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Regulatory oversight of emergency medical services occurs primarily at the state level based on the provision laid out in the Emergency Medical Services (EMS) Systems Act of 1973. Despite this fact various levels of regulation exist at various levels of government in order to address the needs of the overall system. In addition to governmental agencies, some nongovernmental entities have produced standards that have been adopted by many jurisdictions (federal and state), making them de facto parts of the regulatory structure, despite their lack of regulatory authority.


  • Discuss federal regulations that directly and indirectly impact EMS systems.

  • Discuss the states' provision of EMS and give examples of different state EMS organizational systems.

  • Give examples of local, regional, state, and federal regulatory organizations that govern/oversee EMS systems.

  • Discuss how no governmental organizations influence regulation of EMS.


While the laws, regulations, and policies that regulate EMS within the United States flow from our federal government for EMS operations within our borders, some EMS agencies transport across these borders. International operations, such as fixed-wing aircraft EMS, must be aware of and in compliance with a variety of international laws and regulations. In particular, transport of controlled substances, licensing of providers, and operation of aircraft outside of the United States require particular attention. Any international EMS operation, including disaster relief, repatriation via commercial aircraft, and any cross-border ambulance transport should enquire about these issues prior to initiating operations.


The history of federally regulated EMS in the United States dates from the 1960s, when physicians returning from the Vietnam War noted differences between military medicine and civilian EMS. In 1966, the Institute of Medicine published Accidental Death and Disability, the Neglected Disease of Modern Society, also known as the EMS White Paper.1 This report argued effectively that the lack of civilian EMS and trauma care was leading to many avoidable disabilities and deaths. Congress followed by funding regional EMS system development in 1973 with addition of the Emergency Medical Services (EMS) Systems Act of 1973 (42 U.S.C. 300d) to the Public Health Service Act. This empowering legislation provided funding for states to establish EMS systems. Subsequent funding, including specific funding for EMS for children efforts, has aided in ­further development and regulation of EMS in the United States.

In addition, specific federal legislation, such as that regulating transfer of patients between facilities, reimbursement of healthcare providers, release of medical information, control of pathogens, and other topics are of particular importance to EMS. While not an inclusive list, the outline below describes in brief several federal agencies and other organizations that act at a national level to regulate EMS in the United States.


The Department of Transportation, ...

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