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When East Texas Medical Center Emergency Medical Service began as an effort to retain an ambulance service in Tyler and Smith County 40 years ago, its leaders then probably had no idea that it would grow to the be the largest rural EMS provider in the state.

But grow it did, to cover 17 counties with vehicles known as “mobile intensive care units.” This year, officials said, ETMC EMS will probably respond to 130,000 calls, which will result in about 100,000 transports.

The services has 95 ambulances in Texas and employs about 525 people, said Ron Schwartz, operations director.

The annual EMS Week, a week for recognizing emergency medical service providers, will begin Monday. ETMC EMS usually celebrates its birthday, in the spring of 1968, each year during EMS Week. This year it will celebrate its 40th anniversary.

EMS service has come a long way from the days the ill and injured were loaded into hospital-bound vehicles most likely operated out of local funeral homes. Nowadays, an EMS unit is an intensive care unit on wheels — or in the air — and in high-tech communication with hospital support.

Johnny Brown, ETMC EMS regional director, said about four funeral homes ran the ambulance service in Smith County until the late 1960s.

Equipment and training has changed a lot since the days of the funeral home ambulance service.

“Even in those years they required them to have minimal equipment, but it was minimal,” said Don Elbert, ETMC EMS paramedic training coordinator. “Resuscitation bags, bandages and stuff; it was very limited. They very often would have a first aid card, a first aid training card (showing) that they took a first aid class. That wasn’t even always required.”

Still, Elbert said, the local funeral homes did a very good job at running an ambulance service.

Brown, an EMS employee for nearly 29 years, said the legislature passed a bill requiring ambulances to be staffed 24 hours a day, seven days a week, and that is when the local funeral homes decided they could not provide the service anymore.

For a while, a private company, Southwest Ambulance Service, provided the service.

In 1968, Southwest ceased operations and the ETMC system, then known ast the East Texas Hospital Foundation, agreed to accept responsibility for operating an ambulance service for Tyler and Smith County.

Elbert said in its early years ETMC EMS was the only emergency medical service in the state whose responders were all certified emergency medical technicians. In 1980, all responders were trained to be paramedics.

“The paramedic is a much more well-trained EMT, and the primary differences in responsibility are in drug administration, reading EKGs, IV therapy and advanced airway management,” said Elbert, who has been with ETMC EMS more than 29 years. “As recently as ’80 it was unheard of to have paramedic operations (in less populated areas of Texas). You’d have to go to Dallas, San Antonio, Houston.”

In 1980, the service initiated its first expansion, taking over the operation of the ambulance service in Athens.

“We’re the largest rural provider of EMS in Texas,” said Don Elbert, paramedic training coordinator. “We are considered the second-largest in the United States. … As far as contiguous rural area, that’s extremely rare.”

Its area includes 17 counties, from as far west as McLennan County to as far east as Panola County, and from as far north as Upshur County to as far south as part of Harris County.

Elbert said the service grew so large because of its reputation.

“Other counties that had services that needed to be upgraded, virtually every area was brought on that way, and we were invited to come in and put in a bid,” he said.

Dr. William Moore, ETMC EMS regional medical director, said in the early 1990s the city’s choice of ambulance provider became a large issue every year, attracting many letters to the newspaper that were for or against the ETMC provider.

“Certain hospitals wanted the contract, and it got to be a huge thing,” Dr. Moore said.

The city and county hired a consultant who developed a system that had many checks and balances for ambulance service. The EMS Medical Control Board, which consists of medical professionals from across the EMS region, was appointed to review and rate the service, and report to the EMS Administrative Agency, which votes on whether to renew the contract.

“We’re rating on a vote from zero to five, and it’s by response times … and is the quality of the service appropriate,” Dr. Moore said.

The city attorney compiles the votes and reports it to the administrative agency, which votes on whether to renew a contract.

“Now, if we don’t perform, we lose the contract,” Moore said.

As times have changed, ETMC has made upgrades to its EMS service. It installed an 800-megahertz radio system that is used by multiple agencies.

But, as the officials said, the department is not a money maker in all areas.

“We are a division of the hospital, and obviously the hospital benefits from the patients we bring on board as well, so from that perspective we are a revenue generator,” said Ron Schwartz, operations director. “But there are some areas that we provide service to that, because of our trauma commitment, … we may not generate enough patients in some of our rural areas to actually pay for an ambulance in some of these outlying communities.”

And ETMC EMS goes where it is needed.

It sent 10 units and more than 100 people to New Orleans for 10 days after Hurricane Katrina struck. It also sent units to assist those injured in Hurricane Rita.

EMS continues to submit bids to areas seeking a provider, Schwartz said.

“We’re also in the process of analyzing other bids right now outside of Texas,” he said. “Right now the hospital is very supportive of us growing EMS. We’re looking for the opportunity to expand our service.”