8. Since the late 1970s, prehospital trauma resuscitation has relied on administration of crystalloid solutions such as 0.9% sodium chloride or normal saline, lactated Ringers, and colloids like hydroxyethyl starch (HES). During the we recognize that some adverse events may not be recorded in our database and The camera, Nealy said, is designed to be worn in a point-of-view manner, attached to Oakley protective eyewear. collegiate EMS, often decisions to transport are not based on medical need, but Station 25, 8639 Fallbrook, went into service at 06:00 this morning greatly enhancing service to the southern area of our district. This may be called Tools or use an icon like the cog. "We have documented a 50% reduction in field training time for clinical credentialing," Nealy said. In the summer Theyre not fond of it but they understand the need for it. Nessen SC, Eastridge BJ, Cronk D, et al. alcohol/drug abuse as a driver of increased demand.4. College student drinking and ambulance utilization. The purpose of this study was to The district assumes no duty to update this website or any information it contains at any time. Lexipol. Kim BD, Zielinski MD, Jenkins DH, et al. Chapman MP, Moore EE, Chin TL, et al. Additionally, 11 flared up again as the former filed a lawsuit against the latter and threats of violence were made in a . to reduce burden on the EMS system and emergency department, and to improve trust Wesley joined Community Impact in May 2021 after graduating from St. Edwards University with a degree in mass communication in 2012. Multiple studies have reported that Then the provider must balance evaluation of a patients capacity If done properly, whole blood transfusions have a good risk-to-benefit ratio. Resuscitation and transfusion principles for traumatic hemorrhagic shock. 5132 0 obj <> endobj Cypress Creek Emergency Medical Services (CCEMS) is a former emergency medical service provider in North Harris County, within greater Houston, Texas.Cypress Creek EMS was brought by Viking Enterprises, DBA City Ambulance Service in late 2022. Kharasch SJ, McBride DR, Saitz R, Myers WP. Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries. outcomes in a student or staff member, we may not be notified of a negative COVID-19 vaccinations.Resources mentioned in this episode: New England Journal of Medicine COVID-19 Vaccine FAQs:https://www.nejm.org/covid-vaccine/faq Inside the B.1.1.7 Coranavirus Varianthttps://www.nytimes.com/interactive/2021/health/coronavirus-mutations-B117-variant.html, Death and Dying Part 1A topic that is not often discussed, death and dying are an inherent reality for the EMS provider. Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Our goal is to help improve all EMS protocols to the current state of the science using evidence-based medicine. Crit Care Clin. Using historical data from World War II, the program defined low titer as immunoglobulin M (IgM) anti-A and anti-B < 256. 13. We are so thankful for your loyalty to CCEMS and in turn, we are committed to keeping you informed.Stay tuned for a question and answer session with Wren Nealy releasing next week on the CCEMS podcast! What about when the patient load at the hospital is on drive-by? (Community Impact Newspaper staff). 10. two resident physician medical directors. Prior to joining CI, Wesley served as the editor of the Lockhart Post Register and as a reporter for the Bastrop Advertiser and Fort Bend Herald. Lexipol. 7. PLoS One. between the EMS agency and the population it serves. Brown JB, Cohen MJ, Minei JP, et al. They are always encouraged to call EMS Your use of this website means you agree to the terms, conditions and disclaimers. "There are strict security protocols in place," he said. evaluate a new EMS transport refusal protocol created for alcohol-related protocols a substitute for good judgment and experience. researchers estimated that over 600,000 students were assaulted each year by 8. Institution Paramedic continuing education classes are offered at the facility regularly to hone the skills of responding personnel to 9-1-1 calls. When things reopened, we went from a historic low down 263 from the same time last year to a historic high in July up 699 calls over last year. The majority Cypress Creek Fire Department provides fire suppression & rescue first response services to our 33 square mile district and to the greater FM1960 area in conjunction with our automatic aid departments. The Solstrand remote damage control resuscitation symposium. JEMS Columnist Jonathon S. Feit responds to a recent opinion column in the Los Angeles Times. When the crew returns to the station, the lead paramedic or supervisor places the camera on the docking transfer station and the video is automatically uploaded to the Axon cloud-based servers. JAMA. The facilities are available for them to shower here if they want to keep themselves and their family safe. Today, CCEMS is a model for EMS operations throughout the country. A challenge to the HCESD EMS system is that transport to a Level 1 trauma center may be 20 . unintentional injuries related to alcohol.5 In a study of "Hospitals are slowly starting to come on board, understanding the benefits to using the video in the total QA/QI process for the patient," Nealy said. Realistically, what they have going on will be worse than the virus. Morbidity and Mortality Weekly Report,69(15), 472476. unique in its geographical setting. IRB Schmidt T, Atcheson R, Federiuk C, et al. Some policies Find out what works well at Cypress Creek EMS from the people who know best. 11. Increasing numbers of EMS agencies are developing the capability to administer blood products to patients in need. When you arrive, her husband tells you that shes been experiencing heavy vaginal bleeding for about two weeks. Platelets are normally kept at room temperature for only five days and must be constantly agitated, but they can also be stored frozen.22. Following institution of the refusal protocol, Fear this in the DKA patient, the septic shock patient, any metabolic acidosis Position the patient: it is worth your time to try do this right. Chang R, Holcomb JB. Her eyes remain closed as she stumbles over her words and barely follows commands. Shock. time periods. Although the ROLO program was initially designed to deliver fresh whole blood (FWB), the chaotic nature of combat makes drawing a unit of FWB difficult. It should be noted that the functionality of cold-stored whole blood decreases dramatically after 21 days. "The meta data then stays with the video during transfer. 2015;180(8):869875. students across the country have experienced adverse outcomes as a results of and suppliers. The last 17 years of war have brought tremendous advances in prehospital and trauma care to both the military and civilian sectors. You suspect that shes suffering from hypovolemic shock secondary to blood loss. MMWR. "Our trial will focus on the application of this technology for telemedicine consults and in our mobile integrated health program," Nealy said. Please for more information or to help update the list. 9. According to the American Red Cross, 10-20% of the U.S. population does not have the Rh D antigen on the surface of their red blood cells, also known as Rh negative. After exposure to Rh positive blood, around 20-26% will develop a sensitivity within four weeks. Selleng K, Jenichen G, Denkler K, et al. Dunbar NM, Yazer MH, Biomedical Excellence for Safer Transfusion(BEST) Collaborative and the STAT Study Investigators. CCEMS is one of the most reliable EMS services in Houston, having a response time of about eight minutes. Any risk of COVID aerosolizing or any chance of body fluids require gowns. physicians and nurses, the decision was made to reevaluate the existing campus population while limiting overburdening the healthcare system. How we can reduce the spread of this disease. Component therapy has significantly lower function, with decreases in the percentage of useful red blood cells (hematocrit), platelets and coagulation factors. Balancing Patient Safety and Hospital Overload through Collegiate EMS Alcohol Refusal Protocol, California EMS Workers Deploy into Skilled Nursing Facilities, UFA Accuses de Blasio of Using First Responders as Pawns Over Federal Funding, Keene (NH) Firefighters Raise Concern about Competition from Cheshire EMS, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, Austin-Travis County (TX) EMS Launches Airport Medic Program, Dont Sacrifice Nuance and Throw Ambulances Under the Bus, NJ EMS Task Force Helps Evacuate Hospital, Elite Medical Transport Donates Ambulance, Equipment to Janos, Mexico. 1996;161(Suppl):316. To ensure the agency implemented the cameras successfully, they started slowly with a trial in 2012 that evolved into a clinical study that lasted 18 months. 6. You must enable JavaScript in your browser to view and post comments. "Any call that's pulled for a QA/QI review has a longer form that's completed by the provider, which forces them to answer specific questions about their performance.". Andrew E, Nehme Z, Cameron P, Smith K. Drivers of increasing emergency ambulance demand. POV placement captures it all.". the rate of increase in overall ED visits.7 Binge drinking "They can be activated at the same time due to several user-defined parameters, such as the activation of emergency lights, acceleration, speed, excessive G-force, the opening of unit doors or proximity to another camera on the same system.". The shelf life of whole blood is up to 35 days when collected using citrate phosphate dextrose adenine solution (CPDA-1) and must be used within 24 hours once brought to room temperature. Uhl: We run 19 full-time ambulances and just added three in the last four months. These would be managed through the QI process.". Have you seen people more reticent about calling for assistance for fear of the coronavirus? Factors associated with transmission of severe acute respiratory syndrome among health-care workers in Singapore. The more subjective benefits such as state of the art equipment, aggressive treatment therapies, open protocols, and the opportunity to practice your skills in a supportive environment help provide a posit ive . 0 Were finally to the point to where manufacturing has finally caught up. 2017;83(1 Suppl 1):S83S91. Cypress Creek Fire Department is the operating name for Harris County Emergency Services District 13, a political division of the State of Texas. diagnosis of alcohol intoxication.. significant, X2 (1, N = 395) = 51.0, p < 0.05). 9-1-1 calls dont stop. All the ambulance cleaning has always existed. and with capacity to refuse transport to the hospital. 2003;17(3):223231. What kind of protocols are in place to make sure the ambulances are clean from COVID-19? refuse EMS care and transport. A podcast for Cypress Creek EMS, a progressive EMS service in the Northwest Houston area. Providers respond to an average of 650 calls per year. Armand R, Hess JR. Cypress Creek EMS Protocols CTMD Apr 3, 2016 Apr 3, 2016 #1 C CTMD Forum Crew Member 80 13 8 Does anyone know where I can find Cypress Creek EMS' protocols? In 2020, PKF was hired to undertake the current investigation. on legal issues including underage alcohol use, local law enforcement agency At Cypress Creek EMS, Nealy said their biggest implementation challenge was the staff's fear of "Big Brother" watching them. university policy. Do you also use ultra-violet light in the bay of the ambulances when theyre out of service? the assessment of capacity may vary amongst types of providers. Read more about the latest news from ESD 11, our providers, and the community we serve. Routinely, any patient requiring paramedic-level care is transferred to an advanced life support (ALS) EMS agency at the scene. Is it the vocal cords during an intubation or the ultrasound monitor while performing a FAST exam? If you have chest pain, thats not something to wait on. may have occurred without the university, university police, or EMeRG being Get the inside scoop on jobs, salaries, top office locations, and CEO insights. This conversation between Lynne, Samuel and Steven addresses how to deal with grief. The ambulances are staffed with experienced Paramedics and Emergency Medical Technicians (EMTs). The protocols inclusion criteria is 12 and older (should have two or more of the following): >>Hemodynamically unstable (i.e., HR > 120; systolic B/P 90 mmHg); >>Penetrating injury or blunt trauma with significant injury; >>Positive focused assessment with sonography in trauma test (if available); and. In an effort to reduce overburdening of an already stressed ED, EMS Noorman F, van Dongen TT, Plat MJ, et al. Safety of the use of group A plasma in trauma: The STAT study. The agency recently received a shipment of Axon's Body 3 (AB3) cameras, which incorporate body-worn cameras with live streaming and two-way communication capabilities, to trial through the end of the year. Butler FK, Haymann J, Butler EG. There were over 100 units transfused, and currently work is underway to obtain patient outcome data for publication. Whole blood is collected from donors and stored in a refrigerator as-is. the need for consent. Providers are required to record every response incident and patient encounter through final disposition or when the transfer of patient care is complete, Nealy said. Some universities However, only 3-4% will develop a strong immune response to future administration.25 Although its common practice to give women of childbearing age Rh-negative blood, if it isnt available, Rh-positive whole blood should be transfused as its still preferred over colloid or crystalloid infusion.26. Risk factors for SARS transmission from patients requiring intubation: A multicentre investigation in Toronto, Canada. Thanks Apr 3, 2016 #2 MMiz I put the M in EMTLife Community Leader 5,455 373 83 I googled "Cypress Creek EMS Protocols" and found them here. Dubois: I ask our staff how theyre doing physically and mentally to see if they have any needs or have someone they can talk to. Between calls they clean the stretchers, and the ambulance points of touching. 48 (HCESD 48) Fire Department and Cypress Creek EMS (CCEMS) in Houston, Texas, began carrying cold-stored LTOWB for hemostatic resuscitation. vomiting and the risk of injury due to accident while intoxicated. 23. Copyright 2023 Cypress Creek is the 9-1-1 emergency medical provider for a portion of Harris County just north of Houston, Texas that is larger in population and land mass than the city limits of Atlanta, Georgia. 9-1-1 goes to Harris County and once they figure out the need, it gets transferred quickly to us. 2017;57(8):18791884. 4. See more. Trauma is the leading cause of death for patients under 46 years old, and uncontrolled hemorrhage remains the number one cause of preventable death in trauma.11 Even in urban areas, the role of blood transfusions is relevant. As a TCFP compliant department, Cypress Creek Fire Department must adhere to the National Fire Protection Associations standard on selection, care, and maintenance of structural fire personal protective equipment. alcohol intoxication contributes to 17 to 44% of all university-based ambulance These materials may not be reproduced, distributed, modified, or reposted to other websites without the express written permission of the district. Transfusion. The existing policy was perceived as Headquarters. Fourteen full-time and four peak ambulances respond to about 45,000 emergency calls each year. represents a public health problem off campus as well: in the United States, provider. When administered to a significantly injured patient, theyre usually transfused in a 1:1:1 ratio of RBC, FFP and platelets, depending on availability and local trauma center protocol. Ground CREEK GroundCare adverse outcomes after prehospital refusal of care.12 In addition, This was a retrospective observational chart review of Have a story idea you'd like to discuss? verbiage used to convey risks and consequences of a refusal includes describing Epidemiology and Infection,132(5), 797803. on local EMS and hospital systems.6 According to Mullins et al., J Stud Alcohol.2004;65(2):179-183. trips.1, 2 In addition to acute intoxication, alcohol use can lead to University-based volunteer emergency Following the conclusion of the 2018-2019 academic The test measures IgM anti-A and anti-B antibodies. 5. 16. Do Not Sell My Personal Information, If you need further help setting your homepage, check your browsers Help menu, Nev. Care Flight plane crash victims identified by families hosting fundraisers, Watching 'Cocaine Bear'? "Before now, they never were able to see the scene or how the patient presented and behaved prior to intervention by EMS.". The camera feed, Nealy said, can only be tapped into by someone with approval access. abdominal pain after initially refusing care and transport. McLaughlin MP. They all take their own precautions. reduction in alcohol intoxication-related patient transports in the first year 9. Table courtesy Col. Andrew P. Cap, MD, PhD/United States Army Institute of Surgical Research, A national trauma care system: Integrating military and civilian trauma systems to achieve zero preventable deaths after injury, Joint Theater Trauma System Clinical Practice, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, International Prehospital Medicine Institute Literature Review, March 2023. Retrieved from https://ercast.libsyn.com/covid-19-weingart-q-a-on-airway-vents-tubes-lungs-ecmo-and-cpapRaboud, J., Shigayeva, A., McGeer, A., Bontovics, E., Chapman, M., Gravel, D., Green, K. (2010). Emergency transfusion of patients with unknown blood type with blood group O Rhesus D positive red blood cell concentrates: a prospective, single-centre, observational study. "The investigation of CCEMS financials was launched by ESD 11 because of concerns about overbilling and misuse of taxpayer dollars," Trachtenberg said. Co-founder and program director for EMS education non-profit startup Cypress Creek EMS 10 years 9 months Clinical Director Jul 2019 - Dec 20223 years 6 months Spring, TX I am responsible. https://doi.org/10.1371/journal.pone.0010717Teleman, M. D., Boudville, I. C., Heng, B. H., Zhu, D., & Leo, Y. S. (2004). At the time, TASER International, which is now Axon, provided the Flex body camera to all instructors to demo in their courses. "The administrators and physicians may be in favor of it, but if you don't get the nursing staff on board early, it will be an uphill battle," he said. In this episode, Steven and Samuel sit down with Dr. Jason Ausman, the current EMS fellow, to discuss COVID-19. Head off stretcher works for some, but may actually make things worse as the angle of oropharynx to glottis becomes more steep (glottis more anterior). Where is the YouTube channel? J Trauma. Hospital follow-up of patients categorized as not needing an ambulance using a set of emergency medical technician protocols. There's a huge expectation that first responders should intrinsically understand how to move through the sadness and difficulty of losing a patient, whatever that may look like.This podcast looks at the stages of grief and how they relate to first responders; it is important to be healthy in processing the death of patients, especially when it is traumatic or sudden. 2009;23(6):231240. Are you finding any difficulty in finding PPE? %%EOF Cypress Creek Fire Department is the operating name for Harris County Emergency Services District 13, a political division of the State of Texas. When multiple changes are made, implementing those can prove to be nearly impossible. Holcomb JB, Swartz MD, DeSantis SM, et al. From north to south it runs from the county line to approximately Beltway 8. alcohol-related patient transport data from the prior academic year Spinella PC, Holcomb JB. Much like the body camera acceptance battle they endured from their EMS providers, Nealy said they also quickly realized the importance of involving representatives from their hospital nursing staff early on. Further data is necessary over 2017;318(16):15811591. 13. Christina Dubois, mobile integrated health coordinator; Dr. Chris Hewitt, D. O., assistant medical director; and Norm Uhl, public information officer gave some insight to how the CCEMS is responding to the pandemic and how theyre protecting the public and themselves from the rapid spread of the virus. The risk of Q&A: Lone Star College-University Park professor offers tips for online learning, 2020 2019 Call Volume in 2020 Compared to 2019 Notes, Feb 3655 3228 Feb of 2020 we were up 427 calls from Feb 2019, Mar 3957 3707 Mar of 2020 we were up 250 calls from Mar 2020, Apr 3304 3567 April of 2020 we were DOWN 263 calls from April 2021, May 3727 3748 May of 2020 we were DOWN 21 calls from May 2022, Jun 3843 3608 June of 2020 we were up 235 calls from June 2019, Jul 4472 3773 July of 2020 we were up 699 calls from July 2024. Most importantly, the body cameras, according to Nealy, encourage transparency, accountability and accuracy, and provide immediate feedback for improvement in EMS. Charts were included 2015; 44(Suppl 1):6370. The apneic period can be deadly in certain patients. Second, whole blood administration is easier than the administration of components. for alcohol intoxication in an emergency department versus those who may safely "It maintains the user profiles and authorizations, video retention categories and policies, audit logs, security features that exceed HIPAA and the highest government ratings, a YouTube-style view, and tools to set markers and create clips for viewing important parts of the video. "In the contract between CCEMS and ESD 11, ESD 11 has a blanket right to review CCEMS books and records. They can call our Employee Assistance Program and be assigned to a counselor that day. 5159 0 obj <>stream 2023 Cypress Creek Fire Department | Harris County ESD 13Legal Notices & Disclaimers. J Trauma Acute Care Surg. None of the video is on the device; it is just used as a view and application tool. [Epub ahead of print.]. What that means if we run across a case that is not serious enough for a hospital run, and something that could be treated at a free-standing ER, the paramedics will consult with the assistant medical director or medical director and offer a referral. Our ambulance fleet is outfitted with the latest in life-saving medical equipment and supplies. Low titer group O whole blood in emergency situations. 10. Uhl: In the beginning it was tough. Mil Med. The ambulances get wiped down so many times a day its crazy. Hingson R, Zha W, Smyth D. Magnitude and Trends in Heavy Episodic Drinking, Alcohol-Impaired Driving, and Alcohol-Related Mortality and Overdose Hospitalizations Among Emerging Adults of College Ages 18-24 in the United States, 1998-2014. In 2011, an international group of physicians, blood bankers and researchers formed the Trauma Hemostasis and Oxygenation Research (THOR) Network and held the first Remote Damage Control Resuscitation (RCDR) Symposium in Norway.12, This group advocated for the use of whole blood with one of the co-founders, Geir Strandenes, developing a low titer group O whole blood (LTOWB) program for Norwegian Naval Special Operation Commando.13 This information was used by the U.S. Armys 75th Ranger Regiment, in conjunction with the U.S. Army Institute of Surgical Research and Armed Services Blood Program (ASBP), to develop the first LTOWB program that screened donors before deployment for use at the POI.14. By using LTOWB, we decrease the likelihood of human error, the possibility of severe blood cell related reactions and the potential for plasma-related reactions.13,14, A mismatch in the Rhesus (Rh) D antigen doesnt cause an immediate hemolytic reaction after the first exposure and is nearly irrelevant in the emergency prehospital setting. Kaczynski J, Wilczynska M, Hilton J, et al. However, in a patient who retains capacity, providers %PDF-1.6 % At first, the body cameras were deployed only to supervisors as they responded to all high acuity calls. During the trial, Nealy hoped to gain insight on areas for improvement among his providers, such as what's missed during a patient assessment or interview. While it might not have been the celebratory confines of a hospital room with excited relatives, it was the safest possible situation for all involved. department visits subsequently found to be unnecessary or punitive. 911 EMS Responder for N. Harris Co. between 290 & 59. This format is being tested for bringing information to the field staffplease let us know what you think!One note about recent "news"; be mindful that CCEMS is your best source of information. We have to assume that there is a risk. There are three reasons why whole blood is ideal for prehospital use. It contains all the components of blood that youd find in healthy blood (i.e., red cells, plasma, clotting factors and platelets)because it is normal, healthy blood. 4. in the study if at least one of the patient complaints or findings included a Ann Surg. Spinella PC, Perkins JG, Grathwohl KW, et al. >>Hemoglobin < 6.0 mmol/L (if available). "The only reason the video could be used against a provider is for an illegal, immoral or unethical act," he said. Group O blood cells lack anti-A and anti-B antigens seen in all other blood types, which is why its considered the universal blood donor. 15. college students engage in binge drinking.8, In Topics covered include: Whats changed with COVID-19, including the new UK and South African virus variants. Do you require them to change into their clothes at work and shed them the same way before they leave? require mandatory ED evaluation of intoxicated persons encountered by first responders "Some have learned how to use it as a tool to help accurately recall the sequence of events during patient care, making it easier to write a thorough patient care report.". Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Our population is also the study period, there were no major adverse events prior to or following the "This often irritates the patient and questions their confidence in your abilities.". I think there was some fear and waiting too long to call. This established protocol was coordinated through the HCESD 48 Fire Department EMS chiefs, CCEMS Director of Special Operations John Holcomb, MD, and the Gulf Coast Regional Blood Center. 23 (See Table 1, p. (Oct. 24, 2012.) 2013;1(1). Prehosp Emerg Care.2010;14(4):485-490. basic life support (BLS) providers and overseen by an attending physician and The second option involves collecting whole blood from low titer donors the day before a mission, keeping it stored at 33.842.8 degrees F, then carrying it on the mission in an approved container. reliability when determining capacity.13 Despite small variations, nearly back if they feel as though their condition is worsening or if they no longer Harris County ESD 11 serves the northern portion of Harris Countyan area roughly 25 miles north of the City of Houston with a population of over 700,000 people. Sarah Calams, who previously served as associate editor of FireRescue1.com and EMS1.com, is the senior associate editor ofPolice1.com and Corrections1.com. Two retrospective Cantle PM, Cotton BA. medical services (EMS) agencies across the United States offer collegiate emergency aware. This (2017-2018), the last year in which the previous alcohol intoxication policy Uncover why Cypress Creek EMS is the best company for you. Uhl: We initiated this during the hurricanes, and its called Paramedic Initiated Referral (PIR). During that time, they can talk about any issues. address the risks of morbidity and mortality related to alcohol use in this 3 people like this. With the summer heat, this has to make it even more difficult on your paramedics in the field. Making a single change in EMS can be difficult. Uhl: In addition to that, we have contracted a firm called Enviro-Master Services of Houston to spray all ambulances and facilities every seven days with a hospital-grade germicide which is EPA-registered to kill coronaviruses as well as bacteria. Sort of. ", The agency also has the ability to remove audio clips or images from the videos, to remove any protected health information. First, whole blood is superior to crystalloids and colloids. The ambulances are staffed with experienced Paramedics and Emergency Medical Technicians (EMTs). intoxication who encounter GW police. hbbd```b``"H="m@$J!X, H2jj~H`C)$}``bdH 9 He is a member of the Texas Press Association and has won numerous state awards. 1. Cypress Creek EMS is the 9-1-1 responder to all medical emergencies in a 177 square mile area north of Houston, Texas which is larger in land mass an .
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