National EMS Intelligence Brief

51 States·21,836 Agencies·84,816 Facilities·Derived from NEMSIS StateDataSet·
51
Jurisdictions Analyzed
21,836
Registered EMS Agencies
84,816
Destination Facilities
8
States with Opioid Surveillance
76%
of States Run ImageTrend
$58,857
National Paramedic Median
$535.05
Avg ALS1 Medicare Rate
01

ePCR Vendor Market Share

Finding 1 of 7

ImageTrend Dominates US EMS Data Infrastructure

ImageTrend Elite dominates US EMS data infrastructure, running in 39 of 51 states (76%). Two states — Ohio and Texas — operate custom government-built platforms, representing significant interoperability challenges for multi-state operators.

02

Opioid Surveillance Gap

Finding 2 of 7

84% of States Cannot Track Opioid Incidents

Only 8 of 51 states (16%) have built opioid incident surveillance into their NEMSIS state configuration. This means 84% of states cannot systematically identify opioid-related EMS incidents at the state data level — a critical gap in national overdose response infrastructure.

Tracking Opioid Incidents
Not Tracking

Tracking (8)

AKAZCTDEDCRISDWV

Not Tracking (43)

ALARCACOFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPASCTNTXUTVTVAWAWIWY
03

Documentation Burden Ranking

Finding 3 of 7

8x Variance in Required Documentation

Virginia and Alabama mandate the most rigorous EMS documentation in the nation at 594 required elements — 8x more than Nevada (24 elements). This variance creates significant operational complexity for multi-state EMS operators.

Highest Documentation Burden (Top 15)

Lowest Documentation Burden

24
NV71
AK194
UT198
OK205
IA
04

Agency Density

Finding 4 of 7

New York Leads with 1,843 Registered Agencies

New York leads all states with 1,843 registered EMS agencies — reflecting extreme fragmentation driven by volunteer fire department EMS services. Iowa has 1,211 agencies for just 3.2 million residents, one of the highest per-capita agency rates in the nation.

05

Data Currency

Finding 5 of 7

State Configuration Freshness Varies Significantly

State NEMSIS configurations vary significantly in freshness. Several states have not updated their StateDataSet in over 2 years, raising questions about whether their approved formularies and required elements reflect current practice.

2 Fresh|27 Stale (> 1 year)
StateEffective DateDays SinceStatus
VAVirginia——Unknown
NDNorth Dakota——Unknown
NCNorth Carolina——Unknown
HIHawaii——Unknown
DCDistrict of Columbia——Unknown
LALouisianaNov 15, 20221,294Stale
INIndianaMay 17, 20231,112Stale
MNMinnesotaMay 17, 20231,112Stale
NJNew JerseyMay 17, 20231,112Stale
SCSouth CarolinaMay 17, 20231,112Stale
VTVermontMay 17, 20231,112Stale
WAWashingtonMay 17, 20231,112Stale
WYWyomingMay 17, 20231,112Stale
NVNevadaAug 21, 20231,016Stale
MAMassachusettsOct 27, 2023949Stale
MEMaineNov 1, 2023944Stale
NMNew MexicoNov 16, 2023929Stale
TNTennesseeDec 1, 2023914Stale
MOMissouriDec 28, 2023887Stale
AKAlaskaFeb 7, 2024846Stale
WVWest VirginiaFeb 9, 2024844Stale
MDMarylandFeb 24, 2024829Stale
OHOhioMar 6, 2024817Stale
NYNew YorkMar 12, 2024812Stale
DEDelawareApr 30, 2024763Stale
OKOklahomaMay 23, 2024740Stale
KYKentuckyAug 5, 2024666Stale
AZArizonaJan 29, 2025489Stale
TXTexasFeb 21, 2025465Stale
SDSouth DakotaFeb 28, 2025459Stale
UTUtahApr 1, 2025427Stale
IAIowaMay 21, 2025377Stale
NHNew HampshireJun 30, 2025337Aging
CTConnecticutJul 2, 2025335Aging
PAPennsylvaniaJul 23, 2025314Aging
RIRhode IslandJul 24, 2025313Aging
IDIdahoSep 12, 2025263Aging
ILIllinoisSep 11, 2025263Aging
KSKansasSep 24, 2025251Aging
ALAlabamaSep 24, 2025250Aging
COColoradoOct 7, 2025238Aging
MIMichiganOct 9, 2025235Aging
NENebraskaDec 1, 2025183Aging
OROregonJan 1, 2026152Aging
GAGeorgiaJan 13, 2026140Aging
MSMississippiFeb 9, 2026113Aging
WIWisconsinFeb 11, 2026111Aging
ARArkansasFeb 27, 202695Aging
CACaliforniaMar 4, 202690Aging
FLFloridaMar 17, 202677Fresh
MTMontanaApr 1, 202662Fresh
06

Custom Configuration Complexity

Finding 6 of 7

West Virginia Leads Custom Data Collection

West Virginia has built the most customized NEMSIS configuration in the nation with 389 custom elements — reflecting years of targeted data collection investment driven by the state's opioid crisis. Rhode Island (161) and Delaware (84) follow, both states heavily impacted by overdose deaths.

11 states use only standard NEMSIS elements (no custom configuration)

07

Public Health Surveillance Index

Finding 7 of 7

Only Alaska Achieves Perfect Surveillance Score

StateIQ scores each state's public health surveillance infrastructure across 4 dimensions: opioid incident tracking, naloxone administration tracking, trauma activation capture, and homeless patient status. Only Alaska achieves a perfect 4/4 score.

2 with perfect 4/4|43 with 0/4
#StateOpioidNaloxoneTraumaHomelessScore
1AKAlaska4/4
2WVWest Virginia4/4
3AZArizona2/4
4CTConnecticut2/4
5DEDelaware2/4
6DCDistrict of Columbia2/4
7RIRhode Island2/4
8SDSouth Dakota2/4
9ALAlabama0/4
10ARArkansas0/4
11CACalifornia0/4
12COColorado0/4
13FLFlorida0/4
14GAGeorgia0/4
15HIHawaii0/4
16IDIdaho0/4
17ILIllinois0/4
18INIndiana0/4
19IAIowa0/4
20KSKansas0/4
21KYKentucky0/4
22LALouisiana0/4
23MEMaine0/4
24MDMaryland0/4
25MAMassachusetts0/4
26MIMichigan0/4
27MNMinnesota0/4
28MSMississippi0/4
29MOMissouri0/4
30MTMontana0/4
31NENebraska0/4
32NVNevada0/4
33NHNew Hampshire0/4
34NJNew Jersey0/4
35NMNew Mexico0/4
36NYNew York0/4
37NCNorth Carolina0/4
38NDNorth Dakota0/4
39OHOhio0/4
40OKOklahoma0/4
41OROregon0/4
42PAPennsylvania0/4
43SCSouth Carolina0/4
44TNTennessee0/4
45TXTexas0/4
46UTUtah0/4
47VTVermont0/4
48VAVirginia0/4
49WAWashington0/4
50WIWisconsin0/4
51WYWyoming0/4

Economic Intelligence

08

EMS Wage Analysis

Wage Finding 1

$55,760 Gap Between Highest and Lowest Paramedic Wages

WA leads the nation paying paramedics a median of $100,780/year, while AL trails at $45,020. Washington state is a notable outlier with paramedic wages exceeding $100,000 — driven by strong union contracts and high cost of living.

Wage Finding 2

9 States Pay Paramedics Under $50,000

9 states have median paramedic wages below $50,000/year, including MT, KS, WV and 6 others. These compensation levels contribute to chronic staffing shortages and high turnover rates in EMS.

09

The Double Squeeze

Economic Finding

7 States Face Low Wages AND Low Reimbursement

7 states pay paramedics under $50k AND receive below-average Medicare ALS1 reimbursement — a "double squeeze" on EMS sustainability. States in this category include KS, WV, OH, OK and 3 others. These states face the greatest EMS workforce sustainability challenges.

10

Coverage & Density

Coverage Finding

81.2 vs 1.2 Agencies per 100k — Massive Coverage Gap

WY has 81.2 EMS agencies per 100k population while CA has only 1.2. DC is the most densely populated state at 11122/sq mi, compared to AK at just 1.3/sq mi.

11

Healthcare Shortage Severity

HRSA Finding

MS Has Worst Primary Care Shortage Severity at 19.6/25

MS has the highest average HPSA severity score for Primary Care at 19.6/25, compared to VT at just 8.2. For Mental Health, PR leads with a severity score of 19.6/25. Severity scores are the true apples-to-apples comparison — raw area counts (NY has 1519) naturally correlate with state size and include geographic, population-based, and facility designations. 0 states have critical-level severity (20+), indicating EMS crews face severely limited hospital and specialist resources for patient handoffs.

StateIQ — National EMS State Configuration Intelligence Platform

Published by Amsler Labs