If you could build your own agency from scratch, what would be your top priority?
I'd have a list:
...a viable and stable financial environment...
I think about this more than I should, maybe because as a paramedic and aspiring physician, I do hope to be a medical director...
Ultimately, I think matching services to the needs of the community. Though the numbers vary from place to place, it is generally known that paramedic-level services are only needed on a minority of 911 calls. However, I think the EMT-B leaves a lot to be desired as minimum level for an ambulance. I think AEMT would be good ambulance base-level (high-yield interventions for time sensitive conditions as a bridge to paramedic care, but also some interventions to spare paramedics for some calls that may have traditionally req'd a paramedic) and then have paramedic back-up. I would like staff to have options... emergency, critical care, prevention, and education divisions.
The emergency division would consist of AEMT ambulances and medic chase cars. Critical care division would do IFT, but also be secondary paramedic response during surges in call volume. The prevention division would staff both AEMTs and Paramedics and would include wellness checks, following up on patient refusals, frequent callers, etc. They'd also be available as first-responders to high acquity calls and could provide extra hands in MCIs, etc. Education would consist of clinical education for EMS students, residents, etc., but also go out in to the community such as schools, assisted living facilities, and so on.
Don't ask how I'd fund it, I haven't thought this pipe-dream that far through.