Overview Strategic Planning Equipment Personnel Medical Direction Clinical Operating Guidelines Regulatory Agencies DEA DSHS Logistics Program Quality Auto and Mutual Aid MIH and CPP

Strategic Planning Organizational History District Needs Local Control First Responder Transport Local Control Type of service Costs Quality Response Times

Equipment Vehicles Equipment Training Equipment $268,000 $40,000 defibrillator $50,000 stretcher $20,000 ALS supplies Training Equipment Mannequins Airway Simulator IV Simulator Additional Props ($120,000)

Personnel Plan, budget, & implement actions for an applicable number of ALS transport personnel. Hiring in central Texas can be a very competitive environment for fire-based Paramedics ($8,000 per year) Training of existing personnel will generally take between 12-24 months New and changing organizational culture

Medical Direction Seek out & establish medical direction that supports your department’s and district’s goals Works for the Fire Chief and supports that role Determine the necessary hourly range, per month, you will require from your medical director and budget accordingly Training, QA/QI, Administration, Meetings, etc… In general, the relationship of time required from the medical director is linked to the existing administrative and operational support system a department already possesses. A department may choose to work with a potential new medical director and develop their upcoming system for an extended period of time prior to the actual change taking place.

Clinical Operating Guidelines Work with your medical director in order to establish a set of clinical operating guidelines (aka protocols) that fits your system’s needs and capabilities. There are a wide variety of completed COG’s available for download. Locally available COG’s are generally a good place to begin building from.

Regulatory Agencies This part takes time and is complicated by moving targets Contact others who have been there and done that The US Drug Enforcement Agency Texas Department of State Health Services Medicare Medicaid Other interested partners Hospitals Governors EMS and Trauma Advisory Council (GETAC) Regional Advisory Council (RAC)

US Drug Enforcement Agency Licensure

Internal Controlled Substances Tracking Provide stringent and traceable access Protecting all personnel and the interests of the Department, as a whole Reporting requirements Fines

“First Responder Organization” to “EMS Provider” upgrade is required with Texas Department of State Health Services

Texas Department of State Health Services EMS Provider Initial Survey

Logistics Budget support Increased EMS supplies Increase maintenance costs Increase in training costs Storage

Program Quality Access to Accurate Data Analytical Processes for an Active QA/QI System

Other Issues Dispatching Auto and mutual aid Positives What are the costs? Who is willing? Auto and mutual aid Who is covering for you? Who is assisting you? Positives New Opportunities Interfacility transports Mobile Integrated Healthcare (MIH) Community Paramedicine Program (CPP)

Summary District Needs Local Control Quality goals are being met and exceeded Response times have improved Employee satisfaction is up Local Control Has ensured the Districts vision of service is met (Note - TCESD#2 budgets approximately $675,000 per year for operational costs of each ambulance)

QUESTIONS