The establishment and maintenance of pre-hospital patient care delivery systems requires that special emphasis be placed on key areas. Those areas include post start-up activities beginning with a commitment from the business, government and medical communities in order to commission an investigative study aimed at gaining local medical authority and funding approval.

Additionally, once the system is established, there exists several challenges to program managers, including the provision of appropriate and timely leadership and medical education and the establishment of a quality data collection system which supports the expansion and reevaluative processes.