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State EMS Systems

Every U.S. State and Territory has an EMS system, though there’s a lot of variation in how agencies are organized and deliver services. What nearly all have in common, though, is that they continue to evolve as the needs of the patients and communities they serve change, and as healthcare itself changes. 

To find contact information for a State or Territory, visit the National Association of State EMS Officials (NASEMO) site or the State EMS Agency Map on the National Registry of Emergency Medical Technicians’ site.

Here you’ll find information about EMS-related legislation at the State level as well as details about how to request a free assessment of your State’s EMS system.

State EMS Legislation

Since late 2021, the Office of EMS has partnered with the National Conference of State Legislatures (NCSL) to create a searchable online database of EMS-related legislation introduced in all 50 states, the District of Columbia and U.S. Territories. The legislative database, which is searchable by year, state, topic, keyword, status or primary sponsor, is updated weekly by NCSL staff.

Topics include:

  • Administration (such as quality assurance and state EMS offices)

  • Funding (such as service fees and changes in funding structure)

  • Rules (such as reimbursement and Good Samaritan laws)

  • Systems (STEMI, stroke and trauma)

  • Workforce classification of EMS and 911 providers

The National Association of Emergency Medical Technicians (NAEMT) tracks key state legislation on its site as well. The NCSL also tracks 911-related legislation; you can find more at’s 911 Legislation page or by going to the NCSL’s State 911 Bill Tracking Database.

State System Assessments

State EMS officials often have the most insight into what their state EMS system is doing well and where there's room for improvement. Making the case for change without third-party validation, however, can be a challenge.

Since 1988, NHTSA has supported comprehensive expert evaluations of State emergency medical and trauma systems. These State EMS assessments help States recognize and build on strengths, identify gaps in policy and programming, and improve the effectiveness of EMS care. They also provide State officials an opportunity to discuss these issues with technical experts and share best practices.

States following an EMS assessment have addressed the enactment of comprehensive EMS and trauma system legislation, the addition of full-time positions to help with program implementation and data analysis, and the development of statewide EMS plans.

What an Assessment Entails

To conduct an assessment, NHTSA assembles a team of five to six individuals with broad experience in EMS development. While NHTSA funds the effort, the team is composed of experts who serve at the State and local level, typically including at least one emergency physician, one trauma surgeon, one State EMS director and one State official with legal expertise.

The group spends several days on-site with the State EMS officials who requested the assessment, receiving briefings about their programs and results. They then spend one to two days creating and presenting a report that includes specific recommendations for improving the EMS program.

The reports evaluate 11 specific components of a State’s EMS system:

  • 1

    Regulation and Policy

  • 2

    Resource Management

  • 3

    Human Resources and Training

  • 4


  • 5


  • 6


  • 7

    Public Information and Education

  • 8

    Medical Direction

  • 9

    Trauma Systems

  • 10


  • 11


Requesting a State EMS Assessment

Since the program’s inception, 48 States, two U.S. Territories and two Federal agencies have received at least one assessment of their EMS systems, with several undergoing periodic reassessments as well. To request a NHTSA State EMS Assessment, State officials apply through their State Highway Safety Office to the appropriate regional office.

In addition to EMS system assessments, NHTSA supports assessments of several other State programs, including 911 systems. The NHTSA Safety Program Assessment provides support to State Highway Safety Offices, State EMS offices and other State agencies. State EMS officials with questions about the NHTSA State EMS Assessment program should contact Dave Bryson, Emergency Medical Services Specialist at the NHTSA Office of EMS. Read about New Hampshire’s State EMS assessment in the Winter 2020 issue of the “EMS Update” newsletter.

Last Updated: 10/18/2023