Austin–Travis County Emergency Medical Services (ATCEMS) is a joint EMS agency serving both the City of Austin and Travis County, with a mission to preserve life, improve health, and promote safety. Established in 1976, ATCEMS has grown into a comprehensive public safety organization providing advanced and basic life support through a fleet of ambulances and specialized vehicles, including motorcycles for rapid response during special events. The agency operates out of approximately 40 stations, many of which are co-located with fire departments across both urban and rural areas. With a workforce of over 600 medics and staff, ATCEMS not only responds to 9‑1‑1 emergencies but also leads a range of innovative programs focused on public health and community outreach. These include the Community Health Paramedicine Program, injury prevention education, the Buprenorphine Bridge Program for substance use treatment, and specialized units such as tactical medics, rescue medics and whole blood response teams. ATCEMS emphasizes public transparency and maintains a 24/7 Public Information Office to keep the community informed. Through a commitment to high-quality care, continuous improvement, and health equity, ATCEMS plays a vital role in enhancing the well-being of residents throughout the Austin-Travis County region.
If you’re considering a long-term EMS career, ATCEMS is a strong option—especially if you value representation and collective bargaining through union support. As a City of Austin employee, you benefit from stable retirement (around 30+ years) and solid benefits. One of the biggest strengths here is the opportunity for career development—you’re not stuck riding a box forever. There are many specialized units and clinical paths to pursue.
Clinically, ATCEMS offers excellent opportunities. I had real autonomy and was able to practice at the top of my license—performing procedures like surgical crics, finger thoracostomies, DSI, and conscious sedation. The system used to support high-level care and trusted medics to make sound clinical decisions in the field. Dr. Escott and Dr. Abraham have no backbone after losing the GOAT Dr. Pickett. So, clinically there has been erosion.
That said, leadership at the chief level is currently a serious problem. Many decisions being made are out of touch with street-level realities and are negatively impacting both safety and working conditions. Morale has taken a hit. The good news is, leadership changes over time. If you’re in this for the long haul, you may be able to ride out the current wave of poor management and be part of the agency’s next chapter.
ATCEMS has become a disgraceful shadow of what it once was. On paper, the protocols may look solid but in practice, they’re either ignored or used as weapons against the those expected to follow them. If you take initiative or do your job well, you’re punished with micromanagement, interrogations, and the looming threat of unjust disciplinary action.
The environment has become toxic. Get a complex call? Expect to be swarmed by command staff, PAs, and physicians who proceed to take over, undermine your judgment, and make it abundantly clear that you are not trusted to do your job. It’s no longer about patient care; it’s about optics, ego, and control.
Dr. Escott’s leadership is authoritarian and vindictive. He has no problem revoking credentials without proper cause, jeopardizing careers and livelihoods with no transparency or due process. This is not leadership it is punitive control masked as oversight.
The administration? Completely spineless. They don’t advocate for their crews. Instead, they make self-serving decisions that protect their positions at the expense of the field personnel who are barely holding the system together. The department used to support medics. Now, it uses them.
The City of Austin has money resources but you’d never know it by how medics are treated. Overtime has been stripped down to the bone, despite the fact that it’s essential for survival in a city as expensive as Austin. The department has effectively told its people: “Figure it out.” So now, we’re forced to juggle second jobs just to pay rent while risking our lives every shift in a system that treats us as expendable.
ATCEMS is out of touch, unsupportive, and unrecognizable. This used to be a place where you could do good medicine. Now it’s a “Mother, May I” bureaucracy built on fear, control, and hollow leadership. The people suffering most? The ones still out there trying to make a difference despite the system working against them every step of the way.
This department is a complete facade. Looks good from the outside, but talk to those who work there.
There’s a reason why they run an academy 2 to 3 times per year with 20 to 40 people. It’s a civil service 3rd service city department with “private ambulance” leadership.
Don’t be fooled by their clinical guidelines thinking it’s high speed medicine all shift. There’s no BLS trucks so they burn their paramedics out literally running on “I can’t find my glasses” at 3am. If you perform even an intubation, you’ll have a call review, even if everything ran fine.
Dr. Escott, the medical director, publishes articles about how sending an ambulance to everyone is not the answer, yet he does not apply it to his own system. They utilize MPD so communication medics are required to hold to the script. So the “man laying in the grass” will many times constitute a cardiac arrest response.
The “Community Health Paramedic” program is a complete joke as it focuses on the frequent flyer homeless and mental health patients that usually transported anyways. Yes, they have PA’s each with a base salary of 160k + per year also. There’s a C4 (Collaborative Care Communication Center) that’s supposed to be like a telehealth line. The problem is that it’s staffed with paramedics who’s parameters are extremely narrow so not many calls are spared an ALS response (remember, no BLS trucks).
All of these programs are window dressing for the department as none of them make any kind of significant difference, hence the burnout rate and the turnover.
The executive staff butchered the 144 million dollar budget, having to make concessions just 6 months into the fiscal year. Their answer… they brown out 5 or more ambulances per day, canceling overtime for those willing to fill those spots making the remaining trucks even busier. It’s not uncommon for 20+ calls per day for many of the trucks, 19 of which most likely didn’t need an ambulance let alone a paramedic ambulance.
The equipment, trucks, stations (when you’re in station), and schedule 24/72 are the positives, and that’s it.
Pension is 30 yrs plus age 62 before you can start collecting. No way you can do 30 yrs on a box in the ATCEMS system, and the upward ladder is very limited to get off the box.
Until there’s a change at the top (Chief, Chief of staff, and Assistant Chiefs, and Medical Director) I’d look elsewhere.
There’s are agencies out there who’s pay is equivalent or more, less call volume, more progressive, and who’s leadership believes in their employees and public safety rather than trying to save a buck on the expense of the providers’ backs.
Rating Breakdown
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2.3/5
3 Reviews on “Austin-Travis County EMS”
If you’re considering a long-term EMS career, ATCEMS is a strong option—especially if you value representation and collective bargaining through union support. As a City of Austin employee, you benefit from stable retirement (around 30+ years) and solid benefits. One of the biggest strengths here is the opportunity for career development—you’re not stuck riding a box forever. There are many specialized units and clinical paths to pursue.
Clinically, ATCEMS offers excellent opportunities. I had real autonomy and was able to practice at the top of my license—performing procedures like surgical crics, finger thoracostomies, DSI, and conscious sedation. The system used to support high-level care and trusted medics to make sound clinical decisions in the field. Dr. Escott and Dr. Abraham have no backbone after losing the GOAT Dr. Pickett. So, clinically there has been erosion.
That said, leadership at the chief level is currently a serious problem. Many decisions being made are out of touch with street-level realities and are negatively impacting both safety and working conditions. Morale has taken a hit. The good news is, leadership changes over time. If you’re in this for the long haul, you may be able to ride out the current wave of poor management and be part of the agency’s next chapter.
ATCEMS has become a disgraceful shadow of what it once was. On paper, the protocols may look solid but in practice, they’re either ignored or used as weapons against the those expected to follow them. If you take initiative or do your job well, you’re punished with micromanagement, interrogations, and the looming threat of unjust disciplinary action.
The environment has become toxic. Get a complex call? Expect to be swarmed by command staff, PAs, and physicians who proceed to take over, undermine your judgment, and make it abundantly clear that you are not trusted to do your job. It’s no longer about patient care; it’s about optics, ego, and control.
Dr. Escott’s leadership is authoritarian and vindictive. He has no problem revoking credentials without proper cause, jeopardizing careers and livelihoods with no transparency or due process. This is not leadership it is punitive control masked as oversight.
The administration? Completely spineless. They don’t advocate for their crews. Instead, they make self-serving decisions that protect their positions at the expense of the field personnel who are barely holding the system together. The department used to support medics. Now, it uses them.
The City of Austin has money resources but you’d never know it by how medics are treated. Overtime has been stripped down to the bone, despite the fact that it’s essential for survival in a city as expensive as Austin. The department has effectively told its people: “Figure it out.” So now, we’re forced to juggle second jobs just to pay rent while risking our lives every shift in a system that treats us as expendable.
ATCEMS is out of touch, unsupportive, and unrecognizable. This used to be a place where you could do good medicine. Now it’s a “Mother, May I” bureaucracy built on fear, control, and hollow leadership. The people suffering most? The ones still out there trying to make a difference despite the system working against them every step of the way.
This department is a complete facade. Looks good from the outside, but talk to those who work there.
There’s a reason why they run an academy 2 to 3 times per year with 20 to 40 people. It’s a civil service 3rd service city department with “private ambulance” leadership.
Don’t be fooled by their clinical guidelines thinking it’s high speed medicine all shift. There’s no BLS trucks so they burn their paramedics out literally running on “I can’t find my glasses” at 3am. If you perform even an intubation, you’ll have a call review, even if everything ran fine.
Dr. Escott, the medical director, publishes articles about how sending an ambulance to everyone is not the answer, yet he does not apply it to his own system. They utilize MPD so communication medics are required to hold to the script. So the “man laying in the grass” will many times constitute a cardiac arrest response.
The “Community Health Paramedic” program is a complete joke as it focuses on the frequent flyer homeless and mental health patients that usually transported anyways. Yes, they have PA’s each with a base salary of 160k + per year also. There’s a C4 (Collaborative Care Communication Center) that’s supposed to be like a telehealth line. The problem is that it’s staffed with paramedics who’s parameters are extremely narrow so not many calls are spared an ALS response (remember, no BLS trucks).
All of these programs are window dressing for the department as none of them make any kind of significant difference, hence the burnout rate and the turnover.
The executive staff butchered the 144 million dollar budget, having to make concessions just 6 months into the fiscal year. Their answer… they brown out 5 or more ambulances per day, canceling overtime for those willing to fill those spots making the remaining trucks even busier. It’s not uncommon for 20+ calls per day for many of the trucks, 19 of which most likely didn’t need an ambulance let alone a paramedic ambulance.
The equipment, trucks, stations (when you’re in station), and schedule 24/72 are the positives, and that’s it.
Pension is 30 yrs plus age 62 before you can start collecting. No way you can do 30 yrs on a box in the ATCEMS system, and the upward ladder is very limited to get off the box.
Until there’s a change at the top (Chief, Chief of staff, and Assistant Chiefs, and Medical Director) I’d look elsewhere.
There’s are agencies out there who’s pay is equivalent or more, less call volume, more progressive, and who’s leadership believes in their employees and public safety rather than trying to save a buck on the expense of the providers’ backs.