Johnson City, TN

EMS and Ambulance Services are not an Essential Service

John M. Dabbs

(Photo by John Dabbs)

Healthcare resources are more scarce than ever. The new normal has EMS as the "healthcare safety net" for most of the United States. Local EMS agencies, like Washington County-Johnson City EMS, are finding it more difficult to recruit qualified applicants. Moreover, they are finding it harder to find suitable personnel to apply and be trained.

Many rural EMS agencies across the country have closed due to financial hardship. Others are relying on volunteers to augment staffing. The job of EMTs and paramedics has become more difficult due to a myriad of responsibilities that were once dealt with by other jobs - positions that are no longer filled.

The fact remains - ambulance services are not an essential service. That is the current position most ambulance services find themselves in. At present, only 11 states have designated EMS as an essential service. As such, most states don't fund them like they do police and fire services.

Essentially ignored

While ambulance services often seek reimbursement for services, especially transportation, the insurance reimbursement is inadequate. Medicare and Medicaid reimbursement rates are less than the cost of providing care. This economic model makes it increasingly difficult for EMS providers to compensate EMTs and paramedics at a rate comparable to their healthcare peers. The quality and value they bring to patient care are not reflecting the care and value they bring to the community and patients.

Historically low wages combined with a dangerous work environment often put off many well-suited candidates. Another drawback comes from the work schedules. Many staffing schedules do not reflect the inherent overtime due to calls for service coming in a few minutes before shift change. These calls, and night calls disrupting sleep on stations working 24-hour shifts, significantly impact the circadian rhythms of personnel. Such natural sleep cycle disruption impacts personal health and stress levels.

(Photo by John Dabbs)

Opting for change

These are only a few of the reasons EMS agencies are finding it difficult to fill many positions. The workforce pool is drying up, and many providers are leaving the streets in favor of private employment with health systems, doctors' offices, industry, and theme parks. Others have sought higher compensation in other fields. At least four area paramedics are now physicians, while others have gone into nursing, physical therapy, or become physician assistants.

On the level

On the state level, only 11 states recognize EMS as an essential service:

  • Connecticut
  • Deleware
  • Hawaii
  • Indiana
  • Louisiana
  • Nebraska
  • Nevada
  • Oregon
  • Pennsylvania
  • Virginia
  • West Virginia

The state government provides some EMS funding in these states. The other states rely on local funding for EMS. The federal government doesn't recognize EMS as an essential service either. (Erika Edwards, NBC News

Funding for EMS doesn't come at the federal, except through ancillary programs where funds can also be used for EMS. Grant opportunities have presented themselves in the Assistance to Fire Fighters Grant, and SAFER (Staffing for Adequate Fire and Emergency Response Grant). There is also a rural emergency communications pilot program grant.

The Federal Integrated Committee on Emergency Medical Services works through the U.S. Department of Transportation. It's the place where it all started, with the white paper on needless death and dying on America's highways. One problem that complicates things on the federal and state-level - EMS comes in many forms and fashions in our landscape. Services are provided by hospitals, volunteers, private companies, fire departments, and third-service agencies of local county and municipal governments. Remember New York City EMS? It was finally rolled into the New York City Fire Department for sustainability issues.


The Tennessee legislature is hopefully taking the next big step in joining the other 11 states. A bill introduced by Senator Paul Bailey of Sparta, Tennessee (SB-1597) would give ambulance services (EMS) official designation as an essential service in Tennessee. The bill proposes ambulance services be provided by public, private, or non-profit organizations. While the bill doesn't mandate counties provide such service themselves, they must provide for the service in some fashion. They may contract through interlocal agreements, hospitals, healthcare facilities, or any means where at least one licensed ambulance service is provided.

(Photo by John Dabbs)

The proposal makes it clear, a county is not required to appropriate county revenues for the service when it can be provided through other means. says, " codifies the existing relationship between counties and municipalities in regards to their abilities to provide this service with the approval of their governing bodies."

The bill has passed the Tennessee Senate and has been forwarded to the House. It has been put on the regular calendar for April 8, 2021.


The Tennessee Ambulance Service Association has been pushing for this legislation for many years. The association is comprised of volunteer, private, public, and healthcare-based ambulance service companies from across the state - some of which operate nationwide. The association does not expect designation to alter the composition of EMS as it exists in Tennessee. They expect grant opportunities and other funding streams may become more readily accessible.

Johnson City

Local agencies and EMS personnel are asking, and hoping their representatives in the state and federal legislature are taking note. It is evident from their roles in the current pandemic, and other emergencies and natural disasters occurring every day. Ambulance services and EMS providers have become an essential part of life in the United States.

(Photo by John Dabbs)

Washington County-Johnson City EMS responded to the flooding in Nashville with a swift-water rescue team in 2010 and has responded to Hurricane's as part of the Tennessee USAR Team and with the Region 1 Ambulance Strike Team with ambulances and the region's AmbuBus to Hurricanes in Florida, South Carolina, and North Carolina as part of an Emergency Management Assistance Compact, coordinated by the State of Tennessee.

EMS and rescue services have become an essential part of every community in the U.S.

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John is An outdoor enthusiast passionate about travel and adventure, a consultant, author, and journalist.

Bristol, TN

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