Q:        Why was Bastrop County ESD #3 formed?   

A:         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.  

Q:        Don’t cities normally operate the local EMS agency?

A:         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. 

Q:        Why are some ESDs fire only, EMS only or a mix of both? 

A:         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.

Q:        Why do some ESD’s have elected commissioners and some have appointed commissioners?

A:         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.  

Q:        I heard that the Bastrop County ESD #3 does not cover the entire county.  Is that true?

A:         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. 

Q:        What happens to the current contract between Bastrop County and Acadian?

A:         Bastrop County, the District and Acadian are working to assign the current contract to the District to manage.   Once this is done, Acadian and the District will negotiate an extension of the contract to run through September 2026.   During that time, the District’s Board of Commissioners will explore a long-term solution for enhanced EMS services in Bastrop County.

Q:        How will EMS be different under the District?

A:         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 are negotiating an extension that would allow 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 will staff a 24-hour critical care, clinical supervisor to support the system.   The supervisor will respond 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.

Q:        What all in involved in “managing” the Acadian contract?

A:         The District will be actively involved with our partner – Acadian Ambulance.   We are in the process of adopting Clinical, Operation and Communications Standards.   Acadian will measure their performance against these standards and report to the Board on a monthly (or quarterly for some measures) basis.   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.

Q:        I have heard response times have been a challenge for Acadian.   Will things get better under the District?

A:         We believe so.  The additional ambulances on the street will make a tremendous difference.   With only four ambulances, when a unit goes on a call, their territory is open.  To spread out the remaining unit coverage, the dispatcher relocates one of the other ambulances half way between its station and the open station.   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 get longer across the county.   The additional units will reduce the need to relocate, thus reducing “uncovered’ areas.

Each month, the Operations Oversight Committee will meet with Acadian to review response times.   They will seek opportunities to “tune” the deployment plan and improve coverage and response times.   

Q:        I have heard that the District has entered into a purchase agreement for twelve (12) ambulances and plans to purchase additional equipment.   Why?

A:         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.  Owning the property and capital assets will enable the District to immediately pivot to another contractor or rapidly implement a District operated EMS agency if the need arises.   Either way, the taxpayer’s interest is optimally protected.

Q:        Why does the District have a Medical Director?

A:         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.

Q:        When will the District adopt and budget and tax rate?

A:         The District will adopt it’s first budget and tax rate in late Summer 2025 in accordance with the calendar requirements established by the legislature.   Budget and tax hearings will be advertised in the local newspaper and on the District website (sign up for notifications).

Q:        Does the District have any staff?

A:         Currently, no.  However, the Board is seeking to hire a General Manager to carry out the administrative functions of the District.   The earliest possible hire date would be June 1, 2025.

Q:        Does the Board welcome feedback?

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