Across the nation, a growing and deeply concerning trend has taken hold within the emergency medical services industry. Out-of-state EMTs and companies are crossing borders to perform work without regard for local laws, training requirements, or scope-of-practice protocols. It is a quiet problem, but one that is steadily eroding both the professional integrity of licensed emergency personnel and the safety of the public they serve. Just because a provider carries a National Registry of Emergency Medical Technicians (NREMT) card does not mean they can legally operate anywhere in the United States. Emergency medical authority rests with the individual states and, in many cases, with counties or cities that impose their own standards. Ignoring these rules is not only unlawful—it undermines the profession itself.
In California, for example, the Emergency Medical Services Authority (EMSA) governs statewide licensing and oversees the local EMS agencies that establish their own protocols. Los Angeles County, one of the most tightly regulated jurisdictions in the country, maintains a unique set of medical control policies that must be followed by every EMT and paramedic operating within its boundaries. California Health and Safety Code §1797.170 clearly defines that no person may provide emergency medical services unless certified or licensed under state authority. The county medical director must sign off on an EMT’s competency and scope before that EMT can legally function. When out-of-state companies arrive with personnel who have never been trained in California’s patient care guidelines, they are in direct violation of these laws. Yet the practice continues—often justified by the mistaken belief that NREMT certification provides blanket permission to work anywhere.
Nevada faces the same issue, and in some ways, the problem is even more acute in Las Vegas and Clark County. Nevada Revised Statutes 450B and the Southern Nevada Health District regulations set strict boundaries on what an EMT may and may not do. Out-of-state EMTs hired to cover major events in Las Vegas—concerts, conventions, or film productions—often perform medical tasks outside the local scope, such as administering medications or transporting patients without authorization. Not only are they breaking state law, they are exposing event organizers and employers to significant liability. If a patient is harmed or a claim arises, the insurance coverage held by those companies is likely void, because the services were provided illegally. These situations are not hypothetical—they happen every year, and local professionals are forced to watch as unqualified personnel take work that should rightfully belong to those who have earned it through proper state certification.
Golden State Lifeguards/SEMS USA, a Southern California/Las Vegas leader in lifeguard and EMS staffing, has been outspoken about this issue for years. The company adheres strictly to every state and county regulation, ensuring that every EMT it provides has been fully trained, licensed, and cleared to work under the local medical control authority. The team has seen first-hand the damage done when outside providers bypass the rules. When production companies or event organizers bring in out-of-state EMTs because they are cheaper or more convenient, they are not just cutting costs—they are compromising safety. Golden State Lifeguards believes that professionalism and compliance are not optional; they are the foundation of effective emergency medical response.
At the core of the problem lies a misunderstanding of the National Registry credential. The NREMT was never designed to serve as a national license. It is merely a testing and registry system used by many states as part of their certification process. Each state retains authority to set its own training standards, clinical skills, and approved medications. For instance, California EMTs follow specific scope items such as assisting patients with prescribed nitroglycerin or epinephrine auto-injectors, but they may not start IVs or administer medications intravenously. Nevada EMTs operate under slightly different guidelines. A provider who learned one set of rules in New York or Florida may unknowingly perform procedures that are prohibited elsewhere. The only way to ensure safe and legal care is to follow the local protocols established by each state’s EMS office and its designated medical director.
Unfortunately, enforcement has not kept pace with this growing interstate problem. With the rise of online staffing platforms and gig-style labor brokers, companies can easily advertise EMT services nationwide without verifying licensure status. These brokers often promise “nationwide coverage” and ship personnel across borders for large events, construction projects, or film shoots. Many of these workers arrive with nothing more than a copy of their NREMT card, unaware that they are operating illegally the moment they step on site. The lack of enforcement emboldens the practice and pushes local providers, who follow the law, out of valuable contracts. Golden State Lifeguards and other compliant providers in California have lost work to these unqualified teams, even though they cannot legally operate under state law. It is a loophole that lawmakers must close.
There are serious public-safety implications when EMTs unfamiliar with local systems are allowed to practice. Each jurisdiction has its own medical control communication systems, hospitals, and patient transport protocols. In Los Angeles County, an EMT must know which receiving facilities are trauma centers, which handle pediatric cases, and how to communicate with base hospitals through the County’s 9-1-1 EMS radio network. An outsider without that training cannot safely integrate into the system. The same applies to Clark County, Nevada, where every EMS call is coordinated through a complex network managed by the Southern Nevada Health District and local fire departments. The learning curve is steep—and lives can be lost when untrained EMTs are allowed to improvise.
Lawmakers need to understand that this issue is not about limiting opportunity—it is about maintaining standards. Each state invests heavily in designing its EMS education programs, certifying instructors, and maintaining data on patient outcomes. When out-of-state companies bypass that system, they are effectively undermining decades of investment in public health infrastructure. These companies also place an unfair burden on the local workforce. Licensed California and Nevada EMTs, who pay for their training, certifications, background checks, and continuing education, suddenly find themselves competing with cheaper labor imported from across the country. The result is wage suppression, lost job opportunities, and declining morale among professionals who strive to do things the right way.
From a business perspective, hiring unlicensed EMTs is a legal and financial risk. If a medical incident occurs and the personnel involved are not authorized to practice under state law, liability may extend directly to the company or production that hired them. In California, operating an ambulance service or providing emergency medical care without certification can result in fines, cease-and-desist orders, and potential criminal penalties. Insurance companies may refuse to cover claims related to unauthorized care. The same is true in Nevada, where the Southern Nevada Health District can revoke event permits or refer cases for prosecution. Event promoters, film producers, and venue operators must understand that compliance is not optional. Hiring a legitimate local provider like Golden State Lifeguards ensures both safety and legal protection.
Beyond legality, there is an ethical dimension. EMS is a profession built on trust and accountability. Every patient has the right to be treated by someone who is properly trained and authorized to deliver care within that community. When companies import EMTs who have never been oriented to the local system, they betray that trust. Golden State Lifeguards has made it a point to educate its clients about this responsibility. The company encourages event organizers to verify licensure with local EMS agencies before hiring any out-of-state staff. This diligence protects everyone involved—the patient, the employer, and the broader EMS community.
The time has come for stronger oversight and collaboration among states. Lawmakers in Sacramento, Carson City, and other capitals should coordinate on mechanisms to prevent unauthorized practice. One possible solution is to require interstate verification systems that flag companies attempting to operate without local credentials. Another is to impose fines on event organizers that knowingly hire unlicensed EMTs. At the federal level, Congress could direct the Department of Health and Human Services to issue guidance clarifying that NREMT certification is not a universal license to practice. Clear communication from top to bottom would eliminate much of the confusion that enables these abuses.
There is also a need for awareness within the business community. Many companies that hire EMTs for events, productions, or construction sites assume that any EMT credential is valid nationwide. They are not willfully breaking the law—they simply do not know. Education campaigns led by compliant providers like Golden State Lifeguards can make a real difference. When clients understand the risks, they are far less likely to cut corners. Local agencies, such as the Los Angeles County EMS Agency and the Southern Nevada Health District, can partner with industry leaders to distribute compliance guides and host informational workshops. By working together, the EMS industry and regulatory bodies can restore fairness and integrity to the system.
The broader EMS workforce also has a role to play. EMTs themselves must hold the line by refusing to work illegally in other states. Professionals who value their certification should recognize that each time an unlicensed provider crosses a border to take a job, it weakens the standing of every legitimate EMT. Peer accountability, combined with strong regulation, can turn the tide. Organizations like Golden State Lifeguards continue to demonstrate that it is entirely possible to provide nationwide service responsibly—by partnering with local licensed providers rather than importing unqualified labor. That collaborative model is the future of lawful and ethical EMS staffing.
The message to lawmakers and businesses is clear: respect the boundaries of state EMS law. Protect local jobs. Uphold patient safety. Support those who do it right. Golden State Lifeguards stands as a model of compliance, demonstrating that professionalism and profit can coexist when integrity guides every decision. The unchecked spread of out-of-state EMT operations is a direct threat to both economic fairness and public health. It is time for decisive action—through enforcement, education, and collaboration—to ensure that emergency medical services remain lawful, local, and accountable.
When the public calls for help, they deserve a responder who knows the system, the community, and the law. Anything less is unacceptable. Golden State Lifeguards calls on lawmakers in California, Nevada, and beyond to strengthen enforcement against unauthorized EMS operations and to support the dedicated professionals who uphold the standards that keep our citizens safe. Businesses must also take responsibility: hire local, verify credentials, and partner only with compliant providers. Together, we can end the exploitation of the EMS system and restore the trust, integrity, and safety that every patient and professional deserves.