In order to form a countywide Emergency Services District, county commissioners need to have formal support from city and town councils. All three incorporated towns must pass a resolution supporting the formation, according to RCW 32.32.480. A public hearing must be held and county commissioners must find it is in the interest of the county.
Smaller EMS districts could be formed. Hospital districts, fire districts and cities and towns could form smaller districts.
In order to pass a tax, three-fifths, or 60%, of the voters must approve.