Report on the Restructuring of Emergency Medical Services in Fort Worth

Executive Summary

In response to growing financial unsustainability and operational challenges within its Emergency Medical Services (EMS) system, the City of Fort Worth has initiated a strategic transition to integrate EMS operations into the Fort Worth Fire Department (FWFD). This report outlines the background, analysis, and strategic decisions leading to this change, with a significant focus on how the new model aligns with the United Nations Sustainable Development Goals (SDGs). The primary objective is to establish a financially sustainable, responsive, and high-quality EMS system that ensures the long-term health and safety of residents and visitors, directly contributing to SDG 3 (Good Health and Well-being), SDG 8 (Decent Work and Economic Growth), SDG 11 (Sustainable Cities and Communities), and SDG 16 (Peace, Justice, and Strong Institutions).

Background and System Analysis

The MedStar Public Utility Model and Financial Challenges

The previous EMS system was operated by MedStar, a public utility under the Metropolitan Area Emergency Medical Services Authority. This model was designed to be self-sustaining, funded primarily through fees for service collected from health insurance and government programs.

• Since 2009, the City of Fort Worth and other member cities had not provided direct financial subsidies to MedStar.
• Rising operational costs, supply chain issues, and significant revenue shortfalls created an unsustainable financial model.
• A substantial portion of EMS calls (25-30%) resulted in no payment due to lack of insurance or insufficient government reimbursement.
• Despite cost-saving measures, including outsourcing and operational integrations, expenditures began to exceed revenues, threatening service viability.

Findings of the Fitch & Associates Comprehensive Study

A 2023 study by Fitch & Associates provided a critical analysis of the EMS system’s performance and structure, revealing significant deficiencies.

• Resource and Personnel Shortages: The system did not deploy sufficient resources or personnel to meet established response time objectives.
• Suboptimal Response Times: The average travel time for emergency 911 responses was 13.5 minutes. The study concluded that with proper resourcing, this could be improved by as much as 5.5 minutes, achieving an 8-minute target.
• High Call Volume Strain: System calls significantly exceeded established standards for best practice, placing immense pressure on available resources.

Strategic Transition to an Integrated Fire-Based EMS Model

City Council Approval and Governance Structure

In May 2024, the Fort Worth City Council approved recommendations to establish an EMS system within the Fort Worth Fire Department, effective July 2025. This decision aims to create a system that is financially sustainable, responsive, and focused on high-quality patient care. To support this new structure, the Council also approved the creation of two key oversight bodies:

1. An EMS Advisory Board
2. A Medical Control Board

Labor Agreement and Workforce Integration

A Memorandum of Understanding (MOU) was approved between the City of Fort Worth and the International Association of the Fire Fighters Local 440. This agreement is crucial for a smooth transition and aligns with principles of fair labor.

• It amends the Collective Bargaining Agreement to incorporate incoming EMS positions into the FWFD.
• Former MedStar employees, including EMTs, paramedics, and telecommunicators, will be granted civil service status.
• This ensures job security and standardized labor conditions for the essential EMS workforce.

Alignment with Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

The primary driver of the EMS restructuring is to ensure universal access to quality essential services. The new model directly supports SDG 3 by:

• Ensuring High-Quality Patient Care: The transition is explicitly focused on maintaining and enhancing the quality of emergency medical care for all individuals in Fort Worth.
• Improving Emergency Response: By addressing resource shortages, the city aims to reduce emergency response times from 13.5 minutes to a target of 8 minutes, a critical factor in improving patient outcomes.
• Creating a Resilient Health Service: Establishing a financially stable funding model ensures the EMS system can reliably serve the community for years to come, preventing service degradation due to financial crises.

SDG 8: Decent Work and Economic Growth

The integration of the EMS workforce into the FWFD promotes stable and fair employment, a key target of SDG 8.

• Promoting Decent Work: The MOU provides former MedStar employees with civil service status, offering job security, protections, and standardized benefits under the city’s established labor framework.
• Supporting an Essential Workforce: By formalizing the roles of EMTs, paramedics, and telecommunicators within the municipal structure, the city recognizes and secures their vital contribution to the local economy and public safety.

SDG 11: Sustainable Cities and Communities

This initiative is a core component of building a resilient and sustainable urban environment, directly addressing the targets of SDG 11.

• Building Sustainable Infrastructure: The creation of a financially sustainable EMS system is a critical investment in the city’s essential public service infrastructure.
• Enhancing Urban Safety and Resilience: A reliable and efficient emergency response system is fundamental to making a city safe and resilient, capable of protecting its population during individual emergencies and large-scale events.

SDG 16: Peace, Justice, and Strong Institutions

The process undertaken by the City of Fort Worth exemplifies the principles of effective, accountable, and transparent governance as outlined in SDG 16.

• Evidence-Based Policymaking: The decision was based on a comprehensive, independent study by Fitch & Associates, ensuring the new model addresses data-driven findings.
• Accountable and Transparent Governance: The establishment of an EMS Advisory Board and a Medical Control Board creates a framework for public oversight and accountability.
• Inclusive Decision-Making: The city engaged in a collective bargaining process with the firefighters’ association to ensure a just and collaborative transition for the workforce.

Analysis of SDGs, Targets, and Indicators

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on the Fort Worth Emergency Medical Services (EMS) system addresses and connects to several Sustainable Development Goals (SDGs) by focusing on public health, urban infrastructure, institutional governance, and collaborative partnerships.

• SDG 3: Good Health and Well-being: This is the most prominent SDG, as the article’s central theme is the provision of “high-quality patient care” through an effective and responsive EMS system. It discusses health service delivery, emergency response, and ensuring access to care for all residents and visitors.
• SDG 11: Sustainable Cities and Communities: The article directly relates to making a city’s infrastructure and services resilient and sustainable. It focuses on the operational and financial sustainability of the EMS system, a critical public service for the City of Fort Worth and its surrounding communities.
• SDG 16: Peace, Justice and Strong Institutions: The discussion revolves around the governance and restructuring of a public institution (the EMS system). It details the City Council’s decisions, the creation of advisory boards, and the establishment of a new operational model within the Fort Worth Fire Department to ensure an effective, accountable, and financially stable public service.
• SDG 17: Partnerships for the Goals: The article highlights the importance of collaboration. It describes the partnership between the City of Fort Worth, 14 other member cities, the Fort Worth Professional Firefighters Association, and the previous public utility model, MedStar. The entire restructuring process involves multi-stakeholder engagement to achieve a common goal.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the issues discussed, several specific SDG targets can be identified:

1. Target 3.d (under SDG 3): “Strengthen the capacity of all countries… for early warning, risk reduction and management of national and global health risks.”
   • The article focuses on strengthening the capacity of the local EMS system to manage health emergencies. It notes that the previous system “did not deploy sufficient resources” and that the new model aims to improve response times and overall service delivery, which is a direct effort to enhance capacity for managing health risks.
2. Target 11.5 (under SDG 11): “By 2030, significantly reduce the number of deaths and the number of people affected… caused by disasters… with a focus on protecting the poor and people in vulnerable situations.”
   • A medical emergency is a personal-level disaster. The article’s goal of improving EMS response time from 13.5 minutes to a potential 8 minutes is a direct strategy to reduce deaths and the severity of health outcomes from emergencies. The financial discussion also touches on vulnerability, noting that 25-30% of calls resulted in no payment, often due to a lack of insurance.
3. Target 16.6 (under SDG 16): “Develop effective, accountable and transparent institutions at all levels.”
   • The article describes a major institutional reform. The City of Fort Worth is moving the EMS system into the Fire Department and creating an “EMS Advisory Board and Medical Control Board” to ensure the system is “financially sustainable, responsive, timely and focused on high-quality patient care.” This is a clear example of developing a more effective and accountable public institution.
4. Target 17.17 (under SDG 17): “Encourage and promote effective public, public-private and civil society partnerships…”
   • The article is a case study of a public-public partnership. It details the relationship between the City of Fort Worth and other member cities in the MedStar authority. Furthermore, it describes the new partnership formed through a “Memorandum of Understanding (MOU)” and a “Collective Bargaining Agreement (CBA)” between the City and the Fort Worth Professional Firefighters Association to integrate EMS services.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article mentions and implies several quantitative and qualitative indicators that can be used to measure progress:

• EMS Response Time: This is a direct, measurable indicator of the system’s effectiveness and capacity (Target 3.d, Target 11.5). The article provides a baseline (“current 13.5 minutes”) and a clear goal (“just an 8-minute travel time”), allowing for precise measurement of improvement.
• Financial Sustainability: This is a key indicator for the success of the institutional reform (Target 16.6). The article implies this can be measured by tracking whether the system is self-sufficient or requires subsidies. The previous model was “spending more than it was taking in,” so a key indicator of success would be a balanced budget or a reduction in financial losses.
• Personnel and Resource Levels: An indicator of strengthened capacity (Target 3.d) is the number of available personnel and deployed resources. The article states the old system “had less personnel available to meet the desired response time objectives.” Progress can be measured by tracking the number of EMTs, paramedics, and ambulances in service under the new model.
• Formal Agreements and Governance Structures: The existence of the “Memorandum of Understanding (MOU)” and the establishment of the “EMS Advisory Board and Medical Control Board” are themselves indicators of progress towards building effective institutions and partnerships (Target 16.6, Target 17.17).
• Service Call Payment Rate: The article notes that “Between 25 and 30 percent of EMS calls resulted in no form of payment.” While the new model’s funding structure is different, tracking revenue collection and the financial impact of uncompensated care remains an important indicator of the system’s financial health and the community’s access to care regardless of ability to pay.

4. SDGs, Targets and Indicators Table

Source: fortworthtexas.gov