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

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

4. 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)

5. 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 months
New and changing organizational culture

6. 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.

7. 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.

8. 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)

9. US Drug Enforcement Agency Licensure

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

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

12. Texas Department of State Health Services EMS Provider Initial Survey

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

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

15. 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)

16. 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)

17. QUESTIONS