Emergency medical services (EMS) in Washington can be provided by city fire departments, regional fire service authorities, fire districts, public hospital districts, and private ambulance services. Emergency medical service is defined in RCW 18.73.030(10) - Emergency medical service means medical treatment and care which may be rendered at the scene of any medical emergency or while transporting any patient in an ambulance to an appropriate medical facility, including ambulance transportation between medical facilities. This page lists the major statutes authorizing EMS services by local governments and provides a few examples of interlocal agreements.
A Statewide Trauma Care System is provided for in Ch. 70.168 RCW. The statewide plan is to be updated every two years (RCW 70.168.015 (7)). The state is divided into eight emergency medical services and trauma care planning and service regions. RCW 70.168.100 creates regional emergency medical services and trauma care councils. RCW 70.168.120 provides that a county or group of counties may create a local and regional emergency medical services and trauma care council.
The state sets the standards and regulates EMS providers under Ch. 18.73 RCW, Emergency Medical Care and Transportation Services. The state licenses all ambulance and aid services and vehicles. Services must be consistent with the statewide and regional EMS/TC plans and approved patient care procedures (See Department of Health Regional EMS and Trauma Care Plans). Cities and towns may impose a business fee, but not a license fee.
Ch. 246-976 WAC, Emergency Medical Services and Trauma Care Systems, sets out the criteria for: (a) training and certification of basic, intermediate and advanced life support technicians (b) licensure and inspection of ambulance and aid services; (c) verification of prehospital trauma services; (d) development and operation of a statewide trauma registry; (e) the designation process and operating requirements for designated trauma care services; (f) A statewide emergency medical communication system; and (g) administration of the statewide EMS/TC system.
Authority for Local Governments to Provide Ambulance and Emergency Medical Services
Cities and Towns
- RCW 35.21.762 - Authorizes the formation of an urban emergency medical services district for cities and towns whose territory is included in two counties, under certain circumstances.
- RCW 35.21.770 - Provides that upon adoption by a two-thirds vote of the full legislative body, the legislative body of any non-code city or town may authorize any of its members to serve as ... volunteer ambulance personnel... and may receive the same compensation, insurance, and other benefits received by others.
- RCW 35.21.766 - Provides authority for regional fire protection service authority, cities and towns to create an ambulance service to be operated as a public utility where existing ambulance service is not adequate.
- Prior to the Washington State Supreme Court ruling in Arborwood, Idaho, L.L.C. v. City of Kennewick, 151 Wn.2d 359 (2004), 12 Washington cities funded their ambulance utilities under RCW 35.21.766 with a monthly fee per household. The court found this charge to be a tax rather than a fee and that it exceeded the taxing authority granted to cities under RCW 35.21.768. RCW 35.21.766 was amended in 2005 to authorize cities to establish ambulance utilities through a required process.
Before establishing an ambulance utility, a city council must first find that existing private ambulance services are inadequate according to acceptable medical standards and reasonable levels of service and must give that private ambulance service 60 days to meet these standards.
A cost of service study must be done before establishing the rates and charges. Costs must be separated into “availability costs” and “demand costs.” Availability costs include those for dispatch, labor, training, equipment, and supplies – costs that are incurred to be ready to respond to a call for service. Demand costs are those that are incurred in responding to an individual call for ambulance service and vary with frequency of call, distance to hospitals, etc. Fees are set by spreading availability costs over all classes of service and adding demand costs for each separate class.
Additional requirements include: (1) fee exemptions for those who are Medicaid-eligible and who reside in a nursing home, boarding home, adult family home, or who receive in-home services; (2) continued allocation by cities that had utilities prior to May 5, 2004 of at least 70 percent of general fund dollars they were expending at that time toward the total costs of the utility; (3) support from the general fund and/or EMS levy funds of 70 percent of the total costs of the utility for cities that established a utility on or after May 6, 2004; and (4) allocation of revenues received from direct billing toward the demand-related costs.
- RCW 35.21.768 - Authorizes a city or town to adopt: (1) a business and occupation tax on the privilege of engaging in the ambulance business; and/or (2) an excise tax on all persons, businesses, and industries served and billed for the ambulance service owned and operated or contracted for by the city or town.
- RCW 35.23.456 - Provides second class cities with the power to operate a municipal ambulance service where commercial ambulance service is not readily available.
- RCW 35.27.370(15) - Authorizes towns to operate ambulance service to serve the town and surrounding rural areas and to charge for such service.
- RCW 36.01.095 - Authorizes counties to establish a system of emergency medical service
- RCW 36.01.100 - Authorizes counties to establish a system of ambulance service for all or part of a county and to award contracts for that service.
- RCW 36.32.470 - Provides authority for counties to furnish financial or other assistance to any municipal corporation or political subdivision for fire protection, ambulance, medical or other emergency services provided by such corporation or subdivision.
Emergency Medical Service Districts
- RCW 36.32.480 - Provides authority for counties to establish for emergency medical service districts governed by county or by interlocal cooperation agreement if city or town included within the district.
- RCW 41.24.330 and .340 - Provides for a board of trustees for Emergency Medical Service Districts under Title 41, Volunteer Fire Fighters' And Reserve Officers' Relief and Pensions
- RCW 52.02.020 - Authorizes formation of fire protection districts for provision of fire protection services, fire suppression services, emergency medical services, and for the protection of life and property in areas outside cities and towns, except where cities and towns have annexed to a fire protection district, or where such existing district is continuing service pursuant to RCW 35.02.202.
- RCW 52.12.131 - Authorizes fire districts make reasonable charges for emergency medical services in order to reimburse the district for its costs of providing EMS services.
- RCW 52.12.031 (3) - Authorizes fire districts to contract with any governmental entity under Ch. 39.34 RCW or private person or entity to consolidate, provide, or cooperate for ... emergency medical purposes.
- RCW 52.12.135 - Authorizes a rural fire protection district to contract pursuant to Ch. 39.34 RCW with a contiguous city for the furnishing medical services in the form of ambulance services by the city to the fire protection district. The fire protection district may impose a monthly utility service charge on each developed residential property located in the portion of the fire protection district districts served pursuant to the contract.... A fire protection district may contract with the contiguous city or with any other governmental entity pursuant to Ch. 39.34 RCW for the billing and collection services related to the monthly utility service charge for ambulance service. The city may charge persons using the service reasonable rates for the service.
Regional Fire Protection Service Authority
- RCW 35.21.766 (1) - Provides that a regional fire protection service authority may provide for the establishment of a system of ambulance service to be operated by the authority as a public utility operated by contract after a call for bids.
- RCW 52.26.040(3) (b) - Provides that a regional fire protection service authority planning committee adopt a plan that includes a system of ambulance service to be operated by the authority or operated by contract after a call for bids, if members of the authority are not adequately served by existing private ambulance service
Public Hospital Districts
- RCW 70.44.007 - Defines health care facilities and services of public hospital districts to include ambulances and ambulance services
Authority for Emergency Medical Service Tax Levies
- RCW 84.52.069 - Provides authority for county, emergency medical service district, city or town, public hospital district, urban emergency medical services district, regional fire protection service authority or fire protection district to impose property tax levies for emergency medical care and service.
Financing Public Emergency Medical Services and Service Delivery
All counties, emergency medical service districts, cities or towns, public hospital districts, urban emergency medical services districts, regional fire protection service authorities or fire protection districts are allowed to ask the voters for authority to levy an additional property tax of up to 50 cents per thousand dollars of assessed valuation to support emergency medical services. The levy presented to the voters can be imposed for six years, 10 years, or permanently (See Note 1)
RCW 84.52.069, as amended in 2012, changed the voting requirement for continued EMS levies. A permanent EMS tax levy or the initial imposition of a six-year or 10-year EMS levy requires a three-fifths majority to pass. The continuation of a six- or 10-year EMS levy requires approval of a majority of registered voters. See also MRSC Insight Article, Revisiting the “Uninterrupted Continuation” EMS Levy with an Informal Attorney General’s Opinion and AGO 2013 No. 4, September 27, 2013 on EMERGENCY MEDICAL SERVICES—TAX LEVIES—Authorizing The Uninterrupted Continuation Of An Emergency Medical Services Levy.
There are two different scenarios for voter approval of this levy. If at least 60 percent of the voters vote "yes," with a voter turnout of more than 40 percent of the number of people voting in the last general election, the measure is passed. However, if the voter turnout is 40 percent or less of the number voting in the last general election, all is not lost. In that case, as long as the number of "yes" votes is equal to at least 60 percent times 40 percent of the number of people voting in the last general election, the measure will pass. If, for example, 1,000 people voted in the last general election, as long there is a majority "yes" vote of at least 240 (1,000 x .4 = 400; 400 x .6 = 240), it will pass even if the number of people voting is less than 400 (40 percent of those voting in the last general election). (See Note 2)
If a permanent levy is imposed, the jurisdiction must account separately for the expenditure of the revenues. (See Note 3) In addition, a permanent levy is subject to a referendum at any time. (See Note 4) This provision means the "permanent" levy may not be permanent.
An EMS levy is a "regular property tax levy." (See Note 5) As such, it is governed by RCW 84.55.010. After the initial levy is approved by the voters, cities with a population under 10,000 may increase the amount of the levy by a maximum of one percent a year plus an additional amount ("add-ons") from new construction, increases in state-assessed utility valuations, and annexations. Because of Referendum 47, cities with a population of 10,000 and over are limited each year to a levy increase that is no greater than the increase in the implicit price deflator for personal consumption expenditures, plus add-ons, unless the council makes a finding of "substantial need" with a majority plus one vote of the city council.
This levy is not subject to the limitation in RCW 84.52.043(2), which provides that the aggregate levies of special districts and the city and county shall not exceed $5.90 per thousand dollars assessed valuation. (See Note 6) It is, however, subject to the constitutional provision that the aggregate of all regular property tax levies (except levies by ports) shall not exceed one percent of assessed value ($10 per thousand dollars assessed valuation). (See Note 7)
- Ambulance Utility ( RCW 35.21.766 ) - This provision was amended in 2005 by Ch. 482, Laws of 2005 (ESHB 1635) which set out new requirements. See explanation under Authority Heading above.
- Review of Ambulance Utilities, State of Washington Joint Legislative Audit and Review Committee (JLARC), Report 08-4, January 9, 2008
- Emergency Medical Service District (RCW 36.32.480) - Can be created by the county with its legislative authority as the governing body, if the district is only in the county. If it includes a city or town, the emergency medical service district may be governed by an interlocal agreement adopted pursuant to Ch. 39.34 RCW.
- Clark County, North Country Emergency Medical Service District - A designated service area in North and Northeast Clark County, Southeast Cowlitz County, and west central Skamania County
- Ferry County Emergency Medical Services District No. 1 - EMS services to central part of Ferry County
- Okanogan County
- Methow Valley Emergency Medical Services District -Twisp, Winthrop, County (Carlton and surrounding areas)
- Twisp Municipal Code Ch. 1.10 - Emergency Medical Service District
- Oroville Rural Emergency Medical Services District.
- Tonasket Emergency Medical Service District
- Pacific County Ordinance No. 152 - North Pacific County Emergency Management Services - Raymond, South Bend, FPD 3,6,7,8 and Naselle FD
- EMS Interlocal Cooperation and Other Agreements - Many jurisdictions obtain EMS services through a variety of interlocal cooperation arrangements. A city may contract with a fire district or vice versa. In many instances, cities and towns will assess a levy for EMS services and then contract with another jurisdiction to provide EMS Services. A number of areas have regional providers which may create interlocal agencies to provide the EMS services. In some cases, a combination of both public and private EMS services are used.
Sample Agreements and Other Documents
Note: Centralia and Lewis County Fire District 12 formed a new entity, the Riverside Fire Authority. The documents listed below have been retained for purposes of illustration.
- Centralia and Lewis County Fire District 12
- Centralia Fire Department, Lewis County Fire District 12 and American Medical Response
- Skagit County Medic One
- Skagit County Code
- Ch. 2.48 - Skagit County Emergency Medical Service Commission
- Ch. 2.52 - Central Valley Ambulance Authority
- Ordinance No. O2009003 - Restructures and clarifies the authority of the Emergency Medical Service Commission and provides for a new public commission to deliver emergency medical services, passed 04/2009
- Ordinance No. O2009004 - Creates the Central Valley Ambulance Authority under RCW 35.21.730 to provide emergency medical service delivery under contract with the Skagit County Emergency Medical Services Commission, passed 04/2009
Washington State Department of Health
(1) Ch. 224, Laws of 1999 and RCW 84.52.069. Note that under the prior legislation, the levy could be for a maximum of six years, but a city could choose to do it for less than six years. That is no longer an option.
(2) Id. Note that an easy way to express this alternative for voter approval is to say that when voter turnout is less than 40 percent of the voter turnout at the last general election, the "yes" votes must be at least 24 percent (240/1000) of the voter turnout at the last general election in order for the measure to pass.
(3) Ch. 224, Laws of 1999, and RCW 84.52.069(3).
(4) Ch. 224, Laws of 1999, and RCW 84.52.069(4). The standard referendum procedure requires that a petition must be filed within seven days of the passage of the ordinance. Within 10 days, the officer with whom the petition is filed must confer with the petitioner concerning the form and style of the petition and provide a ballot title. The petitioner has 30 days to gather valid signatures from at least 15 percent of the registered voters as of the last general election. If enough valid signatures are gathered, the referendum must be placed on the ballot at the next general election, if one is to be held within 180 days of the filing of the petition, or at a special election called for that purpose.
(5) AGO 1993 No. 7.
(6) RCW 84.52.069(5) and RCW 84.52.043(2)(d). RCW 84.52.010 sets out the order in which the special district levies get cut in the event that the aggregate rate exceeds $5.90.
(7) RCW 84.52.050 and art. 7, §2, of the Washington State Constitution. Note that excess levies for operations and maintenance are not subject to this one percent limit, nor are port district levies. RCW 84.52.052 and RCW 84.52.050.