Everyone was buzzing about House Bill 675 and for good reason. It threatened to shake up EMS credentialing across North Carolina, and it should have raised eyebrows. But while providers were busy fighting that fire, a bigger, hotter blaze was building in the background: House Bill 219.
If HB 675 was the smoke, HB 219 is the fire.
This bill is like backboarding a stubbed toe, completely unnecessary and guaranteed to push the wrong buttons. HB 219 proposes removing the North Carolina general statute that allows local governments to franchise EMS services. Translation? Counties could lose the authority to decide who serves their citizens and how.
Currently, there’s a balance: the NC Office of EMS (OEMS) sets the standards, and local counties tailor services to their communities. That flexibility matters. What works in Buncombe may not work in Beaufort. But HB 219 flips that structure, giving the state sole power to determine who operates in each jurisdiction.
Sounds like the Wild West of EMS? Not quite, but it could still get messy. OEMS would have to expand its reach, oversee new service contracts, and set performance standards for providers across the board. In theory, that could standardize care, a good thing, right? Some counties do have better access to advanced care than others and this bill could allow care to improve in rural areas across NC.
But here’s the problem: the bill doesn’t explain how OEMS will actually do this, or how it will impact the boots-on-the-ground providers who keep the wheels turning.
Let’s be honest, this bill smells like lobbyist fuel. Likely pushed by private EMS companies eager to crack open new territory. Removing GS 153A-250 makes that easier. But the price won’t be paid by the regulators; it’ll be paid by the paramedics and EMTs who could see wages slashed, benefits gutted, and pensions eliminated as counties consider dumping their in-house EMS systems and allowing the state to award the service to a private agency.
The care won’t suffer, at least not immediately because state oversight will still exist. But the people who deliver that care might. Providers could be forced to choose between continuing to serve their communities or protecting their livelihoods.
So here’s the burning question: Is this change truly necessary? Or are we watching a power shift cloaked in buzzwords like “efficiency” and “standardization”?
Drop your thoughts in the comments. Let’s start a real conversation about who controls EMS in North Carolina and who should.
And if you’re fired up about this, like and subscribe to Edge Notes for more blunt, unfiltered takes on the issues shaping the future of prehospital care.
Coming up in the next Edge Note: we’re diving into the clash of care. Private EMS vs. County based EMS and breaking down what really sets them apart.
Kaleb Frady BS, NRP, EMT-P
References
allasio, marco. (2020, September 17). People Watching Fire · Free Stock Photo. Pexels. https://www.pexels.com/photo/people-watching-fire-4276087/
RDNE Stock project. (2021, January 17). Woman Standing Behind an Ambulance with Arms Crossed · Free Stock Photo. Pexels. https://www.pexels.com/photo/woman-standing-behind-an-ambulance-with-arms-crossed-6519899/
North Carolina General Assembly. (2025). House Bill 219: Counties/Franchise ambulance service. https://www.ncleg.gov/BillLookUp/2025/H219
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