The EMS Bill of Rights

Pay EMS fairly

EMT start pay $35.00/hr. Paramedic start pay $55.00/hr.

Low pay has to be linked directly to long hours, hazardous work, and the physically and mentally draining conditions that expose EMTs and paramedics to ongoing suffering and periodic carnage. Livable wages have to be linked to retaining skilled, competent personnel.

This is not justified on lifesaving skill alone. EMS is a billable, monetized service in high demand. Full pay and benefits parity must be achieved with firefighters and law enforcement. Each year thousands of trained EMTs and paramedics leave the profession — not for lack of commitment, but because of systemic neglect and underinvestment.

Full coverage medical benefits

EMS must be cared for when sick or injured, on or off the job. Fully paid healthcare must be provided by the employer, with dental, vision and equitable family coverage, and no copays.

There must be employer-subsidized health plans and employer-subsidized accident, injury and short-term disability insurance. EMS has high rates of injury, behavioral health problems, cancer, premature death and mortality.

20-year EMS pensions

A pension after 20 years of full-time service. This job is physically and mentally difficult, and should be covered accordingly.

Contributions come from both employer and employee and are managed by the State. The pension is fully transferable between agencies. In the event of a line-of-duty death, the pension transfers in full to a surviving spouse, child, or elderly parent.

Unlimited sick leave with valid documentation

All illness occurring while fully employed is assumed to have been contracted on the job. Injury on or off the job is covered by paid sick leave until the member returns to light duty or is placed on long-term disability.

Preliminary annual banks, separate from other PTO: five critical stress and mental health days, and five unplanned sick days requiring no note. Beyond that, unlimited sick leave with valid medical documentation.

Agencies must let members use mental health days, unplanned time off or PTO to attend the funerals of EMS colleagues, and should treat EMS deaths in their system as if they were their own members.

Adequate paid time off and vacation

Six weeks per year, with an additional week for every four years worked. Docking leave as a disciplinary measure is prohibited.

This is paid leave for rest, leisure and family. Twelve holidays accrue time-and-a-half if worked, or two days of comp time, or are paid at regular rate if off duty. With documentation of religious observance, the eleven federal holidays plus one may be swapped for days of a specific observance.

Premium shift differentials

Shift work has a proven harmful effect on the body and mind.

• 30% nocturnist, when all shifts are night shifts
• 25% for night shifts
• 20% for weekend shifts
• 15% for field training ride-alongs
• 10% hazard pay for MCIs and all working fires

Double time is paid for any mandation, to disincentivize an inefficient and stressful arrangement of shift coverage.

Improved longevity pay

The average EMT leaves the field within four years due to low pay, high stress and lack of upward mobility.

Beginning at year five with an employer and increasing every three years, members gain an improved longevity stipend: 3% at five years, 6% at eight, 9% at eleven, 12% at fourteen, 15% at seventeen, 18% at twenty, 21% at twenty-three, 25% at twenty-six years of service.

State-regulated EMS longevity is retained between employers at year nine, at half the accrual rate if the member changes employers.

Paid meal and bathroom breaks, with clean and decent quarters

At every turnout location, garage, station or EMS base, standards have to be met. A meal or bathroom break is granted for every eight hours worked, in an uninterrupted 30-minute bank, with the unit placed out of service until it is over.

Bases are to be kept clean and organized by the employer, who provides basic cooking, hydration, showers, bunking and a gym. A unit may be pulled from a meal break for a cardiac arrest, major trauma or other genuinely critical call if no other unit is available, and resumes the break afterward.

Credential differentials

Added to base pay when operating in these specialized capacities:

• CLI +$10 · CIC +$20 · FTO +$3
• Hazmat +$3 · Rescue +$10
• Critical Care +$10 · Community Paramedicine +$10
• Flight Medic, fixed wing +$10 · Flight Medic, helicopter +$20

Uniform standardization and allowance

All EMS providers should be clad in a standardized regional uniform, not dressed in unique colors by the deploying agency. Standardized uniforms are provided for every day worked, with individualized bunker gear including high-quality boots, helmets, eye protection and respiratory PPE. A $1,000 annual laundry stipend applies, damaged uniforms are replaced one-for-one, and bulletproof vests are available on request.

PPE requirements. EMS providers must be issued and trained in at least Level C protection as the minimum standard — disposable N95s, half-face respirators, full-face CBRNE masks, and SCBA where risk assessment warrants it. All personnel must receive annual training and fit testing, enforced by the state EMS office across every service delivery model: public, private, nonprofit or volunteer.

Increase EMS educational opportunity

Every agency will establish study grants and health service scholarships to allow more EMTs to advance to paramedic.

Healthcare must be de-siloed — removing prohibitive barriers to move from one health trade into another. We recommend paramedic-to-RN/RT/PA/NP/MD bridge programs, with scholarships from the state and the employer, plus public health, emergency management and healthcare administration tracks, tuition reimbursement, and expanded public service debt forgiveness.

Incentives for teaching and clinical precepting roles must be enacted. Leveraging the expertise of experienced EMS clinicians without adequate compensation is unfair and unrealistic.

Elevate educational standards

We will raise the academic standards of this profession without creating unnecessary barriers to entry. We recommend a separate longer track of two-year (A.S.), four-year (B.S.) or six-year (M.S.) paramedic programs, resulting in a six-year “Paramedic Practitioner” with pay and benefits parity with PAs and NPs.

A modular EMT progression program lets EMTs advance while working — EMT-I, EMT-CC/AEMT, then Paramedic — with bridge programs, licensure, and a unified continuing education system. Hazmat, rescue, critical care, flight and officer upgrades should be incorporated seamlessly into coursework, formally recognized, and supported with tiered compensation.

Marriage, maternity and paternity leave

A maternity policy that allows light duty three months prior, sick leave a month before the due date, then a combined FMLA and employer-subsidized paid bank for 24 weeks — half employer, half state. After that, vacation days and up to 365 days of unpaid leave.

Twenty-four weeks at 100% salary for both parents, with a mandatory eight weeks off for childbirth and bonding, and up to one year fully paid when combined with existing leave balances. Employers grant 14 consecutive PTO days for a new marriage of two employees.

Death and disability insurance

Death and disability benefits must be matched to comparable plans offered by regional law enforcement and fire services. Employers, and unions where involved, must provide subsidized on-or-off-job injury insurance and accidental death and long-term disability plans, tiered to cover varying lengths of disability.

Adoption and caregiver leave must be recognized as essential components of every benefits package. Many EMS clinicians care for older family members or adopt children, and should be allowed leave to bond and care for new family members, aligned with federal FMLA standards and state equivalents.

Functional and engaging CISM and peer support

Across America we have an unwell workforce with high, persistent levels of suicide and self-harm. Employers must establish programs to protect members from cumulative and post-traumatic stress, and the State must mandate a separate balance of PTO days for mental health recuperation after serious calls.

Critical stress debriefing must be triggered after any call involving major trauma, pediatrics or mass casualty. Each agency must appoint one or more Mental Health Resilience Officers to build and oversee wellness programs, and peer-support counseling teams must be mandatory.

Every EMS clinician must receive entry-level mental health protection training with annual continuing education in stress management, trauma recovery and coping strategies — overseen by the state EMS authority to ensure uniform implementation across all systems.

Make EMS a “uniformed service”

Uniformed status means EMS bargains independent of civilian titles. Any EMS clinician — private, nonprofit, hospital, municipal, state or federal — should have the same responsibilities, powers and authorities, with equal protection and legal standing.

Classify EMS legally as a unique and uniformed field with the same protections as law enforcement, firefighters and sanitation, and mandate that municipal EMS bargain separately from larger civilian conglomerations.

Action items for legislation

Equal legal standing as public safety personnel. Define EMTs and paramedics as essential public safety professionals under all state and federal statutes, applied uniformly across agencies whether public or private, unionized or not.

Occupational safety and violence prevention. Cover all EMS providers under workplace violence prevention laws: enhanced criminal penalties for assaulting EMS personnel, the right to withdraw from unsafe scenes without punitive consequences, and employer-paid body armor and de-escalation, escape and self-defense training.

Due process and whistleblower protections. Protection against retaliation for clinical advocacy or patient safety reporting, a formal grievance process, and shielding from termination without just cause.

Legal immunity and liability protection. Extend qualified immunity to all EMTs and paramedics operating under medical direction or local and state protocol. Fear of litigation inhibits clinical decision-making.

Make EMS an “essential service”

Essential means EMS is integral to the budget as something that must be provided for the running of society. Ambulance services are an expected entitlement of the taxpayer and must be funded as a necessity of public safety.

EMS should be budgeted as an essential part of all municipal and state budgets — a vital service, not left to the private sector or to volunteerism.

Federal EMS Corps

An EMS Corps must be established at the federal level to deploy EMS personnel in a manner similar to military service, ending the shortage of EMTs and paramedics nationwide. Young people serving a three-to-four year term would receive healthcare and educational opportunities comparable to regular service.

The Corps would recruit and train EMTs and paramedics for deployment across urban, rural, tribal and disaster-affected systems under contracts of two to six years, rotating by regional need. Benefits would match the armed forces: comprehensive health insurance, a living wage with hazard pay, housing stipends, tuition-free advanced training, and a structured pension or loan forgiveness program.

It would emphasize continual professional development with promotion tracks and specialization in wilderness medicine, tactical EMS, disaster response and public health education — strengthening national resilience against climate disasters, pandemics and infrastructure failure.

Expansion of community paramedicine

Community paramedicine has developed nationwide, driven by insurers seeking to cut the enormous costs of in-hospital care. Community paramedic wellness checks must be widely expanded to prevent recurrent use of the emergency department for primary care, and made fully billable or broadly subsidized.

The large, successful models combine four elements: check-ups and surveillance for vulnerable patients with high ER usage; digital telemetry letting patients check in with an advanced provider while a paramedic performs the physical exam and administers medication; social workers and a care team following up and making referrals; and logistics of care, such as transport to appointments, more home health aide hours, and equipment that prevents repeat hospitalization.

State-level billing compensation must begin for all treat-and-release and treat-in-place calls, as well as diversions to alternative destinations. Dispatchers and 911 units should be able to downgrade a call type to a private transport agency.

Emergency service worker parity

A large number of EMS in America are deployed from fire departments and a smaller number from police agencies. Pay and benefits must be equalized for all EMS deployed within those services.

Where dual-resource fire-based EMS exists, becoming an EMT should be a prerequisite to becoming a firefighter, and there should be a reverse promotion from firefighter into more specialized, more clinical EMS — not the other way around.

Firefighter CFRs should be used for crisis staffing alone, not routinely sent on medical calls without justification, and should not be released without direct authorization of the EMS unit on scene. It must be prohibited for any fire department to provide separate and unequal facilities to its non-firefighter EMS personnel.

Volunteer ambulance corps

Volunteer corps systems must be audited, merged and consolidated, with $2,500 tax credits for viable operations. All economically stable corps should seek to use paid employees.

Agencies with documented ongoing service receive a fixed subsidy from city and state officials to sustain operations. Those unable to meet 24/7 coverage are merged or closed. Corps are given specific units and cross-street designations and deployed into the 911 system as regular units.

Tax incentives increase for volunteer groups operating professionally and consistently, with scholarship opportunities for EMTs and paramedics active with a corps. Any corps employing EMTs or paramedics registers them with the nearest adjacent municipal service and establishes pay and benefit parity on equitable regional lines.

EMS training and continuing medical education

EMS training and certification in the United States needs complete revitalization. The current fragmented system — inconsistent state standards, variable course quality, insufficient clinical exposure — produces uneven skill levels and poor professional continuity.

A national overhaul should establish competency-based, standardized curricula integrating simulation training, early hands-on experience and current clinical science. The goal is not test-passing graduates but capable, adaptable clinicians ready for prehospital care in high-stress environments.

Continuing medical education must become a career-building process rather than a perfunctory requirement: flexible in format, grounded in real-world scenarios, covering trauma-informed care, mental health crises, disaster response and community paramedicine, and tied to clear pathways for promotion and specialization.

Demonetize actual emergency EMS

We must take the money out of EMS where it is used as its training and purpose warrant — not where it is used as a medical taxi or a means to shift civic liability.

EMS should be removed from the fee-for-service healthcare model and treated as an essential public safety function on par with police and fire. Unlike those counterparts, EMS is forced to operate inside a healthcare billing system where transports and interventions are tied to reimbursement. This creates delays, disincentivizes necessary care, and treats lifesaving help as a commodity.

Tying funding to transport billing has distorted the mission. Agencies are rewarded financially for taking patients to the hospital whether or not it is clinically necessary, and receive little or nothing for treating on scene or preventing an unnecessary ER visit. This burdens hospitals, wastes spending, and undermines community paramedicine.

The monetized system also erodes public trust. People hesitate to call an ambulance out of fear of cost, especially in underinsured communities. No one should weigh financial ruin against surviving a heart attack, overdose or stroke.

Third-service EMS

In every place where EMS is based in fire or police, its members are second-class first responders. EMS needs to be deployed out of municipally and state-funded departments of EMS. Getting an ambulance in an actual emergency should be an essential right, not a billable commodity.

Police uphold the law. Firefighters protect property. EMS preserves human life. They are not the same, and EMS should not stand in the shadow of the other two.

EMS is already acknowledged as a mandatory benefit under Medicare and Medicaid. Legislation should formally designate EMS as an essential public safety service equivalent to police and fire, requiring every jurisdiction to provide consistent coverage backed by stable and equitable funding, with statewide minimum standards for clinical care, staffing and response times, and workforce protections including wage floors, mental health resources and workplace safety measures.

One national EMS union

It is time to organize ourselves nationwide. Form EMSPAC chapters. Join and revitalize existing unions, knowing there should be only one union for the industry. Demand real representation and dignity at work. Run for office on EMSCOs and in our towns and cities. Refuse defection and defeat.

We pursue a singular EMS-only labor organization combining active-duty and retired EMS into a trade union dependent on no other labor federation. So far no coherent or powerful unity has emerged: each existing union is dominated largely by non-EMS workers. As of 2025, 90% of all EMS are non-union, with under 100,000 EMS spread between IAFF, CSEA, IAEP, IBOTU, AFSCME and SEIU.