Central Arizona Region

Introduction

As a result of funding received from the Arizona Department of Health Services, Bureau of Emergency Medical Services and Trauma System, Arizona Emergency Medical Systems, Inc. (AEMS) played a key role in strengthening the Central Arizona rural EMS communities by expanding paramedic education opportunities. AEMS received $100,000 each year for 2023 and 2024, with a portion retained to cover administrative expenses. The funds were distributed to help rural fire departments/districts and transport agencies elevate their current emergency medical care technician - basic (EMCT-B) staff to the paramedic level (EMCT-P) through targeted financial assistance.

To be eligible for this funding, 'rural' was defined as fire departments/districts and transport agencies serving Pinal and Gila Counties, non-automatic aid organizations in Maricopa County, and tribal entities across all three counties. Hospitals¹ were not eligible to apply Our goal was to provide full funding to as many organizations as possible, with awards covering paramedic education costs, including tuition, books, and course materials. Any leftover funds would be distributed to applicants who demonstrated further need and could be applied toward the partial training of an additional candidate.

Our Eligibility Process

The application process consisted of four phases:

1. Needs assessment

2. Application including the acknowledgement of terms of agreement

3. Participation in the funding priority distribution meeting.

4. Post funding distribution and post training evaluations of the organization and their selected EMCT-B student candidates

Needs Assessment

The purpose of the Needs Assessment was to identify specific challenges and operational demands among rural EMS agencies to determine their need for funding to support EMCT-B personnel in becoming certified paramedics.

By assessing staffing levels, paramedic availability, response times, call volumes, and turnover rates, we aimed to identify where funding for paramedic training could most effectively address service gaps.

The needs assessment helped us determine which rural departments and agencies would benefit most from funding, enhancing their service capabilities to better meet the healthcare needs of their communities.

Terms of Agreement

As part of the application process, each organization was required to acknowledge and adhere to the following terms of agreement before receiving funding:

• The funding was to be used solely to elevate one of the organization’s existing EMCT-B employees to an EMCT-P by covering the costs associated with paramedic training. Eligible expenses included tuition, books, and coursework materials, with no allowances for backfill, mileage, meals, or other incidental costs.

• The organization were required to identify their student candidate by a certain date and all awarded funds were to be expended by a specific deadline. Extensions were allowed in certain cases based on the timing of the training program’s registration process.

• The recipient organization agreed to provide AEMS with the following:

o Information on the selected employee.

o An invoice reflecting proof of registration and required supplies.

o A timeline of the training, including the anticipated completion date.

o A student progress report or proof of continued enrollment, as needed.

o A plan for redistributing funds if their employee did not complete the paramedic training.

o A plan for the employee’s commitment to service after completing the training.

o Notification of any changes in the employee’s status in training or employment within 10 days of such changes.

o Timely provision of additional information requested as needed.

• All organizations were required to submit a final report detailing how the funds were expended, with supporting documentation such as receipts.

These terms promoted accountability and clear expectations between AEMS and the funding recipients, including both organizations and their EMCT-B candidates. This structure helped keep everyone informed and engaged throughout the process while maintaining the intended purpose of the funding.

Funding Priority Distribution Meeting

Collaboration, cooperation, and inclusiveness are central to AEMS's mission and guided are funding distribution prioritization and determination. As part of this process, applicants were required to participate in the Funding Priority Distribution Meeting to ensure a fair and transparent allocation of funds.

During the meeting, applicants presented their cases, explaining their need for funding and how it would enhance patient care in their rural communities. This interactive process allowed each representative to not only present their needs but also evaluate and ask questions about the needs of fellow applicants.

AEMS staff moderated the meeting, posing standardized questions to guide the discussion, including:

• Does your organization receive Automatic Aid?

• How does your need compare to current staffing?

• How are you vetting your identified EMCT-B candidate?

• What impact will the funding have on your organization and community?

This collaborative decision-making process ensured that funding was distributed based on actual needs rather than organizational wants.

Tracking Progress and Status

To monitor the progress of 2023 award recipients, we developed two distinct questionnaires: one for the organization (department/agency to be completed by authorized representative) and one for their EMCT-B candidate (student) Our intent was to gather both the organization and student perspectives post training All (100%) departments that received funding completed the questionnaire, as did all (100%) of the students who remained employed with their department and did not withdraw from the process.

For the 2024 award recipients, a questionnaire was designed to assess the current training status of their EMCT-B students, differing from the 2023 version, which tracked post-training progress. This questionnaire was provided only to the organizations, and all (100%) departments that received funding completed it. In 2025, after a full year has passed, we intend to send the post-training questionnaires to both organizations and students to assess their outcomes.

The responses from these questionnaires provide valuable insights into how the funding has supported the various rural EMS communities and where students currently stand in their paramedic training journey.

2023 Rural Paramedic Education Funding

- Central Arizona Region Organization Progress Questionnaire Response Summary

Representatives from all nine departments awarded funding completed the organization questionnaire. Seven departments provided responses to most questions, while two offered limited responses due to changes in their students' status. Note: The respondents’ comments are presented in their original form with limited grammatical editing.

How has having an additional paramedic impacted ALS emergency response times?

• Four departments responded that “the level of care is improved and transport to definitive care is improved ”

• Three departments reported that “no information is available about response times ”

• Two departments did not respond.

Has the addition of a newly certified paramedic impacted your department’s ability to provide advanced life support (ALS) in your rural community?

• Three departments responded that “it has improved our coverage so that we have ALS response 24/7.”

• Three departments reported that “it has improved our coverage, but we continue to have gaps ”

• One department stated that “it is not applicable.”

• Two departments did not respond.

How has the funding alleviated financial burdens on your agency regarding staffing, overtime, or recruitment costs?

• Five departments responded that “staff now have the ability to take vacations and coverage remains comprehensive ”

• Two departments stated that “it is not applicable ”

• Two departments did not respond.

Did the funding help reduce the need for mutual aid requests or dependency on outside agencies for advanced medical interventions?

• Three departments responded that “yes, the need has decreased.”

• Three departments indicated that “no, we continue to have the same level of needed support.”

• One department stated that “it is not applicable.”

• Two departments did not respond.

Did the elevation of an EMCT-B to an EMCT-P help address specific staffing shortages, particularly in remote areas where ALS coverage was previously limited?

• Six departments responded that “yes, staffing is improved.”

• One department indicated that “no, staffing continues to be a challenge because of turnover.”

• Two departments did not respond.

What suggestions do you have for improving the funding program PROCESS to better support paramedic students and rural communities?

• Eight departments selected “no suggestions, the process works well for our department.”

• One department indicated “other” and offered the following suggestion: Offer EMT-B certification as well as EMT-P for recruitment purposes. We are seeing a limited number of certified people interested, and those who do not have certifications.

Please share a positive community story involving the newly trained paramedic funded by this award. We are particularly interested in feel-good moments, successful interventions, or examples of how having an additional paramedic has positively impacted on your community. Please ensure that any shared details respect patient privacy and adhere to HIPAA regulations.

• Kianna Munoz (Gila Bend Fire/EMS) began her career by following in her father’s footsteps. Victor Munoz, a dedicated volunteer firefighter for the town of Gila Bend for the past ten years, never imagined he would pursue EMT school himself. But everything changed when he witnessed his daughter’s remarkable journey through paramedic school. Over the course of twelve months, Kianna faced numerous challenges, all while radiating determination and positivity. Victor watched in awe as she tackled each obstacle, culminating in the proud moment when she graduated and passed the NREMT on her first attempt. This achievement opened Victor’s eyes to the vital role of prehospital medical care and inspired him to enroll in EMT school.

Kianna’s impact goes beyond her own accomplishments; she has influenced her father, her coworkers, and many others in their community. Working in rural Arizona’s EMS presents unique challenges, particularly regarding the culture surrounding continuing education. The extra time, expenses, and commitment often create hesitation among potential candidates. Yet Kianna’s unwavering attitude and dedication have begun to shift this mindset, inspiring others to pursue further training and embrace growth. From the bottom of our hearts, we thank you for providing us with this opportunity. Kianna’s journey is a testament to the power of inspiration and the profound impact one person can have on their community.

• Having an additional Firefighter/Paramedic has increased our ALS coverage on shift and has been a great benefit to our department. We are hopeful that this funding can continue and serve as an incentive for more EMT-Bs to consider EMT-P upgrades! Cade Pierson (Regional Fire and Rescue Department) has not been challenged in the two months he has been a Paramedic so we do not have any stories to share at this moment, but he will have his day, one day soon! Thank you so much for your funding assistance to benefit Rural Providers!

• Adding Daniel Hicklin (Globe Fire Department) to our rotation as a paramedic has allowed us to begin staffing a secondary ALS unit on his assigned shift. This was previously lacking. This provides better coverage for overlapping calls.

• Having an additional Paramedic has significantly increased our level of service and allowed us to have more constant paramedic staffing. This is huge for us for how far we have come in our EMS journey. Our goal is to have two paramedics on each truck.

• Identified a lethal heart rhythm in the field and gave Adenosine. The new paramedic felt like he was able to help someone in need because normally as a BLS crew he would have to call for mutual aid or for a helicopter for support.

• As a new paramedic, Victor Reyes (Eloy Fire Department) arrived and found an unresponsive trauma patient. Because of his recent paramedic certification, he was able to render lifesaving airway support and facilitate transport to a level one trauma center. The patient is expected to make a full recovery.

• Additional Paramedic Firefighters are an instrumental part of our staffing and deployment model. As we continue to train and employ additional Paramedic's we are increasing our capabilities to provide stellar customer service to our community.

Other Comments

• Cade Pierson (Regional Fire and Rescue Department) was a great choice and an exemplary student. He passed his final and went straight to the NREMT-P exam and passed it on the first try. He completed class on July 31st and took his exam, receiving his NREMT-P on 8/5/2024! An excellent outcome! Thank you to AEMS, the Board of Governors and BEMS Staff for making this funding available to rural providers and I am hopeful the funding can be continued and expanded to offer EMT-B Certification! Thank you, Chief Steve Kerber RFRD

• Excellent program that should continue. Thank you!

• Thank you so much for the funding and support!

2023 Rural Paramedic Education Funding -

Central Arizona Region Student Progress Questionnaire Response Summary

Of the eleven EMCT-B student candidates selected for training by their affiliated departments, eight successfully submitted their responses. Three student candidates, however, did not complete the questionnaire due to changes in their status: one student candidate withdrew from training, while two others completed the program but left their employment to pursue other opportunities. Note: The respondents’ comments are presented in their original form with limited grammatical editing.

How did the Rural Paramedic Funding Award impact your decision to complete the training required for EMCT-P certification?

• Two EMCT-B students responded that “I would not have sought the additional training.”

• Six EMCT-B students indicated that “I would have had to borrow the money to gain the additional training.”

How has your role evolved within the department now that you are a certified paramedic?

• Seven EMCT-B students responded that “I have additional responsibilities in the department.”

• One EMCT-B student indicated that “I have been promoted.”

Has the training impacted your professional confidence in managing critical calls where transport times to higher-level care are significantly longer?

• Eight EMCT-B students responded that “yes, I have utilized the additional skills successfully.”

How do you plan to meet your continuing education requirements (as required for recertification and for professional interest topics)?

• Eight EMCT-B students responded that “my department provides education as required for recertification ”

• Seven EMCT-B students reported that “I will utilize on-line education modules ”

• Seven EMCT-B students indicated that “I will attend virtual conferences for topics of professional interest.”

• One EMCT-B student stated that “I will need to find conferences and education sessions as required for recertification. My department cannot provide what is required ”

• Four EMCT-B students responded that “I am willing to travel in-state to attend inperson education events for recertification topics and topics of professional interest.”

What suggestions do you have for improving the funding program to better support paramedic students and rural communities?

• Eight EMCT-B students did not respond.

Which topics or skills would be most beneficial for your professional development and effectiveness as a rural paramedic (e.g., advanced trauma care, pediatric emergencies, mental health crisis intervention, wilderness EMS, etc.)

• Eight EMCT-B students selected the topics of: Pediatric Trauma, Cardiac, and Airway Management

• Six EMCT-B students selected the topics of: Traumatic Brain Injury (TBI)

• Five EMCT-B students selected the topics of Geriatric Medical Emergencies, Crush Injury, Burns, and Medical Legal

• One EMCT-B student selected other and offered the following suggestions: Rapid Sequence Intubation and Med-Math/Drip Rates

• I have had a few calls now since receiving but the one sticks out the most to me was being able to identify a lethal rhythm of Supraventricular Tachycardia (SVT) in a patient who was having symptoms and being able to correct with the right medication Adenosine and right dose (initial dose of 6mg which corrected the rhythm) to being able to correct that rhythm and helping the patient feeling better.

• One story that comes to mind would be being able to explain to a young boy what was going on with his grandfather. His grandfather had new onset A-Fib, and I was able to show the boy his grandpas heart rhythm and then explain what was going on with his grandfather’s heart.

• I was off duty at a local store and witnessed an elderly woman have a ground level fall. The elderly woman had an obvious hip and femur fracture and was screaming and wailing in pain. I introduced myself and explained to her that I was a new Paramedic that worked for the Fire Department. I held her in a position that was able to keep weight and pressure off her hip/femur. This gave her a sense of ease, reducing her anxiety and allowed me to keep the women calm and in a position of comfort until the Fire Department arrived and gave her some pain management. The elderly woman, her husband, and store management were extremely grateful. Even though I did not use any ALS skills, I was able to keep her and her husband calm and explain to them what was going to happen when Fire arrived.

• Being able to identify medical problems and use correct interventions has made a tremendous impact on me during calls. I have been able to use good judgment on how to treat and transport a patient.

• As I only became a medic a few weeks ago, I have yet to work my first shift alone as a new medic. I have done training shifts and am very grateful I was given the opportunity. I am beyond excited to work my very first shift alone in the weeks to come and hope to have a few stories to tell soon.

• Because of the training I received, I was able to recognize a stroke early on. With the early recognition, transport, and treatment the family came back to the station within 1 week and thanked the crew for allowing their family member to live a normal life with the rest of them. They described the crew as fast-moving and careful, which made someone’s life better. In all they brought the station 50+ cookies to the station to show their appreciation.

What does becoming a Paramedic mean to you and your family?

• Being a Paramedic has been such a blessing. I would not have been able to attend the course had we not received the award. I am extremely grateful for the opportunity to increase my skills that have positively impacted the community in which I serve.

• Becoming a paramedic has lifted a large financial burden off my family and I’s back. My wife takes great pride in the fact that I am able to do what I do and help people of my community.

• It helps me gain the knowledge I need to further be able to care and provide for my family.

• When I first made the decision to become a first responder, I decided to become an EMT, I quickly realized I wanted to be the person sitting in the back of the ambulance with the greater knowledge and scope of practice. I wanted to become a better version of myself and become more knowledgeable for the people in my community. It was my dream to become a paramedic while I was in EMT school. I knew I was going to be the best paramedic I could possibly be, when the opportunity would present itself to have the money to go back to school. Without the help of the grant, I would not have been able to become a paramedic as soon as I did. My family is beyond proud as I completed one of my dreams. I am excited to begin my career as a paramedic helping thousands of people in my community and surrounding communities.

• The opportunity to not only better myself I feel as induvial but as well as for my family with not only my increased level of training but as well as the increase of pay to help support with day-to-day expenses by being able to promote within my organization.

• I am able to serve the community more efficiently, cover more shifts when needed. My kids have seen me go through the school and watch me struggle and study and saw that I passed and that makes me proud of myself that I can be a person they can look up to.

• It has given me a raise that will positively impact my family finances.

• It allows me to provide a better service to the community and gives me a better sense of fulfillment after every call. The pay increase means that my wife does not have to work as hard, and that means the world to me

Additional Comments

• Just wanted to reiterate how grateful my family and I are for the opportunity to make a positive impact on the community in which I serve! We will be forever grateful for blessing us with your generous gift! Thank you! Respectfully, Brandon Baker (Casa Grande Fire Department).

• I appreciate the grant; I would probably not have been able to attend paramedic school and now that I have, I will do everything I can to continue my education and experience.

• Thank you for the gracious opportunity I was given, the opportunity my department was given. Being a rural department, we are often forgotten or looked past compared to bigger cities, this was a huge deal for us. I am grateful I was able to complete the program, make my parents, coworkers, friends, and myself proud. Thank you again.

2024 Rural Paramedic Education Funding - Central Arizona Region Organization Status Questionnaire Response Summary

Representatives from all eight departments that received funding completed the organization questionnaire, representing a total of eleven EMCT-B students.

The following is an overview of the training status for each EMCT-B student candidate:

• One department reported that their student graduated in October 2024 .

• Six departments reported that their students, totaling nine, are currently enrolled in training, with expected graduation dates ranging from December 2024 to January 2026.

• One department indicated that their student is not yet enrolled due to a training program cancellation. This student plans to enroll by January 2025, the next available start date for their chosen program.

Conclusion

Rural EMS departments encounter numerous challenges related to staffing, response times, and transport limitations. The Rural Paramedic Education Funding Initiative was developed to strengthen rural EMS agencies by investing in their current employees, allowing EMCT-B personnel to become certified paramedics and expanding Advanced Life Support (ALS) services in underserved areas. By equipping personnel with enhanced skills, this initiative increases EMS’ capacity to deliver high-quality, life-saving care to rural residents.

A fair and transparent eligibility process was key to the success of this initiative. This process included a needs assessment, a formal application with an acknowledgment of terms, and a Funding Priority Distribution Meeting. The Needs Assessment offered valuable insights into the unique needs of rural EMS agencies, while the terms of agreement ensured accountability in the use of resources. During the Funding Priority Distribution meeting, applicants presented their cases, discussed challenges, and detailed how funding would enhance patient care, fostering a collaborative environment to allocate funds based on genuine need.

Our post funding distribution and training evaluations further confirmed the initiative's significant impact. Of the eleven student candidates awarded funding in 2023, ten successfully completed their training, with many affirming that the funding was essential to their progress. The newly certified paramedics reported increased confidence and preparedness in handling critical calls, enhancing both care quality and transport efficiency. Among the eleven student candidates awarded funding in 2024, one has already graduated, nine are enrolled in training, and one is scheduled to begin in January 2025.

This funding initiative has undoubtedly advanced paramedic training and strengthened emergency care in rural areas. Continued funding is crucial to sustaining and expanding these improvements, ensuring rural communities have access to vital ALS services.

Endnotes:

1. Although hospitals were not eligible for the Rural Paramedic Education initiative, Kearney Ambulance, previously a separate entity, was integrated into Cobre Valley Regional Medical Center after receiving the funding

2023 Central Region Rural EMS Needs Assessment

2024 Central Region Rural EMS Needs Assessment - Overview

+Due to an inaccurate figure, there is insufficient data. *Due to the recent establishment of the fire department and its transition from a contracted agency, there is currently insufficient data available for meaningful comparison or analysis

2023 Rural Paramedic Education Funding Progress Overview -

Arizona City Fire District

$11,200

Applied to training of 2 EMCT-Bs

(one full training and one partial training)

Makenna Schenk and Lauren Freeman

EMCT-Bs completed paramedic training

May 2024

Casa Grande Fire Department

Eloy Fire District

Gila Bend Fire and Rescue Department

$9,000

Applied to training of 1 EMCT-B

$9,000

Applied to training of 1 EMCT-B

$8,950

Applied to training of 1 EMCT-B

Brandon Baker

Victor Reyes

EMCT-B completed paramedic training December 2023

Both EMCT-Bs voluntarily left Arizona Fire District shortly after they graduated from paramedic training.

Arizona City Fire District has recouped funds from one of their former employees and reallocated it toward the training of another EMCT-B. They continue to pursue recouping funds from the second employee and will reallocate any funds returned toward the training of another EMCT-B.

Kianna Munoz

EMCT-B completed paramedic training

August 2024

EMCT-B completed paramedic training

August 2024

2023 Rural Paramedic Education Funding Progress Overview -

Central Arizona Region (AEMS)

DEPARTMENT FUNDING RECEIVED EMCT-B STUDENT

Globe Fire Department

$8,725

Applied to training of 1 EMCT-B

Kearney EMS

(Cobre Valley Regional Medical Center)

Regional Fire and Rescue Department

$17,000

Applied to training of 2 EMCT-Bs

$8,725

Applied to training of 1 EMCT-B

San Carlos Apache EMS and Fire

Town of Wickenburg Fire Department

$8,950

Applied to training of 1 EMCT-B

$8,450

Applied to training of 1 EMCT-B

Daniel Hicklin August 2024

Cody Wallace and Elizabeth Barney

Cade Pierson

EMCT-Bs completed paramedic Training

February 2024 and May 2024

Jacob Laaker

EMCT-B completed paramedic training

EMCT-B withdrew from training due to personal reasons

EMCT-B completed paramedic training

July 2024

San Carlos Apache EMS and Fire is in process of identifying a new candidate and training program.

2024 Rural Paramedic Education Funding Status Overview

- Central Arizona Region (AEMS)

DEPARTMENT

Ak-Chin Fire Department

$9,000

Applied to training of 1 EMCT-B

Arizona City Fire District

$13,500

Applied to training of 2 EMCT-Bs

Matthew Hearn Completed paramedic training

October 2024

Eloy Fire District

$9,000

Applied to training of 1 EMCT-B

Peter Quezada and David Troutman

Both EMCT-Bs currently enrolled in Paramedic Training

January 2026 (anticipated)

Hannah Hartman

Currently enrolled in Paramedic Training

July 2025 (anticipated)

Partial funding received and recouped in 2023 was reallocated to combine with partial funding award received in 2024 to apply as full training of the second student.

Fountain Hills Fire Department

Florence Fire and Medical Department

$13,500

Applied to training of 2 EMCT-Bs

$9,000

Applied to training of 1 EMCT-B

Byron Phillips and Anthony Benitez

Currently enrolled in Paramedic Training

December 2024 (anticipated)

Alex Short Not currently enrolled in Paramedic Training

To be determined pending enrollment.

The program EMCT-B was originally enrolled in got cancelled. Currently in the process of identifying a training program that starts before January 2025.

2024 Rural Paramedic Education Funding Status Overview -

Central Arizona Region (AEMS)

DEPARTMENT

Gila River Fire Department

$18,000

Applied to training of 2 EMCT-Bs

Maricopa Fire and Medical Department

Matthew Nadeau and Brison Howard

$9,000

Applied to training of 1 EMCT-B

Rural Metro Fire Department

$9,000

Applied to training of 1 EMCT-B

Spencer Nathe

Both currently enrolled in Paramedic Training March 2025 (anticipated)

Cole Montgomery

Currently enrolled in Paramedic Training December 2024 (anticipated)

Currently enrolled in Paramedic Training

March 2025 (anticipated)