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State Department: Arizona

Arizona lacks reciprocity with any other states, meaning you cannot transfer your certification there.
Arizona EMS regions
Arizona EMS paramedic patch
Arizona EMS EMT patch
Arizona EMS helicopter

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 is worth a look. Our goal is to accentuate everyday aspects of potential destinations from a prehospital provider’s point of view.

Author’s note: Arizona’s Bureau of Emergency Medical Services and Trauma System (BEMSTS) declined to be interviewed about Arizona EMS. Unless otherwise referenced, EMS information is based on content from the BEMSTS website as of 9/7/18.


  • Approximate number of EMS providers: 18,000 EMCTs (Emergency Medical Care Technicians, includes EMTs, AEMTs, paramedics)11
  • Average straight-time wages: EMT $14.07/hour, paramedic $18.04/hour1
  • Cost of living index: 94.6 (U.S. average = 100)10
  • Recertification cycle: 2 years
  • National Registry state: Yes
  • Volunteering: Best opportunities in the Western region, where 26% of EMCTs are volunteers12
  • Large EMS employers: Fire districts, municipal fire departments, and privates12
  • Paramedics with degrees: About half of paramedics have at least an associate degree12
  • State EMS website (Central Region protocols)
  • Approximate state population: 7,016,000
    • Change since 2010: +10%
    • Average population per provider: 390
  • State area: 113,990 square miles 
    • Average population per square mile: 61
    • Rank (↓): 33
  • Most populous cities (approximate): Phoenix 1,615,000, Tucson 531,000, Mesa 485,000 
  • Violent crime one-year change: Mesa -6%2
    • State violent crime rank (↑): 413
    • State property crime rank (↑): 393
  • Health rank (↓): 314
  • Top state income tax: 4.5%6
  • Average sales tax: 8.3%6
  • Average property tax: 0.70%6,7
  • Median home value: $242,0008
    • One-year change: +8%8
  • Median monthly rent: $1,4508
  • Average cost of electricity: $0.13/kwh9
  • Average temperatures: Summer 78ºF, Winter 44ºF5

Arizona Lifestyle

What’s it like in Arizona? That depends on the location. Southern Arizona, which includes Phoenix and Tucson—the state’s most populous cities—is hot and dry, with summer temperatures often exceeding 100ºF. Northern Arizona is heavily forested, much cooler, and gets lots of snow—more than 100 inches a year in Flagstaff. That northern hub is only 120 miles from Phoenix, yet average temperatures in those two regions vary by more than 25 degrees year-round.

Arizona also has plenty of mountains, but it’s even more famous for two gigantic holes in the ground: the 277-mile-long Grand Canyon in the state’s northwest corner and the 50,000-year-old Barringer Meteorite Crater just west of Winslow. From the rim of the mile-wide crater, you could contemplate the modern-day consequences of a hypersonic, 300,000-ton rock striking the Earth or maybe just enjoy the view.

Head northeast from Winslow through the Navajo Nation, the largest Indian reservation in the U.S., and you’ll reach the Four Corners, the only place in the country where four states intersect (Arizona, Colorado, Utah, and New Mexico). While you’re standing on the X marking that spot, consider these fun facts about Arizona:

  • It’s the 48th and newest of the contiguous states (admitted in 1912).
  • Hawaii is the only other state that doesn’t observe daylight savings time.
  • As a territory during the Civil War, Arizona fought with the Confederacy and hosted the war’s westernmost battle.
  • Arizona enacted the nation’s first “stupid motorist law,” which makes drivers who ignore flash-flood barricades responsible for the cost of their rescue.
  • Oh, and it’s illegal in Arizona for donkeys to sleep in bathtubs. Seriously.

Arizona EMS

EMS in Arizona is divided into four regions: Northern, Central, Southeastern, and Western, with the Central busier than the other three combined.11 The state’s 65-and-over population, 15% of the total, accounts for 37% of EMS call volume.11

Reciprocity is one of the most important issues facing EMS providers pursuing relocation. If Arizona is your destination, consider this from the BEMSTS website: “Arizona does not have reciprocal agreements with any other states; therefore, you cannot transfer your certification to Arizona.”

Arizona is an NREMT state, meaning you must be nationally registered to be eligible for certification. You’ll also have to live in Arizona unless “a certification manager (obtains) approval.” The process for gaining such an exception is unclear.

Once you’re certified in Arizona, you may select any of these options to renew:


  • A 24-hour refresher followed by written and practical exams;
  • Twenty-four hours of continuing education;
  • A challenge exam involving written and practical exercises;
  • Current National Registry certification.


  • A 48-hour refresher followed by written and practical exams;
  • Forty-eight hours of continuing education;
  • A challenge exam involving written and practical exercises;
  • Current National Registry certification.

AEMTs and EMT-Is (99) must satisfy paramedic-level criteria to remain certified as intermediates.


1. EMS World. EMS World Salary Survey 2018,

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

3. Ibid., 2016.

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

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

6. Tax Foundation Facts & Figures,

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

11. Arizona Department of Health Services. Emergency Medical Services 2016 Annual Report,

12. George T. 2016 Arizona Statewide Emergency Medical Services Needs Assessment,

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

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