50th Anniversary of the National Registry
The organization celebrated five decades of advancing EMS professionalism, highlighting its legacy of protecting the public and standardizing prehospital care across the nation.
2020
6 events
Launch of the National EMS-ID
The National Registry introduced the EMS-ID — a unique, lifelong identifier for each certified professional — improving data tracking and credentialing consistency across jurisdictions.
March 13, 2020
1 event
National Event
U.S. Declares National Emergency Over COVID-19
In response to the global COVID-19 pandemic, the Trump Administration declared a national emergency on March 13, 2020. The announcement included sweeping measures to restrict international travel, including a ban on non-U.S. citizens arriving from 26 European nations. This marked a turning point in the U.S. federal pandemic response and initiated unprecedented public health and emergency mobilizations nationwide.
2020
6 events
EMS Compact Declared Operational Under REPLICA
On March 15, 2020, the Interstate Commission for EMS Personnel Practice declared the EMS Compact operational, establishing the first interstate licensure recognition framework in EMS history. Authorized under the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA), the Compact enabled EMS clinicians licensed in any member state to practice across state lines without obtaining additional licenses. The declaration came two days after the national COVID-19 emergency, and the Compact proved immediately critical to pandemic response.
Crisis Standards of Care Implemented for EMS
In response to overwhelming demand during the COVID-19 pandemic, EMS systems across the U.S. activated Crisis Standards of Care (CSC) to prioritize resources and guide ethical decision-making. These standards helped EMS providers deliver care when staffing, equipment, and hospital capacity were critically constrained.
CMS Launches ET3 Model and COVID-19 Treatment-in-Place Waiver
In February 2020, the CMS Center for Medicare and Medicaid Innovation selected 205 ambulance agencies to participate in the Emergency Triage, Treat, and Transport (ET3) model, the first federal initiative to reimburse 911 services for treating patients on scene or transporting them to alternative destinations. Months later, CMS issued a separate COVID-19 pandemic waiver extending treatment-in-place reimbursement to all Medicare ground ambulance providers nationwide, dramatically accelerating adoption of the concept.
West Virginia, Indiana, and Iowa Enact EMS Compact Legislation
West Virginia, Indiana, and Iowa enacted REPLICA as state law in early 2020, bringing total Compact membership to nineteen states. All three adoptions took effect within days of the Compact's operational declaration on March 15, enabling their EMS clinicians to immediately exercise the Privilege to Practice during the emerging COVID-19 pandemic response.
2021
5 events
Driverless Medical Transport Pilot Project Launched
In 2021, the City of Peoria, Arizona launched an autonomous shuttle pilot program known as RoboRide Medical, designed to transport residents to and from medical appointments using driverless vehicle technology.
Updated National EMS Education Standards Released
The National Highway Traffic Safety Administration (NHTSA) released the updated 2021 National EMS Education Standards, modernizing the framework for EMS clinician education across all certification levels.
IBSC Launches Wilderness Paramedic Certification (WP-C)
In 2021, the International Board of Specialty Certification (IBSC) introduced the Wilderness Paramedic (WP-C) credential to formally recognize paramedics working in wilderness, remote, and austere environments. The WP-C exam includes 135 questions—110 scored and 25 unscored—administered over 2.5 hours. The test evaluates deep knowledge in wilderness medicine principles, environmental challenges, and austere care strategies. The WP-C represents a major step in professionalizing care delivery in extreme conditions worldwide.
South Dakota and Louisiana Enact EMS Compact Legislation
South Dakota and Louisiana enacted REPLICA as state law in 2021, bringing total Compact membership to twenty-one states. Both adoptions occurred as the Compact demonstrated its value during sustained COVID-19 pandemic mutual aid deployments and interstate wildland fire responses.
Volkswagen Reveals ID. Buzz Self-Driving Ambulance Concept
At the 2021 ITS World Congress in Hamburg, Germany, Volkswagen Commercial Vehicles unveiled an autonomous ambulance prototype based on its all-electric ID. Buzz platform. The driverless concept eliminated the need for a driver entirely, freeing both paramedics to provide patient care simultaneously—doubling the efficacy of a traditional two-person EMS crew. Developed in partnership with Argo AI, the concept featured Level 4 autonomous driving capabilities, with all seating oriented toward the patient care compartment and integrated medical equipment.
2022
5 events
Third Edition: National Model EMS Clinical Guidelines
The National Association of State EMS Officials (NASEMSO) released the third edition of the National Model EMS Clinical Guidelines, enhancing clinical consistency and evidence-based care across EMS systems nationwide.
NEMSIS Version 3.5 Adopted
The newest version of the National EMS Information System (NEMSIS) dataset was released, expanding data capture fields to support improved analytics and performance measurement.
Maine Blue Ribbon EMS Commission Report
In December 2022, the Blue Ribbon Commission to Study Emergency Medical Services in the State of Maine released a comprehensive report addressing the EMS system's crisis conditions.
Joint Position: Prehospital Blood Transfusion Protocols
In 2022, the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians issued a joint position statement supporting the use of prehospital blood product transfusion protocols. This guidance emphasized that transfusions administered in the field may significantly improve survival for patients experiencing hemorrhagic shock, and that EMS systems should consider implementing such protocols in appropriate settings.
Pennsylvania Enacts EMS Compact Legislation
Pennsylvania enacted REPLICA as state law through Act 35 of 2022, becoming the twenty-second EMS Compact member state and the first major northeastern state to join. Pennsylvania's adoption extended the Compact's geographic reach into the densely populated Mid-Atlantic corridor.
State Assessment
Georgia NHTSA EMS Reassessment
NHTSA reassessed Georgia's EMS system, the first federal review since the 1995 initial assessment — a 27-year gap. The Technical Assistance Team noted a strong collaborative culture between OEMST and system partners across 10 EMS regions, while highlighting workforce shortages, challenges transporting time-sensitive patients to specialty care hospitals, and difficulties establishing consistent clinical protocols under a tradition of local control.
2023
10 events
Autonomous Ambulance Concept Designed by Students
In 2023, engineering students at Cedarville University unveiled prototype concepts for autonomous ambulances as part of a senior design project, exploring how AI, robotics, and advanced navigation systems might transform prehospital care delivery.
South Dakota EMS Sustainability Report Released
In 2023, the South Dakota Department of Health released its Regional Services Designation and Assessment report, capturing insights from over 400 EMS stakeholders and outlining strategies to address long-standing system challenges in rural and frontier communities. The report committed $7.5 million to ensuring no resident waits more than 30 minutes for ambulance response anywhere in the state.
Adoption of Scaled Score Reporting
On June 1, the National Registry implemented scaled score reports for cognitive exams, providing more informative feedback to unsuccessful candidates and improving exam preparation and transparency.
Prehospital Blood Transfusion Initiative Coalition (PHBTIC) Launched
The Prehospital Blood Transfusion Initiative Coalition (PHBTIC) was established in 2023 as a national effort to address barriers to life-saving blood product use in the field, led by a multi-disciplinary steering committee including Dr. John Holcomb of the University of Alabama at Birmingham.
DHS Publishes AI-Facilitated EMS Call Center Software Market Report
In December 2023, the U.S. Department of Homeland Security released a market survey evaluating AI-Facilitated EMS Call Center Software, highlighting emerging capabilities for triage, dispatch prioritization, and clinical decision support in EMS communications centers.
Ambulance Deserts Identified in U.S. EMS Landscape
A landmark 2023 study revealed that over 4.5 million Americans live in "ambulance deserts" — areas where no ambulance station exists within a 25-minute drive. The study found 82% of U.S. counties had at least one ambulance desert, with 52% of affected residents in rural counties.
Announcement to Discontinue ALS Psychomotor Examinations
The National Registry announced its intent to eliminate ALS-level psychomotor exams, shifting emphasis to cognitive assessments and reflecting advancements in EMS education and clinical verification.
EMS Compact Unveils Official Seal
The Interstate Commission for EMS Personnel Practice officially unveiled its new governmental seal in 2023, symbolizing its role as a state-authorized regulatory body under the U.S. Constitution, incorporating visual elements reflecting emergency care, public protection, and multistate cooperation.
Nevada and Oklahoma Enact EMS Compact Legislation
Nevada and Oklahoma enacted REPLICA as state law in 2023, bringing total Compact membership to twenty-four states and expanding coverage into the western and southern plains regions.
Colorado EMS Sustainability Task Force Report Released
Colorado's EMS System Sustainability Task Force released its Phase 1 Report in 2023, identifying foundational challenges threatening EMS delivery across the state including funding gaps, workforce retention concerns, and barriers to equitable EMS access in rural areas.
December 2023
3 events
EMS Compact Publishes Biometric Criminal History Check Position Paper
The Interstate Commission for EMS Personnel Practice issued Position Paper 2023-01, calling on all states, territories, and jurisdictions to urgently implement uniform FBI-compliant biometric criminal history record checks for EMS licensure.
Sri Lanka Launches AI & Mixed Reality-Powered Connected Ambulance
In December 2023, Sri Lanka's national emergency ambulance service, 1990 Suwa Seriya, partnered with Singapore-based Mediwave to launch the world's first mixed reality and AI-powered connected ambulance. The system integrated Mediwave's Emergency Response Suite—featuring AI-driven speech-to-text for electronic health records, Microsoft HoloLens augmented reality for remote physician consultation, and Internet of Medical Things (IoMT) connectivity—enabling EMTs to monitor vital signs and provide specialized care before reaching the hospital.
2024
11 events
ONDCP Launches National Drug Overdose Surveillance Dashboard
On August 7, 2024, the White House Office of National Drug Control Policy unveiled the Drug Overdose Surveillance Dashboard, integrating CDC mortality data with real-time EMS data from NEMSIS to provide an unprecedented view of the nation's overdose crisis.
Launch of Updated AEMT and Paramedic Exams
NREMT launched new certification exams without the ALS psychomotor requirement, streamlining the path to licensure and aligning testing with modern educational practices.
All 50 States Recognize National Registry Certification
New York became the final state to recognize National Registry certification in 2024, completing a nationwide framework for consistent EMS credentialing and licensure mobility across all 50 states.
First AI Charting Solution for EMS Launched
On May 27, 2024, Mediwave launched the nation's first purpose-built AI charting platform for EMS, using voice recognition and AI transcription to streamline documentation and enhance clinician efficiency.
FAA Reauthorization Act Includes First-Ever Advanced Air Mobility Title
The FAA Reauthorization Act of 2024 (P.L. 118-63) included, for the first time, a subtitle dedicated to Advanced Air Mobility — authorizing Airport Improvement Program funding for eVTOL charging infrastructure and establishing the regulatory foundation for electric aircraft operations, including medical transport.
Prehospital Blood Transfusion Programs Expand Across U.S. EMS Systems
By fall 2024, thirty-eight states permitted paramedic-initiated blood transfusion in the field — a dramatic expansion from near-zero civilian ground EMS programs a decade earlier. The ACS estimated the intervention could save 10,000 lives annually.
EMS Compact Adopts Code of Conduct and Forms Advisory Committees
On October 16, 2024, the Interstate Commission unanimously adopted the Privilege to Practice Code of Conduct, establishing uniform ethical and professional standards for EMS clinicians operating across Compact member states. Two new advisory committees were also created to engage NGOs, EMS associations, and federal partners.
National Registry Launches New Exams for Paramedics and AEMTs
On July 1, 2024, the NREMT launched new certification examinations for AEMTs and Paramedics — reflecting years of planning, field validation, and alignment with evolving clinical expectations, and completing the transition away from ALS psychomotor requirements.
AI-Powered Ambient Documentation Emerges Across EMS
By late 2024, multiple vendors were deploying AI-powered ambient documentation tools for prehospital care, using large language models to generate patient care reports from ambient audio during EMS encounters. These tools promised to reduce documentation burden — a leading contributor to clinician burnout — while capturing richer clinical narratives than traditional point-and-click ePCR systems.
Medical Drone Delivery During Live 911 Calls
Drone systems began delivering AEDs, naloxone, and tourniquets during live 911 calls, reaching patients in under two minutes. Beyond Visual Line of Sight (BVLOS) operations expanded under FAA waivers, with the medical drone delivery market projected to reach $2.5 billion by 2034.
Autonomous Vehicles Reach Scale in U.S. Cities
By late 2024, Waymo had completed over 4 million autonomous rides and reached 200,000+ paid rides per week across multiple U.S. cities. The proven safety record and operational model raised direct questions about the future of ground medical transport and the role of autonomous systems in EMS.
State Assessment
NHTSA State EMS Reassessments: Kentucky and Idaho
NHTSA conducted reassessments of EMS systems in Kentucky and Idaho, both representing the first federal reviews in over three decades. The Kentucky assessment — 33 years after the 1991 initial assessment — evaluated the Board's transition to an independent agency, workforce shortages at the paramedic level, and the unfunded 2008 trauma care law. The Idaho assessment — 31 years after the 1993 initial assessment — found a state at a 'crossroads' where 40% of practitioners were volunteers covering 70% of the geography, with no Level I trauma center and no statewide strategic EMS plan despite extensive studies.
2025
8 events
Wyoming EMS System Report Released
In June 2025, the Wyoming Department of Health published a groundbreaking report offering a comprehensive review of Ground Emergency Medical Services across the state. The report provides data-driven insights into system performance, funding models, personnel challenges, and rural service gaps.
Ground Ambulance Data Collection System (GADCS) Report Published
On January 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the first comprehensive analysis from the Medicare Ground Ambulance Data Collection System (GADCS). Drawing on data from 3,712 EMS organizations selected in Years 1 and 2, the report offers unprecedented transparency into the true cost structure of EMS operations nationwide.
- Labor Costs (69%) – Salaries, benefits, and training dominate EMS expenses.
- Vehicle Costs (10%) – Includes maintenance, fuel, and depreciation.
- Facilities (4%) – Station operations and overhead.
- Equipment & Supplies (4%) – Essential tools for readiness and patient care.
- Other Costs (13%) – Contracted services, licensing, continuing education, and more.
February 2025
1 event
EMS Compact Adopts Workforce Privacy Protection Position Paper
On February 19, 2025, the Interstate Commission for EMS Personnel Practice formally adopted Position Paper 2025-01, emphasizing the protection of Personally Identifiable Information (PII) and licensure data of EMS clinicians.
2025
8 events
National Registry Launches Updated BLS Certification Examinations
In 2025, the National Registry of EMTs launched a modernized version of the Basic Life Support (BLS) certification examinations, reflecting updated clinical practices and operational demands.
San Bernardino County Tests Paramedic VTOL Aircraft
In 2025, San Bernardino County introduced a pilot program using a Vertical Takeoff and Landing (VTOL) aircraft to expand paramedic emergency response capabilities in remote and hard-to-reach terrain.
AHA Publishes 2025 Guidelines for CPR and Emergency Cardiovascular Care
In October 2025, the American Heart Association published its most comprehensive resuscitation guidelines revision to date, issuing 760 recommendations across adult, pediatric, and neonatal life support. Developed with the International Liaison Committee on Resuscitation, the guidelines established a unified six-link Chain of Survival across all populations and recommended on-scene resuscitation for out-of-hospital cardiac arrest over premature transport. The update also formally endorsed public access to naloxone alongside AEDs in community response systems.
Arkansas Enacts EMS Compact Legislation
Arkansas enacted REPLICA as state law, becoming the twenty-fifth EMS Compact member state. The adoption came as the CMS Rural Health Transformation Program's scoring criteria incentivized Compact membership, with non-member states receiving lower scores in federal funding applications. Half of all U.S. states were now bound by the interstate EMS licensure agreement.
EMS Compact Reaches 25 Member States
With Arkansas joining through HB 1253, the EMS Compact reached 25 member states, marking a significant milestone in achieving real-time licensure mobility and coordinated disaster response.
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Senator John Barrasso Honors Wyoming's 50th EMS Conference
On August 21, 2025, Senator John Barrasso offered warm greetings at the 50th Anniversary of the Wyoming Trauma & Emergency Medical Services Conference, held in Cheyenne, Wyoming. In this moving address, he read aloud his remarks from the Senate's Congressional Record, celebrating the growth and impact of this vital statewide event.
$50 Billion Rural Health Transformation Program Launched — EMS Recognized as Rural Safety Net, EMS Compact Incentivized in Federal Scoring
CMS launched the Rural Health Transformation Program (RHTP), a $50 billion, five-year initiative established under P.L. 119-21 to strengthen healthcare in rural communities. The program's Notice of Funding Opportunity explicitly included EMS among its strategic priorities — funding treat-in-place models, mobile health units, workforce development, and emergency care coordination. Critically, the NOFO scoring framework awarded bonus points to states that had enacted interstate licensure compacts, including the EMS Compact (REPLICA), and states that had not joined received lower scores on their applications.
December 2025
2 events
BETA Technologies CEO Testifies Before Congress on eVTOL Medical Transport
BETA Technologies founder and CEO Kyle Clark testified before the U.S. House Subcommittee on Aviation on December 3, 2025, disclosing that BETA originally designed its eVTOL aircraft around medical and interfacility transport — including organ delivery, emergency logistics, and inter-hospital patient transfer — marking an inflection point in the convergence of Advanced Air Mobility and EMS.
2026
2 events
DEA Publishes Final Rule Implementing PPAEMA, Establishing National EMS Controlled Substance Framework
On February 5, 2026, the DEA published its final rule implementing the Protecting Patient Access to Emergency Medications Act of 2017. Effective March 9, 2026, the rule established a dedicated DEA registration category for EMS agencies, codified controlled substance storage requirements, formalized standing and verbal order authority, and created hospital restocking protocols — replacing over a decade of inconsistent state-by-state interpretation.
Colorado Introduces EMS Essential-Service Designation (HB 26-1238)
In 2026, the Colorado General Assembly introduced House Bill 26-1238 to formally designate emergency medical services as an essential service within state law. The bill addresses a structural misalignment that has shaped EMS since its origins: because ambulance services emerged from healthcare delivery rather than from state police powers — unlike fire protection and law enforcement — EMS inherited reimbursement-based financing logic rather than readiness-based taxation logic. Essential-service designation clarifies the constitutional placement of EMS as public infrastructure, aligning governance architecture with the function EMS actually performs.