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State Department: Alabama

Alabama Department of Public Health logo
Alabama EMS logo
Alabama EMT patch
Alabama paramedic patch

If you’re an EMS worker who is thinking of relocating or just wants to learn more about life across the U.S., EMS World’s new State Department feature is worth a look. Each month we’ll start with a featured state “snapshot,” then bring you exclusive guidance from local healthcare leaders. The goal is to accentuate everyday aspects of potential destinations from a prehospital provider’s point of view.


  • Number of EMS providers—6.2K EMTs, 0.9K AEMTs, 4.8K paramedics
  • Average straight-time wages—EMT $12.55, paramedic $16.001 
  • Cost of living index—88.8 (U.S. average=100)2
  • Recertification cycle—2 years 
  • National Registry state—Yes 
  • Annual call volume—562,000
  • Volunteering—Lots of fire-based opportunities in small towns
  • Large EMS employers—Lifeguard Ambulance Service, Regional Paramedic Services, NorthStar EMS, Care Ambulance
  • Paramedics with degrees—Associate degrees are fairly common; bachelor’s degrees are rare
  • State EMS website— (protocols
  • Population—4,875,000 
    • Change since 2010—+2% 
    • Average population per provider—410
  • State area—52,000 square miles 
    • Average population per square mile—94 
    • Rank (↓)—27
  • Most populous cities—Birmingham 212,000, Montgomery 200,000, Mobile 193,000
  • Violent crime one-year change—Birmingham +6%, Montgomery +17%, Mobile +17%3
    • State violent crime rank (↑)—384
    • State property crime rank (↑)—444
  • Health rank (↓)—475
  • Top state income tax—5.0%6  
  • Average sales tax—9.0%6 
  • Average property tax—0.40%6,7
  • Median price of homes sold—$126,0008
    • One-year change—+5%8
  • Median monthly rent—$1,0008
  • Electricity cost—$0.12/kwh9
  • Average temperatures—Summer 79ºF, winter 47ºF10

Alabama Lifestyle

If you’re looking for a mixture of urban and rural, forest and shoreline, nature and technology, then Alabama may be the place for you.

“We have beautiful beaches,” says that state’s acting EMS director, Stephen Wilson, about Alabama’s 60-mile Gulf coastline. “It gets pretty hot and humid during summer, but there’s plenty to do even if sunbathing isn’t your thing.”

Wilson is referring to his state’s 450 miles of hiking trails, 1,500 miles of inland waterways, world-class restaurants, and a unique attraction he thinks all visitors should see.

“Huntsville’s U.S. Space & Rocket Center is a hidden gem,” the 42-year-old paramedic says. “I tell people they’ve missed something if they haven’t been there.” The spaceflight museum boasts enough rockets, missiles, exhibitions, high-g simulators, and space memorabilia to keep amateur astronauts entertained all day.

College sports in Alabama—especially football—are a big deal too. When you hear random residents shout “Roll Tide!” they’re not commenting on surfing conditions; they’re declaring allegiance to the University of Alabama football team, the Crimson Tide. Alabama and Auburn University are intrastate league rivals and perennial contenders for conference and national championships. “I’m an Auburn fan,” says Wilson, “so for me, it’s ‘War Eagle’ [Auburn’s equivalent battle cry] all the way.”

Alabama EMS

Wilson, who grew up in Alabama and volunteered for his hometown fire/rescue squad, oversees 12,000 licensed EMTs and paramedics in six regions. Call volume for 2017 was distributed as follows:

Region                                 Calls
1—North                              142K
2—East                                 79K
3—Birmingham Regional    131K
4—West                                39K
5—Southeast                        87K
6—Gulf                                  77K
Other                                       7K
Total                                     562K

Overall, 42% of patients were older than 65, and 5% were under 18. Trauma accounted for 14% of calls. There are four Level I trauma centers.

Shifts are usually 24 hours with 48 hours off. Most agencies roll with one EMT and one paramedic per rig.

“We’re a National Registry state,” says Wilson. “We have all four (national) levels here, plus around 300 EMT-Is who were left over when the registry discontinued that certification. If you’re coming to Alabama looking for reciprocity, you’ll need to be registered.”

Wilson adds that those who do interfacility work have to take a “drug transfer” course. “It’s just another endorsement on the license,” he says. “And everyone has to pass a protocol exam.”

The latter is less problematic than in many states because Alabama has one set of treatment protocols. “Some neighboring states use county-level or service-level protocols,” says Wilson, “but we believe what’s good for patients in North Alabama is good for patients in South Alabama.” Minor variances within scope of practice are up to agency medical directors.

According to Wilson, Alabama’s biggest needs for EMTs and paramedics are in poorer counties, such as Macon and Lowndes in Region 5 and Sumter and Pickens in Region 4. “Currently we have at least one ambulance service providing 9-1-1 coverage in every county,” he says, “but I’m afraid the day might come when we don’t. The volunteer sector is hurting too, just like in most of the U.S.”

Wilson, who began as an EMT in Montgomery 20 years ago, is evidence of his state’s opportunities for advancement. “I never dreamed I’d be the EMS director of Alabama,” says the Highland Home native. “I just kept pushing forward. I’m not one to give up. Those pathways are open for others too.”

So give Alabama a look. And while you’re there, don’t be afraid to let loose with “War Eagle!” or “Roll Tide!”


1. EMS World. EMS World Salary Survey 2018,

2. Missouri Economic Research and Information Center. Cost of Living Data Series, 2018 Annual Average,

3. FBI. Uniform Crime Reporting System, 2017 National Incident Based Reporting System,

4. Ibid., 2016.

5. America’s Health Rankings, United Health Foundation. 2017 Annual Report,

6. Tax Foundation. Center for State Tax Policy,

7. Ibid., Property Taxes Paid as a Percentage of Owner-Occupied Housing Value,

8. Zillow. United States Home Prices & Values,

9. Choose Energy. Electricity Rates by State in 2018,

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

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

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