Overview

The Tidewater EMS (TEMS) region includes the the Eastern Shore (Northampton and Accomack Counties); the South Hampton Roads counties of Isle of Wight and Southampton; and the cities of Chesapeake, Franklin, Portsmouth, Norfolk, Suffolk, and Virginia Beach. Over one million persons reside within the region's 2,700 square mile area.

Emergency medical services in Tidewater are provided by 77 private and public state licensed EMS agencies. Manpower may be either career, volunteer, wage, or some paid/volunteer combination. Fire services often coexist with EMS agencies, usually combined in metropolitan areas and providing first responder services in the rural areas. Two specialized teams offer expertise and economies of scale on a regional basis. EMS training is standardized statewide, with Tidewater agencies utilizing a combination of basic and advanced life support levels.

Faculty members of the EVMS Department of Emergency Medicine serve as Operational Medical Director (OMD) for 17 of the local EMS agencies. Since 1987, four of our faculty have been awarded the "Governors Award for Outstanding Operational Medical Director" - the highest recognition possible for an OMD in the Commonwealth of Virginia. This is more faculty than from any other institution in Virginia.

Emergency Medicine residents, on their EMS rotation, have ample opportunity to ride along with EMS units from Norfolk and Virginia Beach, as well as any specialty teams (i.e., Technical Rescue Team) that may be deployed during their one month rotation. Residents also have the opportunity to fly on Sentara Nightingale Air Ambulance, if they so desire.

Agencies are linked together, to hospitals and to other public safety agencies, by a coordinated network of mutual aid and medical radio frequencies. Access to EMS is provided by the 911 telephone number.
Transportation of personnel and patients is provided by ground ambulances, supplemented by aircraft and watercraft. Dispatching of vehicles is well coordinated through local emergency operations centers and several specialty centers. A region wide system of standardized IV and medical drug boxes and coordinated hospital exchange of boxes and other supplies, standardized medical protocols, and mutual aid agreements has been implemented, even with the diverse variety of agencies and personnel.

Hospital emergency department personnel receive patients and provide medical direction to pre-hospital technicians. Liaison between the hospital and pre-hospital personnel is maintained through the efforts of several committees of the Tidewater EMS Council. Immediate care for all categories of critical care patients is available within the region. Physician involvement in training programs and system evaluation is emphasized.

The Council's newsletter, Web site, media contact and public information and education resources help ensure strong public knowledge and understanding of the EMS system.

The Tidewater EMS Council, a private, non-profit corporation, is one of eight EMS councils designated by the Virginia Board of Health. Its goal, as required in the Code of Virginia, is the development and implementation of an efficient and effective regional EMS delivery system. The Council's board of directors comprise the jurisdictions served plus seven professional medical organizations. The current President of the Council, Dr. Stewart Martin, is one of our faculty.

Political Jurisdictions — Provision of Service

• The City of Norfolk is served by a municipal combined fire and EMS department with cross-trained, dual role personnel. Dr. Barry Knapp, one of our faculty, serves as its OMD, assisted by faculty assisted by Lori Givonetti, M.D., Charles Graffeo, M.D., Jack Mason, M.D. and James Carleo, M.D., all faculty members.
• EMS in the City of Virginia Beach is provided by eleven volunteer rescue squads coordinated through a rescue council and the city's Division of EMS. The city's career staff provides training resources, administrative and funding assistance, infection control, and public information services for the volunteers. The Virginia Beach Fire Department provides first responder support. Dr. Stewart Martin, one of our faculty, serves as its OMD.
• The City of Chesapeake is served by the Chesapeake Fire Department, supported by a volunteer auxiliary.
• EMS in the City of Portsmouth is provided by the Portsmouth Fire Department. Dr. Philip Leavy serves as OMD and Martin Payne, M.D. serves as Assistant OMD; both are our faculty.
• The City of Franklin is served by a municipal EMS agency with active volunteer support.
• The City of Suffolk is served by two active volunteer rescue squads, each with paid EMTs employed during the daytime and some evening hours. The EMTs are funded by their respective agencies. The city's municipal fire department and several volunteer fire departments provide first responder support. Dr. Art Chambers, one of our faculty, serves as OMD for the rescue squads and volunteer fire departments. Dr. Janet Henderson serves as OMD for the Fire Department.
• Southampton County is served by four volunteer rescue squads located in Boykins, Capron, Courtland, and Ivor.
• Isle of Wight County is served by two volunteer rescue squads located in Windsor and Smithfield. The county employs a number of part-time EMS providers to supplement volunteers. Dr. Art Chambers, one of our faculty, serves as OMD for the Windsor Squad.
• Northampton and Accomack Counties, located on Virginia's Eastern Shore, are served by thirteen volunteer rescue squads and two first responder volunteer fire departments. Each squad is supplemented by up to two paid daytime EMTs, usually with advanced EMT and firefighter training. The paid personnel are employed by each county. The Eastern Shore, surrounded by the Chesapeake Bay and Atlantic Ocean, is connected to Maryland to the north and to the Virginia mainland, via a 17-mile toll bridge-tunnel, to the south.

Manpower

Adequate numbers of qualified Emergency Medicine physicians, emergency and critical care nurses, allied health personnel, and pre-hospital personnel are generally available throughout the region to deliver a complete, responsive emergency medical service on a 24-hour basis. There are over 2,800 highly trained persons involved in the delivery of EMS in Tidewater; however, pockets of manpower deficiencies exist, particularly during the daytime workweek in a few rural areas. The numbers do not include the military or other public safety personnel (police, fire, etc.). The majority of firefighters in the metropolitan Tidewater region are CPR and state certified EMTs and are effectively utilized in a first responder mode.

The TEMS region has made excellent progress in meeting established goals for training both in advanced and basic life support. One hundred percent of EMS personnel are certified in CPR. Over 50 percent are certified at the basic EMT-A Level, and an additional 47 percent are advanced Shock Trauma, Cardiac or Paramedic certified. The remaining personnel are in training or are driver only/auxiliary members.

In 1986, the TEMS region joined a statewide effort to provide the availability of critical incident stress management (CISM) for emergency personnel. The regional team consists of professional health care providers and peer debriefers (EMS, fire, dispatchers and law enforcement personnel) available on a 24-hour basis at no cost to emergency workers. Operational policies have been developed by the team, and all members participate in standardized CISD training programs.

In late 1987, the Council's Board of Directors designated a trench and collapse team, later renamed the Tidewater Regional Technical Rescue Team. Available 24 hours a day, members are specially trained for response to trench and excavation emergencies, building collapse, confined space entry, rope rescue, high-angle rescue, and technical helicopter operations. The team is supported by the cities providing manpower as well as by private industry. Virginia Beach Fire Department houses, dispatches, and coordinates the operational aspects of the team. A custom trailer, heavy truck, and considerable amounts of equipment contributed to the team's efforts by private industry are housed by agreement in Virginia Beach Fire Station #10 near Interstate 64, central to the region.

The team is also a component of the Federal Emergency Management Agency (FEMA), designated as Urban Search and Rescue Team, VA-2. In this regard, the team is available as a federal asset and has been provided with extensive equipment and training by FEMA. Two VA-2 tractor-trailers are filled with a remarkable array of search and rescue gear. Faculty of the EVMS Department of Emergency Medicine serve as Medical Directors of the FEMA VA-2 team.

The TEMS Council monitors recruitment and retention difficulties facing career and volunteer agencies within the region and throughout the state. The Council office directs prospective career or volunteer providers to the appropriate agencies. Volunteers and staff are available to provide career information to agencies, schools, and other institutions. A volunteer recruitment booklet describes available opportunities. Career opportunities are publicized in the Council's newsletter, website and bulletin boards.

By networking agencies with demonstrated successful recruitment efforts with those requesting assistance, the Council helps agencies improve manpower levels through proven technique. The Council conducts an annual regional recognition awards program for EMS providers in an effort to improve morale and retention. This program is held in conjunction with an annual EMS family picnic, co-sponsored by Sentara Nightingale Air Ambulance, area hospitals, and emergency physician groups.

Sentara Nightingale Helicopter Ambulance

Sentara Nightingale Regional Air Ambulance

In 1982, the Sentara Nightingale Regional Air Ambulance was founded at Sentara Norfolk General Hospital, the only Level I Trauma Center in the Tidewater area. Sentara Nightingale was Virginia's first hospital-based air ambulance and only the nation's 38^th air medical program at that time.

Omniflight Helicopters, Inc., based in Dallas, Texas, has supplied the helicopter, pilots, mechanics, and aviation services since the program began. The twin-engine American Eurocopter BK-117 helicopter cruises at approximately 145 mph and can carry four crew members and one patient or two crew members and two patients (in addition to the pilot and a copilot).

The Operational Medical Director (OMD) for Sentara Nightingale has always been one of the faculty of the Department of Emergency Medicine. Currently, Lori Givonetti, M.D., FACEP, Assistant Professor of Clinical Emergency Medicine, serves as the OMD for Nightingale. Attending Emergency Medicine physicians in the Emergency Department at Sentara Norfolk General Hospital provide on-line medical control for all flights. Sentara Nightingale travels in an approximate 125-mile radius from its base in Norfolk, and has 56 hospitals programmed into its onboard navigational computer — strong evidence of its regional service.

The medical flight crew consists of a flight nurse and a flight paramedic, combining hospital and pre-hospital experience. Flight nurses are registered nurses with a critical care background and certification as Emergency Medical Technicians (EMT). Flight paramedics are nationally registered EMT-paramedics with additional training in pediatrics. Medical flight crew members are required to maintain specialty certifications to enhance their knowledge and skill levels. Emergency Medicine residents have the opportunity to serve as observers on Nightingale flights during their one month Emergency Medical Services (EMS) rotation. Flying on the helicopter is optional and strictly the decision of the Emergency Medicine resident.

For 1999, a total of 511 patients utilized Sentara Nightingale Air Ambulance; 52 percent of these flights were scene flights and the remainder interfacility transfers. Approximately 72 percent of all flights involved trauma patients and the remainder were medical, with nearly one-half of these being cardiac patients. Since its inception in 1982, Nightingale has transported a total of 8,700 patients. The Sentara Nightingale regional air ambulance serves a dual benefit to such critically ill patients: it provides rapid transport to a Level I Trauma and tertiary care facility while at the same time the flight crew administers critical care support.

For more information on Nightingale, call (757) 388-2500.

Top

Home / Site Map / Search / About EVMS / Patient Services
Education / Research / Departments / Library