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EMS Interlocal Agreement Page 1
CITY OF FORT WORTH – CITY OF FOREST HILL
EMERGENCY MEDICAL SERVICES (EMS) INTERLOCAL AGREEMENT
This EMS Interlocal Agreement (the “Agreement”) is entered into by and between the City of Fort
Worth, Texas, hereafter referred to as “Fort Worth”, acting by and through its duly authorized
assistant city manager, and the City of Forest Hill, a unit of local government, hereafter referred
to as the “Client.” Fort Worth and the Client may collectively be referred to herein as the “Parties”
or individually as a “Party.”
WHEREAS, Fort Worth and the Client were parties to a Restated and Amended Interlocal
Cooperative Agreement, effective July 23, 2020 (the “ILA”), for the provision of out of hospital
emergency medical services (“EMS”), non-emergency medical services, unscheduled medical
transportation and ambulance service, mobile integrated healthcare (“MIH”)(collectively the
“EMS System”), and scheduled interfacility medical transportation (“IFT”);
WHEREAS, through the ILA, Fort Worth, the Client, and other units of local government
created the Metropolitan Area EMS Authority d/b/a Medstar (“MedStar”), an administrative
governmental agency, to administer and provide these services on behalf of the Parties and other
units of local government;
WHEREAS, the Parties agree that it is in the best interests of the public health and welfare
of the people of the Parties’ jurisdictions to have available to them a regulated EMS System with
an exclusively contracted EMS Provider;
WHEREAS, Fort Worth has elected to establish an EMS division through the City of Fort
Worth Fire Department (“FWFD”) to operate a new EMS System and provide services to the
people of the Parties’ jurisdictions;
WHEREAS, the Parties, together with all entities participating in MedStar, previously
executed a memorandum of understanding and agreement (the “MOUA”) to jointly withdraw from
the ILA and dissolve MedStar;
WHEREAS, pursuant to the terms of the MOUA, Fort Worth assumed control of all assets
and property of MedStar to facilitate Fort Worth’s ability to operate an EMS System and offer
services to the Client and other interested units of local government in accordance with the terms
of the MOUA and this Agreement;
WHEREAS, Fort Worth is engaging a physician who is licensed in Texas and board
certified in emergency medicine to serve as the Chief Medical Officer and Medical Director for
the EMS System (the “Medical Director”);
WHEREAS, pursuant to Chapter 791 of the Texas Government Code, the Texas Interlocal
Cooperation Act, and section 774.003 of the Texas Health and Safety Code, the Parties may agree
to regulate and provide governmental services for the public health and welfare, and such services
include those provided by the EMS System;
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WHEREAS, the Parties desire to continue their cooperative efforts sothat Fort Worth may
provide EMS System services to the Client and the public within their corporate limits through the
FWFD and its EMS division (“FW EMS”); and
WHEREAS, the Parties will pay for services to be provided pursuant to this Agreement
from current revenues available to the paying Party.
NOW, THEREFORE, the Parties agree to the following:
Section 1: DEFINITIONS
The following index of definitions includes terms that may not appear in this Agreement but are
used in the MOUA, the Uniform EMS Ordinance, or in the ordinary course of describing the
services of the EMS System. Therefore, the full index is included herein for ease of reference by
the Parties.
1.Advanced Life Support (ALS). Out-of-hospital care that uses invasive medical
acts (as defined in Tex. Health and Safety Code § 773.003(1)).
2.Aeromedical Transportation Unit. Any rotary or fixed wing aircraft providing
basic or advanced life support services and Patient transportation that originates
within the Service Area.
3.Ambulance. A vehicle for transportation of sick or injured person to, from, or
between places of treatment for an illness or injury, and provide out of hospital
medical care to the Patient.
4.Ambulance Mutual Aid Agreement. A written contract between Fort Worth and
one or more entities whereby the signing parties agree to provide backup
ambulance service to one another under the terms and conditions specified therein.
5.Ambulance Service. The transportation of Patients by emergency or non-
emergency ambulance; for purposes of this Agreement, Ambulance Service does
not include IFT services as defined herein.
6.Associate Medical Director.A licensed physician who assists the Medical
Director in carrying out his or her duties under the EMS Interlocal Agreements,
the Uniform EMS Ordinance, and any Medical Director’s agreement with Fort
Worth.
7.Basic Life Support (BLS). Out-of-hospital care that uses noninvasive medical
acts (as defined in § 773.003(2), Tex. Health and Safety Code).
8.Emergency Care Attendant (ECA). A person certified as an “emergency care
attendant” under § 773.046 of the Tex. Health and Safety Code.
9.Emergency Medical Services (EMS). Services used to respond to an individual’s
perceived need for immediate medical care and to prevent death or aggravation of
physiological or psychological illness or injury.
10.Emergency Medical Technician (EMT). A person certified as an “emergency
medical technician” under § 773.047 or an “advanced emergency medical
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technician” under § 773.048 of the Tex. Health and Safety Code, and any other
class of EMT recognized by state law or regulation.
11.EMS Communications Center. The facility designated by Fort Worth as the
central communications center from which all EMS System services offered by
Fort Worth shall be dispatched and coordinated.
12.EMS Interlocal Agreement. The service level interlocal agreements executed by
Fort Worth and Clients to designate Fort Worth as the exclusively contracted EMS
Provider of the EMS System within the Service Area.
13.EMS Provider. The entity that has received a Texas EMS Provider License, as
required by relevant state law, to provide the EMS System services and is the
exclusively contracted provider of the EMS System services within the Service
Area. For purposes of this Agreement, the EMS Provider is Fort Worth.
14.EMS System. The regulated out-of-hospital EMS, non-emergency medical
services, unscheduled medical transportation and ambulance services, and mobile
integrated healthcare system provided by Fort Worth within the Service Area, not
including those first response services Client chooses to provide itself as a First
Responder.
15.First Responder. Any agency that, in cooperation with the EMS Provider,
provides initial response to requests for EMS and, on its own or in cooperation
with the EMS Provider, provides immediate on-scene care to ill or injured persons
but does not transport those persons to healthcare facilities.
16.FW EMS. The EMS division of the Fort Worth Fire Department responsible for
providing the EMS System services.
17.Interfacility Transportation (IFT). The provision of scheduled, or by
appointment, medical transportation services by a person or entity between
hospitals or medical facilities originating within the Service Area.
18.Medical Director. The licensed physician employed or contracted by Fort Worth
who is responsible for carrying out his or her duties under the terms of their
engagement with Fort Worth, the Uniform EMS Ordinance, and the EMS
Interlocal Agreements and for directing the Office of the Medical Director.
19.Medical Transportation. The transportation of Patients by ambulance,
Specialized Mobile Intensive Care Unit, Specialty Care Transport, or Aeromedical
Transportation Unit, including both emergency and low-acuity emergency
transports, where such transportation originates within the Service Area.
20.Mobile Integrated Healthcare (MIH). Services provided by Fort Worth, as
requested by Client, that are designed to enhance, coordinate, effectively manage,
and integrate out of hospital care, in order to improve outcomes, enhance the
participating individual’s experience of care, and improve the efficiency and
effectiveness of healthcare services provided to the enrolled individuals.
21.Office of Medical Director. The department or division through which the
Medical Director carries out his or her functions. The Office of the Medical
Director is comprised of the Medical Director, any Associate Medical Director(s),
and other individuals assigned to the Office to assist the Medical Director in
carrying out the Medical Director’s functions.
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22.Paramedic. A person qualified as a certified or licensed “paramedic" as defined
by Tex. Health and Safety Code Sections 773.049 and 773.0495.
23.Patient. A person: who requests EMS, or for whom EMS has been requested; and
who has any medical or psychological complaint, obvious injury/distress, or has a
significant mechanism of injury.
24.Service Area. That geographical area which is contained within the corporate
limits of the Parties and other local jurisdictions who have entered into an EMS
Interlocal Agreement with Fort Worth and adopted the Uniform EMS Ordinance.
25.Specialty Care Transport. The transportation of a critically injured or ill patient
requiring a level of service beyond the scope of an EMT or Paramedic due to the
patient’s condition requiring ongoing specialized care that must be furnished by
one or more health professionals, such as emergency or critical care nursing,
emergency medicine, respiratory care, cardiovascular care, or a paramedic with
additional training.
26.Specialized Mobile Intensive Care Unit. A vehicle which is specially
constructed, equipped, staffed, and employed in the inter-facility transport of
patients whose requirements for en route medical support are likely to exceed the
clinical capabilities of an Advanced Life Support ambulance.
27.Uniform EMS Ordinance. The ordinance adopted by the Parties and other units
of local government to establish standards for the provision of the EMS System
services and designate Fort Worth as the EMS Provider for the EMS System.
28.Unscheduled Medical Transportation. The transportation of Patients by
ambulance service, Specialized Mobile Intensive Care Unit, Specialty Care
Transport, or Aeromedical Transportation Unit, including both emergency and
low-acuity emergency transports, where such transportation originates within the
Service Area and is not previously scheduled or made by appointment.
Section 2: ELECTION TO BE CLIENT
2.1 As evidenced by the execution of this Agreement and the concurrent adoption of the
Uniform EMS Ordinance (which is attached hereto as Exhibit A and incorporated herein by
reference), the Client has elected to designate Fort Worth as the EMS Provider and the exclusively
contracted provider of the EMS System services for the Client’s jurisdiction, other than those first
response services the Client chooses to provide itself as a First Responder, and to receive EMS
System services from Fort Worth pursuant to the terms of this Agreement.
Section 3: RESPONSIBILITIES OF CLIENT
3.1 The Client agrees to:
3.1.1 Properly adopt and enforce the Uniform EMS Ordinance and this Agreement;
3.1.2 Establish, operate, and fund a First Responder Program, as provided by Texas
Administrative Code 157.14, to represent the interests and needs of Fort Worth and the Client,
which may range from an Emergency Care Attendant Program up to an Advanced Life Support
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Program adopted by Fort Worth and the Medical Director and as approved in collaboration
between Client, Fort Worth, and the Medical Director;
3.1.3 Participate, via the EMS Advisory Board (“EAB”), in the development of and abide
by the medical protocols, credentialing requirements, and medical policies for the EMS System
and First Responders, as established by the Medical Director;
3.1.4 Provide a mechanism for transferring 911 calls requesting medical assistance from
the Client’s 911 center to Fort Worth’s designated EMS Communications Center and transfer 911
callers in accordance with system performance standards adopted by Fort Worth;
3.1.5 Designate a representative of Client to serve as a member of the EAB, who shall
then be appointed by the Fort Worth City Council in accordance with the conditions of this
Agreement and the MOUA. The designated EAB representative of the Client shall not be removed
from the EAB without Client’s consent. The Client retains the exclusive right to remove and name
a replacement for its designated EAB representative at any time, and Fort Worth shall appoint the
representative as so designated by the Client;
3.1.6 Provide funding for the provision of the EMS System as required by thisAgreement
and the MOUA; and
3.1.7 Provide additional information, as may reasonably be needed by Fort Worth, to
assure the success of Fort Worth’s EMS System such as, but not limited to: updated jurisdictional
boundaries or response plans that are unique to the Client.
3.2 Pursuant to Texas Administrative Code 157.11(m), Client authorizes Fort Worth to
operate subscription ambulance services within the Client’s corporate limits.
Section 4: RESPONSIBILITIES OF FORT WORTH
4.1 Fort Worth agrees to use the personnel and equipment of Fort Worth for the purpose of
providing the EMS System services for Client’s jurisdiction including coordinating with Client to
create a mechanism for dispatch services and transferring 911 calls requesting medical assistance
from the Client’s 911 center to Fort Worth’s EMS Communication Center. The equipment and
personnel of Fort Worth shall be under the control and supervision of Fort Worth employees during
an emergency medical response pursuant to this Agreement and the MOUA.
4.2 Fort Worth will serve as the EMS Provider for the Client and provide the EMS System
services within the Service Area. It is recognized and understood that Fort Worth does not assume
responsibility for the provision of the EMS System services in Client’s extraterritorial jurisdiction
or other areas outside of the Service Area.
4.3 Fort Worth’s EMS System services will be provided in accordance with the procedures and
protocols of Fort Worth, the Fort Worth Fire Chief, and the Medical Director for the EMS System
and under the direction of the Fort Worth Fire Chief.
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4.4 Fort Worth agrees to:
4.4.1 Set System Performance standards for the Service Area in compliance with the
clinical and medical protocols and standards established by the Medical Director and adopted by
Fort Worth and the Client.
4.4.2 Provide the Client withEMS System services including: out-of-hospital emergency
medical services, non-emergency medical services, life, or limb, threatening emergency, low
acuity emergency, and Advanced Life Support (“ALS”) and Basic Life Support (“BLS”)
Unscheduled Medical Transportation and Ambulance Service, and MIH with such service to
comply with all applicable laws, rules, and regulations, and with the clinical standards,
credentialing requirements and medical policies that may be promulgated from time to time by the
Medical Director, including the following commitments:
4.4.2.1: To Provide, on a 24-hour daily basis, a mobile intensive care unit
(“MICU”)-capable EMS response and medical transportation service with a
minimum staffing as required by relevant state law, which may be amended from
time to time, for a BLS Ambulance and an ALS ambulance;
4.4.2.2: Fort Worth’s EMS System resources shall respond to incidents in the
Service Area through FW EMS dispatch, using the same algorithms in place for
responses within Fort Worth. FW EMS will respond to calls for EMS System
services throughout the entire Service Area in less than or equal to 8:00 total travel
time 90% of the time for high acuity incidents, as defined by the Medical Director,
measured from the time EMS System resources are en route until the time a unit
arrives on scene. FW EMS will respond to calls for EMS System services
throughout the entire Service Area in less than or equal to 11:00 total travel time
90% of the time for low acuity incidents, as defined by the Medical Director,
measured from the time EMS System resources are en route until the time a unit
arrives on scene. Fort Worth will calculate the total travel time, and the relevant
factors to be considered, in accordance with the information in the attached Exhibit
B;
4.4.2.3: FW EMS will transport patients to the closest or most appropriate receiving
health care facility as determined by FW EMS. If the patient is incapacitated,
otherwise unable to make a choice known, or unable to go to the chosen facility
due to diversion status, FW EMS will transport the patient to the facility best able
to meet the patient’s needs;
4.4.2.4: FW EMS will keep the EMS System resources stocked at all times in
accordance with normal FW EMS operating procedures and local, state, and federal
requirements, as applicable;
4.4.2.5: FW EMS will maintain third-party or self-insured vehicle liability
insurance on its ambulances and its drivers;
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4.4.2.6: FW EMS will provide all maintenance for the ambulances and assume all
operational costs of the ambulances, including fuel;
4.4.2.7: FW EMS shall equip the ambulances at all times with current technological
advancements in emergency equipment, whether portable or fixed in place on or
about the vehicle, as are adopted throughout the FW EMS ambulance fleet.
4.4.3 Obtain the services of a Medical Director that are sufficient to fulfill the Medical
Director’s powers and duties as identified in the engagement between Fort Worth and the Medical
Director, the terms of which will be provided to the Client upon request.
4.4.4 Provide the Client the opportunity to participate in Fort Worth’s EMS, or first
responder, related continuing education training without charge to the Client to obtain or maintain
certifications as agreed upon.
4.4.5 Provide, at least quarterly, written reports of the operational performance of the
EMS System to the Fort Worth City Council, EAB, the Medical Control Advisory Board
(“MCAB”) and by email to the City Manager, or their designee, of the Client, and as reasonably
determined to be necessary by Fort Worth.
4.4.6 Prepare and provide to the Client, at least quarterly, a comprehensive review and
summary of the financial budget, and clinical and operational performance of the EMS System.
4.4.7 Manage accounts, subscriptions, payments, and billing practices related to theEMS
System. Fort Worth may, in its sole discretion and at the EMS System’s expense, elect to engage
one or more contractors to provide these services.
4.4.8 Create and maintain the EAB and MCAB to ensure coordination and
communication between first responder agencies in the Service Area and independent medical
oversight related to patient care protocols for Fort Worth’s EMS System.
4.4.9 Engage participating organizations on best practices in service delivery, as
determined to be necessary or prudent by Fort Worth.
4.4.10 Implement an ambulance subscription program (unless otherwise prohibited by
law) and offer memberships in the program to all residents of the Client’s corporate limits.
Section 5: TERM AND TERMINATION
5.1 This Agreement will be effective beginning July 1, 2025 and will continue for a term of 10
years, unless earlier terminated in accordance with the terms of this Agreement. Thereafter, the
Agreement will renew automatically for successive 10-year terms unless earlier terminated in
accordance with the terms of this Agreement.
5.2 In accordance with the terms of the MOUA, Client has received prior notice of the value
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of Client’s pro rata share of the value of MedStar assets transferred to Fort Worth. The value of
those assets as of July 1, 2025, and Client’s pro rata share of that value, has been determined by
Fort Worth and the amount is $280,691.00. The method of calculation for determining Client’s
pro rata share is reflected in the terms and exhibits of the MOUA. The value of Client’s pro rata
share of such assets will be subject to depreciation over a term of 5 years.
5.3 Termination By Client: The Client may terminate this Agreement and withdraw from the
EMS System by providing ninety (90) days’ written notice to Fort Worth. If the Client terminates
the Agreement within 5 years of July 1, 2025, Fort Worth will determine the value of the Client’s
pro-rata share of MedStar’s assets transferred to Fort Worth pursuant to the MOUA as of the
effective date of the Client’s notice of termination, less depreciation, and distribute the remaining
amount, if any, to the Client within ninety (90) days, however this obligation may be extended by
an additional ninety (90) days if determined necessary by Fort Worth in its sole discretion. After
five years have lapsed since July 1, 2025, the Client forfeits all rights or claims to any assets of
MedStar transferred to Fort Worth pursuant to the MOUA and this Agreement.
5.4 Termination by Fort Worth: Fort Worth may terminate this Agreement for Repeated
Uncured Events of Default by the Client, as defined herein.
5.4.1 Event of Default: An Event of Default includes a material breach of this
Agreement. A material breach includes any failure by the Client to perform a significant obligation
under this Agreement that unreasonably interferes with Fort Worth's ability to provide EMS
System services. For example, a material breach includes, but is not limited to: Client’s failure to
make payments to Fort Worth, as required under Section 6, within 30 days of its due date; Client's
failure to enforce any provision of the Uniform EMS Ordinance; Client's failure to abide by the
directives, credentialing, and policies of the Medical Director; Client's failure to fund and operate
a First Responder Program; and Client's failure to transfer 911 calls to Fort Worth. Fort Worth
shall provide the Client with written notice of any Event of Default and allow the Client 60 days
to cure it. If the Client fails to cure the Event of Default within the 60-day period, it will be
considered an Uncured Event of Default.
5.4.2 If two or more Uncured Events of Default occur in a single fiscal year, or five or
more occur over any single term of this Agreement, the Uncured Events of Default will be
considered Repeated Uncured Events of Default. In such case, Fort Worth may terminate this
Agreement , without penalty, after providing Client with 6 months’ written notice of Fort Worth’s
intent to terminate the Agreement pursuant to this provision.
5.5 Upon the effective date of termination of this Agreement, Fort Worth will cease being the
EMS Provider to the Client and the Client will be responsible for all EMS System services within
its jurisdiction from the effective date of termination.
Section 6: PAYMENT
6.1 The Parties agree that the long-term sustainability of the EMS System requires public
funding. The Parties agree to fund the EMS System using the fully loaded unit hour cost (UHC)
allocation strategy as its annual cost allocation method. This method will require Fort Worth to:
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(1) determine the total number of consumed unit hours in the EMS System; (2) determine the
public funding needed by calculating the total expenditures less total revenues; (3) determine the
residual consumed UHC by dividing the total public funding required for the EMS System (step
2) by the total consumed hours in the entire EMS System; (4) determine the consumed units hours
by each jurisdiction; and (5) determine the cost allocation for each jurisdiction by multiplying the
total consumed unit hours in the jurisdiction (step 4) by the residual consumed UHC (step 3).
For purposes of this Section, the actual unit hours consumed on a 911 call will be based on the
number of minutes spent on the call, not including time spent posting or stationed, in a particular
jurisdiction. The total time for calls within Client’s jurisdiction will be aggregated on a fiscal year
basis (October 1 through September 30)and for purposes of calculating the annual UHC for Client,
the annual hours consumed by the Client will be rounded up or down to the nearest one (1) hour
increment. As detailed below, payment for each fiscal year shall initially be based on a projected
budget and projected utilization with a true-up process in the subsequent fiscal year to ensure final
payment for each year ultimately reflects actual costs and utilization.
6.2 Beginning in Fiscal Year 2026, on or before March 15
th of each year, Fort Worth will
communicate to the Client: (1) the projected budget for total public funding for the EMS System
for the coming fiscal year (based on Fort Worth’s projected costs and projected third-party-
payment offset), expressed as a UHC; (2) Client’s projected utilization rate for the coming year,
which will be the same as the actual utilization rate (number of UHC hours consumed) for the most
recently completed fiscal year; and (3) the total budgeted payment for the Client for the coming
fiscal year (product of (1) multiplied by (2)). Unless otherwise agreed in writing by the Parties,
payment of budgeted costs shall be divided into semi-annual payments with the first payment of
fifty percent due on or before October 15th and the remaining payment due on or before June 1st,
which payment will reflect any true-up adjustment determined in accordance with Sections 6.3
and 6.4.
For purposes of determining costs for Fiscal Year 2025, Client’s projected unit hours consumed
are 2,602, and Client’s projected annual funding obligation is 267,771.81. For Fiscal Year 2025,
Client’s payment obligation has been prorated to $53,982.00 and is due no later than July 1, 2025.
6.3 Beginning in Fiscal Year 2027, on or before December 15
th of each year, Fort Worth will
conduct a true up of actual costs and utilization for the preceding fiscal year. As part of this
process, Fort Worth will communicate to the Client: (1) the actual total public funding for the
EMS System for the preceding fiscal year (based on actual costs and actual third-party-payment
offset, expressed as a UHC; (2) the Client’s actual utilization rate (number of UHC hours
consumed) for the preceding fiscal year; and (3) the total actual cost for the Client for the preceding
fiscal year (product of (1) multiplied by (2)).
6.4 The notice provided to Client by Fort Worth on or before March 15
th each fiscal year will
account for the results of the true up process described by section 6.3 above. Any adjustment that
may be required to Client’s payment obligations as a result of that true up will be reconciled in the
fiscal year immediately following the fiscal year in which the March 15th notice is provided. For
the sake of clarity, if the true up reveals the budgeted payment exceeded the actual costs
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attributable to the Client, then the overpayment amount will be deducted from the first annual
payment of the next fiscal year. If the budgeted payment obligation was less than the actual costs
attributable to the Client, then the extra costs will be added to the first annual payment of the next
fiscal year. Should the Parties seek to terminate this Agreement before the costs may be reconciled
the next fiscal year, the Parties agree to reconcile that obligation, subject to approval and
appropriation by their respective governing bodies, before either Party may terminate this
Agreement.
6.5 Fort Worth shall be responsible for billing patients and third parties for services and shall
have the right to retain all funds received from such billing for services rendered as long as this
Agreement is in place. The actual costs for operating the EMS System will be offset by revenues
received to ensure the public subsidy accurately reflects unreimbursed costs only.
Section 7: EMS SYSTEM GOVERNANCE
7.1 Fort Worth will have direct oversight and budgetary authority over the EMS System. The
Fort Worth City Council, by and through the Fort Worth City Manager or Assistant City Managers,
will assume control and responsibility of all operations, oversight, revenues, and expenditures to
ensure long-term fiscal sustainability that is publicly accountable.
7.2 The Fort Worth Fire Chief, acting under the direction of the City Manager or their designee,
shall be responsible for providing direct management and day-to-day oversight of FW EMS and
the EMS System and will have the powers and duties afforded and required of fire chiefs under
state law.
7.3 The Parties agree that both an EMS advisory board and a medical control advisory board
composed of relevant stakeholders and medical experts are necessary to ensure medical best
practices and Client representation and to facilitate community engagement. Therefore, an EMS
Advisory Board and a Medical Control Advisory Board will be created by Fort Worth. Such
advisory boards are subject to the following conditions at all times:
7.3.1 The EMS Advisory Board (EAB):
7.3.1.1: The EAB shall be created by Fort Worth for the purpose of performing
review of and providing advice to Fort Worth on matters related to the EMS
System, budget, and service to the Client's jurisdiction.
7.3.1.2: The EAB’s membership will consist of the following voting members: one
representative designated by the Client and by each of the other units of government
that is a party to an EMS Interlocal Agreement; and the Fort Worth Fire Chief, or
their designee, who shall serve as the Board Chair. The Medical Director, or their
designee, shall serve as a non-voting member.
7.3.1.3: The EAB shall review and advise on matters related to the performance of
the EMS System and advise Fort Worth regarding issues related to the EMS
System’s goals and standards, including medical direction and clinical oversight
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and selection of the Medical Director.
7.3.1.4: The EAB will recommend performance standards for the EMS System,
including response travel times, call processing time, and data collection and
reporting standards.
7.3.1.5: The EAB may, as determined by a majority vote of its members, establish
various subcommittees for purposes that the EAB deems necessary and that are
consistent with its general role as provided by this Agreement, the resolution
creating the EAB, and the EAB’s governing documents.
7.3.1.6: To ensure long-term fiscal sustainability of the EMS System, the EAB will
review the EMS System budget and conduct an annual budget workshop to advise
Fort Worth concerning revenue and expenditures for the EMS System.
7.3.2 The Medical Control Advisory Board (MCAB):
7.3.2.1: The MCAB will serve as an advisory body to Fort Worth. The MCAB’s
tasks consist of:
advising Fort Worth about the clinical performance of the EMS System;
reviewing medical protocols and clinical policies and procedures for the EMS
System and making recommendations to the Medical Director;
representing the interests of the medical community and First Responders,
Medical Transportation Providers and ambulance standby providers by making
recommendations for improvements to the EMS System as needed;
recommending and reviewing research conducted within the Service Area; and
participating in the selection of the Medical Director and review of the Medical
Director’s clinical performance through processes established by Fort Worth,
provided, however, that the then-current Medical Director will not participate
in matters related to his current duties and performance.
7.3.2.2: The MCAB’s membership shall be composed of the following voting
members: (1) the Medical Director (or a designated associate medical director),
who shall serve as the Board Chair; (2) the Emergency Department physician
medical director, or designee, from each full-service Emergency Department
located in the Service Area; and (3) at least four physician members to represent
relevant specialties or sub-specialties of benefit in developing standards for
emergency out-of-hospital care, with broad representation from different hospital
systems, with such members to be recommended by a majority of the then-existing
members of MCAB and to be appointed by Fort Worth. The Fort Worth Fire Chief,
or their designee, shall serve as a non-voting member. A majority of the voting
members of the MCAB must be physicians who are board certified in Emergency
Medicine or Pediatric Emergency Medicine, or a related medical field.
7.3.2.3: The MCAB may, by an affirmative vote of two-thirds of its voting
members, elect to add other non-voting members as it deems appropriate.
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Section 8: MEDICAL DIRECTOR
8.1 The Medical Director for the EMS System will be retained by Fort Worth. The Medical
Director must be a licensed physician in the state of Texas who is board-certified in EMS and
emergency medicine and meets all state requirements.
8.2 When necessary, Fort Worth shall conduct a hiring and selection process for an EMS
System Medical Director and/or Associate Medical Director(s) that will be inclusive, and the EAB
and MCAB shall advise Fort Worth and make recommendations concerning selection of a Medical
Director for the EMS System.
8.3 The Medical Director is the Chief Medical Officer of the EMS System, will report to the
City Manager of Fort Worth or their designee, and will have the powers and duties afforded and
required of EMS medical directors under state law. The Medical Director will provide all
independent medical direction and clinical oversight for the EMS System. The Medical Director’s
powers and duties concerning the EMS System will be established by agreement between Fort
Worth and the Medical Director, which shall include those afforded and required under state law
with the resources necessary to fulfill such requirements.
8.4 Fort Worth, by resolution or ordinance, will establish a new department or division for the
Office of the Medical Director (“OMD”). The OMD will serve as the clinical office of Fort Worth
through which the Medical Director will carry out their rights and duties.
Section 9: FORCE MAJEURE
9.1 It is expressly understood and agreed by the Parties to this Agreement that if the
performance of any obligations hereunder is delayed by reason of war; civil commotion; acts of
God; inclement weather; epidemics or pandemics; governmental restrictions, regulations, or
interferences; fires; strikes; lockouts, national disasters; riots; material or labor restrictions;
transportation problems; or any other circumstances which are reasonably beyond the control of
the Party obligated or permitted under the terms of this Agreement to do or perform the same,
regardless of whether any such circumstance is similar to any of those enumerated or not (each, a
“Force Majeure Event”), the Party so obligated or permitted shall be excused from doing or
performing the same during such period of delay, so that the time period applicable to such
requirement shall be extended for a period of time equal to the period such Party was delayed. To
invoke this section, a Party must provide written notice of the alleged Force Majeure Event to the
impacted Parties within a reasonable time after the occurrence of a Force Majeure Event,
explaining the Force Majeure Event and the extent to which the Party’s performance of obligations
are hindered.
Section 10: RIGHT TO AUDIT
10.1 The Parties will have the right to audit each other’s financial and business records that
relate to the services provided (collectively "Records") at any time during the Term of this
____________________________________________________________________________________
EMS Interlocal Agreement Page 13
Agreement and for three (3) years thereafter in order to determine compliance with this Agreement.
Throughout the Term of this Agreement and for three (3) years thereafter, each Party shall make
all relevant records available following reasonable advance notice by the other and shall otherwise
cooperate fully with each other during any audit. Notwithstanding anything to the contrary herein,
this Section 10 shall survive expiration or earlier termination of this Agreement.
Section 11: STANDBY EMS, INTERFACILITY TRANSPORT (IFT), AND MUTUAL
AID AGREEMENTS
11.1 This Agreement is not intended to designate Fort Worth as the exclusive, sole, or single
provider of standby EMS for the Client. Nothing herein prohibits the Client from contracting for,
regulating, managing, and governing standby EMS and the provider(s) thereof in its own
jurisdiction.
11.2 This Agreement is not intended to designate Fort Worth as the exclusive, sole, or single
provider of IFT services for any hospital or medical facility. Nothing herein prohibits any hospital
or medical facility from privately contracting for interfacility transport services as deemed
necessary by that facility. Provided, however, each IFT provider must meet the requirements
provided by the Uniform EMS Ordinance.
11.3 This Agreement is not intended to prevent the Client from participating in mutual aid
agreements as is typical and ordinary for the Client.
Section 12: GOVERNMENTAL POWERS
12.1 It is understood and agreed that by execution of this Agreement, the Parties do not waive
or surrender any of their governmental powers or immunities.
Section 13: ELECTRONIC SIGNATURES
13.1 This Agreement may be executed by electronic signature, which will be considered as an
original signature for all purposes and have the same force and effect as an original signature. For
these purposes, “electronic signature” means electronically scanned and transmitted versions (e.g.
via pdf file or facsimile transmission) of an original signature, or signatures electronically inserted
via software such as Adobe Sign.
Section 14: COUNTERPARTS
14.1 This Agreement may be executed in one or more counterparts and each counterpart will,
for all purposes, be deemed an original, but all such counterparts will together constitute one and
the same instrument.
Section 15: LIABILITY
15.1 Each party agrees to be solely liable for the actions, omissions, and negligent acts of its
own employees, agents, and representatives engaged in the provision of services through the EMS
____________________________________________________________________________________
EMS Interlocal Agreement Page 14
System under this Agreement. Except as expressly provided herein, neither party shall be liable to
the other for any indirect, incidental, consequential, special, punitive, or exemplary damages
arising out of or in connection with this Agreement, regardless of the form of action, whether in
contract, tort, strict liability, or otherwise, even if advised of the possibility of such damages.
15.2 The Client assumes no responsibility or liability for payments, wages, income, and
employment tax payments, pensions, benefits, or other payments accrued by or owed to Fort Worth
employees who provide services pursuant to this Agreement.
Section 16: INSURANCE
16.1 Each party shall maintain adequate insurance coverage to protect against claims arising
from the provision of EMS provided by its own employees and contractors, including but not
limited to general liability, professional liability, including malpractice insurance, and worker’s
compensation insurance.
16.2 Each party may, at its discretion, elect to self-insure against claims arising from the
provision of EMS, provided that such self-insurance meets the applicable statutory requirements
and guidelines set forth by state law, including but not limited to chapter 2259 of the Texas
Government Code.
16.3 Regardless of whether a party chooses to self-insure or obtain commercial insurance
coverage, each party shall provide proof of insurance or self-insurance to the other party upon
request. Such proof shall include details of coverage limits, deductibles, and any relevant policy
exclusions. Each party shall maintain continuous insurance coverage or self-insurance throughout
the term of this Agreement and any extensions thereof. Any substantive changes to insurance
coverage or self-insurance arrangements shall be promptly communicated to the other Party in
writing.
16.4 In the event of any claim, lawsuit, or demand arising under this Agreement, each party
shall be responsible for managing and defending its own claims, whether through its insurance
provider or self-insurance program. However, parties may collaborate as necessary to resolve
claims efficiently and fairly.
Section 17: GOVERNING LAW AND VENUE
17.1 This Agreement shall be construed in accordance with the laws of the State of Texas. If
any action, whether real or asserted, at law or in equity, is brought on the basis of this Agreement,
venue for such action shall lie in state courts located in Tarrant County, Texas or the United States
District Court for the Northern District of Texas, Fort Worth Division.
Section 18: NOTICES
18.1 Notices required pursuant to the provisions of this Agreement shall be conclusively
determined to have been delivered when (1) hand-delivered to the other party, its agents,
employees, servants or representatives, or (2) received by the other party by United States Mail,
____________________________________________________________________________________
EMS Interlocal Agreement Page 15
registered, return receipt requested, addressed as follows:
TO FORT WORTH:
City of Fort Worth
Attn: Assistant City Manager
100 Fort Worth Trail
Fort Worth TX 76102
With Copy to the City Attorney
at same address
TO CLIENT
City of Forest Hill
Attn: Venus Wehle City Manager
3219 California Parkway E.
Forest Hill, TX 76119
Any notices given pursuant to this section shall be confirmed by email sent to the following
addresses:
IF TO FORT WORTH:
Ashley.Clement@fortworthtexas.gov
IF TO CLIENT
vwehle@foresthilltx.org;
sgutierrez@foresthilltexas.org
Section 19: CONFIDENTIALITY
19.1 Fort Worth shall comply with all applicable federal and state laws and regulations
regarding the privacy and confidentiality of patient records, including the federal Health Insurance
Portability and Accountability Act of 1996 (HIPAA). Upon request, Fort Worth will provide the
Client with utilization reviews, but all patient information shall be de-identified. Fort Worth, and
the FWFD, in providing the EMS System services, and directly related activity such as billing,
will be considered a covered entity under the HIPAA Privacy Rule and the Texas Medical
Privacy Act. 45 C.F.R. §160.103; Tex. Health & Safety Code § 181.001(b)(2). The Parties agree
to execute business associate agreements, and any other additional agreements concerning
protected health information (PHI), as may be necessary, to ensure compliance with the relevant
data privacy rules.
Section 20: ACCESS TO RECORDS
20.1 The parties agree that until the expiration of six years after the last date of furnishing of
services provided under this Agreement, the parties will make available to the Secretary of the
United States Department of Health and Human Services (the Secretary) and the United States
Comptroller General, and their duly authorized representatives, this Agreement and all books,
documents, and records necessary to certify the nature and extent of the costs of those services. If
a Party carries out the duties of this Agreement through a subcontract worth $10,000 or more over
a twelve-month period, the subcontract will also contain an access clause to permit access by the
____________________________________________________________________________________
EMS Interlocal Agreement Page 16
organization’s books and records.
Section 21: NO WAIVER
21.1 No course of conduct or verbal waiver or consent shall be deemed a waiver by a Party of
its rights under this Agreement. The waiver by a Party of a breach or violation of any provision
of this Agreement shall not operate as, or be construed to be, a waiver of any subsequent breach
of the same or other provision of this Agreement
Section 22: ASSIGNMENT AND DELEGATION
22.1 The Agreement shall be binding upon and inure to the benefit of the Parties and their
respective successors and permitted assigns. No party may assign or transfer any of its rights or
obligations under this Agreement without prior written consent of the other Party.
Section 23: ENTIRE AGREEMENT
23.1 This Agreement, including any exhibits attached hereto and any documents incorporated
herein by reference, contains the entire understanding and agreement between the Parties, their
assigns and successors in interest, as to the matters contained herein. Any prior or
contemporaneous oral or written agreement is hereby declared null and void to the extent in
conflict with any provision of this Agreement.
(signature page follows)
IN WITNESS WHEREOF, the Parties hereto have executed this Agreement in multiples.
____________________________________________________________________________________
EMS Interlocal Agreement Page 17
[Executed effective as of the date signed by the Deputy City Manager below.] / [ACCEPTED
AND AGREED:]
City of Fort Worth:
By: ___________________________
Name: Valerie Washington
Title: Assistant City Manager
Date: ___________________
CITY OF FORT WORTH INTERNAL ROUTING PROCESS:
Approved as to Form and Legality:
By: ______________________________
Name: Taylor C. Paris
Title: Assistant City Attorney
Contract Authorization:
M&C No. 25-0172
Contract Compliance Manager:
By signing I acknowledge that I am the person
responsible for the monitoring and administration
of this contract, including ensuring all
performance and reporting requirements.
By: ______________________________
Name: Ashley Clement
Title: Deputy Fire Director
City Secretary:
By: ______________________________
Name: Jannette S. Goodall
Title: City Secretary
City of Forest Hill: Attest
�:Oe,:u,Qe ��e: &:! �
Title: City Manager Title: City Secretary
Date: 0�011-/w-zs Date:
EMS lnterlocal Agreement Page 18
Ordinance No. _____ 1
ORDINANCE NO.___________________
AN ORDINANCE AMENDING CHAPTER [INSERT NUMBER]
“AMBULANCES/EMERGENCY MEDICAL SERVICES,” OF THE CODE
OF THE CITY OF [NAME], TEXAS (YEAR), AS AMENDED, BY
REPEALING ARTICLE I “IN GENERAL,” ARTICLE II “BOARDS; THE
AUTHORITY,” AND ARTICLE III “VIOLATIONS; PENALTIES; TRAFFIC
LAW EXEMPTION”;” AND ENACTING A NEW ARTICLE I “IN
GENERAL,” ARTICLE II “FORT WORTH EMS SYSTEM AND
INTERFACILITY TRANSPORTATION,” AND ARTICLE III
“VIOLATIONS, PENALTIES, TRAFFIC LAW EXEMPTION;” PROVIDING
THAT THIS ORDINANCE SHALL BE CUMULATIVE OF ALL PRIOR
ORDINANCES AND REPEAL CONFLICTING ORDINANCES;
PROVIDING FOR A SEVERABILITY CLAUSE; PROVIDING FOR A
SAVINGS CLAUSE; PROVIDING A PENALTY CLAUSE; PROVIDING
FOR PUBLICATION IN THE OFFICIAL NEWSPAPER OF THE CITY;
AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, the City Council of the City of [NAME] ("City Council") seeks to protect the
public safety, preserve the quality of life, and promote efficiency within the City of [NAME] (the
“City”);
WHEREAS, it is in the best interests of the public health and welfare of the people of the
City to have available to them a regulated system for the provision of out of hospital emergency
and non-emergency medical services, unscheduled medical transportation and ambulance service
mobile integrated healthcare (“MIH”)(collectively the “EMS System”) and scheduled interfacility
medical transportation services among and between hospitals and other medical facilities in non-
emergency situations (“interfacility transports or IFT”) with the intent of providing quality clinical
care with performance measures and standards and a goal of facilitating the best possible outcomes
for each patient;
WHEREAS,in 1988 through the adoption of a Uniform EMS Ordinance and Interlocal
Cooperative Agreement between local governments, including the City of Fort Worth (“Fort
Worth”), the Area Metropolitan Ambulance Authority (the “Authority” a/k/a “MedStar”) was
created as a governmental administrative agency to administer and operate an EMS System and
exclusively provide interfacility transports in a service area comprised of the member jurisdictions,
with Fort Worth constituting more than eighty-five percent of the land mass and call volume of
the Authority;
Ordinance No. _____ 2
WHEREAS, the Authority has sustained rising operational and capital costs and flat net
revenues, leading to a dynamic that requires future public funding to ensure the long-term
sustainability of those services;
WHEREAS, the Fort Worth City Council has elected to establish an EMS division through
the Fort Worth Fire Department to operate an EMS System and provide services to the people
within its jurisdiction and people in other jurisdictions, provided each such jurisdiction adopts this
Uniform EMS Ordinance and enters into an EMS Interlocal Agreement with Fort Worth (each a
“Client City”);
WHEREAS, Fort Worth is engaging a physician who is licensed in Texas and board
certified in emergency medicine to serve as the Chief Medical Officer and Medical Director for
the EMS System (the “Medical Director”);
WHEREAS, the member jurisdictions of the Authority have agreed to dissolve the
Authority, and with those adopting this ordinance and executing an EMS Interlocal Agreement
opting to become Client Cities;
WHEREAS, due to the relatively low population and low population density of some areas
at issue and the extremely high, start-up and fixed operating costs of a state-of-the-art EMS
System, it is necessary to designate Fort Worth as the exclusively contracted EMS Provider of
EMS System services within the City in order to maximize clinical proficiency, enhance
operational effectiveness, and maximize economies of scale for providing such services;
WHEREAS, although Fort Worth will not be assuming the Authority’s role as exclusive
provider of interfacility transports, there remains a need to ensure such transports within the City
are only conducted by properly qualified and authorized providers in order to ensure clinical
standards are met and public safety is preserved; and
WHEREAS, the City Council finds this Ordinance to be reasonable and necessary.
NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF [NAME]
TEXAS, THAT:
SECTION 1.
Chapter [NUMBER] “Ambulances/Emergency Medical Services” of the Code of the City
of [NAME] is hereby amended by repealing Article I “In General,” Article II “Boards; The
Authority,” and Article III “Violations; Penalties; Traffic Law Exemption,” and enacting a new
Ordinance No. _____ 3
Article I “In General,” Article II “ Fort Worth EMS System and Interfacility Transportation” and
Article III “Violations; Penalties; Traffic Law Exemption,” the text of which shall read as follows:
“ARTICLE I: GENERAL
§ 5-1 STATUTORY AUTHORITY.
This chapter is enacted by the City pursuant to Tex. Health and Safety Code §
773.051, which provides that local governments may establish standards for
ambulances, and pursuant to Tex. Government Code Chapter 791, which
authorizes combinations of local governmental units to contract for the provision
of governmental services.
§ 5-2 GENERAL PURPOSES AND INTENT OF ORDINANCE.
It is the purpose of this Ordinance:
To establish a regulated out-of-hospital emergency medical services, non-
emergency medical services, unscheduled medical transportation and ambulance
service, and mobile integrated healthcare system (collectively the “EMS System”)
which can provide quality clinical care with performance measures and standards,
with the goal of facilitating the best possible outcomes for each Patient.
To designate Fort Worth as the EMS Provider of the EMS System within the
corporate limits of City as provided by the terms of the EMS Interlocal Agreement
between Fort Worth and the City to maintain consistent, high-quality service while
controlling costs through efficiencies and economies of scale;
§ 5-3 DEFINITIONS.
For the purposes of this Ordinance, the following words and phrases shall have the
meanings respectively ascribed to them by this section:
(a)Advanced Life Support (ALS). Out-of-hospital care that uses invasive medical
acts (as defined in Tex. Health and Safety Code § 773.003(1)).
(b)Aeromedical Transportation Unit. Any rotary or fixed wing aircraft providing
basic or advanced life support services and patient transportation that originates
within the Service Area.
(c)Ambulance. A vehicle for transportation of sick or injured person to, from, or
between places of treatment for an illness or injury, and provide out of hospital
medical care to the Patient.
(d)Ambulance Mutual Aid Agreement. A written contract between Fort Worth and
one or more entities whereby the signing parties agree to provide backup
ambulance service to one another under the terms and conditions specified therein.
Ordinance No. _____ 4
(e) Ambulance Service. The transportation of Patients by emergency or non-
emergency ambulance; for purposes of this Ordinance, Ambulance Service does
not include IFT services as defined herein.
(f)Associate Medical Director.A licensed physician who assists the Medical
Director in carrying out his or her duties under this Ordinance, Fort Worth’s EMS
Interlocal Agreements, and the Medical Director’s agreement with Fort Worth.
(g)Basic Life Support (BLS). Out-of-hospital care that uses noninvasive medical
acts (as defined in § 773.003(2), Tex. Health and Safety Code).
(h) Emergency Care Attendant (ECA). A person certified as an “emergency care
attendant” under § 773.046 of the Tex. Health and Safety Code.
(i) Emergency Medical Services (EMS). Services used to respond to an individual’s
perceived need for immediate medical care and to prevent death or aggravation of
physiological or psychological illness or injury.
(j) Emergency Medical Technician (EMT). A person certified as an “emergency
medical technician” under § 773.047 or an “advanced emergency medical
technician” under § 773.048 of the Tex. Health and Safety Code, and any other
class of EMT recognized by state law or regulation.
(k)EMS Communications Center. The facility designated by Fort Worth as the
central communications center from which all EMS System services offered by
Fort Worth shall be dispatched and coordinated.
(l) EMS Interlocal Agreements. The service level interlocal agreements executed
by Fort Worth and Client Cities to designate Fort Worth as the exclusively
contracted EMS Provider of the EMS System within the Service Area.
(m) EMS Provider. The entity that has received a Texas EMS Provider License, as
required by relevant state law, to provide the EMS System services and is the
exclusively contracted provider of the EMS System services within the Service
Area. For purposes of this ordinance, the EMS Provider is Fort Worth.
(n)EMS System. The regulated out-of-hospital EMS, non-emergency medical
services, unscheduled medical transportation and ambulance services, and mobile
integrated healthcare system provided by Fort Worth within the Service Area, not
including those first response services City chooses to provide itself as a First
Responder.
(o)First Responder. Any agency that, in cooperation with the EMS Provider,
provides initial response to requests for EMS and, on its own or in cooperation
with the EMS Provider, provides immediate on-scene care to ill or injured persons
but does not transport those persons to healthcare facilities.
(p) FW EMS. The emergency medical services division of the City of Fort Worth Fire
Department responsible for providing the EMS System services.
Ordinance No. _____ 5
(q)Interfacility Transportation (IFT). The provision of scheduled, or by
appointment, medical transportation services by a person or entity between
hospitals or medical facilities originating within the Service Area.
(r)Medical Director. The licensed physician employed or contracted by Fort Worth
who is responsible for carrying out his or her duties under their engagement with
Fort Worth, this Ordinance, and Fort Worth’s EMS Interlocal Agreements with
Client Cities and for directing the Office of the Medical Director.
(s)Medical Transportation.The transportation of Patients by ambulance,
Specialized Mobile Intensive Care Unit, Specialty Care Transport, or Aeromedical
Transportation Unit, including both emergency and low-acuity emergency
transports, where such transportation originates within the Service Area.
(t) Mobile Integrated Healthcare (MIH). Services provided by Fort Worth, as
requested by City, that are designed to enhance, coordinate, effectively manage,
and integrate out of hospital care, in order to improve outcomes, enhance the
client’s experience of care, and improve the efficiency and effectiveness of
healthcare services provided to the enrolled clients.
(u) Office of Medical Director. The department or division through which the
Medical Director carries out his or her functions. The Office of the Medical
Director is comprised of the Medical Director, any Associate Medical Director(s),
and other individuals assigned to the Office to assist the Medical Director in
carrying out the Medical Director’s functions.
(v) Paramedic. A person qualified as a certified or licensed “paramedic" as defined
by Tex. Health and Safety Code Sections 773.049 and 773.0495.
(w) Patient. A person: who requests EMS, or for whom EMS has been requested; and
who has any medical or psychological complaint, obvious injury/distress, or has a
significant mechanism of injury.
(x) Service Area. That geographical area which is contained within the corporate
limits of the City and other local jurisdictions who have elected to become Client
Cities by entering into an EMS Interlocal Agreement with Fort Worth and
adopting this ordinance.
(y)Specialty Care Transport. The transportation of a critically injured or ill patient
at a level of service beyond the scope of the EMT-Paramedic when the Patient’s
condition requires ongoing care that must be furnished by one or more health
professionals in an appropriate specialty area; for example, emergency or critical
care nursing, emergency medicine, respiratory care, cardiovascular care, or a
paramedic with additional training.
(z)Specialized Mobile Intensive Care Unit. A vehicle which is specially
constructed, equipped, staffed, and employed in the inter-facility transport of
patients whose requirements for en route medical support are likely to exceed the
clinical capabilities of an Advanced Life Support ambulance.
(aa) Uniform EMS Ordinance. This ordinance.
Ordinance No. _____ 6
(bb)Unscheduled Medical Transportation. The transportation of Patients by
ambulance service, Specialized Mobile Intensive Care Unit, Specialty Care
Transport, or Aeromedical Transportation Unit, including both emergency and
low-acuity emergency transports, where such transportation originates within the
Service Area and is not previously scheduled or made by appointment.
§ 5-4-5-15 Reserved
ARTICLE II: FORT WORTH EMS SYSTEM AND INTERFACILITY
TRANSPORTATION
§ 5-16 POWERS AND DUTIES OF FW EMS
(a) Fort Worth, by and through FW EMS, is hereby designated as the
exclusively contracted EMS Provider of the EMS System within the City's
corporate limits as provided by the terms, conditions and provisions of the City’s
EMS Interlocal Agreement with Fort Worth and for so long as Fort Worth is a
party to the City’s EMS Interlocal Agreement.
(c) Fort Worth shall comply with all terms of the EMS Interlocal Agreement
and have all the powers and duties enumerated therein.
§ 5-17 INTERFACILITY TRANSPORTATION
(a) This ordinance is not intended to designate Fort Worth as the sole provider
of interfacility transportation services between hospitals and other medical
facilities within the Service Area.
(b) Notwithstanding the above, any person or entity who wishes to provide
such IFT services within the Service Area must be registered with Fort Worth as
an IFT provider and permitted by Fort Worth and the Medical Director to provide
such services.
(c) Any IFT provider who obtains a permit to provide IFT services from Fort
Worth must comply with the provisions of this ordinance and the directives of the
Medical Director.
§ 5-18-5-30 Reserved
ARTICLE III: VIOLATIONS; PENALTIES; TRAFFIC LAW
EXEMPTION
§ 5-31 VIOLATIONS.
(a) So long as Fort Worth is a party to the City’s EMS Interlocal Agreement, it
shall be unlawful:
Ordinance No. _____ 7
(1) To knowingly give false information to induce the dispatch of an
ambulance or Aeromedical Transportation Unit.
(2) To perform duties as an ECA, EMT, Paramedic or emergency
ambulance dispatcher without current credentials issued by the Office
of the Medical Director, unless participating in a training program
approved by Office of the Medical Director or performing duties as a
First Responder of the City;
(3) To permit a person to work as an ECA, EMT, Paramedic or emergency
ambulance dispatcher without current credentials issued by the Office
of the Medical Director, unless participating in a training program
approved by Office of the Medical Director or performing duties as a
First Responder of the City;
(4) To use, or cause to be used, any Ambulance Service other than FW
EMS, except as permitted in subsection (b) below;
(5) For any person or entity other than Fort Worth and FW EMS to
provide EMS System services within the Service Area, not including
those first response services which City provides itself as a First
Responder and except as permitted by subsection (b) below;
(6) For any person to provide Medical Transportation originating in the
Service Area without a permit issued by Fort Worth;
(7) For any agency to provide First Responder services without a First
Responder Agreement with Fort Worth or a written automatic aid or
mutual aid agreement with the City;
(8) To use an ambulance for the transportation of persons other than in
connection with the transportation of a Patient.
(b) It shall be a defense to any alleged violation of this section that a vehicle is
being used or service is provided solely in any of the following manners:
(1) As a privately-owned vehicle not ordinarily used in the business of
transporting persons who are sick, injured, wounded, incapacitated or
helpless;
(2) Rendering service as an ambulance at the request of the EMS
Communications Center upon the declaration of a disaster by Fort Worth,
the City,another unit of local government, the State of Texas, or the United
States; or a declaration of a major catastrophe or extreme system overload
by the City Fire Chief, or the Fort Worth Fire Chief;
(3) Any ambulance owned or operated by the federal or state government;
(4) Ambulance mutual aid calls when rendered pursuant to an Ambulance
Mutual Aid agreement approved by the City or Fort Worth;
(5) Wheelchair transport services for persons other than Patients, when the
service is not provided by ambulance; and
Ordinance No. _____ 8
(6) Medical Transportation of a Patient where the transport originates outside
the Service Area.
(7) IFT between hospitals or medical facilities within the Service Area if the
provider has first obtained a permit from Fort Worth.
§ 5-32 PENALTIES.
(a) Any person convicted of violating the provisions of Section 5-31 shall be
guilty of a Class C misdemeanor and shall be punished by a fine not to exceed
$500 (Tex. Penal Code §12.23).
(b) This Section does not serve to limit any other remedies available to the
City in law or equity.
(c) Each violation of this Ordinance shall constitute a separate offense.
§ 5-33 TRAFFIC LAWS; EXEMPTION.
When the driver of an emergency medical response vehicle has reasonable grounds
to believe that an emergency exists, as determined by the EMS Communication
Center, the vehicle shall be treated as an “authorized emergency vehicle” within
the meaning of Chapter 546 of the Tex. Transp. Code and shall be exempt from
traffic laws as provided therein.
§ 5-34-5-39 Reserved”
SECTION 2.
This ordinance shall be cumulative of all provisions of ordinances of the Code of the City of
[NAME], Texas (YEAR), as amended, except where the provisions of this ordinance are in direct
conflict with the provisions of such ordinances and such Code, in which event conflicting provisions
of such ordinances and such Code are hereby repealed.
SECTION 3.
It is hereby declared to be the intention of the City Council that the phrases, clauses, sentences,
paragraphs and sectionsof this ordinance are severable, and, if any phrase, clause, sentence, paragraph
or section of this ordinance shall be declared unconstitutional by the valid judgment or decree of any
court of competent jurisdiction, such unconstitutionality shall not affect any of the remaining phrases,
clauses, sentences, paragraphs and sections of this ordinance, since the same would have been enacted
by the City Council without the incorporation in this ordinance of any such unconstitutional phrase,
clause, sentence, paragraph or section.
Ordinance No. _____ 9
SECTION 4.
All rights and remedies of the City of [NAME], Texas, are expressly saved as to any and
all violations of the provisions of the Code of the City of [NAME], or any other ordinances of the
City, that have accrued at the time of the effective date of this ordinance; and, as to such accrued
violations and all pending litigation, both civil and criminal, whether pending in court or not, under
such ordinances, same shall not be affected by this ordinance, but may be prosecuted until final
disposition by the courts.
SECTION 5.
Any person convicted of violating the provisions of the Code of the City of [NAME]
Section 5-31 as enacted by this Ordinance shall be guilty of a Class C misdemeanor and shall be
punished by a fine not to exceed $500 (Tex. Penal Code §.12.23). This Section does not serve to
limit any other remedies available to the Jurisdiction in law or equity. Each violation of this
Ordinance shall constitute a separate offense.
SECTION 6.
The City Secretary of the City of [NAME], Texas is hereby directed to publish the caption,
penalty clause and effective date of this ordinance for two (2) days in the official newspaper of the
City of [NAME], Texas, as authorized by Texas Local Government Code, Section 52.013.
SECTION 7.
All other provisions of Chapter 5 of the Code of the City of [Name], as amended, shall
remain in full force and effect, save and except as amended by this ordinance.
SECTION 8.
This ordinance shall take effect upon adoption and publication as required by law, and it is
so ordained.
APPROVED AS TO FORM AND LEGALITY: ATTEST:
___________________________________ ________________________________
Assistant City Attorney [NAME], City Secretary
Date: ______________________________
Ordinance No. _____ 10
ADOPTED: _________________________
EFFECTIVE: ________________________
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City of Fort Worth,
Mayor and
DATE: 02/25/25
Texas
Council Communication
M&C FILE NUMBER: M&C 25-0172
LOG NAME: 36FD EMS ILA
SUBJECT
(ALL) Adopt a Revised Emergency Medical Services Ordinance to be Effective July 1, 2025, and Authorize Execution of Interlocal Agreements
with Other Local Jurisdictions to Authorize Fort Worth to Operate as the Licensed Emergency Medical Services Provider and Furnish EMS
System Services in Each Jurisdiction
RECOMMENDATION:
It is recommended that City Council:
1. Adopt the attached revised Emergency Medical Services Ordinance, to be effective July 1, 2025, which will replace the City's current
ordinance and serve as the uniform Emergency Medical Services Ordinance for all jurisdictions wishing to receive Emergency Medical
Services from Fort Worth; and
2. Authorize the execution of Interlocal Agreements with each local jurisdiction that elects to receive Emergency Medical Services System
Services from the City of Fort Worth, subject to a requirement that each such jurisdiction adopt the Emergency Medical Services Ordinance
and authorize the City of Fort Worth to operate as that jurisdiction's licensed Emergency Medical Services Provider and to furnish EMS
System Services, within such jurisdictions.
DISCUSSION:
In 1988, the City of Fort Worth (City) and certain other local municipalities came together to create a regional ambulance and emergency medical
services (EMS) agency known as the Area Metropolitan Ambulance Authority, d/b/a Medstar, (Authority) through the adoption of a uniform EMS
ordinance and interlocal cooperative agreement under the provisions of Section 773.051 of the Texas Health and Safety Code and chapter 791 of
the Texas Government Code.
Beginning in 2020, the Authority (now known as the Metropolitan Area EMS Authority and operating under the trade name MedStar Mobile
Healthcare) operated under a Restated and Amended Interlocal Cooperative Agreement (Fort Worth City Secretary Contract No. 54348;
hereinafter, the Agreement) and an updated uniform EMS ordinance. The Agreement provided that the Authority would continue in existence until
all participating units of government (Member Cities) withdrew from the Agreement.
Pursuant to the Memorandum of Understanding and Agreement (MOUA) executed by all Member Cities and effective December 31, 2024, all
Member Cities agreed to: withdraw from and terminate the Agreement; dissolve the Authority; and designate the City as the licensed EMS
Provider for the Member Cities. Pursuant to the MOUA, the Authority continues to exist, operate, and serve as the EMS Provider for the Member
Cities, under the management and control of the City, in a limited, transitional capacity until at least July 1, 2025 (Transition Period).
It remains in the best interests of the public health and welfare of the people of the Member City jurisdictions to have available to them a regulated
EMS System with an exclusively contracted EMS Provider. Therefore, the City has established an EMS division through the City of Fort Worth Fire
Department to operate a new EMS System and provide services to the people of the jurisdictions who execute an EMS Interlocal Agreement with
the City and adopt a new uniform EMS ordinance, each a"Client City."
The City is engaging a physician who is licensed in Texas and board certified in emergency medicine to serve as the Chief Medical Officer and
Medical Director for the City's EMS system (Medical Director). And, by and through Ordinance No. 27372-12-2024, adopted by the City Council
on December 10, 2024, the City established a new department, the Department of Office of the Medical Director, which shall be responsible for
serving as the clinical office through which the Medical Director carries out his or her rights, duties, and obligations under the City's Uniform EMS
Ordinance and the City's EMS Interlocal Agreements.
The purpose of this Mayor & Council Communication (M&C) is to authorize the City to execute the EMS Interlocal Agreements with each Client
City, as contemplated by the MOUA. The EMS Interlocal Agreements will govern the relationship between the City and each Client City and
authorize the City to serve as the licensed EMS Provider and exclusive provider of certain EMS services within each Client City's jurisdiction
beginning July 1, 2025 and upon the City receiving its EMS provider license from the Department of State Health Services, whichever occurs later.
With the approval of this M&C, the City will execute an EMS Interlocal Agreements with the following cities:
• Blue Mound;
• Edgecliff Village;
• Forest Hill;
• Haltom City;
• Haslet;
• Lake Worth;
• Lakeside;
• Richland Hills;
• River Oaks;
• Saginaw;
• Sansom Park;
• Westover Hills;
• Westworth Village; and
• White Settlement.
In addition to serving as the licensed EMS Provider for each Client City, the EMS Interlocal Agreements require the City to, among other things: set
system performance standards in accordance with protocols established by its Medical Director, provide each Client City with "EMS System
services" which include: out-of-hospital EMS, non-emergency medical services, life, or limb, threatening emergency, low acuity emergency, and
Advanced Life Support and Basic Life Support unscheduled Medical Transportation and Ambulance Service, and mobile integrated healthcare
services; obtain the services of an independent medical director; create two advisory boards known as the EMS Advisory Board and Medical
Control Advisory Board; provide quarterly written reports of the operational perFormance of the EMS System to each Client City and the advisory
boards; provide quarterly comprehensive reviews of the budget and clinical performance of the system; and manage the billing, subscriptions, and
payment practices. The City will not be the exclusive provider of interfacility transportation services.
The term of each EMS Interlocal Agreement is for 10 years beginning July 1, 2025 and will renew automatically for successive 10-year terms
unless earlier terminated in accordance with the terms of the EMS Interlocal Agreement. The above notwithstanding, one Client City, Edgecliff
Village, has requested an initial term of 5 years, with successive 5 year renewal terms.
The EMS Interlocal Agreements obligate the City and each Client City to fund the EMS System using the fully loaded unit hour cost (UHC)
allocation strategy. This method will require the City to: (1) determine the total number of consumed unit hours in the EMS System; (2) determine
the public funding needed by calculating the total expenditures less total revenues; (3) determine the residual consumed UHC by dividing the total
public funding required for the EMS System (step 2) by the total consumed hours in the entire EMS System; (4) determine the consumed unit hours
by each jurisdiction; and (5) determine the cost allocation for each jurisdiction by multiplying the total consumed unit hours in the jurisdiction (step
4) by the residual consumed UHC (step 3). The actual unit hours consumed on a 911 call will be based on the number of minutes spent on the call,
not including time spent posting or stationed, in a particular jurisdiction. The total time for calls within a Client City's jurisdiction will be aggregated
on a fiscal year basis (October 1 through September 30) and for purposes of calculating the annual UHC for a Client City, the annual hours
consumed by the Client City will be rounded up or down to the nearest one (1) hour increment. Payment for each fiscal year shall initially be based
on a projected budget and projected utilization with a true-up process in the subsequent fiscal year to ensure final payment for each year ultimately
reflects actual costs and utilization.
In addition to authorizing the execution of the EMS Interlocal Agreements, approval of this M&C will adopt the attached Uniform EMS Ordinance
(Ordinance). The purpose of the Ordinance is to replace the existing Uniform EMS Ordinance which designates the Authority as the exclusive EMS
Provider within the City. The Ordinance will designate the City as the exclusive EMS Provider of the City's EMS System Services within the City's
corporate limits and of those Client City's who also adopt the Ordinance. In addition to the above, the Ordinance will require other EMS providers
to register with the City and obtain a permit in order to operate interfacility transportation services within the corporate limits of the City and of
those City's who adopt the Ordinance.
Under the Ordinance, it is unlawful, among other things, to knowingly give false information to induce the dispatch of an ambulance or to use or
cause to be used any ambulance service other than the City (except in an expressly authorized manner). If found guilty of a Class C Misdemeanor
for a violation as set out in the Ordinance, a person shall be punished by a fine not to exceed $500.00 per violation.
These contracts will be with a governmental entity, state agency or public institution of higher education: Other local governments.
These agreements will serve ALL COUNCIL DISTRICTS.
A Form 1295 is not required because: This M&C does not request approval of a contract with a business entity.
FISCAL INFORMATION / CERTIFICATION:
The Director of Finance certifies that upon approval of the above recommendations and execution of the agreements funds will be deposited into
the Emergency Medical Services Fund. The Fire Department (and Financial Management Services) is responsible for the collection and deposit
of funds due to the City.
Submitted for City Manager's Office bk Dana Burghdoff 8018
Originating Business Unit Head: Jim Davis 6801
Additional Information Contact: