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Fort Worth eyes transition from MedStar to fire-based EMS

Fort Worth firefighters stand and talk to each other at the scene of a house fire in December 2023.
David Moreno
Fort Worth Report
Fort Worth firefighters stand and talk to each other at the scene of a house fire in December 2023.

After more than 38 years, MedStar’s time as the designated EMS provider for Fort Worth is drawing to a close.

Fort Worth’s EMS committee, which has been researching alternative models for six months, recommended April 16 that the city switch to a fire-based EMS model. Under that model, the fire department would house employees — including those currently working at MedStar — whose sole role is to respond to medical emergencies. The projected cost for the switch is approximately $10 million.

“We’ve finally alighted on one EMS option that everyone is on board with,” council member Carlos Flores, who chairs the committee, said in an interview.

In a written statement, Matt Zavadsky, MedStar’s chief transformation officer, said the entire MedStar team is committed to working with the city on an effective transition.

“We are also committed to working collaboratively with the city to help assure that the more than 500 MedStar team members, many of whom have served this community for more than 30 years, are able to fairly transition into any new EMS system delivery model,” he said.

The overhaul of Fort Worth’s EMS system came after MedStar acknowledged rising costs and declining reimbursements were making it difficult for the entity to sustain itself independently. Fort Worth initially considered a transitional funding plan, but ultimately didn’t allocate any funds.

The EMS committee, assembled by Mayor Mattie Parker, took analyzing next steps for emergency services in the city head-on. Fire-based EMS was one of four models proposed by Fitch & Associates, a consulting firm hired by the city in October.

The current plan is to help transition MedStar staff into roles within the city’s fire-based EMS. Still up in the air is whether this new EMS system will be staffed by civilian or sworn employees. Sworn employees are members of the IAFF 440 fire union, who are afforded specific protections as a result of their designation.

Michael Glynn, president of IAFF 440, said it’s important that any employees brought over from MedStar are treated the same as current sworn fire department employees.

“That’s just simply a matter of giving them the protections that they deserve, as public safety professionals, working side by side along with the firefighters and police officers on emergency scenes,” Glynn said.

Committee members will choose between a civilian or sworn model April 30. The committee’s recommendations will then be taken up for a vote by the full City Council on May 21. If approved by council, the transition is expected to take 12 to 18 months.

Right now, MedStar operates as a result of an interlocal agreement between 14 cities, first created in 1986. In order to shift to fire-based EMS, Fort Worth must withdraw or dissolve the interlocal agreement.

Fort Worth is the largest city in the interlocal agreement. It doesn’t make financial sense for MedStar to continue serving the smaller member cities on their own, officials said.

“There is economy in size,” Haslet Mayor Gary Hulsey said to committee members.

Hulsey was one of several representatives from member cities who spoke at the April 16 meeting. He said that whenever Haslet residents called MedStar, they were there to provide service. If Fort Worth moves forward with fire-based EMS, he urged the city to hire people whose sole role is emergency care — not a dual emergency and firefighter role.

“When I call for the ambulance, I’m not interested that you know how to put out a kitchen fire, I want you to get me to the hospital,” he said.

Haslet and other member cities have expressed concerns about how the transition will impact their own residents and budget process. City officials assured them that the member cities will have the opportunity to enter longer-term service agreements with Fort Worth for fire-based EMS services. The committee is still fine-tuning what those agreements could look like.

“Fort Worth is the 900 pound gorilla in the room,” council member Elizabeth Beck said. “… I think it’s prudent to have more than just individual agreements with every city.”

Not everyone agreed with the committee’s recommendation. Dr. Terence McCarthy, chair of emergency medicine at TCU’s Burnett School of Medicine, said the existing MedStar system is functioning fairly well.

“If it ain’t broke don’t fix it, and it’s really not broke,” McCarthy said.

Once MedStar is dissolved, Fort Worth will receive facilities and other assets — like ambulances — from MedStar, and enter contracts to provide the other member cities with fire-based EMS services. If the city doesn’t receive those assets, costs for a fire-based system would balloon to $50 million.

Several other aspects of the transition remain in flux. Hospital leaders and city officials agree it makes sense to privatize nonemergency interfacility transports and remove those calls from the 911 system, but the exact method of doing so will be hammered out in later meetings.

Both groups also agreed on the importance of maintaining an independent office of medical director. Currently, Jeffrey Jarvis serves as the chief medical officer for the EMS system. His office is responsible for evaluating emergency responses and offering medical direction and oversight.

“I won’t support anything that doesn’t maintain the independence of the medical office,” Mayor Mattie Parker said. “I think I’ve been very clear about that.”

How we got here

July 2023: MedStar asks for transitional funding from the city of Fort Worth, citing increasing costs and declining reimbursements.

Aug. 8, 2023: Mayor Mattie Parker assembles EMS committee to oversee a third-party study of the EMS system and potential alternatives.

Sept. 19, 2023: Fort Worth City Council passes a budget with$4.2 million set aside for potential allocation to MedStar.

Oct. 4, 2023: MedStar passes a stopgap October budget, puts building on the market while waiting for transitional funding allocation.

Oct. 22, 2023: The Fort Worth Report reports on unpaid jail invoices incurred by MedStar and the organization’s efforts to get reimbursed for that care.

Oct. 31, 2023: Fort Worth picks consultant to evaluate MedStar, EMS system.

Nov. 2, 2023: MedStar passes second stopgap budget as Fort Worth mulls subsidy.

Dec. 11, 2023: MedStar switches gears, passes annual budget without help from Fort Worth.

Feb. 20, 2024: Council committee considers four EMS models.

March 18, 2024: MedStar reaches agreement with JPS for reimbursement of jail invoices.

March 19, 2024: Committee members receive a draft of the consultant’s final EMS report.

This article first appeared on Fort Worth Report and is republished here under a Creative Commons license.

Emily Wolf is a local government accountability reporter for the Fort Worth Report. She grew up in Round Rock, Texas, and graduated from the University of Missouri-Columbia with a degree in investigative journalism. Reach her at for more stories by Emily Wolf click here.