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Emergency Medical Services Provision in Washington State

This page provides an overview of emergency medical services (EMS) provision for local governments in Washington State, including major statutes and examples of interlocal agreements.


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.

State Regulation

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 (8)). 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 EMS and Trauma Care Clinical Guidelines). 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 35.21.770/35A.11.110 - Provides that upon adoption by a two-thirds vote of the full legislative body, the legislative body of a 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 provided the service does not compete with an existing private system.
  • 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

Fire Districts

  • 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; authorizes districts to provide training, expend resources, and enter into interlocal agreements to mitigate injuries and reduce level of harm and occurrents in calls they respond to.
  • 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

  • Emergency Medical Services (EMS) Levies - Property tax up to $0.50 per $1,000 assessed value. For more information, see our page on EMS Levies.
  • 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.

Examples of Agreements and Other Documents

Clark County

King County

Skagit County

Thurston County

Whatcom County

Additional References

Washington State Department of Health

Last Modified: January 06, 2022