Introducing SPaR: The State EMS Progressiveness & Readiness Maturity Model

Why Black Flag EMS Created SPaR for EMS Operations

The State EMS Progressiveness & Readiness (SPaR) Maturity Model was born from a simple but pressing question: How do we compare EMS systems across the U.S. in a way that is fair, actionable, and forward-looking? For years, EMS professionals, state regulators, and advocates have lacked a standardized way to measure the maturity of their systems beyond anecdote and reputation. SPaR solves that gap by offering a data-driven, six-domain rubric that scores and explains the readiness and progressiveness of EMS systems in all 50 states, the District of Columbia, and U.S. territories thereby helping to vastly improve EMS Operations.

Where We Got the Data

The SPaR Maturity Mode draws on a combination of:

Publicly available state EMS statutes and regulations (scope of practice, treat-in-place authority, alternate destination rules).

State EMS office and NAEMT MIH-CP program listings.

Industry benchmarking from NAEMT, NASEMSO, and peer-reviewed EMS system assessments.

Workforce culture indicators from Glassdoor reviews, EMS forums (including Reddit), and published workforce retention data.

Operational insight from field experience, QA reports, and state-specific EMS news coverage.

Example Data Points:

Colorado: Statewide authority for MIH-CP, advanced clinical scope including RSI and POCUS, Medicaid reimbursement for non-transport.

Florida: Limited TIP authority, inconsistent advanced protocols, low culture scores from workforce reports.

Oregon: Highly integrated EMS-public health systems, robust QA, and strong retention culture.

The Six Domains of SPaR

SPaR scores each jurisdiction on a 100-point scale across six domains:

1. Legal Authority (22 points)Measures the statutory and regulatory foundation for advanced EMS practices. Without enabling laws, innovation is impossible.
   

2. Reimbursement & Funding (22 points)Evaluates the financial backbone. Even the best protocols fail without sustainable reimbursement.
   

3. Advanced Capabilities (18 points)Assesses clinical scope beyond the national paramedic baseline (e.g., prehospital antibiotics, RSI expansion, surgical airway).
   

4. QA/Training Standards (13 points)Gauges the rigor of quality assurance and ongoing education. This ensures care consistency and clinician growth.
   

5. Scale & Integration (13 points)Looks at statewide scaling of programs and integration with hospitals, public health, and HIE systems.
   

6. Culture (12 points)Measures leadership quality, workforce morale, retention, and public trust.

   
   

Why Each Domain Matters

Legal Authority: No law, no practice. This is the gatekeeper domain.

Reimbursement: Innovation without funding is unsustainable.

Advanced Capabilities: Defines the system's clinical ceiling.

QA: Without review, errors repeat and excellence erodes.

Scale & Integration: Prevents programs from being isolated in a single metro area.

Culture: Poor culture undermines every other investment.

How to Use the SPaR Model

State EMS Agencies: Benchmark against peers, identify weakest pillars, and prioritize reforms.

Lobbyists & Advocates: Use scores and recommendations to push legislation and funding.

Clinicians & Leaders: Identify states with better operational environments for recruitment or best-practice adoption.

How to Use the SPaR Interactive Map

The SPaR Interactive Map is a free tool that allows you to visualize the SPaR Model results. States in green are considered EMS "leaders" where as those in orange are showing signs of advancing their core practices. Those states in "red" are viewed as trailing and not staying abreast of the latest EMS best practices or innovation.

By clicking on a state, you are presented with the rationale for the score as well as high-level recommendations for improvement and the individual domain scores. You can also quickly view a state's score and state by hovering over the state with your mouse pointer.

Top 3 States: What They’re Doing Well

Colorado

Strengths: Statewide MIH-CP, Medicaid reimbursement for TIP, advanced airway and POCUS authority.

Why it Works: Policy aligns with funding, and QA drives integration.

Oregon

Strengths: Full RSI, integrated EMS-public health systems, strong retention culture.

Why it Works: Focus on clinician wellness and inter-agency cooperation.

Washington

Strengths: Advanced protocols for rural and metro agencies, strong QA, and grant-funded scaling.

Why it Works: Combines legal authority with aggressive adoption of best practices.

Bottom 3 States: Where They Struggle

Northern Mariana Islands

Gaps: Limited advanced scope, minimal QA infrastructure, no formal TIP authority.

Impact: Reliance on basic transport delays care.

American Samoa

Gaps: Weak reimbursement framework, almost no advanced capabilities, low integration.

Impact: Advanced interventions often require hospital arrival, increasing morbidity.

Mississippi

Gaps: Low culture scores, inconsistent adoption of advanced skills, limited funding pathways.

Impact: Clinician turnover undermines program stability.

Why SPaR Works and is Accurate

Balanced Scoring: No single domain can dominate the total score—it forces a complete-system view.

Actionable Output: Each jurisdiction gets targeted recommendations tied to its weakest domains.

Data-Backed: Uses a blend of statutory, operational, and cultural data sources.

Repeatable & Transparent: The model’s scoring logic is published and can be applied consistently by any qualified analyst.

You can access the SPaR Interactive Map here.