The NCSL Blog


By Kelsie George

Emergency medical services (EMS) is a network of systems that respond to provide emergency medical care.

In recent years, EMS has played an increasingly important role in healthcare, emergency management, public health as well as the traditional first responder role. The COVID-19 pandemic and opioid epidemic has placed EMS on the frontlines as a key component of public health.

States have taken several legislative actions to ensure that residents have access to these life-saving EMS resources.

ambulanceIn late 2021, NCSL launched a new Emergency Medical Services Legislative Database to track enacted state actions on the topic. The easy-to-navigate database currently features 2021 legislation and will be updated regularly with legislation from 2022 sessions and beyond.

In 2021, at least 30 states enacted more than 60 bills addressing various aspects of EMS, including administration, funding, regulation, statewide systems and workforce.

States administer EMS services in a variety of ways. At least 12 states enacted legislation establishing or making changes to state EMS offices; creating quality assurance programs, protections or data collection; or authorizing EMS as an essential service to provide to citizens. Hawaii required and appropriated funding for each county to establish, administer and maintain an EMS system.

Thirteen states enacted 19 bills addressing EMS funding, including Maine, which required carriers to reimburse out-of-network ambulance services providers at the same rate as in-network providers.

States have the authority to regulate EMS delivered within their borders. Eleven states enacted 12 bills addressing rules and regulations for EMS. For example, West Virginia required air ambulance service providers and affiliated entities to be licensed with the Offices of the Insurance Commissioner as an insurer.

Systems of care provide organized, coordinated efforts in defined geographic areas for the delivery of health care services, such as EMS, trauma, stroke and acute ST-elevation myocardial infarction (STEMI) care. Five states enacted legislation to establish or make changes to statewide systems, including Michigan, which appropriated funding to its department of health and human services to integrate the statewide stroke and STEMI systems of care into the statewide trauma system and EMS system.

Eight states enacted legislation in 2021 addressing the certification, licensure or scope of practice for EMS professionals, particularly in rural communities. Illinois, for example, allowed registered nurses, physician assistants and advanced practice registered nurses to serve as emergency medical technicians in communities with less than 7,500 residents.

NCSL would like to acknowledge the National Highway Traffic Safety Administration (NHTSA) for supporting this database.

Kelsie George is a policy analyst in NCSL’s Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.