How did 9/11 change EMS in the United States?

The September 11, 2001 attacks exposed critical gaps in mass casualty response, interagency communication, and first responder coordination. In the aftermath, the federal government invested heavily in disaster preparedness, created the Department of Homeland Security, and integrated EMS into national incident management systems. The tragedy also accelerated adoption of evidence-based protocols and national data systems for EMS.

What is the EMS Agenda for the Future?

Published in 1996 by NHTSA, the EMS Agenda for the Future was a visionary document that outlined 14 attributes of a ideal EMS system and set a strategic direction for the profession. It called for EMS to evolve from a transport-focused service into an integrated component of the healthcare system, with emphasis on evidence-based practice, information systems, and clinical sophistication.

Era 5: Clinical Maturation & System Integration (2000

2000 7 events

Strategic Plan Adopted by the National Registry Board

The National Registry Board of Directors adopted its first formal strategic plan to guide the development of national EMS certification. This effort marked a shift toward long-term organizational planning and evidence-based leadership. The LEADS committee completed its second national EMS workforce survey, laying the groundwork for future data-driven decisions.

EMS Education Agenda Released

In 2000, the EMS Education Agenda for the Future: A Systems Approach was released, refining the vision of the 1996 Agenda by outlining a structured, integrated, and nationally consistent framework for EMS education and certification.

The Education Agenda called for alignment of national EMS education standards, curricula, certification, and accreditation. It provided the blueprint for how EMS clinicians should be prepared—from instructional content to credentialing and ongoing competency.

View source (EMS.gov PDF)
EMS Education Agenda — Systems Approach (local PDF)

Pediatric Ambulance Safety Standards Released

National pediatric ambulance transport standards were established to improve safety protocols for children in EMS vehicles. This helped catalyze the development of child-specific restraints and treatment policies, reducing the risk of injury during transport.

Ambulance Defined by State Law (Virginia)

The Virginia General Assembly officially defined “ambulance” as any vehicle, vessel, or aircraft permitted by the Office of EMS. This provided a clear regulatory baseline for EMS transport, ensuring consistency in licensing and safety standards across the Commonwealth.

International Board of Specialty Certification (IBSC) Founded

The International Board of Specialty Certification (IBSC) began as the Board for Critical Care Transport Paramedic Certification (BCCTPC) and offered its first specialty certifications in 2000. Focused initially on critical care transport and tactical paramedicine, the organization has grown into a global leader supporting paramedics in specialized fields. Its certifications set professional standards for advanced clinical roles beyond standard EMS practice.

IBSC Certification Banner

Source: PubMed Article

JRC‑EMT‑P Becomes CoAEMSP

In 2000, the Joint Review Committee on Education Programs for the EMT‑Paramedic (JRC‑EMT‑P) was officially renamed the Committee on Accreditation of Emergency Medical Services Professions (CoAEMSP). This change reflected the expanding scope and formalization of EMS education. For administrative efficiency, the CoAEMSP was co‑located with the accreditation committee for respiratory therapy programs.

Historical Note: The lineage of EMS program accreditation can be traced back to 1975, when the National Registry of EMTs and Dr. J.D. Farrington formally requested the American Medical Association (AMA) to recognize EMT‑Paramedic as a legitimate allied health profession. Although the accrediting body’s name has changed over time, its foundational purpose—ensuring the quality and legitimacy of paramedic education in the United States—remains constant.

GPS Accuracy Enhanced for Civilian Use

On May 1, 2000, President Bill Clinton ordered the removal of "Selective Availability" from the Global Positioning System (GPS), significantly improving the accuracy of civilian GPS receivers. Originally developed for military use, GPS had been available to civilians since 1983, but its precision was intentionally degraded for non-military users.

The removal of this restriction enabled accurate, real-time location tracking and revolutionized public safety and emergency response. EMS systems could now more effectively route ambulances, track resources, and improve response times—ushering in the modern era of location-based services and mobile navigation.

Connecticut NHTSA EMS Reassessment

NHTSA reassessed Connecticut's EMS system, following the 1991 initial assessment. The report documented the revitalization of the Office of EMS under Commissioner Joxel Garcia after the mid-1990s downsizing that had abolished the EMS Director position, noting that EMS legislation was passed and staffing increased from eight to thirteen FTEs.

2001 7 events

GAO Report on EMS Preparedness

In 2001, at the direction of Congress, the Government Accountability Office (GAO) released a report assessing the state of local emergency medical services across the country. The report concluded that "local emergency medical services have reported substantial needs for improving the emergency care they provide."

The GAO found that while EMS played a vital role in community health and disaster preparedness, it remained underfunded, fragmented, and often excluded from federal preparedness initiatives. The report raised national awareness of longstanding structural and financial challenges facing EMS providers.

Read the full GAO Report (PDF link pending)

National Registry Exams Used by 43 States and Territories

The adoption of the National Registry exams by 43 states and territories marked a significant milestone in national certification standardization, strengthening reciprocity and professional mobility across state lines.

Peter Safar Publishes History of EMS

In 2001, Dr. Peter Safar—widely known as the "Father of CPR"—published a personal and professional account of the development of modern Emergency Medical Services. His paper provides one of the most authoritative and firsthand histories of the EMS field, as shaped by a life devoted to resuscitation science and prehospital care.

Dr. Safar's contributions laid the foundation for countless EMS protocols and systems worldwide. This document offers critical insight into the clinical, academic, and global evolution of EMS from the perspective of one of its most transformative figures.

Read the full publication (PDF)

NEMSIS Project Launched

Thirty years after Dr. Peter Safar envisioned the need for computerized EMS record analysis, the National EMS Information System (NEMSIS) was formally launched in 2001. NEMSIS created a unified national database to standardize EMS patient care reporting across all 50 states.

NEMSIS became the backbone of EMS performance benchmarking, quality improvement, and policy development. It allowed researchers and policymakers to analyze millions of EMS events, uncover trends, and enhance clinical and operational protocols.

View source (EMS.gov 2021 Newsletter)

Introduction of the GlideScope® Video Laryngoscope

In 2001, the GlideScope® became the first commercially available video laryngoscope, revolutionizing airway management in prehospital and hospital settings. By positioning the camera away from the tip, the device provided an enhanced perspective and improved visualization of the vocal cords, significantly increasing first-pass success in difficult airway cases. It marked a major innovation in airway control, especially critical in emergency and trauma settings.

The original GlideScope® video laryngoscope design.
Image: Wikimedia Commons

Learn more about the history of laryngoscopy

EMS Research Agenda Released

In 2001, the National Highway Traffic Safety Administration (NHTSA) and the Maternal and Child Health Bureau jointly released the EMS Research Agenda. This document outlined national priorities to strengthen the scientific foundation of emergency medical services and improve evidence-based care.

The agenda emphasized the need for greater investment in EMS research, better integration with academic institutions, and enhanced data collection to inform future protocols, training, and system design.

View source (EMS History PDF)

National Event

September 11 – Terrorist Attacks on the U.S.

EMS providers were among the first responders to the attacks on the World Trade Center and Pentagon. The tragic loss of life and large-scale emergency response led to the creation of national initiatives such as the Department of Homeland Security and major changes in emergency preparedness, communications, and funding for EMS and public safety agencies.

2002 5 events

The History of Modern EMS (2002 Version)

In 2002, EMS pioneer James O. Page, JD — Publisher Emeritus of JEMS — wrote and hosted the updated documentary The History of Modern EMS, a 51-minute visual journey through the development of emergency medical services in the United States. The film captured key milestones, innovations, and influential leaders who shaped modern EMS. This was an update to Page's original 1997 documentary EMS: Making a Difference.

Page's earlier scholarship on the medical-legal framework for EMS, including his 1980 article documenting ~40 prehospital lawsuits with zero losses under medical control and the "borrowed servant" doctrine governing paramedic-hospital relationships, helped shape the profession's legal foundations.

State Assessment

NHTSA State EMS Assessment: South Dakota

NHTSA assessed South Dakota's EMS system, evaluating progress and identifying ongoing challenges in rural and frontier EMS service delivery.

Note: a PDF long archived under the filename “2002 NHTSA NevadaReassessmentFinal” is actually the February 2009 Nevada reassessment — Nevada's NHTSA assessments took place in 1991 and 2009, with no 2002 reassessment.

Therapeutic Hypothermia Improves Cardiac Arrest Outcomes

In 2002, two randomized trials in the New England Journal of Medicine reported that cooling comatose survivors of out-of-hospital cardiac arrest to roughly 32 to 34 degrees Celsius improved neurologically intact survival. International guidelines endorsed the practice in 2003.

The findings launched targeted temperature management as a standard post-resuscitation therapy and prompted EMS systems to develop prehospital cooling protocols, though later trials refined the optimal temperature target.

NEJM: Mild Therapeutic Hypothermia after Cardiac Arrest

Public Health Security and Bioterrorism Preparedness Act Signed

President Bush signed P.L. 107-188 on June 12, 2002, establishing a national framework for public health and bioterrorism preparedness. The Act created the Strategic National Stockpile, expanded hospital preparedness grants, and formally positioned first responders — including EMS — as essential components of the federal emergency preparedness infrastructure.

The legislation was a direct response to the September 11 attacks and the subsequent anthrax mailings. It authorized new funding streams that would flow to state and local EMS agencies for training, equipment, and interoperability — accelerating EMS integration into the broader public health and homeland security ecosystem.

View the legislation on Congress.gov

First Registry Fee Increase Since 1973

The National Registry implemented a fee increase for the first time in nearly 30 years. This change allowed for reinvestment in technology, research, and operational sustainability.

“Four-for-Life” Legislation Passed (Virginia)

Virginia passed legislation increasing EMS funding to $4 per vehicle registration to support workforce development, training, and local EMS system improvement. Although withheld for homeland security in 2002, the funds were restored in 2004.

2003 4 events

HIPAA and Bioterrorism Roles Defined

The implementation of HIPAA brought new compliance responsibilities to EMS agencies. Simultaneously, HHS formally recognized EMS as a frontline responder to bioterrorism and public health emergencies.

National EMS Research Program Launched

The National Registry created its first dedicated research program to advance test development and patient safety. It also achieved full national accreditation (NCCA) for all five certification levels, affirming the credibility and rigor of its exams.

First Multiagency EMS Data Integration for Homeland Security

The Indianapolis-Hamilton County, Indiana UASI project pioneered the integration of EMS agencies into a central health information exchange (HIE). This effort marked the first large-scale deployment of electronic patient care reports (ePCRs) across multiple EMS agencies for real-time syndromic surveillance.

Funded under the Urban Area Security Initiative (UASI), the project demonstrated the potential for EMS data to support public health alerts and homeland security monitoring. It became a foundational model for future EMS-HIE collaborations nationwide.

LUCAS CPR Device Introduced

The LUCAS (Lund University Cardiac Assist System) device was first introduced in 2003 following years of development in Sweden. It was created to provide consistent, high-quality mechanical chest compressions in environments where manual CPR may be difficult—such as during ambulance transport, in tight spaces, or for prolonged resuscitation efforts. The system improved outcomes by reducing interruption and ensuring adherence to compression depth and rate standards.

Learn more on Wikipedia

Image: LUCAS CPR device demonstration (JASDF, 2014). Source: Wikimedia Commons

2004 6 events

King Airway Introduced to EMS

While supervising paramedic students in the operating room, educator Donnie Woodyard observed a member of the King Systems R&D team demonstrating a new anesthesiology device. With King Systems headquartered just down the road in Noblesville, Indiana, Woodyard recognized its potential for prehospital care and initiated collaboration to adapt the device for EMS. Later that year, Indiana formally approved the King LT airway for both EMT and Paramedic use—marking the start of its widespread adoption in prehospital airway management.

View Source

Read the original 2004 news article on the King LT-D (PDF)

OPALS Study Reframes the Value of Prehospital ALS

In August 2004, the Ontario Prehospital Advanced Life Support study reported that adding paramedic advanced life support to an optimized rapid-defibrillation system did not improve survival to discharge for out-of-hospital cardiac arrest, across more than five thousand patients in seventeen cities.

OPALS challenged long-held assumptions about the value of prehospital ALS for cardiac arrest and helped refocus EMS resuscitation priorities toward high-quality CPR, early defibrillation, and bystander response.

NEJM: Advanced Cardiac Life Support in Out-of-Hospital Cardiac Arrest

Cardiac Arrest Registry to Enhance Survival Founded

In 2004, the CDC partnered with Emory University to create CARES, a standardized registry linking 911, EMS, and hospital data for out-of-hospital cardiac arrest. Data collection began in Atlanta in 2005 and later grew to more than a thousand EMS agencies nationwide.

CARES gave EMS systems the benchmarking backbone needed to measure and improve cardiac arrest survival, underpinning much of the modern resuscitation quality-improvement movement.

CARES: About the Registry

Virginia EMS Sustainability Review Released

The 2004 Review of Emergency Medical Services in Virginia identified major sustainability concerns for the Commonwealth’s EMS system. It highlighted the lack of a legal requirement for localities to provide EMS coverage, resulting in over-reliance on volunteerism and inconsistent financial support. Over 25% of certified providers were unaffiliated with any agency, and the availability of advanced life support (ALS) training—especially in rural areas—was limited. The report also pointed to untapped billing revenue, rising training demands, and the absence of standardized response benchmarks, all of which threaten the long-term viability and equity of EMS across Virginia.
Read the full report (PDF link pending)

Rural and Frontier EMS Agenda for the Future

Recognizing the unique challenges faced by rural communities, this national agenda outlined a vision for strengthening EMS in rural and frontier areas. It emphasized workforce shortages, geographic barriers, funding inequities, and the need for adaptable, community-based solutions.

Published in collaboration with NHTSA and rural EMS stakeholders, the document served as a strategic guide for federal, state, and local action to improve rural emergency care delivery.

View full report (PDF link pending)

State Assessment

NHTSA State EMS Assessments: Maine and Mississippi

NHTSA technical assessments of Maine and Mississippi documented the distinct challenges facing EMS in northeastern rural systems and southern states, contributing to the growing body of evidence on regional EMS disparities.

2004 Maine NHTSA Final Report (PDF)

2004 Mississippi NHTSA Assessment (PDF)

National Incident Management System (NIMS) Developed

In 2004, the U.S. Department of Homeland Security established the National Incident Management System (NIMS) to standardize emergency response across all levels of government and disciplines. NIMS provided a unified framework for coordination among federal, state, tribal, and local responders during incidents of all types and sizes. Its implementation significantly impacted EMS operations by defining roles within the Incident Command System (ICS), ensuring EMS integration in national preparedness.

View source (FEMA – 20 Years of NIMS)

EZ-IO Device Receives FDA Clearance

The EZ-IO, a handheld battery-powered intraosseous (IO) access device developed by Vidacare, received FDA clearance in 2004. This device transformed emergency vascular access in EMS.

The EZ-IO allowed EMS clinicians to quickly and safely deliver fluids and medications directly into the bone marrow when traditional intravenous access was not feasible—especially in critical trauma or cardiac arrest cases.

Replacing the older manual IO hand-drill method, the EZ-IO made intraosseous access faster, more consistent, and more widely adopted in both prehospital and in-hospital emergency care settings.

View Image

State Assessment

Maryland NHTSA EMS Reassessment

NHTSA reassessed Maryland's EMS system, evaluating progress on prior recommendations and examining the state's integrated EMS-trauma system model, medical direction infrastructure, communications systems, and workforce development.

2004 Maryland NHTSA Reassessment (PDF)

2005 4 events

National Event: Hurricane Katrina Hits During JEMS Conference

Hurricane Katrina devastated the Gulf Coast in August 2005 while EMS professionals were gathered at the national JEMS Conference. The storm overwhelmed local infrastructure, displacing medical systems and responders. Many EMS leaders, including conference attendees, were immediately deployed or redirected to aid in the response. The event underscored the critical need for EMS disaster readiness, mutual aid, and national coordination.

Hurricane Katrina EMS response

Source: JEMS – The Chaos of Katrina

Federal Interagency Committee on EMS (FICEMS) Established

Congress formally established the Federal Interagency Committee on Emergency Medical Services (FICEMS) in 2005 to strengthen coordination across federal agencies that support local, state, tribal, territorial, and regional EMS and 911 systems. FICEMS serves as a platform for interagency collaboration aimed at improving the delivery and effectiveness of EMS nationwide.

Legislative Text (PDF) | Learn More

Ferno Powerflex: First Battery-Powered “X” Frame Cot

In 2005, Ferno introduced the first battery-powered “X” frame cot — the Powerflex. Designed to reduce lifting-related injuries and improve safety for EMS crews, the Powerflex could raise or lower patients up to 700 pounds unassisted. This innovation significantly eased physical strain on ambulance personnel and marked a turning point in EMS transport ergonomics.

Stryker followed in 2006 with a similar design, launching the Power-PRO stretcher system.

Ferno Powerflex Cot

Image courtesy of the National EMS Museum

State Assessment

Montana NHTSA EMS Reassessment

NHTSA reassessed Montana's EMS system, fourteen years after the 1991 initial assessment. The Technical Assistance Team found the Section 'unable to address many of the 1991 recommendations' due to chronic underfunding and staffing limitations. Despite trauma enabling legislation passing in 1995, it remained inadequately funded, and no state EMS medical director, statewide protocols, functional data system, or completed statewide EMS plan existed.

2005 Montana NHTSA Reassessment (PDF)

LifeNet EMS: Two Indiana Counties Build a Unified EMS Data Network

Building on Riverview Hospital’s 2002 multitenant electronic patient care reporting system, Hamilton and Marion Counties combined their parallel data projects into LifeNet EMS, funded by a $4.4 million Department of Homeland Security Urban Area Security Initiative grant. The partnership put ruggedized tablet PCs on 241 certified EMS vehicles across more than two dozen fire departments and ambulance services, streamed cardiac-monitor data, delivered EMS charts directly into receiving hospitals’ information systems, and fed a unified two-county patient care database—its stated goal, per the project’s own implementation records, “creation of the largest multi-department EMS database in the world.” A companion UASI project built a regional fiber-optic ring linking Riverview and Wishard hospitals, both counties, the cities of Noblesville, Carmel, Fishers, and Westfield, and the State of Indiana—the first fiber network built to carry EMS data.

2006 3 events

Four-for-Life Budget Bill Enacted (Virginia)

Virginia codified the distribution percentages for EMS vehicle registration funding, improving transparency and enabling targeted investment in certification and training initiatives.

National EMS Museum Organized

With support from a start-up grant by the National Association of EMTs (NAEMT) and private donations, the National EMS Museum was founded to preserve the history of prehospital medicine and honor the pioneers of EMS in the United States.

Learn more

State Assessment

NHTSA State EMS Assessments: Nebraska and Oregon

NHTSA conducted needs assessments in Nebraska and Oregon, examining EMS system capacity in states with significant rural and frontier service areas. The reports documented challenges in workforce recruitment, response times, and system funding.

2006 Oregon NHTSA Assessment (PDF)

2007 5 events

National EMS Scope of Practice Model Published

In 2007, the National Highway Traffic Safety Administration (NHTSA), in partnership with the National Association of State EMS Officials (NASEMSO), published the National EMS Scope of Practice Model. This foundational document formally defined the roles, responsibilities, and clinical competencies of EMS personnel across four levels: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced EMT (AEMT), and Paramedic.

The model was designed to promote consistency in EMS education, certification, and licensure nationwide, laying the groundwork for future updates to education standards, testing, and clinical protocols.

View the full 2007 Scope of Practice Model (PDF)

EMS at the Crossroads — IOM Report, 2007 (PDF)

GAO Report on Ambulance Provider Costs

The Government Accountability Office (GAO) published a congressional report analyzing the costs and expected Medicare margins for ambulance service providers. The findings revealed a mismatch between actual service costs and Medicare reimbursement rates, raising concerns about financial sustainability for EMS agencies.

The report provided data-driven insight into how Medicare policies impacted EMS operations, especially in rural and high-cost regions, and influenced ongoing debates over EMS funding models.

View full GAO report (PDF)

State Assessment

NHTSA State EMS Reassessments: Kansas and Michigan

NHTSA reassessments of Kansas and Michigan evaluated EMS system maturation in both a rural Great Plains state and a large industrial Midwest state, documenting progress and persistent challenges in system coordination and funding.

2007 Kansas NHTSA Reassessment (PDF)

2007 Michigan NHTSA Reassessment (PDF)

Computer-Based Testing Fully Launched Nationwide

In 2007, the National Registry of EMTs completed its nationwide rollout of Computer-Based Testing (CBT) at over 300 Pearson VUE testing centers. This historic shift allowed EMS candidates to schedule exams year-round, receive faster results, and experience adaptive testing tailored to individual performance.

The transition to CBT modernized the certification process, improved exam security, and set a new standard for health professions testing. NREMT became the first national certification organization in the U.S. to implement computer-adaptive testing in emergency care.

“EMS at the Crossroads” Published by the Institute of Medicine

This seminal report by the Institute of Medicine identified critical fragmentation within EMS systems and recommended structural reforms. It advocated for greater federal leadership, improved data systems, workforce development, and integration with public health and emergency preparedness systems.

“EMS at the Crossroads” became a foundational text in national EMS policy dialogue and helped catalyze long-term federal and state-level changes in system design and oversight.

View full report (National Academies Press)

2008 2 events

EMS Integrated into U.S. Fire Administration Law

In 2008, Congress amended Public Law 92-498 to formally include Emergency Medical Services as a component of the U.S. Fire Administration. This legislative change acknowledged the intertwined nature of fire and EMS response and supported a more unified approach to emergency services at the federal level.

The amendment reinforced the role of EMS in national emergency preparedness, policy development, and workforce support under the U.S. Fire Administration’s guidance.

View Source Document (PDF link pending)

Prehospital ECG Guidelines for STEMI Patients

In 2008, the American Heart Association (AHA) issued national guidelines recommending that EMS systems routinely acquire and interpret prehospital 12-lead ECGs for patients with suspected ST-segment–elevation myocardial infarction (STEMI). These recommendations reinforced the critical role of EMS in early cardiac care and drove nationwide adoption of ECG-capable monitors in ambulances.

View Full Guideline

2009 4 events

National EMS Education Standards Released

In 2009, the National Highway Traffic Safety Administration (NHTSA) published the National EMS Education Standards, establishing a comprehensive and uniform framework for EMS education across the United States. These standards defined the knowledge and competencies for all EMS clinician levels — EMR, EMT, AEMT, and Paramedic — and replaced the outdated National Standard Curricula.

The Standards aligned with the National EMS Scope of Practice Model and provided educators, regulators, and providers with a modernized instructional guide rooted in competency-based education. They have since become the national benchmark for EMS instructional programs and certification exams.

View the Standards (NHTSA)

National EMS Education Standards — full document (PDF)

Yale Thesis: Rise of Emergency Medicine in the 1960s (PDF)

Launch of Community Paramedic Programs

In 2009, several groundbreaking Community Paramedicine programs were launched across the United States. Eagle County, Colorado, initiated the country’s first rural community paramedic program to address healthcare gaps in underserved areas. That same year, Fort Worth, Texas, and Wake County, North Carolina, also launched early community paramedic efforts. These programs represented a major evolution in EMS, expanding paramedic roles to include preventive care, chronic disease management, and behavioral health support—often delivered in patients’ homes or community-based settings.

Community paramedic conducts a home visit.
Image Credit: JEMS

Eagle County Community Paramedic Program: 10-Year Anniversary

Online Recertification Launched by the Registry

Digital recertification replaced paper processes, increasing efficiency for EMS clinicians and simplifying state tracking. The Registry also realigned exam content into five domain areas and initiated a new psychomotor competency portfolio model.

State Assessment

NHTSA State EMS Assessments: Colorado and Oklahoma

Colorado received a legislative EMS report and Oklahoma underwent a NHTSA reassessment, both documenting the ongoing evolution of state-level EMS systems. These assessments highlighted workforce sustainability, funding mechanisms, and the integration of EMS into broader healthcare systems.

2009 Oklahoma NHTSA Reassessment (PDF)

State Assessment

Nevada NHTSA EMS Reassessment

NHTSA conducted its second reassessment of Nevada's EMS system, following the 1991 initial assessment. The report examined a state of geographic and demographic extremes, where well-resourced urban centers contrasted with rural volunteer agencies struggling to staff two EMT-Basics, and documented OEMS staffing shortfalls, declining volunteerism, and informal hospital relationships.

2009 Nevada NHTSA Reassessment (PDF)

2010 3 events

Record Participation in National Registry Exams

A total of 140,686 EMS professionals completed National Registry certification exams — a historic peak. That same year, NASEMSO formally recognized the National Registry as the National EMS Certification body, reinforcing national alignment.

NREMT Annual Report, 2010 (PDF)

NASEMSO Reaffirms Single Paramedic Accreditation Board

In 2010, the National Association of State EMS Officials (NASEMSO) passed a formal resolution reaffirming the importance of a single national accrediting body for paramedic educational programs. This move reinforced the profession’s commitment to consistent quality standards in advanced EMS education.

The resolution emphasized the value of national consistency, public protection, and the need for a centralized authority to ensure accreditation integrity and oversight.

View full NASEMSO Resolution (PDF)

Community Paramedicine Funded Through CMS Innovation Grants

The Centers for Medicare & Medicaid Services began funding community paramedicine programs through innovation grants, allowing EMS to expand into preventive and home-based care.

State Assessment

Missouri NHTSA EMS Reassessment

NHTSA reassessed Missouri's EMS system, following the 1994 initial assessment. The report highlighted the pioneering Time Critical Diagnosis System — a first-in-the-nation law authorizing regionalized systems of care for trauma, stroke, and STEMI. The Technical Assistance Team noted the system was at a crossroads, needing to shift from a local to statewide perspective as regionalization demanded cooperation across diverse communities.

2010 Missouri NHTSA Reassessment (PDF)

2011 3 events

Revised Psychomotor Exams and AEMT Certification Begins

The National Registry introduced new psychomotor examinations for EMR, EMT, and AEMT levels. The first AEMT certifications were issued under the updated National EMS Education Standards.

NEMSAC Calls for a Federal Lead Agency

In 2011, the National EMS Advisory Council (NEMSAC) released a formal position paper advocating for the establishment of a designated federal lead agency for Emergency Medical Services. The council emphasized that EMS lacked unified national leadership, hindering progress and integration with broader healthcare and emergency preparedness systems.

The paper outlined structural barriers and fragmentation within federal EMS oversight, recommending that a single agency be given formal responsibility and funding authority to coordinate and advance EMS across the United States.

Read the full position paper (PDF)

State Assessment

Ohio NHTSA EMS Reassessment

NHTSA reassessed Ohio's EMS system, reviewing progress since the 2001 reassessment. The report noted that 11.5 million Ohioans depended on an EMS system that had evolved over forty years, but the lead agency lacked clear uniform regulatory authority, safety belt fine revenues were declining, and data repositories had not been fully transformed into useful policy information.

2011 Ohio NHTSA Reassessment (PDF)

EMS Workforce Agenda for the Future Published

The National Highway Traffic Safety Administration (NHTSA) publishes the "EMS Workforce Agenda for the Future," outlining a strategic vision for strengthening and sustaining the EMS workforce. It emphasizes four key focus areas: workforce data and research, education and certification, workforce planning and development, and safety, health, and wellness.

Source: EMS Workforce Agenda for the Future (NHTSA)

2012 4 events

DHS Grant Launches EMS Compact Project

The Department of Homeland Security awarded a grant to NASEMSO to develop an interstate EMS licensure compact addressing national workforce mobility and disaster deployment concerns.

State Assessment

Wisconsin NHTSA EMS Reassessment

NHTSA conducted its third reassessment of Wisconsin's EMS system, following the 1990 initial assessment and 2001 reassessment. The Technical Assistance Team recognized tremendous strides over 22 years while warning that state EMS funding had decreased in absolute terms and EMS had been demoted within the governmental bureaucracy, threatening infrastructural erosion of a system built on volunteerism and community spirit.

2012 Wisconsin NHTSA Reassessment (PDF)

Congress Establishes FirstNet

First authorized by Congress in 2012, the First Responder Network Authority (FirstNet) was created under the Middle Class Tax Relief and Job Creation Act (Public Law 112–96). The law allocated $7 billion and 20 MHz of spectrum to build the first nationwide, high-speed broadband network dedicated to public safety. The FirstNet Authority was tasked with ensuring deployment, rural coverage, and long-term operation of the network. Its inaugural board meeting was held on September 25, 2012.

Image: FirstNet.gov

2013 3 events

Intermediate Certifications Retired (I/85 & I/99)

Initial certifications for EMT-Intermediate levels were phased out, consolidating licensure around the revised Scope of Practice and supporting national consistency.

EMS Compact Drafting and Governance Structure Created

National advisory panels met to shape the EMS Compact. Drafting teams wrote the model legislation during meetings in June, August, and October, forming the foundation for future adoption.

The Drafting Team consisted of:

National Association of State EMS Officials
Council of State Governments
Association of Air Medical Services
International Association of Flight and Critical Care Paramedics
International Association of Firefighters
National EMS Management Association
National Association of EMTs
Vedder Price Law Firm

ABEM Launches EMS Subspecialty Certification

In fall 2013, following the approval by the American Board of Medical Specialties in September 2010, the American Board of Emergency Medicine (ABEM) awarded its first board certifications in Emergency Medical Services medicine. This created a standardized pathway and credential for physicians specializing in pre-hospital and out‑of‑hospital care.

The certification arose from a dedicated task force and a published Core Content outlining key EMS knowledge domains—enhancing physician training, patient safety, and integration of pre-hospital care into the healthcare continuum.
NAEMSP Overview

Offerings continue biennially, supported by fellowship programs accredited by the ACGME:
EMRA Fellowship Guide | ABEM Certification Info

State Assessment

NHTSA State EMS Reassessments: Connecticut and Florida

NHTSA conducted reassessments of EMS systems in Connecticut and Florida. The Connecticut assessment found a system advanced in some areas yet undeveloped in others, serving 169 municipalities without county government. The Florida reassessment — initiated after discord drew national attention — found the 4th most populous state's trauma system operating as a 'loose aggregation of trauma centers with little cooperation and almost no central coordination,' with only two ambulance inspectors for over 4,000 permitted vehicles.

2013 Florida NHTSA Reassessment (PDF)

2010 3 events

Record Participation in National Registry Exams

A total of 140,686 EMS professionals completed National Registry certification exams — a historic peak. That same year, NASEMSO formally recognized the National Registry as the National EMS Certification body, reinforcing national alignment.

NREMT Annual Report, 2010 (PDF)

NASEMSO Reaffirms Single Paramedic Accreditation Board

In 2010, the National Association of State EMS Officials (NASEMSO) passed a formal resolution reaffirming the importance of a single national accrediting body for paramedic educational programs. This move reinforced the profession’s commitment to consistent quality standards in advanced EMS education.

The resolution emphasized the value of national consistency, public protection, and the need for a centralized authority to ensure accreditation integrity and oversight.

View full NASEMSO Resolution (PDF link pending)

Community Paramedicine Funded Through CMS Innovation Grants

The Centers for Medicare & Medicaid Services began funding community paramedicine programs through innovation grants, allowing EMS to expand into preventive and home-based care.

2011 3 events

Revised Psychomotor Exams and AEMT Certification Begins

The National Registry introduced new psychomotor examinations for EMR, EMT, and AEMT levels. The first AEMT certifications were issued under the updated National EMS Education Standards.

NEMSAC Calls for a Federal Lead Agency

In 2011, the National EMS Advisory Council (NEMSAC) released a formal position paper advocating for the establishment of a designated federal lead agency for Emergency Medical Services. The council emphasized that EMS lacked unified national leadership, hindering progress and integration with broader healthcare and emergency preparedness systems.

The paper outlined structural barriers and fragmentation within federal EMS oversight, recommending that a single agency be given formal responsibility and funding authority to coordinate and advance EMS across the United States.

Read the full position paper (PDF)

EMS Workforce Agenda for the Future Published

The National Highway Traffic Safety Administration (NHTSA) publishes the "EMS Workforce Agenda for the Future," outlining a strategic vision for strengthening and sustaining the EMS workforce. It emphasizes four key focus areas: workforce data and research, education and certification, workforce planning and development, and safety, health, and wellness.

Source: EMS Workforce Agenda for the Future (NHTSA)

View the EMS Workforce Agenda for the Future (PDF link pending — S3 source link in entry body has expiry date)

2012 4 events

DHS Grant Launches EMS Compact Project

The Department of Homeland Security awarded a grant to NASEMSO to develop an interstate EMS licensure compact addressing national workforce mobility and disaster deployment concerns.

Congress Establishes FirstNet

First authorized by Congress in 2012, the First Responder Network Authority (FirstNet) was created under the Middle Class Tax Relief and Job Creation Act (Public Law 112–96). The law allocated $7 billion and 20 MHz of spectrum to build the first nationwide, high-speed broadband network dedicated to public safety. The FirstNet Authority was tasked with ensuring deployment, rural coverage, and long-term operation of the network. Its inaugural board meeting was held on September 25, 2012.

Image: FirstNet.gov

EMT-Paramedic Certification Retired for Entry-Level

The National Registry retired the EMT-Paramedic certification as an initial entry pathway, requiring all new paramedics to meet enhanced curriculum and accreditation standards.

FEMA Publishes Handbook for EMS Medical Directors

In 2012, the U.S. Fire Administration and FEMA released the Handbook for EMS Medical Directors. This foundational document provides guidance for physicians serving in EMS medical oversight roles, emphasizing clinical governance, protocol development, quality assurance, and the evolving role of the EMS Medical Director in modern systems.

The handbook helped professionalize and standardize expectations for physician involvement in EMS operations nationwide.

Source: FEMA/USFA Publication PDF

2013 3 events

Intermediate Certifications Retired (I/85 & I/99)

Initial certifications for EMT-Intermediate levels were phased out, consolidating licensure around the revised Scope of Practice and supporting national consistency.

EMS Compact Drafting and Governance Structure Created

National advisory panels met to shape the EMS Compact. Drafting teams wrote the model legislation during meetings in June, August, and October, forming the foundation for future adoption.

The Drafting Team consisted of:

National Association of State EMS Officials
Council of State Governments
Association of Air Medical Services
International Association of Flight and Critical Care Paramedics
International Association of Firefighters
National EMS Management Association
National Association of EMTs
Vedder Price Law Firm

ABEM Launches EMS Subspecialty Certification

In fall 2013, following the approval by the American Board of Medical Specialties in September 2010, the American Board of Emergency Medicine (ABEM) awarded its first board certifications in Emergency Medical Services medicine. This created a standardized pathway and credential for physicians specializing in pre-hospital and out‑of‑hospital care.

The certification arose from a dedicated task force and a published Core Content outlining key EMS knowledge domains—enhancing physician training, patient safety, and integration of pre-hospital care into the healthcare continuum.
NAEMSP Overview

Offerings continue biennially, supported by fellowship programs accredited by the ACGME:
EMRA Fellowship Guide | ABEM Certification Info

2014 8 events

FAA Issues Landmark Helicopter Air Ambulance Safety Rule

In February 2014, after a surge in fatal air ambulance crashes, the FAA issued sweeping rules requiring stricter weather minimums, preflight risk analysis, operations control centers, terrain-awareness equipment, and flight data monitoring for helicopter air ambulances.

The rule was the most significant federal safety intervention in air medical history, directly targeting one of the most dangerous roles in EMS and reshaping how helicopter programs assess and accept risk.

Federal Register: Helicopter Air Ambulance Final Rule

Electronic Certification Cards (eCards) Introduced

The National Registry launched secure, digital certification cards, modernizing proof-of-credential processes and streamlining system access.

National Model EMS Clinical Guidelines Released

In September 2014, the National Association of State EMS Officials (NASEMSO) released the first edition of the National Model EMS Clinical Guidelines. This landmark document offered evidence-based recommendations to guide EMS care across diverse states and systems, supporting consistency, quality, and adaptability in prehospital practice.

Developed through a collaborative effort of clinicians, educators, and medical directors, the guidelines addressed core treatment protocols and emerging practices, promoting alignment with the National EMS Education Standards and Scope of Practice Model.

View official release from NASEMSO

NCCP Pilot Launched in Alabama

Alabama became the first state to implement the National Continued Competency Program (NCCP), emphasizing flexible, competency-based recertification aligned with clinical relevance and evidence-based content.

EMS Compass Project Launched

The EMS Compass project, launched in 2014, was a national initiative to improve Emergency Medical Services (EMS) through the development of meaningful performance measures. Funded by the National Highway Traffic Safety Administration (NHTSA) and led by the National Association of State EMS Officials (NASEMSO), the project established benchmarks and data-driven processes to enhance system accountability, clinical care, and patient outcomes.

Image: EMS Compass Project – NASEMSO/NHTSA

First Mobile Stroke Unit Launches in the U.S.

In 2014, Dr. James Grotta launched the nation’s first Mobile Stroke Unit at the University of Texas Health Science Center at Houston in partnership with Memorial Hermann Hospital. This groundbreaking initiative brought stroke care directly to patients, equipping the vehicle with a portable CT scanner and clot-busting tPA medications to begin treatment immediately at the scene—dramatically improving outcomes by reducing time to intervention.

Image: UTHealth / Memorial Hermann

Learn more about Mobile Stroke Units

NFPA 1917 Ambulance Design Standards Adopted

The adoption of new ambulance manufacturing standards improved safety, ergonomics, and operational consistency across the nationwide fleet of EMS vehicles.

The National Fire Protection Association (NFPA) developed NFPA 1917 as the comprehensive standard for automotive ambulances in the U.S. It replaced the long-standing KKK-A-1822 federal specification and introduced stricter safety and equipment guidelines.

View the NFPA 1917 Standard

EMS Compact Model Legislation Released

In 2014, a coalition of stakeholders representing state EMS officials, national organizations, and legal experts released model legislation for the Recognition of EMS Personnel Licensure Interstate Compact (REPLICA). This Compact enables qualified EMS professionals to practice across state lines without obtaining additional licenses, supporting workforce mobility and coordinated emergency response.

The Compact builds upon the success of similar licensure compacts in nursing and medicine and includes provisions for background checks, data sharing, and accountability. As of today, 24 states have enacted the Compact into law.

View Source Document (PDF link pending)

EMS Recognized as a Public Good

The National Highway Traffic Safety Administration (NHTSA) publishes a foundational analysis titled "An Analysis of Prehospital Emergency Medical Services as an Essential Service and as a Public Good in Economic Theory." The report frames EMS as an essential, non-excludable, and non-rivalrous service that justifies government intervention and funding.

This analysis influenced subsequent policy debates by reinforcing the role of EMS as critical public infrastructure, essential to public safety and health equity—especially in underserved areas.

View Source Document (PDF link pending)

State Assessment

Alaska NHTSA EMS Reassessment

NHTSA reassessed Alaska's EMS system, following the 1999 reassessment. The Technical Assistance Team addressed the extraordinary challenges of delivering EMS across 663,000 square miles where communities are often widely dispersed and not connected by roads, highlighting the blending of traditional Inupiat values with modern emergency medicine.

2014 Alaska NHTSA Reassessment (PDF)

2015 4 events

Colorado Joins the EMS Compact

Colorado enacted HB1015, becoming the first state pass the REPLICA legislation and join the EMS Compact.

Texas Joins the EMS Compact

Texas passed HB2498, affirming its commitment to multistate EMS licensure and workforce mobility.

Stop the Bleed Campaign Launched

In October 2015, the White House and the American College of Surgeons launched the national Stop the Bleed campaign, training bystanders in hemorrhage control through direct pressure, wound packing, and tourniquet use. The effort grew out of the Hartford Consensus and lessons from military trauma care.

Stop the Bleed established bleeding control as a public bystander skill on par with CPR, normalizing tourniquets in civilian EMS and lay response and extending lifesaving care to the moments before EMS arrives.

Stop the Bleed: History

NAEMT Launches Tactical Emergency Casualty Care (TECC)

In response to the increasing frequency of active shooter and mass casualty incidents, the National Association of Emergency Medical Technicians (NAEMT) launched the Tactical Emergency Casualty Care (TECC) course in 2015. TECC trains EMS clinicians and first responders to deliver trauma care in high-threat environments. Adapted from military principles of Tactical Combat Casualty Care (TCCC), the course is aligned with civilian public safety needs and focuses on hemorrhage control, rapid evacuation, and coordinated response under fire.

TECC prepares EMS to respond safely and effectively in tactical situations.
Image Credit: NAEMT

Learn more about TECC at NAEMT.org

Colorado and Texas Become First States to Enact EMS Compact (REPLICA)

Colorado and Texas became the first two states to enact the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) as state law, entering into a binding interstate contract under the Compact Clause of the U.S. Constitution. Each state's legislation adopted REPLICA verbatim, committing to mutual recognition of EMS licenses, FBI-compliant background checks, and participation in a national EMS licensure database. Ten states were required to activate the Compact.

Colorado: CO Rev Stat § 24-60-3502 (effective May 8, 2015)
Texas: TX Health & Safety Code § 778A.001 (effective Sept. 1, 2015)

Cumulative EMS Compact member states: 2 of 10 required for activation.

State Assessment

Iowa NHTSA EMS Reassessment

NHTSA reassessed Iowa's EMS system, examining a state with over 3 million residents, 99 counties, and 931 authorized service programs. The Technical Assistance Team documented 'near universal calls for regionalization' from presenters and found no formalized EMS or trauma regions, an outdated 1994 statewide trauma plan, and a Bureau of Emergency and Trauma Services operating on $830,000 after grants were distributed.

2015 Iowa NHTSA Reassessment (PDF)

2016 8 events

NASEMSO Publishes “Bridging the Gap” Report

In 2016, the National Association of State EMS Officials (NASEMSO) published “Bridging the Gap: Easing the Transition from Military Medic to Civilian Paramedic.” This report explored barriers faced by military-trained medics attempting to enter the civilian EMS workforce, including differences in certification pathways, scope of practice, and regulatory challenges. It called for systemic reforms to improve veteran access to EMS licensure and recognition of military experience.

Source: NASEMSO & NAEMSE Report (2016)

NEMSAC Advisory on EMS Compact

The National EMS Advisory Council (NEMSAC) issued a formal advisory supporting the Recognition of EMS Personnel Licensure Interstate Compact (REPLICA). The advisory emphasized the importance of interstate licensure mobility, national coordination, and strengthened emergency response capacity.

View source (PDF)

NEMSAC Advisory on EMS Funding & Reimbursement

The National EMS Advisory Council (NEMSAC) published a landmark advisory in 2016 addressing the longstanding challenges of EMS funding and reimbursement. The report emphasized the need for sustainable financing mechanisms and proposed federal and state policy reforms to align EMS reimbursement with modern care delivery models.

The advisory urged a shift away from transportation-based payment models toward outcomes-based funding, recognizing EMS as a critical component of the broader healthcare and public health systems.

View Source Document (PDF link pending)

Five States Join the EMS Compact

Idaho (SB1281), Kansas (SB225), Tennessee (HB1888), Virginia enacted HB222, and Utah (HB100) expanded the Compact’s reach across the West and South.

Rolling Recertification Introduced

The Registry implemented “rolling recert,” giving providers flexibility to fulfill renewal requirements throughout their certification cycle, rather than in fixed windows.

Prehospital Use of Tranexamic Acid (TXA) in Trauma

In 2016, EMS literature and clinical protocols began formally supporting the prehospital use of Tranexamic Acid (TXA) for injured patients at risk of significant hemorrhage. TXA is an antifibrinolytic medication that reduces bleeding by stabilizing blood clots. Based on findings from both military and civilian studies, early administration of TXA in the field showed promise in reducing mortality in trauma patients with suspected internal or external hemorrhage.

Read Full Study

Spinal Immobilization Removed from Routine Trauma Care

In 2016, the National Registry released guidance reflecting a major shift in prehospital trauma care: the removal of routine spinal immobilization using long backboards. This change was based on a growing body of research showing potential harm from unnecessary immobilization.

Evidence revealed that long backboards may cause agitation, pain, pressure ulcers, aspiration risk, and unnecessary radiography. EMS protocols across the country began transitioning to selective spinal motion restriction based on clinical judgment.

Read Official Resource Document

Six States Enact EMS Compact Legislation

Virginia, Idaho, Utah, Wyoming, Kansas, and Tennessee enacted REPLICA as state law in 2016, bringing total Compact membership to eight states. Each legislature adopted the identical interstate compact language, binding their state to mutual EMS license recognition and standardized investigative protocols. The six adoptions in a single year demonstrated growing momentum toward the ten-state activation threshold.

Virginia: VA Code § 32.1-371 (effective Mar. 1, 2016)
Idaho: ID Code § 56-1013B (effective Mar. 16, 2016)
Utah: Utah Code § 53-2e-101 (effective Mar. 21, 2016)
Wyoming: WY Stat § 33-36-201 (effective Mar. 21, 2016)
Kansas: KS Stat § 65-6158 (effective Mar. 31, 2016)
Tennessee: TN Code § 68-140-602 (effective Apr. 19, 2016)

Cumulative EMS Compact member states: 8 of 10 required for activation.

2017 4 events

Georgia Joins EMS Compact

With Georgia’s enactment as the 10th state, the EMS Compact reached the threshold for activation, establishing multistate practice privileges and coordinated disaster response.

Inaugural Meeting of EMS Compact Commission

The Interstate Commission for EMS Personnel Practice held its first official meeting on October 7–8, 2017, in Oklahoma City. This meeting marked the formal launch of the Compact’s governance structure and the operational beginning of multistate EMS coordination under REPLICA.

View source (EMS Compact History)

Inaugural EMS Compact Commission Meeting 2017

October 7, 2017 — The inaugural Commissioners for the first meeting of the Interstate Commission for EMS Personnel Practice. Front (L–R): Jeanne-Marie Bakehouse (CO), Donna G. Tidwell (TN), Alisa Williams (MS), Joe Schmider (TX). Back Row (L–R): Wayne Denny (ID), Guy Dansie (UT), Diane McGinnis Hainsworth (DE), Stephen Wilson (AL), Andy Gienapp (WY), Joe House (KS), Gary Brown (VA). Not pictured: Keith Wages (GA).

Protecting Patient Access to Emergency Medications Act Signed into Law

President Trump signed the Protecting Patient Access to Emergency Medications Act (P.L. 115-83) on November 17, 2017, resolving a years-long crisis over EMS use of controlled substances. The NAEMSP-championed legislation amended the Controlled Substances Act to authorize DEA registration for EMS agencies, permit administration of Schedule II–V medications under standing and verbal orders without the physical presence of a physician, and codify protocols for vehicle restocking and field storage. The bill passed both chambers unanimously.

The legislation was a direct response to the DEA's 2014 announcement that it intended to ban the use of standing orders for controlled substances in EMS — a move that would have required paramedics to obtain individual physician authorization before administering pain medications or anti-seizure drugs. Sponsored by Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC), and Senators Bill Cassidy (R-LA) and Michael Bennet (D-CO), the Act was supported by NAEMSP, NAEMT, and ACEP. The DEA published its final implementing rule on February 5, 2026, more than eight years after enactment.

View the legislation on Congress.gov

NAEMSP: DEA Releases Final PPAEMA Rule (February 2026)

Five States Enact EMS Compact — Ten-State Activation Threshold Met

Mississippi, Nebraska, Alabama, Georgia, and Delaware enacted REPLICA as state law in 2017, pushing total membership to thirteen states and surpassing the ten-state threshold required to activate the EMS Compact. Meeting the activation threshold triggered formation of the Interstate Commission for EMS Personnel Practice, the governing body responsible for implementing Compact rules, establishing the National EMS Coordinated Database, and organizing the Commission for operational launch.

Mississippi: MS Code § 41-59-101 (effective Mar. 20, 2017)
Nebraska: NE Code § 38-3801 (effective Mar. 20, 2017)
Alabama: AL Code § 22-18-50 (effective May 17, 2017)
Georgia: O.C.G.A. Title 38, Ch. 3, Art. 4 (effective May 8, 2017)
Delaware: 16 DE Code § 98A-100 (effective Sept. 15, 2017)

Cumulative EMS Compact member states: 13. Activation threshold of 10 met.

State Assessment

Michigan NHTSA EMS Reassessment

NHTSA reassessed Michigan's EMS system, ten years after the 2007 assessment. The Technical Assistance Team recognized tremendous strides in building the state's EMS and trauma system across areas ranging from rural to highly urban, with over 3,000 miles of freshwater coast, while praising a culture of transparency that embraced external evaluation.

2017 Michigan NHTSA Reassessment (PDF)

2018 8 events

National Registry Mobile App Released

The National Registry of EMTs launched its first mobile app in 2018, allowing EMS professionals to access certification status, manage recertification requirements, and receive official updates. It quickly became one of the most downloaded medical apps in the App Store.

View source (National Registry)

Uber Health Launches

Uber launches Uber Health, a HIPAA-compliant platform enabling healthcare providers to schedule non-emergency rides for patients—helping reduce missed appointments and improve access to care.

Image credit: Uber Newsroom

Visit Uber Health

EMS Integrated into National Security Planning Under CISA

The Cybersecurity and Infrastructure Security Agency (CISA) formally includes Emergency Medical Services (EMS) as a component of the Emergency Services Sector—one of the 16 critical infrastructure sectors vital to national security and resilience. This designation recognizes EMS as essential to public safety, homeland security, and continuity of government operations.

Source: CISA Emergency Services Sector

JEMS Ceases Print Publication

In June 2018, the Journal of Emergency Medical Services (JEMS) released its final print edition, marking the end of an era for the most widely recognized publication in EMS. Founded in 1980 by Jim Page and Keith Griffiths, JEMS had become a central voice for EMS professionals, educators, and leaders around the world.

National EMS Memorial Authorized by Congress

In 2018, Congress enacted Public Law 115-275, officially authorizing the National EMS Memorial Foundation to establish a permanent National EMS Memorial in Washington, D.C. The memorial will honor EMS clinicians who have died in the line of duty and recognize the vital role EMS plays in public health and safety.

Image: National EMS Memorial Foundation

Source: Public Law 115-275

National EMS Quality Alliance (NEMSQA) Formed

The EMS community launched the National EMS Quality Alliance (NEMSQA) in 2018 to govern and promote standardized EMS performance measures, with the goal of enhancing accountability, clinical effectiveness, and patient outcomes across the system.

NEMSQA Logo

Image: NEMSQA

Source: NEMSQA History & Background

National Registry Surpasses 400,000 Certified Professionals

Over 400,000 EMS clinicians held active National Registry certifications, representing widespread adoption of standardized credentialing.

Three More States Enact EMS Compact Legislation

Missouri (SB870), Nebraska (LB1034), and South Carolina (H4486) enacted REPLICA as state law in 2018, expanding Compact membership across the Midwest and Southeast and bringing total membership to fifteen states. All three adoptions occurred while the Interstate Commission for EMS Personnel Practice was organizing governance structures, developing administrative rules, and building the National EMS Coordinated Database in preparation for operational launch.

South Carolina: SC Code § 44-61-710 (effective May 18, 2018)
Missouri: MO Rev Stat § 190.900 (effective July 9, 2018)

Cumulative EMS Compact member states: 15.

State Assessment

New Hampshire NHTSA EMS Reassessment

NHTSA reassessed New Hampshire's EMS system. The publicly released Executive Summary contained standards and recommendations only, with status narratives omitted. The recommendations revealed foundational trauma system gaps: no mandatory hospital trauma designation, no dedicated trauma program manager or registrar, no sustainable trauma funding, and the Division lacking authority to sanction personnel for standards of care violations.

2019 2 events

Iowa and North Dakota Enact EMS Compact Legislation

Iowa (H.F.694) and North Dakota (HB1337) enacted REPLICA as state law in 2019, becoming the fifteenth and sixteenth EMS Compact member states. Both adoptions came as the Interstate Commission neared completion of administrative preparations for operational launch, scheduled for early 2020.

North Dakota: ND Century Code § 23-27.1 (effective Apr. 1, 2019)

Cumulative EMS Compact member states: 16.

AAA EMS Employee Turnover Study, 2019 (PDF)

EMS Agenda 2050 Released

Building on the 1996 EMS Agenda for the Future, the EMS Agenda 2050 set a visionary framework to guide EMS development through the mid-21st century. The agenda emphasized a people-centered, data-driven, and adaptable EMS system that fully integrates with public health, healthcare, and emergency management.

Developed through a consensus-driven process, EMS Agenda 2050 outlines six guiding principles: Inherently Safe & Effective, Integrated & Seamless, Reliable & Prepared, Socially Equitable, Sustainable & Efficient, and Adaptable & Innovative.

Download the full EMS Agenda 2050 (PDF)

EMS Agenda 2050: Guide to the Vision (PDF)

State Assessment

Hawaii NHTSA EMS Reassessment

NHTSA reassessed Hawaii's EMS system, examining the unique challenges of delivering emergency medical services across an island state where counties are separated by miles of open water. The report noted Hawaii's unparalleled model as the only state where a single government agency serves as the sole payer for emergency ambulance services, serving 1.5 million residents and over 10 million visitors annually.

2019 Hawaii NHTSA Reassessment (PDF)