Guy Gleisberg

ACE Achievers

By Guy Gleisberg

The time is 2:37 a.m. and the weather is already hot and humid in Montgomery County, Texas. I turn off the 336 Loop into the driveway of the Montgomery County Hospital District (MCHD) administration building and follow it to the back of the dimly lit parking lot where several vehicles are parked. I pause and notice a faint light coming from the triple-pane, tinted, hurricane-proof windows on the second floor.

The dispatchers are at work.

MCHD emergency dispatchers take their places in this building every day and night, 24/7 x 365. These professionals must remain peaceful and calm no matter the call—a lonely elderly woman who wants to talk; a scared, severely bleeding high school student reporting a multi-vehicle accident; or a hysterical mother whose 8-month-old infant has stopped breathing and is turning blue.

Then seconds later, another 9-1-1 caller comes over the line.

County with a past

Montgomery County was founded in 1875 in a region of prime agricultural land stretching northwest from Houston, Texas, and sweeping farther west to Washington-on-the-Brazos (a major political and commercial center in early Texas). Historians credit the county’s name to the traditional branding route followed by most early counties in Texas, commemorating national and state heroes, battles, and early pioneers.

Maj. Lemuel Montgomery was Sam Houston’s commanding officer at the Battle of Horseshoe Bend and died in Houston’s arms during the charge against the Creek Indian barricade. Houston was the first president of the Republic of Texas.

The new county of Montgomery was huge. In her book, Texas in 1850, Melinda Rankin described the new county as follows1:

“Montgomery was at that time the local seat of government of a territory larger than the State of Delaware, extending from the San Antonio road (the old ‘king’s pass’ of the anti-Texan era) on the north, to Spring Creek on the south, and from the Brasos on the west, to the Trinity river on the east, some seventy miles on either course.”

Special legislation

MCHD is a political subdivision of the state of Texas and was established through special legislation in 1977 to provide health care to the indigent residents of Montgomery County. The district has since expanded its charter to provide both emergency and non-emergency ambulance transport for a county covering 1,100 square miles and a population of more than 500,000. The agency’s approximate 280 employees respond to about 50,000 calls for assistance each year.

The communication center—MCHD ALARM—has dispatched MCHD EMS services since 1994, although it changed locations twice before moving into current quarters at the MCHD administration building in Conroe, Texas.

At the time of submission, it is the only dual-Accredited Center of Excellence (ACE) in Texas, earning both an EFD ACE and an EMD ACE. MCHD ALARM received initial EMD accreditation in 2007.

The drive for dual titles has to do with the MCHD EMS culture, according to MCHD ALARM Manager Mathew Walkup.

“The motivation is our lifeblood, our DNA,” he said. “Accreditation highlights our professionalism, dedication, and commitment.”

Fire ACE implementation was easier to gain because the processes and experience were already in place from achieving the EMD ACE, Walkup said.

MCHD ALARM command staff, along with Conroe Fire Department, gave their support and once dispatchers were EFD certified, it was a matter of organizing committees (Quality Improvement Unit [QIU], Dispatch Review Committee [DRC], and Dispatch Steering Committee [DSC]) and collecting and analyzing the data required for the submission process.

“Then of course we had to learn the EFD methodology, procedures, and, basically, their way of doing things,” he said.

The MCHD ALARM command staff was particularly supportive in understanding the EMD and EFD way of doing things, Walkup said. In September 2013, command staff approved a full-time quality assurance/improvement supervisor position. The employee—Lois Clancy—is the point person for EMD and EFD: collecting and analyzing reports, organizing committees, and creating weekly continuing dispatch education (CDE) assignments based on the previous month’s scores or items identified during system daily case reviews.

“We constantly observe and measure where we encounter weak areas and then create process improvements to quickly overcome them,” Clancy said. “Sounds like a definition, and it is, but that is what keeps the center out in front and leading.”

The supervisor pulls together information from multiple data sources to present a picture of each calltaker that identifies an individual’s strengths and weaknesses and provides a vehicle for greater interaction and targeted training.

Each calltaker maintains an individual compliance score over 95 percent every month, which Clancy attributes to their passion for excellence.

“For me, the ACE recognition validates what I already knew,” she said. “MCHD is an organization with its focus on saving lives that continuously looks for ways to offer and improve industry-leading patient care.”

ACE benefits

Walkup cites the benefits from accreditation, with the overall goal of providing the public with the correct resources at the right time, when needed. He said their success lies in the Academy’s best practices, methodologies, and the well-defined algorithms that produce repeatable successful results.

“The support of the Academy also helps us mentally and emotionally deal with the calls that are going to have bad outcomes, despite all efforts,” he said. “That’s important considering the type of calls we receive and the complexity of the situations.”

Walkup manages two shift supervisors and a QA supervisor; there are 29 people on staff. Their backup center is located in The Woodlands Fire Station in The Woodlands, Texas.

MCHD EMS provides 24-hour ambulance coverage to the citizens of Montgomery County by utilizing 21 EMS units, three squads, and four supervisors. MCHD ALARM coordinates the system status management and tactical dispatch for MCHD EMS and Conroe Fire Department. Conroe Fire serves the city of Conroe with five full-time fire stations and five engines, one ladder, one rescue, and one booster.

MCHD ALARM provides EMS first response partners to 15 local fire departments to provide rapid response basic life support and defibrillation to Montgomery County. A community-based program from PHI Air Medical and hospital-based Memorial Herman Life-Flight also services the county. =


1Kameron K, Searle J.D. “Early History of Montgomery County (1837-2012).” 2012; July 2. (accessed Aug. 19, 2014).