The goal of Montgomery County Hospital District’s Department of Clinical Services is to provide a consistent and superior system of emergency and non-emergency services to our community and provide support for our employees through leadership and professional management.  This includes protocol development, oversight of the electronic Patient Care Record (PCR), quality improvement process, professional development, continuing education, provider credentialing, community education, and integration of the care MCHD provides with the healthcare community

The Clinical team employs the following tools to improve MCHD’s success:

  • Review and analysis of all reports related to strokes, cardiac events, and trauma
  • Regular attendance at local emergency department meetings to foster clear lines of communication and quality improvement
  • Regular case reviews with emergency department personnel and the paramedics on those cases
  • Procedural review, changes and/or training as called for by the case reviews
  • Studies on the implementation and effectiveness of best practices
  • Published research papers


A critical role of the department is ensuring MCHD’s paramedics are trained and best positioned to utilize their knowledge, abilities, and talents in the field.  MCHD creates an environment where our paramedics continuously develop their skills as a provider while growing within the agency and are trusted with more responsibility.  The following are the different levels of credentialing utilized by MCHD.  In order to maintain the current level of authorization, the paramedic must successfully pass a re-credentialing exam every other year.

  • PI – Attendant: This is an emergency medical provider who has passed credentialing exams and holds a TDSHS EMT-Intermediate or EMT-Paramedic certification or license.
  • PII – In Charge: This is a paramedic who has shown clinical proficiency through multiple written and scenario evaluations. They have limited clinical authority and consults with higher-authorized provider prior to performing certain skills.
  • PIII – In Charge: An In Charge who has demonstrated enhanced clinical proficiency beyond that of a PII. This paramedic has an expanded level of clinical authority and is no longer required to consult with a higher-authorized provider prior to performing certain skills.
  • PIV – Supervisor: The highest level of authorization for MCHD is a PIV. This employee has shown excellent operational and clinical proficiency. They are authorized to provide medical direction through consults to paramedics at lower levels of authorization.

MCHD Department of Clinical Services shares our best practices and lessons learned and often publishes our findings through professional journals and magazines. Below are a few of our most recent publications:

  • Stroke Coordination of Care – Cambridge Core, June 2016
  • Thoracostomy Philosophy – JEMS June 2016
  • LVO Stroke: How to improve EMS Response and Patient Survival – EMS1 June 2016
  • Ketamine for Excited Delirium Syndrome: Results of a 3-year case series – EMS1 April 2016
  • A Paradigm Shift in EMS Evaluation of Stroke – JEMS August 2016
  • Improving Systems of Care in Time Sensitive Emergencies