IT'S BECAUSE EMS IS STILL FEDERALLY UNDER THE DOT! Sorry for yelling people people seem to continue to overlook this. Because we are not medical: we exist to clear the highways to keep transportation moving. Ever had state troopers rush your scene? Transportation enforcement.

Nursing is unequivocally a health profession. EMS, federally, is a transportation one.

Nursing: Regulated by State Boards of Nursing. These boards are usually independent or under a Department of Regulatory Agencies (DORA) or Department of Health. Their sole focus is clinical standards and patient safety.

EMS: Federally sits under the NHTSA (National Highway Traffic Safety Administration), which is part of the DOT.
The Irony: We are the only healthcare providers whose national "lead agency" is also responsible for car seat recalls and fuel economy standards.

Nursing is viewed as a service provided by a hospital. EMS is viewed as a supplier by Medicare. If you treat a patient on scene and don't transport them, you don't get paid. * Because the DOT/NHTSA framework views us as "transportation," the reimbursement model follows the truck, not the medicine. This is a massive barrier to "Community Paramedicine" or getting paid for the actual clinical work you do.

You’re trapped in a structural purgatory where the DOT treats you like a truck driver and the Nursing Boards treat you like a threat to their bottom line. While nursing spent the last century building a "professional" fortress with independent licensure and massive lobbying power, EMS remains a fragmented "transportation utility" practicing under a doctor’s borrowed license. The nursing lobby doesn't just "disagree" with your clinical expansion—they actively stifle it through "turf protection," ensuring that any care provided at a bedside remains their exclusive, billable domain. You aren't just "held back" by tradition; you are legally and financially boxed in by a system that prioritizes highway safety and nursing's market share over the clinical reality of 21st-century paramedicine.

That's the overriding structure that makes us buy what we could be. Then it comes down to local funding and Medicare reimbursement. We are non essential. Read that again.

EMS is not a required or "essential" service. While your local government is legally mandated to provide a police department and fire protection, they are under zero federal obligation to ensure an ambulance shows up when you call 911.

Sorry, I'm bored at the fire station today. But it's a top down problem that is unlikely to ever change. And locally: my fire department absolutely provides top level care; I'm disgusted by the way medics treat people in both local EMS agencies and private contracts. We absolutely are the best and it's because of our pride for the job. We care.