f;P(~kOVF1L OF Itd-tE:k--LUGFiL CiiN-iRGiC"( Wi-I-N i~i~IY OF
K[_Ri1VILLL RIVD Ifdt:3(~Nt+l 1-Uf2 Lt*1t: 'i~ERr.'Ity}`3
Un F.his thre rtStY; day of DecEmber 199~i, +_r~on motion made t_~y
Lommi~asi~ner• Iiol.ekam(,, seconded L-}y trommissioner Lehman, L-hc--.
Ccr~_n-t unanimously approved 6y a vote of 4-Qr-Qy to apF_~rove the
Inter-t_oceii Gorvtr-act. witt-i the Litt of V.er-rvilie and Ingram For
I_MS Ser-vices and a~_rl'horization for the i:.o~.rnty .:i~.rdge to sign
=_aid doc~_rment.

EMS INTERLOCAL AGREEMENT
This Agreement (herein "Agreement") is made by and between the
City of Kerrville (herein "City"), the County of Rerr (herein
"County") and the City of Ingram (herein "Ingram").
ARTICLE I.
PURPOSE
The City has determined to provide to its citi2ens ambulance
services, both emergency and transfer, through the Fire Department
of the City; and City has agreed to provide such ambulance services
for the residents of County and Ingram pursuant to the terms of
this Agreement.
ARTICLE II.
TERM
The initial term of this Agreement shall be from January 1,
1994 through September 30, 1994.
This Agreement shall be renewed automatically, without action
by any party hereto, for successive periods of one (1) year each,
commencing October 1, 1994 unless notice of cancellation is given
by any party hereto not less than sixty (60) days prior to the
commencement of the renewal term in question.
In the event that either the County or Ingram (and not both)
give notice of cancellation, then this Agreement shall continue
between City and the remaining party.
ARTICLE III.
CONTRACTED SERVICES
A. General. City agrees to provide advanced life support
ambulance service, both emergency and transport, originating
in Kerr County, to the residents of County and to the
residents of Ingram pursuant and subject to the further terms
of this Agreement. City reserves the right to not provide
transfer service (non-emergency) outside a 125 mile radius of
the City limits.
B. Estimated Response Times. City agrees to exercise good faith
efforts to meet the estimated response times set forth in
Exhibit "A" to this Agreement. Although the City believes the
estimated response times are obtainable, actual operations may
prove otherwise. Accordingly, no obligation shall exist with
respect to said estimated response times; and City's failure
to meet the estimated response times shall not constitute a
breach of this Agreement and shall not give rise to any claim
or cause of action against the City.
The following definitions and protocols shall be employed for
purposes of response time measurement and reporting:
1. Definition. Response time is defined as the elapsed time
between the moment a request for ambulance service is
received at City's ambulance control center (i.e., the
moment callback number and location are acquired, either
by voice or by ANI/ALI 911 data transmission and
confirmed) and the moment a first-arriving City
ambulance, Mutual Aid unit, 1st Response team, or
advanced life support capable medical helicopter arrives
at the scene; provided that in order to "stop the clock"
such first-arriving unit shall be: operated by City or by
a Mutual Aid unit or 1st Response organization approved
by the Medical Director.
The Mutual Aid/1st Response team need not be paramedic-
level to "stop the clock" so long as such team has been
approved by the Medical Director for such purposes.
For scheduled patient transfers, "time call received"
shall be the agreed-upon appointment time of patient
pickup. To qualify as "scheduled", the request for
service must be made at least 24 hours in advance of the
requested time of pick-up. Response time calculations
shall not include any request for ambulance service that
does not result in transport of a patient.
2. Method of Measurement. Response time standards shall be
established and response time performance shall be
measured in terms of "fractile distributions" ALONG WITH
GRID COORDINATES -- not average response time
measurements. A minimum of 50 patient transports in each
category are required to measure the response time for
such category.
3. Call Classification. For purposes of response time
measurement, the applicable standard shall be based on
each request's presumptive run code classification (i.e.,
life-threatening emergency, non-l ife-threatening
emergency, unscheduled routine transfer, and scheduled
routine transfer) as established at the time the call is
dispatched by a person trained in the use of and
correctly employing medical priority dispatch protocols
promulgated by the Medical Director. (Retrospective
classification of priority code shall not affect
measurement of response time compliance.)
2
4. En route Upgrades and Downgrades. If a presumptive run
code classification is upgraded to a higher priority
while the ambulance is en route (as a result of
information provided by a physician, 1st responder or law
enforcement officer at the scene), the applicable run
code designation shall be the upgrade priority, and
response time shall be measured from the moment of
upgrade. On the other hand, if a presumptive run code
classification is downgraded to a lower priority while
the ambulance is en route ( as a result of information
provided by a physician or 1st Responder), the applicable
run code designation shall be the downgraded priority,
and response time shall be measured from the original
time of call receipt.
C. Medical Oversight. The City agrees to provide medical
oversight for the EMS services through its Medical Director.
The Medical Director will be a licensed physician appointed by
the City Council of the City to promulgate and update the
City's EMS system , subject to City approval, and to perform
medical audits and otherwise monitor system performance.
D. User Fees and Adjustments. Pursuant to Ordinance No. 93-24,
the City has promulgated rates and fees for EMS services
within its corporate limits, including loaded mileage charges;
and the City is hereby authorized to charge the same rates and
fees (including loaded mileage charges) for each transport of
a patient originating within the County and/or Ingram,
respectively.
Such rates and fees (including loaded mileage charges)
may be adjusted from time to time by resolution of the City
Council of the City, and City will notify County and Ingram of
any such adjustments. The rates and fees charged for
transports originating within the County and/or Ingram will be
the same as the rates and fees charged for transports
originating within the corporate limits of the City.
E. Disaster. During a declared disaster, locally or in a
neighboring jurisdiction, (1) no response time measurements
will be required, and (2) during the course of the disaster,
City will use its best efforts to provide emergency coverage
and may suspend non-emergency tranfers.
F. Special Area. City acknowledges that the County presently has
an arrangement with Kendall County EMS with respect to
ambulance service in the 995 telephone exchange in eastern
Rerr County. City agrees to coordinate with the Kendall
County EMS for the provision of the EMS services by the entity
(either City or Kendall County EMS) best able to respond
promptly and to provide the necessary services.
3
ARTICLE IV.
PAYMENTS TO CITY
To assist City with respect to Medical Director and
administration costs, County agrees to pay to City the sum of
$1,975.00 per month, payable in advance on the first day of each
calendar month, commencing January 1, 1994; and Ingram agrees to
pay to City the sum of $200.00 per month, payable in advance on the
first day of each calendar month, also commencing January 1, 1994.
Payments by the County and Ingram pursuant to the foregoing
shall be made only from current revenues available to the paying
jurisdiction. However, failure of any such party to make payment
timely shall constitute a breach of this Agreement, whereupon the
City, at its option, may cancel this Agreement and services
hereunder to the jurisdiction in question.
ARTICLE V.
ORDINANCE
On or before January 1, 1994, Ingram agrees to adopt an EMS
Ordinance in substantially the form attached hereto as Exhibit "B"
and incorporated herein for all purposes; and to maintain such
Ordinance in effect during the term of this Agreement. To the
extent allowed by law, the City is hereby awarded exclusive rights
and responsibilities for provision of all basic and emergency
ambulance services, both emergency and transfer, originating within
the corporate limits of the City of Ingram, regardless of the
manner in which the request for service is conveyed, subject only
to the exemptions set forth in said Uniform EMS Ordinance.
ARTICLE VI.
EMS ADVISORY BOARD
A. Creation of Advisory Board. There is hereby created an EMS
Advisory Board ("EMS Board"). The EMS Board shall be advisory
in nature and shall perform the duties hereafter provided.
B. Board.
1. Composition. The EMS Board shall be composed of no more
than five (5) voting members, constituted as follows:
(a) Position 1. A resident of the City, Ingram or the
County who is knowledgeable in health care
administration;
4
(b) Positions 2 and 3.
principal place of
Renville; and
(c) Positions 4 and 5.
or the County;
Licensed physicians whose
practice is in the City of
Residents of the City, Ingram
and not more than five (5) ex officio non-voting members, as
follows:
(aa) a Councilperson of the City of Kerrville;
(bb) a Commissioner of Kerr County;
(cc) a Councilperson of the City of Ingram;
(dd) the Medical Director;
(ee) the Fire Chief of the City.
2. Terms. Positions 1, 2, and 3 of the first Board shall
have a term of three years; Positions 4 and 5 shall have
a term of two years. Thereafter, the terms of Positions
1 through 5 shall be for a period of two (2) years;
provided that no such member shall be appointed for more
than two consecutive terms in office.
The terms for the ex officio Councilpersons and
Commissioner members shall be coterminous with the
expiration of such member's term of office with the City,
or the County or Ingram, as the case may be.
The Medical Director's ex officio term shall be
coterminous with his tenure as Medical Director.
3. Election and Appointment. The membership of the Board
shall be chosen as set forth below in Paragraph 6.
4. Removal. Any member of the Board who fails to attend any
three (3) consecutive, regularly scheduled Board meetings
or who fails to attend at least one-half (~) of the
regularly scheduled meetings in any twelve (12) month
period, without a reasonable and valid reason for such
absence, shall be removed from the Board, and his
position filled as provided in Paragraph 6 below.
Removal of a member pursuant to this provision must be
approved by a majority of the members of the Board,
excluding the member in question.
5
5. Vacancy. Any vacancy in the Board occurring by
resignation or otherwise shall be filled as provided in
Paragraph 6 below.
6. Appointments. The membership of the Board shall be
appointed in the following manner:
(a) The Medical Director shall be appointed by the
City.
(b) The City shall appoint (i) three (3) voting
members, and (ii) one Councilperson of the City as
an ex officio member. Except for its ex officio
member, no City Councilperson will serve on the
Board.
(c) The County shall appoint (i) one (1) voting member,
and (ii) one Commissioner as an ex officio member.
Except for its ex officio member, no Commissioner
of the County will serve on the Board.
Appointments by the County shall be made from
nominations by the City as hereinafter provided in
subsection (e) of this Paragraph 6. It is
preferred, but not required, that such member
resides in the County of Kerr, but outside the city
limits of the City or Ingram.
(d) Ingram shall appoint (i) one (1) voting member and
(ii) one Councilperson for its ex officio member.
Except for its ex officio member, no Councilperson
of Ingram will serve on the Board. Appointments by
Ingram shall be made from nominations by the City
as hereinafter provided in subsection (e) of this
Paragraph 6. It is preferred, but not required,
that such member resides in the city limits of
Ingram.
(e) All members of the Board other than those selected
by the City shall be chosen as follows:
For each position, the City will nominate one (1)
person. If the appointing jurisdiction(s) does not
act upon such nomination within thirty (30) days
after submission of the nomination in writing by
the City, then the City shall nominate one (1)
additional person for the position to be filled.
If the appointing jurisdiction(s) does not act upon
such additional nomination within thirty (30) days
after submission of such additional nomination, the
City shall be empowered to fill such position.
6
(f) The filling of vacancies in the Board (whether by
expulsion, resignation or otherwise) shall be made
in the same manner as the original appointment (or
nomination and appointment) process as set forth
hereinabove for the vacated position in question.
C. Duties. The Board shall be advisory in nature only, and shall
have the following specific duties:
1. On or before November 1 of each year, commencing November
1, 1994, the Board shall provide a written report
evaluating response time performance and training and
certification programs for City EMS employees, and such
other aspects of the EMS system as may be directed by the
City Council of the City of Kerrville.
2. Advise the City as to the entire emergency medical
services system (i.e. County-wide and not limited to the
City corporate limits), including first responder
programs, public CPR and other programs, etc., and assist
in the implementation of same.
3. Advise the City from time to time as to any recommended
changes in equipment needs or estimated response times.
4. Advise and make recommendations to the City with respect
to resolution of issues, if any, that may develop between
the Medical Director and the Fire Chief of the City as to
protocols, licensing and related or unrelated EMS issues.
ARTICLE VII.
INDEPENDENT CONTRACTOR
In the performance of its obligations hereunder, the City is
an independent contractor with the exclusive right to supervise,
manage, control and direct the performance of transport and
emergency medical services.
The County and Ingram shall look to the City for results only
and neither the County nor Ingram shall have any right at any time
to direct or supervise the City or its Fire Department or any of
its personnel, agents or employees in the performance of such
services or as to the manner, means or methods in which the
services are performed.
7
ARTICLE VIII.
TERMINATION OF 1992 AGREEMENT
That certain EMS Interlocal Cooperative Agreement dated
September 2 Z 1992, by and between the parties hereto, is hereby
terminated and the REMSA Board created thereby is hereby dissolved.
ARTICLE IX.
GENERAL
In case any one or more of the provisions contained in this
Agreement shall for any reason be held to be invalid, illegal or
unenforceable in any respect, such invalidity, illegality or
unenforceability shall not affect any other provision hereof and
this Agreement shall be construed as if such invalid, illegal or
unenforceable provision had never been contained herein.
This Agreement constitutes the sole and only agreement of the
parties hereto and supersedes any prior understandings or written
or oral agreements between the parties with respect to the subject
matter hereof.
LIST OF EXHIBITS
Exhibit A. Estimated Response Times
Exhibit B. EMS Ordinance (For City of Ingram only)
APPROVAL
Approved and adopted by the Cit Council of the City of
Rerrville, Texas, this ~_ day of >,v ~.~~, 1993.
CITY OF KERRVILLE
By:
J E HERRING, JR., May
ATTEST:
By; ~~. D ~ /~ _ .o
SHE L. B D, City Clerk
APPROVED AS TO FORM:
WALLACE, MOSTY, MACHANN,
JACKSON & WILLIAMS
sy:~ !a-/G9~
E. DWAINE MACHANN
Approved and adopted by the Commissioners Court of Kerr County
this ~R+h day of ~ , 1993.
COUNTY O~F~KERB
ATTEST: _ G~ '"<
' BY° ~
PATRICIA DYE, COUNTY ERK WILLIAM G. STACY County Judge
Approved and adopted by the City Council of the City of Ingram
this day of , 1993.
CITY OF INGRAM
By:
GERALD JOHNSTON, Mayor
APPROVED AS TO FORM:
City Attorney
C134\67AG5
^~,~,~~,~/)~ ova '~?
U . 11
EXBIBIT "A"
Area
Classification
County 0-5 mi.
County 5-10 mi.
County 10-15 mi.
County > 15 mi.
Ingram
C134/67AG5
Life
Threatening
Emergencv
'908 - llm
>_90$ - 15m
?908 - 19m
Best Effort
>_908 - 12m
Non-Life
Threatening
Emergencv
>_908 - 13m
>_90$ - 17m
?908 - 21m
Best Effort
>_908 - 13m.
Unscheduled
Routine
Transfer
>_908 - 60m
>_908 -	60m
?908	- 60m
?908	- 60m
?908	- 60m
Scheduled
Routine
Transfer
?90$ - lOm
?908 - lOm
?90$ - lOm
>_90$ - lOm
?908 - 15m
10