The URL can be used to link to this page

Home My WebLink About2026-043 EMS LieutenantJuly 24, 2026 Report No. 2026- INFORMAL STAFF REPORT TO MAYOR AND CITY COUNCIL SUBJECT: Emergency Medical Services (EMS) Lieutenant BACKGROUND: At the June 16, 2026, then Council Member Stevens proposed a future work session during the budget discussions to discuss, deliberate, and give direction on the feasibility and creation of one to two EMS lieutenant positions for the upcoming budget cycle; including a discussion on the budgetary implications, potential external funding opportunities, as well as the tangible benefits of adding these positions to the fire department. DISCUSSION: The Denton Fire Department (DFD) current organizational chart includes a single EMS Lieutenant position, reporting under the EMS Battalion Chief, and currently assigned in the Operations Division. Given the size of the Department (two battalions covering nine stations) and the clinical demands of maintaining Commission on Accreditation of Ambulance Services (CAAS), it is worth evaluating whether additional EMS Lieutenant positions for example, one per shift would better support day-to-day EMS operations. Reasons to Consider Additional EMS Lieutenant Positions: Community paramedicine program (CPP) – A functional CPP shifts EMS away from pure emergency response toward proactive, coordinated care such as post-discharge follow-ups, frequent-caller intervention, chronic disease management, and hospital/social-service referrals. This type of program needs a supervisor who can operate at the intersection of clinical judgment and daily operations, which is exactly the gap an EMS Lieutenant fills. An EMS Lieutenant can dedicate consistent, hands-on attention to case tracking, coordinating with the Medical Director on protocol boundaries, scheduling, and building relationships with hospitals, home health agencies, and social services that make referrals work. A Lieutenant also brings the field credibility to mentor crews through the different mindset community paramedicine requires spending an hour with a diabetic patient on medication compliance instead of transporting and moving to the next call while still reporting outcomes and data up the chain to justify the program's continued funding. July 24, 2026 Report No. 2026- Incident Safety Officer – An EMS Lieutenant serving as a pre-assigned, dedicated safety officer brings a level of focus to high-hazard scenes that a Battalion Chief juggling overall command simply cannot match. On working fires, hazmat responses, extrication calls, or multi-casualty incidents, having a Lieutenant whose sole job is to watch for firefighter rehab needs, monitor for heat stress and exhaustion, track PPE compliance, and flag emerging medical risks to crews means these hazards get caught in real time instead of after someone is already hurt. Because the position sits at the intersection of EMS and fire operations, the Lieutenant can also make the call to pull a crew for rehab or medical evaluation without it being seen as undermining fire-ground command, since their authority on scene is specifically tied to personnel safety rather than tactical operations. That clear, dedicated role protects both firefighters and patients and gives the incident commander one less thing to track while managing the broader scene. Call volume and EMS dominance of workload — EMS calls make up approximately 65% of the more than 24,000 calls for services (CFS) in 2025, far outweighing fire suppression calls (3% of total CFS). A dedicated shift-based EMS Lieutenant gives EMS operations leadership proportional to the actual workload, rather than treating EMS as secondary within the command structure. Quality assurance/quality improvement (QA/QI) - A dedicated EMS Lieutenant can own patient care report (PCR) review, protocol compliance audits, clinical performance trends, catching documentation gaps, skill decay, or protocol deviations before they become liability or patient care issues. The current process is to have the shift-based firefighter rank performing the QA/QI reviews. Accreditation and regulatory support — DFD holds CAAS accreditation, one of only 34 fire departments in the U.S. and Canada. Maintaining that standard requires sustained clinical oversight, data reporting, and continuous QI documentation. Additional EMS Lieutenants provide the manpower to sustain this long-term, rather than relying solely on a single EMS Battalion Chief and Captain Field-level clinical leadership and mentorship — Lieutenants work shift-to-shift with crews, unlike a Battalion Chief who oversees a wider span. An EMS Lieutenant on scene can provide real-time clinical mentorship, correct skills in the moment, and reinforce protocol adherence, something after-the-fact QA review cannot do. Training and skills maintenance — EMS certifications, especially at the paramedic level, require ongoing continuing education, skills verification, and medical director sign-off. An EMS Lieutenant can manage in-house EMS training schedules, ride-along evaluations, and remediation for personnel with recertification and skills competency. Liaison to medical direction and outside agencies — EMS operations require close coordination with the Medical Director, surrounding jurisdictions' EMS systems, hospitals for destination July 24, 2026 Report No. 2026- decisions, and billing/records vendors. A dedicated shift EMS Lieutenant can serve as the operational point of contact, freeing the EMS Battalion Chief/Captain for higher-level strategy. Incident-level EMS command on multi-patient events — For Mass Causality Incidents, cardiac arrests, and other sentinel events, requiring coordination of multiple resources, or mass-casualty triage, having a Lieutenant whose primary function is EMS command, versus fire suppression command, improves scene organization and triage decision-making. Data-driven system improvement — An EMS Lieutenant can be tasked with tracking metrics such as response times, return of spontaneous circulation rates, and STEMI/stroke bundle compliance, feeding directly into strategic planning and grant or funding justifications as the Department looks toward its next strategic plan. FINANCIAL: The estimated annual cost for each EMS Lieutenant position including base salary, full benefits, uniforms, and required personal protective equipment is $188,660. Adding two positions to provide full 24/7 shift coverage results in a total annual cost of $377,320. Funding is not currently included in the FY 2026–27 budget and would require additional appropriation or approved cost‑sharing arrangements to move forward CONCLUSION: Staff is currently evaluating the feasibility of a partnership between the fire department and local hospitals to launch a community paramedic program that would create value on both sides of the relationship rather than just shifting cost from one organization to another. Hospitals benefit through reduced readmissions and fewer non-emergent Emergency Department visits, since paramedics can follow up with recently discharged patients, monitor chronic conditions like congestive heart failure or COPD at home, and catch problems before they escalate into a 911 call. The fire department benefits by reducing unnecessary transport and freeing up 911 resources for true emergencies, while also opening a new funding stream through hospital partnership agreements or shared grant funding tied to readmission-reduction metrics. Patients get better continuity of care and fewer gaps between discharge and follow-up, and the broader community sees lower healthcare costs and a more efficient EMS system overall — making it a genuinely mutual investment rather than a favor from one side to the other. Currently, the one shift-based EMS Lieutenant serving as a dedicated safety officer gives the fire department real-time, on-scene monitoring of firefighter rehab, heat stress, and injury risk during high-hazard incidents, therefore catching problems before possibly incurring injuries rather than July 24, 2026 Report No. 2026- after. It also frees the Incident Commander to focus on tactical operations, knowing personnel safety and medical oversight are being actively managed by someone whose sole job is watching out for the crew. This enhanced oversight only covers 1 of the 3 shifts currently. STAFF CONTACT: Kenneth Hedges Fire Chief Kenneth.hedges@cityofdenton.com (940) 349-8830 REQUESTOR: Council 2-Minute Pitch Request STAFF TIME TO COMPLETE REPORT: 3 hours