Nonprofit help for building EMS systems that last

What TPF holds itself to

TPF publishes the standards it holds its own work to. The commitments below sum up the Organizational Policies, which govern in full.

• Evidence before preference. Claims rest on data, peer-reviewed research or what was seen in the field. The work says plainly where the evidence is limited or in dispute.
• Findings as found. Findings are reported as found, whatever the client would prefer. A system evaluation reports problems with structure, money and governance clearly and in full.
• Independence. Principals decide what TPF publishes without approval from funders, clients or partner organizations. TPF accepts no advertising.
• Correction in public. Errors of fact are fixed with a dated notice. Published work is never changed silently.
• Respect for sovereignty. Work is carried out on the homelands of sovereign Tribal nations. TPF recognizes their inherent sovereignty and their right to self-determination.

What TPF does

TPF works with state agencies, regional EMS bodies, county governments, hospital systems and legislative partners. It also works with a network of partner organizations that help paramedicine grow as a profession and share knowledge across countries. TPF focuses on the root problems that keep rural and frontier paramedic systems fragile.

The work produces analysis, policy frameworks, governance tools and step-by-step plans that clients can use. Each project starts from the client’s own data, rules and community. It ends with something made for that client to adopt.

TPF also does consulting, training, protocol development and evaluation for austere and wilderness care programs. These cover wilderness and search and rescue (SAR) medicine, event and expedition medicine, and tactical and disaster medicine. This work is separate from rural EMS system design. But the two often overlap in frontier areas.

Why rural EMS problems go beyond staffing

Rural and frontier EMS problems go beyond staffing. Governance, payment, the law and infrastructure all affect whether a system can keep giving reliable care. TPF looks at each of these along with workforce needs. Then it finds the changes that fix the underlying problems.

This approach shapes TPF’s rural EMS system evaluations and needs assessments. It also shapes its EMS policy and legislative services, including legislative drafting.

How TPF works

TPF has a core leadership team and a network of subject matter experts who join projects as needed. Each project draws on the specialties it calls for. These include public safety mapping and modeling with geographic information systems (GIS), EMS billing and Ground Emergency Medical Transportation (GEMT) finance, and rural EMS physician practice. They also include wilderness, tactical and disaster work in places without regular EMS. The consultants are practicing professionals. TPF builds a team for each project instead of handing it to generalists.

The network is international, with active colleagues and projects on four continents. Some of the work is paid consulting. Some is NGO-supported work, used where the mission calls for it and a fee does not fit. The problem decides the form of each project.

All work meets a formal standard for deliverables. Sources are cited in American Psychological Association (APA) 7 style. The work uses structured analytical frameworks. A peer reviews it before it goes out, and versions are tracked. Publicly funded work is published openly. Privately funded work stays confidential unless the client allows its release.

Selected outputs are available in the publications library.

Your first consultation is always free. If TPF is not the right fit, TPF will say so and point you to someone who is.

How TPF engages

TPF can take any of these roles under the Rural Health Transformation Program (RHTP) and related state and federal rural health programs:

• Prime contractor: holds the contract directly with the agency and is responsible for delivery and reporting
• Applicant or consortium member: leads or joins an application with EMS agency or rural health partners, where the solicitation permits
• Technical assistance partner: gives design help, coaching and hands-on support to state agencies or the groups they fund, under a cooperative agreement or technical assistance contract
• Evaluation partner: designs and runs program evaluation, outcome measurement and Centers for Medicare & Medicaid Services (CMS) reporting systems
• Curriculum partner: builds workforce training, clinical education and simulation content for RHTP-funded workforce programs
• Implementation partner: delivers programs together with state agencies and the groups leading them

For RHTP-specific engagement, see the RHTP implementation partner page.

How agencies contract TPF

The Paramedic Foundation holds a national cooperative contract for Consulting Services, available to public agencies nationwide. Contact [email protected] to learn more.

Participating agencies can use the terms and pricing already established in the Master Agreement instead of conducting their own competitive solicitation. To do so, an agency must register with PSAI as a Participating Public Agency under a Master Intergovernmental Cooperative Purchasing Agreement and confirm that the procurement complies with its own state and local procurement law. Purchase orders and payment run directly between the agency and TPF.

Whether a cooperative contract satisfies a given agency’s procurement requirements is a determination for that agency and its own counsel. TPF does not make it. Registered NIGP commodity codes are listed on the capabilities page.

Selected engagements

• 2026–present
  Nebraska Rural Health Transformation Program. Client: Nebraska Department of Health and Human Services, Division of Public Health. Scope: prime contractor for RHTP community paramedicine work and regional EMS technical assistance, beginning in August 2026.
• 2019–2020
  2026–present
  Matanuska-Susitna Borough EMS System Evaluations. Clients: Mat-Su Health Foundation (2019–2020) and Matanuska-Susitna Borough, Alaska (current). Scope: the first project studied EMS use and the pressures on the system. These included behavioral health demand, gaps in access and other ways to respond to calls. The current project is a full system evaluation. It covers demand analysis, deployment modeling, mobile integrated healthcare (MIH) feasibility, financial sustainability, GEMT analysis and workforce strategy. Outcome: the first project set a baseline for analysis that cut startup time on later work. The current project ends with a phased implementation roadmap for Borough leadership and the Assembly.
• 2016–2017
  King County Medic One ALS System Configuration and Deployment Study. Client: Public Health Seattle & King County, Washington. Scope: quantitative analysis of response performance, unit use and geographic coverage. The advanced life support (ALS) system was high-volume and spanned several jurisdictions. The study tested other ways to deploy units. Deliverable: options for decision-makers that weighed performance, governance complexity and workforce realities. Outcome: the findings shaped King County’s approach to ALS unit deployment and system governance in the years that followed.
• 2016–present
  Statewide EMS Workforce and System Assessments, Ohio. Clients: Ohio Office of Rural Health and State EMS Office. Scope: a multi-year assessment of recruitment, retention, training capacity, pay alignment and sustainability across rural and frontier communities. It included statewide surveys of agencies, practitioners, students and unaffiliated providers. Outcome: the findings have informed state workforce strategy. They also produced practical tools to help local agencies stay stable. Each phase has built directly on the last.
• 2019–2026
  Rural and Frontier EMS System Evaluations, Nebraska. Clients: Nebraska State EMS Office and local jurisdictions. Scope: county-level EMS assessments and sustainability planning addressing operational design, workforce limitations, financial fragility, and integration with healthcare systems, including community paramedicine program support. Outcome: the findings shaped state policy discussions and supported stabilization planning for some of Nebraska’s most fragile rural systems. The contract ended in January 2026.