PROVIDED Berkeley County’s new mass-casualty bus and trailer will be on hand at the upcoming Family Circle Cup tennis tournament on Daniel Island. The bus, which was formerly used for rural mass transit, was purchased and retrofitted by the county’s Emergency Medical Services department for $14,000. The bus can accommodate 34 patients at one time and the mass-casualty trailer has supplies to treat an additional 700 patients.

When the Family Circle Cup starts April 12, thousands of visitors will descend on Seven Farms Drive for a week of world-class women’s tennis.

But tennis won’t be on the mind of Bob Mixter, director of Berkeley County’s Emergency Medical Services department. He and his EMS staff will focus on the safety and welfare of the players and fans who attend the event.

"It’s very important for EMS departments to get used to the fact that we live in a different world today," said Mixter, a 30-year EMS veteran who has worked for the county for 19 years. "An incident that could produce mass casualties is a real possibility."

Consequently, this year his staff will unveil a tool designed to treat mass casualties: an emergency room on wheels.

"We’re the only 911 service in the Lowcountry region to own a mass-casualty bus," Mixter said. "...It’s designed to take care of 34 patients at one time."

Mixter invites Daniel Island residents to stop by and visit the bus during the tournament. Put into service a month and a half ago, the bus purchase and retrofitting cost only $14,000.

"I just about stole it," Mixter laughed, noting that he bought the used bus for $5,000 and used state and federal grant monies to rebuild and outfit it. A new bus would have cost at least $300,000, he said.

Berkeley County EMS held a drill in January to test the vehicle’s capabilities. Emergency personnel treated 72 victims in less than one hour or 47.5 seconds per victim. The bus also has a mass-casualties trailer that can accommodate 700 additional patients. In May, Mixter will be lecturing at a Greenville conference on how to perform triage during a mass-casualty situation.

"We’re pretty serious about being ready for mass casualties," Mixter said. "It’s a resource for everyone and one we’ll share wherever it’s needed. It comes with a crew of four – one driver and three caregivers – and is the same as having 17 ambulances. This is a real lifesaver."

Berkeley County EMS has a visible daily presence on Daniel Island. Based at the police and fire station on Seven Farms Drive, its ambulance crew is one of 11 that serve the sprawling rural-suburban 1,200 square-mile county.

The Daniel Island crew averages about 1.2 daily calls in a coverage area that extends out to Captain Bill Lane on Clements Ferry Road, Mixter said. His busiest ambulance units are located in Summerville and Goose Creek and average approximately six or seven daily runs.

"People on Daniel Island enjoy a 4-minute, 32-second response time, which is twice as fast as required by the national standard," Mixter said.

However, confusion between city and county 911 services does occasionally cause slower response times, according to Mixter.

"The most recent problem was at Beresford Creek," he said. "The person had dialed on a land line that got the city 911 service. A corded phone generally rings to the city of Charleston. The dispatcher asked if the emergency was on Daniel Island and the patient said no, which it wasn’t. So the dispatcher moved it over to Charleston County, which extended the response time on that particular call."

Unlike land-line calls, cellular 911 calls will usually ring at the Berkeley County emergency dispatch center, Mixter said.

"Sometimes if you’re close to the river, the call will go to Charleston," he said. "So if you’re calling from Berkeley County, a user should give as specific a location as possible... This can help eliminate confusion. The dispatcher should ask that question, too. It’s about one in a thousand calls that this occurs but it’s something that we’re very sensitive to. The same thing occasionally happens at the bottom end of Goose Creek and it’s really helpful, especially with cell phone calls, if the user clearly identifies their location."

Mixter is proud of the Berkeley County EMS, which was named the best large ambulance service in the state of South Carolina in 2007. Its training program is three to four times more rigorous than what is required by national registry standards.

Mixter said his department has embraced new technologies that enhance emergency medicine. For example, Berkeley County EMS produced a training DVD in concert with Roper Hospital and a Duke Endowment grant on how to read 12-lead electrocardiograms.

"The 12-lead EKG allows us to work in concert with our hospitals by sending information and they see what we’re seeing," Mixter said. If it’s determined that the patient is having a real-time heart attack, the ambulance can be routed directly to the cath lab for treatment. "It’s saving heart muscle and saving lives. It’s an awesome tool."

Berkeley County EMS also began carrying CPAP masks in their units, which can help keep patients off portable ventilators, Mixter said. Another lifesaving tool is a bone injection gun that is used on patients who are in vascular collapse. The gun opens a channel to blood-rich bone marrow and allows EMS personnel to give intravenous fluids.

Another emerging technology that Mixter hopes to obtain is portable ultrasound devices.

"It’s pretty pricey now but I see the cost coming down," he said. "It’s another tool that would allow us to make real-time decisions with real-time data. It lets us look past the skin into the body to check a fetal heartbeat or detect an abdominal bleed."

Mixter’s department also uses North Charleston or Orangeburg County medical helicopter services for situations requiring rapid transport, such as a flight to a burn unit or after a lengthy extraction from a car wreck. It also has an off-road ATV and emergency trailer for responding to emergencies in rugged terrain.

The Berkeley County EMS has a $4.8 million annual budget with 63 full-time and 50 part-time employees. And ultimately it’s the people who make it a vibrant, efficient organization, according to Mixter.

"We’ve got a really good group of men and women," he said. "They’re really strong people who are some of the best practitioners of pre-hospital medicine that you could want."