Field paramedicine and institutional design, in one organization

What TPF does

TPF works with state agencies, regional EMS bodies, county governments, hospital systems, and legislative partners. The Paramedic Foundation does that work alongside a network of partner organizations advancing paramedicine professionalization and international knowledge exchange. TPF’s focus is the structural problems that keep rural and frontier paramedic systems fragile. TPF produces analysis, policy frameworks, governance tools, and implementation roadmaps. These are tools clients can use, not reports that sit on a shelf.

TPF’s principals have spent careers at the intersection of field paramedicine and institutional design. That combination is unusual. Most organizations offer clinical depth or policy experience. TPF brings both. That is why the work holds up under scrutiny from practitioners and policymakers alike.

Every engagement ends with something adoptable. TPF starts from your data, your regulatory environment, and your community’s specific situation. TPF does not apply generic templates.

The TPF perspective on rural EMS

Rural and frontier EMS systems are not struggling because of too few paramedics. The problem is structural: the governance, reimbursement, legal, and infrastructure architecture around them was never built to sustain them, and that is where TPF’s EMS policy and legislative services focus. Treating the problem as a staffing issue produces staffing solutions. Treating it as a structural problem produces lasting change.

That distinction shapes everything TPF does. It is why TPF’s rural EMS system evaluation work starts from structural analysis rather than headcount. It shapes how TPF frames a needs assessment and how it drafts legislation. If you have tried the conventional fixes and found them insufficient, TPF is likely to have useful things to say.

How TPF works

TPF has a core leadership team and a network of subject matter experts engaged on a project basis. TPF consultants are practicing professionals. That means GIS analysts who do public safety spatial modeling. It means financial specialists with EMS billing and GEMT experience. It also means experienced rural EMS physicians who know frontier clinical realities firsthand. It means practitioners who have worked in wilderness, tactical, and disaster environments where conventional EMS infrastructure does not exist. The Paramedic Foundation assembles the right team for each engagement. It does not route everything through generalists.

That network is international. TPF has active colleagues and engagements across four continents. Its work includes both paid consulting and NGO-supported initiatives where the mission calls for it and a fee structure does not fit. The form of engagement follows the problem, not a billing template.

All TPF work product meets a formal deliverable standard. Selected outputs are available in TPF’s publications library. That includes APA 7 citation, structured analytical frameworks, peer review before submission, and version control. Publicly funded work is published openly. Privately funded work stays confidential unless the client authorizes disclosure.

Initial consultations are always free. If TPF is not the right fit, it will say so directly. It will also point you toward someone who is.

How TPF engages

TPF can engage in any of the following roles under the Rural Health Transformation Program (RHTP) and related state and federal rural health initiatives:

• Prime contractor: TPF holds the contract directly with the agency and is responsible for delivery and reporting
• Applicant or consortium member: TPF leads or joins an application with EMS agency or rural health partners, where the solicitation permits
• Federal designation: where federal funds are involved, the awarding agency designates TPF’s role, as a contractor or as a subrecipient, and that designation governs its treatment under 2 CFR Part 200
• Technical assistance partner: TPF provides design, coaching, and implementation support to state agencies or the organizations they fund, under a cooperative agreement or technical assistance contract
• Evaluation partner: TPF designs and executes program evaluation, outcome measurement, and CMS reporting infrastructure
• Curriculum partner: TPF develops workforce training, clinical education, and simulation content for RHTP-funded workforce programs
• Implementation partner: TPF co-delivers programs alongside state agencies and the organizations leading them

How agencies contract TPF

The Paramedic Foundation holds a national cooperative contract for Consulting Services under PSAI RFB 2026-03 (Electronics, IT Solutions and Consulting Services), available to public agencies nationwide through Public Safety Association Inc. (PSAI) and Savvik Buying Group. Contact [email protected] to learn more.

The practical effect is that a public agency can procure TPF consulting under terms and pricing already established in the Master Agreement, rather than conducting its own competitive solicitation. Two conditions apply. The agency registers with PSAI as a Participating Public Agency under a Master Intergovernmental Cooperative Purchasing Agreement, and 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.

TPF also provides consulting, training, protocol development, and evaluation for austere and wilderness care programs, spanning wilderness and SAR medicine, event and expedition medicine, and tactical and disaster medicine. This is a distinct domain from rural EMS system design, though the two frequently overlap in frontier environments.

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

Selected engagements

• 2019–2020
  2026–present
  Matanuska-Susitna Borough EMS System Evaluations — Mat-Su Health Foundation and Matanuska-Susitna Borough, Alaska. TPF has conducted two engagements in Mat-Su. The first (2019–2020, Mat-Su Health Foundation) analyzed EMS utilization and system pressures, including behavioral health demand, access gaps, and alternative response pathways. It established an analytical baseline that reduced startup time on later work. The current engagement is a full system evaluation for the Borough. It covers demand analysis, deployment modeling, MIH feasibility, financial sustainability, GEMT analysis, and workforce strategy. The final deliverable is a phased implementation roadmap for Borough leadership and the Assembly.
• 2016–2017
  King County Medic One ALS System Configuration and Deployment Study — Public Health Seattle & King County, Washington. TPF conducted a quantitative analysis of response performance, unit utilization, and geographic coverage across a high-volume multi-jurisdictional ALS system. The study evaluated alternative deployment configurations and produced clear options for decision-makers. Those options balanced performance, governance complexity, and workforce realities. 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 — Ohio Office of Rural Health and State EMS Office. This multi-year engagement covers recruitment, retention, training capacity, compensation alignment, and sustainability across rural and frontier communities. TPF conducted statewide surveys of agencies, practitioners, students, and unaffiliated providers. The findings have informed state workforce strategy and produced practical tools for local agency stability. Each phase has built directly on the last.
• 2019–2026
  Rural and Frontier EMS System Evaluations — Nebraska — Nebraska State EMS Office and local jurisdictions. TPF conducted county-level EMS assessments and sustainability planning. The work addressed operational design, workforce limitations, financial fragility, and integration with healthcare systems, and included community paramedicine program support. Findings shaped state policy discussions and supported stabilization planning for some of Nebraska’s most fragile rural systems. The contract ended in January 2026; since August 2026, TPF has been prime contractor to the Nebraska Department of Health and Human Services for Rural Health Transformation Program work.