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State Department: Iowa

If you’re a paramedic or EMT who’s thinking of relocating or would just like to learn more about life across the U.S., EMS World’s State Department is worth a look. We start with data-driven “snapshots” of each state, then add a few paragraphs about regional practices and lifestyle. Our goal is to highlight everyday aspects of potential destinations from a prehospital provider’s point of view.

Iowa Snapshot

  • Link to state EMS website
  • Average straight-time wages: EMT $12.25/hour, paramedic $21.001
  • State area: 58,273 square miles
  • Approximate state population: 3,156,000
    • Rank (↓): 31
    • Change since 2010: +4%
  • Most populous cities (approximate): Des Moines 218,000, Cedar Rapids 133,000, Davenport 104,000
  • Violent crime one-year change: Des Moines N/A, Cedar Rapids -19%, Davenport -18%2
  • State violent crime rank (↑): 173
  • State property crime rank (↑): 183
  • Health rank (↓): 184
  • Average temperatures: Summer 72ºF, Winter 22ºF5
  • Top state income tax: 8.53%6
  • Average sales tax: 6.8%6
  • Average property tax: 1.46%6
  • Median home value: $145,7007
    • One-year change: +4.5%8
  • Median monthly rent: $1,1007
  • Average cost of electricity: $0.15/kwh8
  • Cost of living index: 92.0 (U.S. average = 100)9
  • Unemployment: 2.5% (U.S. average = 3.7%)10
  • Best states rank (↓): 1411
  • Approximate annual retirement cost per household: $57,00012

Major Attractions in Middle America

Boy, am I lucky to be writing about Iowa right now. In a few months, when early presidential primaries are the biggest news on the Internet, this column will pop up whenever people Google Iowa caucuses. That means I’ll gain a huge new audience and might be too busy with personal appearances to answer your e-mails. Sorry.

Those imaginary fans of mine are going to be disappointed when they find nothing provocative here—no warnings of civil war or even subzero interest rates. All I’m offering is a few good reasons for my EMS pals to pack a resumé with a change of clothes and take a ride to the Hawkeye State.

First among 50: U.S. News & World Report named Iowa the No. 1 state in the nation based on 77 metrics in eight categories, including healthcare (No. 3), education (No. 5), opportunity (No. 4), and infrastructure (No. 1). I’d just like to point out that if major sports championships had been considered, my home state of Massachusetts would have won in a landslide.

Scholarship and employment: Iowan teenagers must be really smart; 91% of them graduate high school—lots more than the national average of 85%. And almost all of them find jobs, thanks to Iowa’s ridiculously low 2.5% unemployment rate.

Bumper cars and cotton candy: Iowa has a 170-year tradition of state and county fairs. What’s not to like about state and county fairs?

From the majestic to the macabre: Start with a trip to Pike’s Peak—not the one in Colorado, the other one—and enjoy waterfalls, hiking trails, and a panoramic view of the Mississippi River from a 500-foot cliff in the northeastern corner of the state. Then head 350 miles southwest to the Villisca Ax Murder House, site of “the largest unsolved crime in Iowa.” I’m not sure there’s a better place for some of my ex-partners.

Safe at home: Rest easy among the rolling hills of Iowa knowing ax murders are much less common there now. Maybe that’s why Iowa’s population is increasing faster than the rest of the country’s. Or it could be because violent crime fell almost 20% in the state’s biggest cities last year.

Europe on the cheap: There are Czech, German, Dutch, Danish, and Norwegian settlements scattered throughout Iowa, with lots of local festivals featuring suds and sausage. By the time you’ve visited all those old-world enclaves, you’ll know how to say “my head hurts” in at least six languages.

EMS Iowa-Style

As of 2015 Iowa had about 6,800 EMTs, 700 AEMTs (including EMT-Is), and 2,800 paramedics. Almost half of those providers were volunteers—not surprising in a largely rural state.

Iowa not only offers reciprocity; it has a really simple form for it. You’ll need that plus a current NREMT card to become a local lifesaver.

When it’s time to renew every two years, you can submit national certification or meet Iowa’s own CME requirements:

  • EMTs: 24 hours;
  • AEMTs: 36 hours;
  • Paramedics: 60 hours.

At least half of those hours must be “formal”—i.e., “relevant to the delivery and documentation of patient care,” such as airway management, patient assessment, trauma, medical emergencies, ob/gyn, and pediatrics.

In Iowa the alternative to “formal” CME is “optional”: operations, hazmat, EVOC, case reviews, self-study, college courses, clinical rounds, skills workshops, etc. There are hour limits on some topics.

One more thing: Iowa has about 47 tornadoes a year. Don’t approach them without gloves and goggles.


1. EMS World. EMS World Salary Survey 2018,

2. FBI. Uniform Crime Reporting System, 2018 National Incident Based Reporting System,

3. Public Safety Rankings,

4. America’s Health Rankings, United Health Foundation. 2018 Annual Report,

5. Current Results. Average Annual Temperature for Each U.S. State,

6. Tax Foundation Facts and figures 2019,

7. Zillow. United States Home Prices & Values,

8. Choose Energy. Electricity Rates by State,

9. Missouri Economic Research and Information Center. Cost of Living Data Series, 2019,

10. State Unemployment Rate in the U.S. The Content Marketing Trend Study, 2019,

11. Best States 2019: Ranking Performance Throughout All 50 States. U.S. News & World Report. 2019.

12. Hill C. This is exactly how much it will cost to retire well in every state in America. 06/28/19.

Mike Rubin is a paramedic in Nashville and a member of EMS World’s editorial advisory board. Contact him at

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