How one paramedic went from the streets to the C-suite

Source: EMS1 BrandFocus Staff, EMS1

How one paramedic went from the streets to the C-suite

There’s no doubt that public safety companies led by those who have served in the field have a unique advantage when it comes to product development, especially for the emergency medical field.

This is certainly true at software innovator EMS Technology Solutions, which has several EMS veterans on its C-suite team, including Vice President Shane Garrison. We asked Garrison about his career and how a firefighter/paramedic can use his or her field experience to develop the right products for the EMS industry.

When did you know you wanted to be a paramedic?

My grandfather and uncles were firefighters. I had been around fire stations growing up, and like most young boys, I liked the fire trucks and seeing the firefighters work.

My grandfather asked me when I was in college, “So what are you thinking about doing?” When I was unable to provide a clear answer, he mentioned the fire department was hiring. He said it would be a good fit.

I went to an EMT course because that was something that the department was starting to require. As soon as I stepped foot on my first ambulance for a clinical rotation, I ran my first true emergency call. It was a head-on collision. I was assigned to assist with taking care of some of the less critical patients. I really didn’t do that much, but I knew that I was making a difference and I was needed.

From that first call, I was hooked. That was 27 years ago, and I still have a passion for taking care of patients.

You are co-founder of Puckett Emergency Medical Services, based in Cobb County, Ga. What are the challenges of running a private ambulance service?

Probably the biggest challenge of building a successful private ambulance service has been the ever-changing reimbursement rules and regulations that must be navigated.

The profit margins are very thin in the ambulance business. You must bring your A game every day in this business. There is very little room for error.

In 2007, you founded EMS Technology Solutions. What has this endeavor taught you about leadership?

Sometimes the best way to lead is to just get out of the way. Great teams are made up of people with different skills. As a leader, sometimes you must realize that someone else is a better quarterback than you are. Give them the ball and let them go to work.

This is how teams win – putting the right people in the right positions at the right time.

You are a 27-year EMS veteran. How has technology changed the industry?

In my opinion, technology has absolutely changed the industry for the better.

Technology has improved patient care. The flow of information throughout the call process has improved response times, decreased expenses by allowing us to better manage unit hours and has improved patient outcomes by allowing us to share information with the receiving hospitals prior to our arrival.

Twenty years ago most agencies were not utilizing GPS Systems for routing, transmitting 12-lead EKGs or using electronic patient care reports. In today’s EMS environment, it is rare to not see these technologies being utilized by most services.

I feel that we have just scratched the surface of what technology will do for the EMS industry in the future. As battery technology becomes smaller and the devices and data becomes faster, we will see more advancements in EMS.

Telemedicine in the EMS environment is happening today and will become more common place.

I see the things like RFID technology that our development team has married together with Operative IQ, and I am amazed at how an entire ambulance can be inventoried in just a few seconds.

How has Operative IQ changed operations management?

Operative IQ has harnessed the massive amount of data that can be gathered from an agency’s inventory and vehicles.

It is providing that data to supervisors and administrators so they can get a clear picture of what’s going on with their operations.

Operative IQ is cutting down the nonproductive time used to manage vehicles, stations and supplies, cutting costs and limiting the risk and liability of operations by providing accountability and clear records.

How does Operative IQ help serve the evolving tech landscape in EMS?

In today’s environment everything moves much faster. Demands on your services are greater, expectations are higher, and the amount of equipment and the supplies used in managing an operation are enormous.

Operative IQ has been able to lead and adapt to the changing landscape to serve hundreds of EMS and fire departments, helping them gain control over their operations by harnessing the data, reducing costs and better managing risk.

What are some of Operative IQ’s main features?

Operative IQ is a modular system, so it can be used with the smallest of departments all the way up to the biggest of the big. There are four main components:

  • Inventory and Asset Management: handles the materials management, from inspecting a vehicle to purchasing and distributing supplies and assets
  • Narcotics Tracking: provides a biometrically verified cradle-to-grave custody log for controlled substances, greatly reducing the risk of diversion and making audits easy
  • Fleet Maintenance: can be linked to the daily vehicle inspections for real-time input on repairs needed, as well as managing all routine maintenance
  • IQ Genius RFID: tracks equipment, sealed cabinet inventory and speed loader bins using radio waves and GPS.

What is the greatest lesson you learned about using technology for EMS?

If you are going to survive in health care, you need to embrace technology. It’s no longer an option.

Technology is going to continue to evolve, and if you are not engaged now, you will find it difficult to get up to speed later down the road when competitive pressures make it difficult to run a profitable operation.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Operative IQ’s RFID Solution is “Genius”

Operative IQ’s RFID Solution is “Genius”

Centreville, MD – April 13, 2016 – Queen Annes County DES implemented IQ Genius, a vehicle based RFID asset and inventory tracking system compatible with Operative IQ, on 5 of their ambulances in the fall of 2015. The operation has already validated three of the critical use cases for using RFID technology to track inventory and assets used in providing patient care.

Queen Annes County DES responded to a structure fire that resulted in a civilian being rescued. This was a critical patient and a lot of equipment was taken off the ambulance and brought into a chaotic scene. As they prepared to transport the patient, EMS Lieutenant Kevin Brenner glanced up at the IQ Genius RFID unit and noticed the equipment status light was GREEN. This green light provided a great sense of relief indicating that all of the RFID tagged assets were on the unit before leaving the scene.

On a separate occasion an oncoming crew noticed a bag was missing from a unit. Immediately Lieutenant Brenner was able to use IQ Genius to locate the missing equipment. A quick look at asset management data in Operative IQ revealed the last READ location of the bag. The crew was able to drive to that address and retrieve the equipment. This allowed us them to narrow their search and save a lot of time looking for missing equipment.

Ongoing the IQ Genius system enables lightning fast pre-trip inspections of tagged inventory and equipment. Reducing the time it takes to prepare an ambulance for service.

Kevin Brenner is the EMS Lieutenant for Queen Annes County DES and has provided leadership for the deployment of new technology, including IQ Genius RFID, to aid in EMS operations management.

EMS Technology Solutions offers cutting edge, but affordable operations management software and products designed with First Responders in mind. The company’s Operative IQ Operations Management Software offers modules that include: Inventory Management, Asset Management, Purchasing Features, Integrated Purchasing, Fleet Management, Service Desk and RFID Tracking. EMS Technology Solutions has won four consecutive EMS World Top Innovation Awards for its operations management software.

For more information, please contact the Operative IQ team.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Break away from the desk! IQ Mobile & IQ Status Board

IQ Mobile and IQ Status Board Enable you to Break away from the desk

Operative IQ is receiving great feedback on how the operations management software designed specifically for first responders is transforming the way our clients manage operations. We like to draw on this excitement when developing new applications, always seeking innovative ways to bridge the physical and virtual worlds the first responder field requires today. We are excited to share how Operative IQ’s IQ Mobile and IQ Status Board are reducing the gap between these two realms.

IQ Mobile, a powerfully simple tool for inventory management. Allowing you to use your mobile phone or tablet to manage inventory, assets and purchases. Laser barcode readers are available for most mobile devices as well as a small laser barcode reader that can be worn on a lanyard or clipped to your belt. The IQ Mobile application is included with your Operative IQ service. Talk to your Operative IQ Account Manager about barcode scanning equipment options. Read More

IQ Status Board brings key data to the big screen while adding mobility to access your operation’s status board from a mobile device. Status boards are customized to your requirements allowing you to display information that is critical to your operation’s managers. If you are not in the office or shop, no problem! You can pull the status board up on your phone. Talk to your Operative IQ Account Manager about creating a IQ Status Board for your operation. Read More

EMS Technology Solutions offers cutting edge, but affordable operations management software and products designed with First Responders in mind. The company’s Operative IQ Operations Management Software offers modules that include: Inventory Management, Asset Management, Purchasing Features, Integrated Purchasing, Fleet Management, Service Desk and RFID Tracking. EMS Technology Solutions has won four consecutive EMS World Top Innovation Awards for its operations management software.

For more information, please contact the Operative IQ team.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Ambulance Equipment and Supply Costs


What’s in a Sunstar ambulance and how much does it cost?

Pinellas County owns the Sunstar ambulance system, which is funded by the approximately $41 million in user fees collected each year. The county pays Texas-based Paramedics Plus about $21 million a year from those user fees to buy ambulances, fuel and service them, hire and pay paramedics and emergency medical technicians to staff the vehicles, and transport emergency medical calls.

The 74 ambulances in the fleet are owned by Paramedics Plus, but the county has the right to take them should the company default or leave the county.

Pinellas pays Paramedics Plus another $2.8 million a year to buy supplies, such as bandages and drugs, for the ambulances and fire department vehicles that are used for emergency medical services. Most of that — about $1.8 million a year — is used for the Sunstar ambulances.

But how much does it cost to put an ambulance on the road? About $182,731 for supplies, equipment and ambulance personnel. Add another $122,939 for the ambulance itself, the gas and other related costs. That’s about $305,670. And the county has up to 64 on the road at any one time.

Sunstar paramedic Bryan Findley , left, and emergency medical technician Trevor Jackson sit in the back of Sunstar ambulance unit No. 71, which is stocked with essential equipment and supplies.

Equipment and Supplies


Total: $161,016

Not shown: Temperature-controlled drug storage with contents, $1,694; EKG cabinet, $233; burn cabinet, $28; restraint cabinet, $265; pediatric cabinet, $432; IV cabinet, $269; action area, $287; airway bag, contents include portable oxygen, oxygen masks, other equipment, $747; Stryker stair chair, $2,305; scoop stretcher, $436; pediatric immobilizer, $182; Sager splint, $239; KED immobilizer ($112 each, two per ambulance), $224; head blocks ($4 per set, four sets per unit), $16; adult cervical collars ($4 each, four per vehicle), $16; portable suction unit, $480; EZIO intraosseous infusion system, $688; personal protective equipment kit, includes surgical masks, $24; blood pressure cuff, $11, and car seat, $147.
Total: $8,723

Electronics equipment not shown: Mobile data terminal and OMG gateway (wireless network), $4,782; road safety system, $3,195; Motorola mobile $4,071; and Motorola UF pagers ($472 each, two per unit), $944.
Total: $12,992.

Total contents: $182,731



A. AEV Chevrolet/GMC Trauma Hawk Ambulance. Cost $120,000
B. Striping/lettering. $2,000
C. Fuel, 50-gallon tank, $219 to fill up at current prices
D. Tires, $720

Total: $122,939.

Source: Paramedics Plus

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Just-in-Time Stock Control


Just-in-Time Stock Control

For every ambulance on the street there is a supply room, or store, somewhere containing equipment and possibly medications to fill up that vehicle when it returns from its run. The management of this store, whether it looks after one ambulance or 100, can be the cause of financial hemorrhage and litigation risk without tight logistics and operations management.

While preparation and planning is always encouraged, when it comes to expensive medical equipment and supplies, stock on the shelf represents hard cash. If such equipment and supplies spend their entire shelf lives on the shelf, then you might as well throw money away.

The key to good stock control is the creation of a system and processes that ensure efficiency and accountability are maintained at all times. After payroll, medical stock and equipment is the largest expenses an organization has to deal with, so constant attention is a must.

Where to Begin

To best manage your stock, you need to understand usage and flow from the store, or point of ordering, onto the ambulance or into the med pack, and how it is dispensed during the patient episode.

This understanding identifies the par, or stock level required to keep the organization moving. Moving is a key term, as analysis of stores consumed identifies items that move through the logistics system faster than others and consequently must be replenished more frequently.

Once the par is identified, the time it takes a supplier to go from order received to stock on the shelf must be factored in. Par levels may need to be adjusted or stores ordered once they hit a certain level in order to maintain system flow.

Having identified all of the above, a scientific approach to stock control can be adopted with the goal of having enough in stock to deal with normal operations, but not so much that you risk it going out of date before use. This process is known as “just-in-time supply.”

The Richmond Ambulance Authority (RAA) employs this system and can offer some best practices to aid both logistics management and stock flow.

Tracking Systems

When tracking supplies, using an electronic inventory management system enhances the ability to see what supplies are used most and how much money is spent in each individual category (e.g., oxygen, medical equipment, medical supplies and medications).

Such systems can be either bar code reader-based or radio frequency identification (RFID) systems. RAA employs a bar code system that reads directly into a central database that identifies stock usage against the par and stocks to be electronically ordered. If it is not practical to implement an electronic inventory management system, Excel spreadsheets are useful, particularly when trying to track expiration dates.

Moving Stock

The RAA system has identified that a week’s worth of fast-moving supplies (e.g., IV supplies, nonrebreathers, nasal cannulas, ECG pads and nebulizers) is required. Conversely, slower-moving stock (e.g., defibrillation pads, endotracheal tubes and decompression needles) can last 7–10 days before reorder. Do not overstock on these supplies; pay attention to expiration dates.

When ordering supplies, it is best to set aside a specific day of the week to place orders. This allows for a good working relationship between the EMS agency and its supplier. The supplier and its warehouse will know when to expect orders and what supplies are needed. This will help to avoid back orders. RAA’s logisticians set aside early Monday morning for placing supply orders, allowing the orders to be delivered by midweek (based on knowledge of delivery lag times). After the supplies are received, a midweek order is also placed.

High-Performance Logistics

Using a sealed-bin speed-loading system eliminates ambulances being over- or understocked and allows for consistency on each ambulance. Sealed bins are loaded by logistics staff by commodity or treatment (identified by logistics and vehicle-stocking standard operating procedures). Stores are heat-sealed into packs and placed on every ambulance in the same position, providing a uniformity that makes spot-checking easy. From an accountability perspective, as stock is taken from the storage area and sealed into bins, it is classified as used and the par level adjusted, which in turn cues reorder.

For the binning system to be successful, there has to be a level of trust between logistics and field personnel. Field personnel need to be confident that when they open their bins, everything that is supposed to be there is in fact there. The binning system is most successful when staff are dedicated to stocking the bins.

The sealed-bin system allows for the logistics department to successfully manage just-in-time stock control measures. Personnel dedicated to binning have the greatest knowledge about how fast supplies are used. Their knowledge of how quickly supplies move allows for accurate orders to be placed when in a nonautomated stock control system.

Leveraging External Relationships

It is important for EMS agencies to have strong working relationships with their local hospitals. Ask if it’s possible to rotate equipment through and/or have a one-for-one stock exchange. For example, if a nonrebreather, ECG pads and IV lock set are used on a patient, could those supplies be replaced on patient handover? Sign an agreement so both parties understand what is expected. There may also be a requirement to have a one-for-one stock exchange with first response agencies. If they use a nonrebreather, the transporting agency will give them a nonrebreather because it can then be replaced at the hospital. This allows the first response agency to maintain its bag and readiness.

Logistics staff serve a crucial role in ensuring smooth operations. RAA logistics staff not only clean and stock ambulances so they are ready for field crews, they also visit area hospitals and pick up equipment left by field crews after patent handovers. This equipment is brought back to logistics and cleaned prior to being placed back in service. This helps improve hospital turnaround times—crews aren’t tied up cleaning equipment. Each ambulance is deep-cleaned monthly. All bins are removed from the ambulance and replaced with fresh ones. Cabinets are emptied and wiped down. Floors are scrubbed with a heavy-duty cleaner. Logistics staff can also be used for lifting assistance, which avoids the need to take another ambulance or first response fire apparatus out of service.

Stores equal cash on the shelf. A just-in-time supply system keeps stock moving at the appropriate rate of both affordability and consumption.

Best Practices for Stock Control

Don’t overorder: Track what’s used most often and keep enough stock on the shelf for one week. This should provide enough time to place an order with your supplier and have items delivered.

Only order relevant stock: Don’t favor supplies or toys that are outside your EMS agency’s scope of practice. Your OMD can recommend what supplies and equipment work best.

Appoint a lead: Having one person in charge of ordering supplies avoids the potential for double orders or orders being missed.

Implement checks and balances: Check supplies regularly. Complete a thorough walk-through of all supplies needed at least once a week, although we recommend doing it twice.

Manage shelf stocking: When new supplies arrive, place them behind the old stock. This will rotate the stock that needs to be used before expiration.

Stay oxygenated: Sending unused O2 back in cylinders returned for refill is wasteful. Keep an eye on how often oxygen is being exchanged and set a standard for when it should be changed out. RAA uses 500 lbs. for the main oxygen and 700 lbs. for its portable oxygen. RAA is an inner-city system with relatively short transport times; rural system may want to allow for greater minimums.

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ

Fire Captain Mandolini on Operative IQ Professional Services

Fire Captain Mandolini on Operative IQ Professional Services

When Operative IQ rolled out its Professional Services: Onsite Training, we were excited to see how much benefit customers would truly gain from the face-to-face training. As it turns out, there is a clear advantage to onsite training over traditional/virtual training. In a brief interview with Fire Captain Josh Mandolini of the Big Bear Fire Department in Big Bear Lake, California, the benefits of onsite training became apparent: Learning how the software can fit the agency’s needs, and the ability to go beyond “good enough”.

Are you guys fully live at this point?

“Yeah, we’re fully live.”

Awesome! Do you guys like it?

“So far, so good. We love it.”

Can you give me a brief description of some of the reasons why you guys chose Operative IQ and Professional Services Training?

“Well, it started out as we just wanted a way to track our assets, and at some point we decided we were going to start purchasing our own EMS supplies. We were previously being stocked by the hospital so once we took that over we had no idea what we annually spent on this or monthly spent on that. We were doing a bulk order here, a bulk order there and having no idea what was coming in or going out. We looked at some scanning software, and we just happened to hear about you [Operative IQ] at a trade show. Once we saw your software we said, “Uh, why would we even think about scanning software? It doesn’t even make sense.” So that’s kind of how it all evolved. Inventory became our priority, and it’s doing well for what we needed in that category.”

I’m glad it’s working out for you! What made you chose the onsite training service over the traditional training?

“I wanted to make sure that if we’re going to start, we’re going to start right and not mess it up. I didn’t want to come back 3 years from now and say, ‘we should have been doing it this way.”

Right. Using it how it’s meant to be used and getting the full benefit from it.


When you’ve purchased software in the past, was there training involved or were you pretty much on your own?

“It’s kind of hard to describe but it was just one guy running the show and he’s thinking, ‘Oh, this is how I would do it.’ And instead of talking to the people who actually designed the software and going, ‘how do people use it’ or, ‘how do you use it, how was it designed to be used?’ I think that’s more important. To actually understand how it was designed to be used and are we using it that way.”

Operative IQ is such a huge software, do you think that Onsite Training gave you the ability to customize it to match how you do your current processes?

“Honestly, I think if I were to compare Operative IQ to some of the other software we use around here, it’s is probably one of the more user friendly. It almost seemed like we really didn’t need the training once we got here. That was our initial thought.

Once we got Malia at the table and we were doing it, our guys had so many questions that it was obvious that we weren’t ready. They thought they were ready because the software is so easy to use. Sitting down with Malia, you be like, ‘Well, yeah, that is the simple way and that will work, but why would you not do it this way? Why would you not track expirations?’

The one guy being in charge of something and saying, ‘Well this works for me,’ but in reality he wasn’t using the whole software. I think that’s the benefit. We didn’t feel like we needed it because it was such an easy software to get running on by ourselves but I think we would have missed all the little fine details to truly understanding.”

Do you feel that the two days was enough? I understand that you guys purchased Fleet as well as Inventory Management.

“I definitely think we got our money’s worth. But I could see taking 3 more days with her. She kept on complimenting us, making it sound like we had done so much work prior to her getting here. We were feeling like we didn’t need her because we thought we had squared it all away.”

Having a trainer at your disposal is always a good thing to have.

“She came out and she did an awesome job. I definitely felt like she had our back. She was there for us. It went well.”

Did you feel that everything was addressed that you had questions or concerns about?

“Absolutely. When she came, we didn’t really think that we had anything to address. She brought more light to the software. Like, ‘Oh, this is what it is capable of.’ Being able to talk about it over the phone or looking at a PowerPoint we can see that it’s an awesome software but to actually see all the tiny little ins and outs and the way to line stuff up better and to have someone sit down right next to you and say, ‘ok this is how we’re doing it, this is how you set this up.’ That was beneficial.

If I had one more day, that one day would have been on reporting. That’s all it would have been. What kind of reports do we need? How do we set those up? And a step by step of how these little buttons work.”

If you guys add more of our features in the future, would you be interested in professional services again?

“I would recommend it to anybody. Unless you told me that something was coming, did you have anything in mind?”

There are always things coming! You said that you would definitely recommend us, and that’s great! Do you have any other comments or anything else you’d like to add?

“I definitely think it’s a great software. I think it leans toward fire service and lines up well with it. We do like it, and we do appreciate the support that came out to us.”

EMS Technology Solutions, LLC
3771 Tramore Pointe Parkway, SW
Austell, GA 30106

Contact Us

USA: 877-217-3707
Canada: 647-694-0150

EMS World Innovation Award Winner Operative IQ