When Mother Nature challenged the Fort Worth region Dec. 6-9 with a historic weather event, the area’s emergency medical service response agencies collaborated on several innovative service delivery changes to meet that challenge head-on.Winter Storm Cleon, (we prefer to use “Icemageddon”) resulted in a 22 percent increase in typical emergency medical service calls and a 44 percent increase in the time it normally takes to complete a call. Anticipating not only the call volume increase but also the increase in the time it would take to complete the calls, the Fort Worth Fire Department, other area first response agencies, MedStar and the EMS System control authority, the Emergency Physician’s Advisory Board, put several innovative emergency action plans in place: • The Fort Worth Fire Department and other first response agencies offered to respond to low-priority medical calls to assure the patients remained stable during a potentially delayed ambulance response due to weather and call volume. Typically, the medical-director-approved protocol for this type of call would not result in a fire department response, saving the fire resources for the more serious medical, fire or rescue calls. • In some cases, if the patient did not want to go to the hospital, the fire department personnel would complete the patient assessment, consult by phone with the on-call medical director, initiate the ambulance transport refusal process and cancel MedStar’s response so that the ambulance could be reassigned to another response.• Knowing that vehicles involved in weather-related crashes may remain on the side of the road or in a ditch for an extended period of time, we all agreed to tie caution tape, the kind you may see at crime scenes, to the side of the car visible to the street. That way, if another person called 911 reporting the same crash with a car off the road, the MedStar 911 call-taker would ask if the car had caution tape on it. If the caller said yes, we knew the crash had already been investigated, thus preventing another response to a previously handled incident. This helped conserve valuable response resources.• There were times when the fire department would arrive on a scene knowing that there was no chance that the MedStar unit would be able to navigate the treacherous road. They would communicate this to MedStar so the ambulance would stop in a safe location, limiting the potential for the ambulance to get stuck on the ice. In some cases, the fire department personnel brought the patient to the ambulance.This unprecedented level of innovative collaboration came at a time when first response agencies also knew their response volume would be extremely high, when their community would need them the most. The Fort Worth Fire Department responded to 1,724 calls during the four-day weekend, 70 percent higher than normal. MedStar responded to 1,621 calls, 21 percent more than usual. The substantial increase in call volume was partly due to car crashes, but also to help people who had fallen on the ice. The Fort Worth area community should be very proud of the staff and leadership of area first response agencies, MedStar and the medical directors overseeing one of the most innovative EMS systems in the country. Doug Hooten is executive director of MedStar Mobile Healthcare. Rudy Jackson is chief of the Fort Worth Fire Department.