Charles County is substantially expanding its emergency medical services by shifting toward more paid employees, implementing new performance standards and encouraging better cooperation among volunteer companies.

Charles relies primarily on volunteers, who operate out of 15 companies throughout the county, to provide its EMS coverage. About 60 percent of the county is covered around the clock with "advanced life support" response for life-threatening cases, officials said.

"But as we have more and more growth in the county, and there are more and more calls, it becomes increasingly difficult to have the coverage you need in all the areas of the county 24 hours a day, 7 days a week," said commissioners President Murray D. Levy (D-At Large). "We have to improve coordination between the volunteer and paid system. And we have to improve our response time."

In a meeting with volunteers and medical professionals Tuesday, the county commissioners received a report that outlined several ways the EMS system would change in the next few years.

The primary change involves a heavier reliance on paid staff members. The commissioners have agreed to hire 10 "advanced life support" employees -- five paramedics and five emergency medical technicians -- for the upcoming fiscal year, bringing the operational staff to 28 people. In fiscal 2006 and 2007, the recommendations include adding 48 paid personnel to life support teams.

The county will spend about $1.8 million on the EMS expansion in the upcoming fiscal year, said County Administrator Eugene Lauer. The funding will come from a 1 cent increase in the general county property tax rate as well as from billing insurance companies of residents who require the emergency services, he said.

Officials said the goal of the expansion is to eventually have six advanced life support teams -- one team per 20,000 to 25,000 residents -- to provide continuous coverage to all of the county.

"We're way behind the curve," said Richard Alcorta, the state EMS medical director for the Emergency Medical Services System. "The standard of care is really not being met today."

In addition to increased staffing, the county plans to develop uniform performance standards that would apply to all volunteer fire and EMS companies. One of the goals is to improve the speed of transporting patients to hospitals. The report calls for a maximum of 20 minutes from the time a patient is placed on a stretcher or in a wheelchair to when the ambulance arrives at a hospital. Another objective is to reduce the wait time between dispatching backup emergency units from five minutes to three minutes.

"It's going to be a formidable task to implement all this quickly," Lauer said.

The county has also begun training its emergency communications staff members to be able to advise callers who are facing medical emergencies on how to help themselves or prevent further injury before technicians arrive.

"Because of this training, we've already saved a number of lives," Levy said.

EMS volunteers will continue to serve an important role after the expansion, Levy said. The report calls for continued recruiting and increased training of volunteers.

"The volunteers have a great tradition in the county. . . . They've done a great job," he said. "I think this is pretty much a natural evolution in a growing county."