Emergency medical services—a key component of public health and safety—provide prompt, lifesaving responses during emergencies. EMS systems face numerous challenges, from workforce shortages to funding sustainability, according to a report in the journal Emergency Care and Medicine.
Last year, lawmakers across the nation introduced various measures to address these challenges. Here are key trends and legislative efforts from 2024.
Strengthening the EMS Workforce
Staffing shortages and difficult working conditions have challenged EMS systems nationwide. With EMS clinicians often facing long shifts, high-stress emergency situations and the emotional toll of handling trauma, many states are focusing on worker recruitment, training and benefits.
Kentucky (HB 484) established an EMS education grant program that provides financial support and training resources to individuals pursuing paramedic certification. Washington (SB 5940) created a new medical assistant-EMT certification with accompanying requirements and scope of practice, adding another career pathway for EMS clinicians.
States are also providing additional training and education for EMS clinicians to enhance professional skills and ultimately improve patient care. Alabama (HB 126) required fire-protection personnel to complete training every two years on interacting with individuals with sensory needs or invisible disabilities. Virginia (HB 933) required dispatchers, firefighters and emergency medical personnel to undergo training in assisting individuals with Alzheimer’s disease and dementia.
EMS clinicians tend to experience high levels of acute and chronic stress, high rates of depression and substance abuse, and higher risk of suicide than the general public, according to a 2022 review in Frontiers in Psychiatry. Several states expanded access to mental health and other benefits for these personnel. Alaska (SB 103) established a peer support counseling program for EMS clinicians, and Georgia (HB 451) provided mental health treatment coverage for first responders diagnosed with post-traumatic stress disorder. Washington (SB 6197) expanded disability benefits for EMS clinicians and removed the statute of limitations for beneficiaries under the Law Enforcement Officers and Firefighters’ Retirement System.
Enhancing EMS System Infrastructure
States are developing advanced technology, data systems and funding structures to enable better communication and collaboration between different emergency response agencies across jurisdictions.
Indiana (HB 1302) required counties to report EMS data—including provider details, funding, care levels and response times—to the Department of Homeland Security, which compiles and submits recommendations to the Legislature. Utah (HB 41) directed the health data authority to create a plan aimed at improving data collection, analysis and dissemination, with provisions for privacy through an opt-out system.
States have adopted various approaches to improve funding for EMS systems. Oklahoma (HB 1967) allowed counties to implement a voter-approved sales tax of up to 1% to fund EMS operations. Vermont (HB 622) established a special fund to support training, data collection and service delivery, prioritizing “districts that have historically experienced challenges in receiving grants from the fund.” Funding comes from legislative appropriations, donations and the state’s Fire Safety Special Fund. In Iowa (HB 2397), ambulance services transporting people experiencing mental health crises to access centers will receive payments from the state Department of Health and Human Services.
Improving EMS Administration
To improve EMS systems, states are coordinating efforts across agencies and enhancing administrative structures. Recent legislation aims to strengthen these frameworks.
Louisiana (HB 372) established the Ambulance Patient Offload Delay Collaborative, bringing together the state’s Bureau of Emergency Medical Services, Hospital Association and Ambulance Alliance to improve patient transfer times from the ambulance to hospital emergency departments. Oregon (HB 4081) created a statewide program to establish emergency care standards, workforce development initiatives and an EMS data management system. Oversight is provided by the Oregon State EMS medical director and an advisory board.
By addressing workforce, infrastructure and administrative challenges, states aim to improve the quality, effectiveness and efficiency of care provided by EMS systems. These legislative efforts not only support EMS clinicians but also ensure communities are better prepared for emergencies.
To learn more, see NCSL’s EMS Legislation Database, which features enacted bills across a variety of topics from across all 50 states, Washington, D.C., and the territories.
Aneesa Turbovsky is a policy analyst in NCSL’s Health Program.
NCSL acknowledges the NHTSA for its support of this publication. Please note that NCSL takes no position on state legislation or laws mentioned in linked material, nor does NCSL endorse any third-party publications; resources are cited for informational purposes only.