EMS agreements approved with five area cities

The City of Red Oak has come to an agreement with five Montgomery County communities for EMS services.
Since December 2025, representatives of the City of Red Oak, Montgomery County, and surrounding communities have met to discuss the long-term sustainability of paramedic-level Emergency Medical Services (EMS) throughout the region. Red Oak city administrator Lisa Kotter said those discussions have focused on developing a fair and equitable funding model to ensure the continued availability of Advanced Life Support (ALS) ambulance services provided by the Red Oak Fire Department.
“The proposed 28E Agreements with the cities of Stanton, Villisca, Elliott, Emerson, and Grant represent a two-year interim funding arrangement while local officials continue to evaluate options for a permanent essential service funding mechanism, advised Kotter. “The agreements provide for annual financial participation by each community based upon call volume and service area considerations. The cities of Elliott, Stanton, and Grant have approved their respective 28E Agreements. The Cities of Emerson and Villisca have indicated support for participation but have requested minor revisions to agreement language. Those revisions have not yet been received.”
The resolution under consideration authorizes the mayor and city finance manager/city clerk to approve and execute non-substantive revisions to the Emerson and Villisca agreements without requiring additional council action.
“Under the agreements, the Red Oak Fire Department will continue to provide paramedic-level emergency medical response, patient care, advanced life support services, and ambulance transport when dispatched through Montgomery County communications. Individual patients receiving services will continue to be billed directly by the City of Red Oak in accordance with established EMS billing policies and fee schedules,” explained Kotter.
The proposed annual community contributions are as follows, with a total revenue to the City of Red Oak being $22,925:
•  Villisca, $10,000.
• Stanton, $7,141.
• Emersonm $3,695.
• Elliott, $1,733.
• Grant, $356.
‘The agreements are intended to provide short-term financial support for regional EMS services while local governments continue discussions regarding a long-term essential service funding referendum and other sustainable funding options,” commented Kotter.
As per the resolution, Chapter 28E of the Code of Iowa authorizes governmental entities to cooperate and contract for the provision of public services; and the City of Red Oak and each participating community have negotiated separate 28E agreements for the provision of advanced life support emergency medical services; and emergency medical calls originating within the participating communities are received through Montgomery County 911 communications or other authorized emergency dispatch centers and there are times that the calls are dispatched to the City of Red Oak Fire Department EMS personnel for response.
Under the terms of the agreements, City of Red Oak Fire Department EMS personnel will respond to requests for service within the participating communities when dispatched through established emergency communications systems and subject to the availability of personnel, ambulances, and equipment; and all emergency medical services, advanced life support services, patient care, treatment, and ambulance transport services provided pursuant to the agreements may be billed directly by the City of Red Oak to the individual patient receiving such services, or to such patient’s insurance carrier or other responsible payer, in accordance with the City’s established billing policies and fee schedules.
Red Oak will provide backup emergency medical services (EMS response) when Stanton EMS volunteers are unavailable to respond to calls for service within the Stanton service area.
“Red Oak provides paramedic-level emergency medical services and agrees to respond to calls within the Stanton service area when dispatched. The parties acknowledge that Montgomery County 911 dispatchers shall simultaneously page both Stanton EMS and Red Oak EMS for applicable calls. Red Oak’s response under this agreement is intended to ensure paramedic-level service is available when Stanton EMS volunteers are unable to respond or require additional support,” said Kotter. “If Red Oak provides staff to supplement or accompany Stanton EMS personnel on a call, such service shall continue to be compensated under the existing tier agreement between the parties at the amount outlined in the most up-to-date tier agreement between the parties and is not included in the flat fee established in this Agreement.”
According to Kotter, flat fee established in the agreement is intended to compensate Red Oak for instances in which Red Oak EMS provides full-service response to a call within the Stanton service area.
“The City of Red Oak shall continue to bill patients for services when Red Oak provides transport. The City of Stanton shall continue to bill patients when Stanton provides transport, including situations in which a Red Oak employee accompanies Stanton EMS personnel. This agreement does not require Stanton EMS to notify Red Oak of its availability status prior to dispatch, as dispatching is coordinated through Montgomery County 911, but any extended time when the Stanton crew knows it will not have anyone responding would be communicated to Red Oak and Mont County 911 Dispatch,” stated Kotter. “The parties acknowledge that there may be occasions when Red Oak EMS is unavailable to respond due to being committed to previously dispatched calls or other service obligations. Red Oak will make reasonable efforts to respond to all dispatched calls within the Stanton service area when staff is available.”
This agreement is in addition to, and does not replace or modify any existing tiered response or EMS service agreements currently in place between the parties. The agreement shall be for a term of two years, beginning July 1, 2026, and ending June 30, 2028, unless terminated earlier as provided herein.
“Red Oak shall submit invoices to Stanton by September 30 and March 31 of each year prior to the respective payment due dates. The parties acknowledge that this amount is less than previously discussed and is intended as a transitional funding level to allow the City of Stanton and other communities in Montgomery County to review and evaluate EMS as an essential service, including potential funding mechanisms and governance structures, and to allow Montgomery County to review and potentially establish an EMS Essential Service oversight committee and consider a referendum for voter approval,” Kotter advised.
The compensation set forth herein is not intended to represent the full or long-term cost of providing EMS services, and adjustments are anticipated upon renewal. Stanton must maintain its EMS volunteer service to the extent possible, and If Stanton becomes aware in advance that no personnel will be available to respond, Stanton shall notify Montgomery County 911 dispatch and Red Oak command staff as soon as reasonably possible. Red Oak is required to provide backup EMS response when requested and available, maintain all required licensure, staffing, and equipment necessary to provide EMS services, and submit invoices for payment as outlined above.
Red Oak and Stanton shall be responsible for the acts and omissions of its own officers, employees, and agents. Each city shall maintain appropriate insurance coverage as required by law. Either city may terminate this agreement with 90 days written notice to the other party. In the event of termination, compensation shall be prorated based on the number of months of service provided during the fiscal year at a per-month rate derived from the annual fee.  Any outstanding balance shall be invoiced or refunded accordingly.
The Red Oak City Council was in agreement that regional cooperation for the provision of paramedic-level emergency medical services promotes public safety and provides an efficient and cost-effective means of delivering advanced life support services throughout the service area, and approved the resolution for coverage for the five communities as presented.