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Building an EMS system from the ground up

Doug Hooten on how ESD 11 is tackling recruitment, station construction and fleet purchasing


Photo/Harris County ESD11

If someone called you in and presented you with the challenge of creating your own ambulance service and building it from the bottom up – to be up, running, staffed and equipped within 365 days, would you know to begin?

In this edition of EMS One-Stop podcast, our host, Rob Lawrence, interviews Doug Hooten, CEO of the brand-new Harris County Texas, ESD 11 EMS Agency, who was presented with just this challenge.

When most RFPs for ambulance service delivery are awarded, the winning entity is usually a formed corporate body with staff employed to create a service to put in place using existing principles, practices, and processes. For Doug Hooten, he was the only man in the room with a blank piece of paper and the assurance of sufficient investment to complete the task. Harris County Commissioners have budgeted $29 million to put 28 ambulances on the street, thus creating a county operated EMS agency to replace the contracted incumbent, Cypress Creek Emergency Medical Services, whose contract expires in September, 2021.

Rob and Doug discuss the challenges of creating a service from the ground up, including real estate purchase and construction, the challenges of recruiting, and fleet purchasing.


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Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.

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