In October, the Board of Commissioner voted to being a year-long transition to a District operated EMS agency.     Over the next several months, the District will hire a leadership team to build out the system.    Hiring of communciations and field staff will likely occur in mid-to late summer 2026.    The Board's decision was based on a desire for dedicated local leadership and oversight to optimize service delivery and outcomes (operational, clinical and financial).  

In the interim, Acadian Ambulance will continue to provide service in Bastrop County.   

In 2024, A group of citizens petitioned Commissioners Court requesting an election to approve an ESD to fund emergency medical services in Bastrop County.    For almost ten years, Acadian Ambulance provided EMS service through a zero-subsidy contract with Bastrop County – meaning the only revenue to support the system was from billing for EMS transport.  Acadian’s break-even financial point was staffing only four ambulances in the county.  

Everyone agreed that four ambulances was less than optimal.  Adding additional ambulances would require public funding.   However, doing so within the existing County budget would be difficult without going to the voters to approve raising tax rates above the level permitted by State statute. 

Commissioner’s Court ordered an election in November 2024.   Voters approved the formation of the District and established a maximum tax rate of $0.10 per $100 property valuation.  

That is common especially in larger municipalities, often through the city fire department.  In smaller communities, it is most common to see EMS as a County or ESD based department.   It is generally not economical for EMS to be part of a small municipality such as Bastrop, Smithville or Elgin.  The larger County or ESD jurisdiction provides an economy of scale, distributing the fixed costs of operations across a larger population. 

Acadian and the District agree that additional ambulances are needed to meet the growing call volume in the County and reduce response times.   The parties have agreed to an extension that enables Acadian to increase their deployment from four (4) 24-hour ambulances each day to five (5) 24-hour ambulances plus two (2) 12-hour ambulances daily, providing seven (7) ambulances at peak times.   In addition, Acadian staffs a 24-hour critical care, clinical supervisor to support the system.   The supervisor responds to critical calls, perform quality assurance activities, provide coaching and education to staff to enhance their assessment and treatment skills and act a front-line liaison with local public safety departments and health care providers.

Historically, many community EMS agencies were volunteer based and raised money through fund raisers and fee for transport.   Rural fire departments were also volunteer based and often funded through Rural Fire Prevention Districts.  RFPDs were capped at $0.03 cents per $100 property valuation.

As call volume in communities grew, many departments were faced with decreasing volunteer commitment, resulting in the need to hire part-time and/or full-time firefighters.  Further complicating matters, equipment and apparatus costs skyrocketed.  Together, these increased costs exceeded the revenue available from a RFPD tax rate.  To address this, the legislature passed Chapter 775 of the Health and Safety Code, creating the ability for RFPDs to convert to ESDs and adopt tax rates up to $0.10 per $100 property valuation.   This is why the majority of ESD are fire-based or a mix of fire & EMS.  

In Bastrop County, an EMS district made the most sense in order to support a county-wide approach to ambulance response.

In ESDs that span across County lines to provide service for two or more counties and in certain “urban” counties, the statute requires that the Commissioners to be elected.  In single-county ESDs, commissioners are appointed by the County’s Commissioners Court.  

Yes and no.   While the District boundary does have some small carve-outs, the District is negotiating with Bastrop County and the City of Elgin to provide service in these carve-out areas.   Operating as one unified system is the most financially and operationally responsible way to deploy the system. 

There are currenlty five 24-hour ambulances and two additional 12-hour ambulances that provide coverage in Bastrop County.    The 24-hour ambulances are stationed in the following areas:

• Bastrop 
• Elgin
• Smithville
• Cedar Creek (near Hwy 21 and FM 535)
• Highway 95 between Bastrop and Elgin

In addition, there is a 24-hour clinical supervisor that responds to calls in addition to their clinical quality assurance role.

The District is working with Acadian to optimize coverage and response times to life threatening calls.   Additional unit hours are being considered.

The District is actively involved with our partner – Acadian Ambulance.   Clinical, Operation and Communications Standards hav e adopted and Acadian provides ongoing reporting on these metrics.  The District has established a Medical Oversight Committee and an Operations Oversight Committee to review the data and work with Acadian to identify and implement opportunities for improvement.  Acadian can be subject to financial penalties for falling below the minimally acceptable performance level and they have incentives to overachieve.   The District will sample records to ensure reporting is accurate.

The additional ambulances on the street have made a tremendous difference throughout the county, but especially in Smithville and the northern aspect of the county.    Prior to the new resources being deployed, only four ambulances were in service.   When a unit went on a call, their territory was left open.  To spread out the remaining unit coverage, the dispatcher relocated one of the other ambulances half way between its station and the open station.  This usually started with the Smithville unit moving as this was the area least likely to get a call.   While this improves coverage for the open station territory, it dilutes coverage for the ambulance that is being relocated.   As additional calls come in, response times got longer across the county.   The additional units will reduce the need to relocate, thus reducing “uncovered’ areas.

Since adding the 5th 24-hour truck and the two peak units, response times to the most critical calls has improved.   Each month, the Operations Oversight Committee meets with Acadian to review response times and look for ways to “tune” the deployment plan and improve coverage and response times.

The Board of Commissioners feels strongly that whether EMS is provided through a contractor or a District-based EMS agency, it is important for the District to own the capital equipment.   There have been instances in Texas where an ESD provided a significant tax subsidy to a contractor.   The contractor used the subsidy for stations and capital equipment that were titled in the contractor’s name.   When things went bad, the District was left with nothing.  

Now that the Board has decided to transition to a District operated EMS, the ambulances will be used by the ESD to provide care within the territory.    That transition shoud occur in late 2026 after the ambulances are delivered.

EMS is the practice of Emergency Medicine.  While Acadian has their own Medical Director, the Board hired Dr. Kevin Abadi in a part time capacity to advise the Board on clinical, evidence-based standards and to be a peer liaison with the Acadian Medical Director with regard to clinical concerns, standards and performance improvement.  This is another way the District will work to ensure high quality care for our citizens and visitors.

The District adopted its first budget and tax rate at the September regular meeting.   The budget and tax information is available on our website.

Absolutely.   We hold public comment sessions at each Board of Commissioners meeting.  You can also reach out to us at information@bastropesd3.org.