EMS service for Hamilton County started with a private service by county contract.
When the Hamilton County Hospital District was formed in 1989, they took over the responsibility of ambulance service for the district with three BLS/ALS capable ambulances.
In 1997, Hamilton EMS started running BLS/MICU capable ambulances.
Five years later, the progressive Hamilton County Hospital District added an EMS sub-station in the city of Hico and began providing ambulance coverage to the city and northeastern part of the county.
Today Hamilton EMS operates five ambulances, each licensed at the Basic Life Support/Mobile Intensive Care Unit capabilities level.