How EMS Is Evolving Through State Policy

September 14, 2026 | Maggie Nilz

As the nation marks the 25th anniversary of the Sept. 11, 2001, terrorist attacks, this year's National Preparedness Month offers an opportunity to reflect on the critical role emergency medical services (EMS) play in emergency preparedness and response. States continue to advance policies that modernize EMS systems, strengthen the workforce, and support innovative care models to improve emergency response and public health.

EMS System Modernization and Alternative Care Models

Policymakers continue to explore legislation that recognizes EMS as an essential public service and strengthens statewide governance and coordination.

Hawaii recently enacted HB 2314 to modernize Hawaii’s EMS laws through a comprehensive emergency medical systems-of-care model. The law amends the state’s community paramedicine program to include mobile integrated health care, directs the further expansion of telehealth within the program to specifically allow certain types of telehealth practice under department-approved protocols, and expands the state EMS systems of care advisory council. The legislation aims to align Hawaii law with best practices in system integration and improve patient outcomes and statewide resilience during a disaster.

Massachusetts also considered several bills aimed at addressing emergency service delivery. This included H 4120, which would have recognized EMS as an essential service, created a dedicated fund to support EMS agencies, and established an EMS advisory committee to support strategic improvements and implementation for EMS services overall. Additionally, H 4118 would have created a three-year pilot program to explore EMS treatment-in-place models, which allow EMS personnel to treat patients at the scene without transport to an emergency department, with the goal of reducing emergency department overcrowding and creating new financial models for EMS support.

Finally, in October 2025, California enacted AB 645, which aims to support EMS response effectiveness and reduce strain on these systems. The law requires local public safety agencies to provide medical instructions to 911 callers before EMS arrives for certain conditions, including choking, CPR, hemorrhage, and administration instructions for both epinephrine and naloxone. In 2026, the legislature passed a bill (AB 2041) requiring agencies to report their compliance with these requirements to support the implementation of AB 645. It is currently awaiting further action.

EMS Licensing

Interstate licensure compacts and licensing reforms are tools to support workforce mobility and the professionalization of EMS. Several states took action on the multi-state EMS Licensure Compact this session. Arizona (SB 1235) officially became the 27th state to join, establishing reciprocal licensing, standardized training, and EMS pathways for military veterans. Connecticut (HB 5514) and Alaska (HB 110) also enacted the EMS Licensure Compact. However, Connecticut's participation is conditional and will not be activated until one year after a neighboring state also adopts the compact. Finally, Massachusetts considered (H 4119) but did not enact its legislation to authorize joining the compact.

Beyond interstate compacts, states are also exploring ways to streamline and professionalize EMS licensing. Illinois enacted HB 4477, which requires each EMS system to develop a policy that utilizes the Just Culture system, which helps agencies fairly distinguish human errors from reckless actions, emphasizing learning and system improvements. The bill also clarifies that EMS personnel are not required to carry a physical or digital copy of their license while on duty.

EMS Workforce Supports

States are also investing in EMS workforce recruitment and retention, funding, and rural service capacity to ensure communities have access to timely emergency care. West Virginia enacted HB 5168, which creates dedicated revenue funds for EMS and allocates lottery revenue to an existing special revenue fund for EMS training and mental health treatment.

Illinois enacted two bills this session to support its emergency service workforce. HB 1353 expands protections for volunteer emergency workers and prohibits certain employers from taking adverse action due to a worker’s required training and from penalizing workers for engaging in protected activities (e.g., training or emergency response), participating in an emergency response, or mandatory training. In addition, HB 5446 will allow for part-time workers as part of an alternative rural staffing model for vehicle service providers serving rural or semi-rural populations of 10,000 or fewer. This bill is specifically designed to assist rural districts by allowing flexibility in staffing to reduce ambulance wait times and improve response times.

To address severe rural responder shortages, Alabama enacted HB 116, which expands the Volunteer Rescue Squad Tuition Reimbursement Program. The law allows regional EMS agencies to provide direct training and reimburse students who commit to serving in the state for at least two years. Additionally, Alabama passed SJR 93 to create a study commission focused on the challenges facing rural EMS and volunteer fire departments. The commission must explore the coverage and availability of EMS services, different financial models to support sustainability, and workforce barriers, and share its findings with the legislature by Nov. 1, 2026.

From modernizing care delivery, supporting and strengthening the workforce, and enhancing rural capacity, policymakers are working to ensure EMS systems can meet evolving community needs. ASTHO will continue tracking legislative actions on this important public health issue.