A new entertainment district was developed near Fort Worth’s downtown area. Dubbed the West 7th Entertainment District, this 14-block area hosts thousands of visitors on Friday and Saturday nights between 10 p.m. and 3 a.m. The congestion of people and vehicles made it very challenging to provide the type of service MedStar strives to deliver. Further, an analysis of responses into this district revealed that many of the EMS responses were for low-acuity medical issues, often not resulting in the need to transport a patient to a hospital.
The response concept
In September of 2018, Fort Worth Police Lieutenant Fred Long and Commander Cynthia O’Neil approached MedStar with a potential solution. PD had been using officers on bicycles in the district and found that the bike cops were able to efficiently navigate cars and people to quickly access areas where they were needed. However, they were dealing with the logistics of trying to get MedStar ambulances into this area for medical calls, either when people called 911, or when officers wanted someone to be evaluated for a medical or trauma incident.
MedStar had a well-established Bicycle Emergency Response Team (BERT) that is often deployed for large-scale special events, so Commander O’Neil and Lieutenant Long felt it would be valuable to invite the MedStar BERT team to pair side-by-side with PD’s bike officers in the West 7th district during the busy Friday and Saturday nights.
Achieving the goal(s)
The program has been a resounding success on many levels. MedStar’s BERT Team members deployed to the district are provided a police radio so officers can request the team directly if they encounter someone who needs medical evaluation or treatment. If a 911 call is received in the district, MedStar’s bike medics are dispatched directly by MedStar’s 911 center, and MedStar’s bike medics respond with police backup for logistics support and crowd control.
Once on scene, the BERT team performs a full evaluation and determines whether the patient can be treated and released at scene, or if ambulance transport will be required. Since the start of the partnership, 466 patients have been treated by the BERT team, with 282 (61%) of those patients treated and released at the scene. This means that ambulance resources did not have to try and navigate the busy district and were preserved for other calls in MedStar’s service area.
Even if an ambulance is required to transport the patient, the ambulance is often able to respond without lights and siren, since the BERT team is already on-scene. This meets another one of MedStar’s goals, reducing the number of calls MedStar’s ambulances respond to with lights and siren.
The medical care
MedStar’s BERT team members are all credentialed EMTs or paramedics and carry a wide array of medical equipment in three saddle bags attached to each bike. Medical gear includes pulse ox, glucometer, oxygen, AED, suction, BVM and other airway management equipment, trauma and splinting supplies, and drugs authorized for use by the BERT team (including some OTC medications that visitors often ask for, such as Tylenol, Benadryl and aspirin).
The bikes are also issued a computer-aided-dispatch smart phone, patient care reporting tablet and WiFi Hot Spot which allows the BERT team to not only be seamlessly dispatched by the CAD to medical calls, but also complete a full medical chart on all patients treated and released. This technology also facilitates the transfer of patient care notes from their tablet to an arriving ambulance crew’s chart, which makes patient care transfers efficient and effective.
While the clinical cases managed by the BERT team run the full gamut of what you might see on a typical ambulance shift, responses for seizures, falls, assaults and alcohol intoxication are most common. On one evening, BERT team members were the first EMS resources on scene for two gunshot wound victims in two separate locations simultaneously.
The training
BERT team members undergo extensive training following the standards of the International Police Mountain Bike Association (IPMBA), and the BERT team coordinator, Ross Gaston, is a certified IPMBA instructor. Some of the BERT assignments involve bicycling great distances, so to qualify for the training and qualification, BERT members must meet a specific height and weight requirement, and pass a basic physical ability test. Training includes bicycle operation, navigating crowds, traversing various types of terrain (especially curbs and stairs) and bicycle repairs. Due to the highly visible nature of BERT assignments and venues, public relations skills are also reinforced during the training.
The benefits
MedStar has reaped great benefits from the BERT program. In addition to the operational benefits, there is tremendous public and employee relations value. BERT team members have the unique opportunity to interact with the public in ways ambulance crews are typically not able to. It is not unusual for BERT team members to have extensive conversations with the public about MedStar, and even a career in EMS.
During a recent BERT deployment at a 10k fundraiser, a participant suffered a severe stroke. The BERT team made patient contact within minutes, was able to initiate care, summon an ambulance and transfer care quickly to the arriving ambulance for transport to a local comprehensive stroke center. The patient made a full recovery and was featured in local news stories.
Participation on the BERT team is considered a privilege at MedStar, and selection is relatively competitive. This gives employees something to strive to be part of. Additionally, ambulance crews enjoy knowing the BERT team is out there to reduce their responses to calls in difficult-to-access venues, and, when they do respond, much of the patient care is well underway when they arrive.
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About the authors
Ross Gaston is MedStar’s BERT coordinator. He’s been in EMS for 18 years, has been IPMBA certified since 2019 and is an IPMBA Instructor. For more information on MedStar’s BERT program, contact Gaston at RGaston@medstar911.org
Matt Zavadsky is MedStar’s chief transformation officer, and a member of MedStar’s BERT team.
This article, originally published in August 2022, has been updated.
