When communities call 911, they expect Emergency Medical Services (EMS) to be there. Yet many EMS systems are struggling to meet that expectation.

Unlike police and fire services, EMS has long operated without consistent recognition as a core government responsibility. As a result, many agencies rely on transport-based reimbursement, which fails to cover the true cost of 24/7 readiness. Workforce shortages, rising call complexity, and declining volunteerism are putting additional pressure on already fragile systems, especially in rural communities.

In response, states across the country are designating EMS as an essential public service. This shift acknowledges EMS as critical public infrastructure and helps clarify responsibility for coverage and accountability. However, designation on its own is insufficient. Without sustainable funding, investments in the workforce, and clear governance structures, essential status may remain largely symbolic.

PCG’s white paper, From Patchwork to Promise, explores how states and local leaders can move beyond recognition to build stable, accountable EMS systems.

Download the white paper to learn how designation can translate into lasting impact.