EMT Organization and Structure

Your EMT Organization is probably similar to many fire service organizations. That is, one with a chief officer with several sub-ordinate officers. Most Organizations will use some form of the Incident Management System to run their organizations. We will describe a sample EMT organization in which there is a single building with two ambulances running a 24/7 schedule. Before we describe the officers we should focus on the various job functions within the organization. We need to keep in mind the IMS Span-of-control concept that no officer should have more than 5 to 7 individuals reporting to them. You can divide any EMT organization into two broad functions - Operations and Administration. Both require a great deal of attention to detail. Let's describe some of the functions in each area:

In brief, operations cover all aspects of patient care as well as maintenance of the vehicles and training. Here are some of the aspects..

Patient Care
We all know what it means to provide patient care. It's why we do what we do. What I mean here is that the quality assurance for patient care, call response review and record keeping are all part of patient care. When deficiencies are found then an officer has to step in and make corrective action.

Call Coverage/Scheduling/Manpower
It's of no use to have a bunch of ambulances and no body to staff them. An officer needs to ensure that every shift is covered with the appropriate people. When members are unable to respond due to illness, day-time jobs or other reasons then an officer has to plug the hole in the schedule.

Training is very important. We've all heard that our paid brothers are more proficient but even they require annual training. Scheduling training for aspects of EMS not frequently encountered is important. For example, how many emergency childbirths have you done this year? Scheduling drills, both in-house and with your mutual aid agencies is also important. Coordinating these drills is time consuming and requires an officer with some experience.

The third law of thermodynamics in EMS means that equipment breaks. Even with superior preventive maintenance stuff will break. The ambulance requires periodic preventive maintenance such as tune-ups and oil changes and may also require more extensive repairs. Recently we lost all electrical power to the patient compartment due to a worn wire shorting out.

Equipment on the ambulance also requires maintenance such as the stretchers, suction units, defibrillators, etc. This all has to be scheduled and recorded. An officer with a eye towards details is required.

Sometimes a member will do something bad, incorrectly or just plain wrong. On our corps we have members of both sexes as well as varying in age. Some are minors (under 18) and some are adults. Sexual harassment is a big issue and needs to have constant vigilance. Also, patient privacy is a concern (especially with HIPAA). If a member breaches confidentiality then an officer needs to take of the problem.

Each ambulance has to have some consumable supplies. This includes oxygen, masks, gauze, sterile water, sterile saline, etc. Somebody has to make sure each rig is properly stocked and there is enough reserve supplies on hand for restocking. Also, somebody has to make sure no supplies have expired and to ensure stock rotation.

Some administrative functions include record keeping, communications, bill paying, retirement, recruitment and retention, meetings and fundraising.

Record Keeping
There are many aspects to record keeping. In our EMT Organization we handle so many calls that we have a dedicated person to collect, record and account for each patient care report. Some of the information that we record (other than what care was rendered):

    • Patient Information (Name, Address, Date of Birth)
    • Mileage
    • Crew members
    • Equipment used
    • Where the patient was transported

We collate this data for Length of Service Awards, to provide guidance for preventative maintenance and for fund raising.

There are many channels for communication that are not related to actual patient runs. Normally this is the regular mail or E-mail. It may also be phone calls. All of this communication needs to be recorded. Occasionally you will be asked to provide details about a patient care report. You have to make sure that the individual requesting the information is entitled to the information.

Bill Paying
There are many ways to pay bills. Usually a bill gets paid long after the expense is incurred. Records need to be kept and reconciled against what you have in your bank accounts.

Your EMT Organization runs with people. As your current membership retires or resigns you need to replace them. This is an ongoing task. The chief officers need to concentrate on running your organization so you need others to get new members.

Perhaps the biggest function of the administrative staff is to run the periodic meetings. A good administrative staff provides for a well run meeting. Preparing for a meeting can take days, weeks and even months. On my squad I served as president for 7 years. I can tell you for a good meeting to take place you need to plan the meeting in advance. I usually make an agenda right after the end of the previous meeting and fill it out as the month progresses.

Fund raising
Each EMT Organization runs on cash. Where that money comes from varies. On my squad we receive money for most operations from our municipal government but they do not pay for some of the incidentals that we need such as recruitment and retention functions. This means we need to fund raise. This can be a hard thing to do and is often a balancing act between begging and being a pest to the community from which you draw funds.


Every EMT organization needs to have a single officer who oversees all aspects of the organization. In the fire service this is the Chief. In EMS we can also use the concept of a chief but as we saw above, there are just too many functions to be handled by a single person. This violates the span-of-control.

Our organization has two classes of officer - operational and administrative. The chief oversees the entire organization but has the operational officers as a direct report. We also have a president who manages the administrative portion of the organization and reports to the chief. Let's discuss the officers and their duties in our hypothetical organization.


The chief oversees all aspects of the EMT organization. Since their so many aspects, only those functions that directly need the chief's involvement should be assigned to him or her. All other aspects should be handled by subordinates. The deputy chief, captain, president and mechanics directly report to the chief.

Our chiefs serve a single year and has a term limit of 2 years. Chiefs must have previously served as a deputy chief.

The training requirements for Chiefs should be:

  • EMT-B
  • CPR for Health Care Provider
  • IMS-300
  • NIMS-700
  • Hazmat Operations
  • CBRNE Operations

Deputy Chief

The Deputy Chief oversees the EMT organization when the chief is not able to do so. We use this position to train the chief when the current term of office of the chief expires. We have also assigned the ordering of supplies to the deputy chief.

Our deputy chief serves a single year and has a term limit of 2 years. Deputy chiefs must have previously served as a captain. The training requirements for Deputy Chief are the same as for the Chief.


The captain oversees the actions of the lieutenants and is responsible for setting the schedules for the crews. The captain is also responsible for training of all members. In our EMT organization the captain is also responsible for maintaining discipline. The captain reports to the chief.

Captains serves a single year and has a term limit of 2 years. Captains must have served on the squad for at least 2 years.

The training requirements for Captains should be:

  • EMT-B
  • CPR for Health Care Provider
  • IMS-200
  • NIMS-700
  • Hazmat Operations
  • CBRNE awarness


The lieutenants are in charge of each shift and perhaps each crew. Some EMT Organizations call these officers "Crew Chiefs." These are the officers who actually are involved in patient care. The lieutenants are also responsible for training their crews. Mentors for new members are frequently drawn from these lieutenants. The lieutenants report directly to the Captain.

Lieutenants serve at the pleasure of the chief and may serve an indefinite period of time. Lieutenants must have served on the squad for at least 2 years.

The training requirements for Lieutenants should be:

  • EMT-B
  • CPR for Health Care Provider
  • IMS-200
  • Hazmat awareness
  • CBRNE awareness


The mechanic is responsible for maintaining the ambulances and most of the equipment aboard them. Weekly maintenance, routine service and scheduling more advanced service is a requirement for the mechanic. The mechanic should have a good working knowledge of automobiles and light trucks. The mechanic receives information from all members and reports directly to the Chief.

Mechanics are appointed by the chief and may serve an indefinite period of time. Mechanics may have served on the squad for at least 1 year.


The president shares power with the Chief but should take a sub-ordinate role in most matters. The president's main job is to run meetings and account for monies. In addition, communications not directly related to operations are the president's responsibility. The president serves as a check and balance on the chief.

Presidents serve a 1 year term with a 5 year term limit. Presidents must have served previously as a vice-president and have a minimum of 4 years of service in the organization.


The vice-president has similar functions as the president. The VP covers the president when the president is unable to perform the functions of president. Frequently this is to run a meeting. On our organization, the vice-president is the purchasing agent and serves as chairman of the audit committee.

Vice-presidents server a 1 year term with a 5 year term limit. Vice-presidents must have served the organization for a minimum of 4 years.


One of the most important individuals on any EMT organization is the treasurer. This person needs to have a high attention to detail and should be able to balance check books with ease. The treasurer should not have any financial difficulties of their own. The temptation to "Borrow" money is too great which means that the trustees need to audit the treasurer on a regular basis.

Our organization adopted two procedures for the treasurer concerning money. All check require two signatures and no checks may be written outside of a meeting unless they are pre-approved.

Treasurer's serve a 1 year term with 5 year term limits. Treasurer's must have served the organization for at least 2 years.

Recording Secretary

The recording secretary is the historian of the organization. All notes taken during meetings are recorded and transcribed by the recording secretary. The personal traits for the recording secretary include attention to detail and a high degree of organization. It is this position that members will turn to resolve issues concerning past meetings.

Corresponding Secretary

The corresponding secretary is one of the most visible officers of your EMT organization. This is the person who handles your correspondence with other agencies and with civilians. When donations come in they need to be acknowledged by some officer. The corresponding secretary is the human face to your organization.

Corresponding Secretaries are elected and serve for 1 year with no term limits. They must have been a member of the organization for at least 1 year.


Trustees are vital to EMT Organizations. They are usually members with more experience and seniority. They maintain a sense of history of the organization and bring continuity among generations. Our organization recently celebrated its 60th anniversary. We had one trustee who helped start the squad. He was the soul of the squad. We give the delicate matters of auditing monies, discipline and community relations to the trustees. We generally require that a trustee have been a member for more than 5 years and have served as a chief or president.

The term of office for a trustee is 3 years.

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