As the opioid epidemic continues to strain public health systems across the United States, Emergency Medical Services (EMS) agencies have emerged as some of the most critical — and chronically underfunded — responders on the front lines. The influx of opioid settlement funding, projected to exceed $57 billion nationally, has opened a rare and transformative opportunity for EMS systems to stabilize operations, modernize equipment and expand their role in overdose prevention and response.
While early settlement discussions focused heavily on treatment, prevention and community-based recovery, states and counties have increasingly recognized that EMS agencies are indispensable to any effective opioid response strategy. As a result, the scope of allowable spending has broadened and EMS agencies are now securing funding for a wide range of needs — from advanced cardiac monitors to data systems, mobile response units and workforce development programs.
This expansion marks one of the most significant shifts in EMS funding in decades.
EMS at the center of the crisis
EMS clinicians are often the first medical professionals to encounter individuals experiencing opioid overdoses. Their role has grown even more essential as overdose deaths have surged. In 2022 alone, 107,941 Americans died from drug overdoses, with 81,806 involving opioids.
Yet despite their central role, EMS systems have long faced structural instability. Many agencies operate with limited budgets, aging equipment and staffing shortages — conditions that undermine their ability to respond effectively. States have acknowledged these challenges, noting that EMS systems face “funding shortages and workforce challenges” that hinder timely and effective care.
Opioid settlement funding has become a lifeline, allowing EMS agencies to address gaps that traditional funding streams have failed to fill.
A broader interpretation of allowable uses
The national settlement agreements outline approved spending categories in Exhibit E, which include first responder support, overdose response and data collection. Over time, states and counties have interpreted these categories more expansively, enabling EMS agencies to pursue funding for:
• Cardiac monitors and AEDs
• Mechanical CPR devices
• Naloxone distribution and storage systems
• Mobile response units
• Training and certification programs
• Data integration and analytics tools
• Alternative destination transport programs
This shift reflects a growing understanding that overdose response is not limited to naloxone administration. It requires a fully equipped, well-trained EMS workforce capable of managing the full spectrum of medical emergencies associated with opioid use, including respiratory failure, cardiac arrest and polysubstance complications.
Equipment modernization: Closing critical gaps
One of the most visible expansions in opioid settlement spending has been the purchase of advanced EMS equipment.
Across the country, agencies have secured funding for AEDs, cardiac monitors and mechanical chest compression devices — equipment that directly supports overdose-related cardiac arrest response. These purchases align with settlement guidelines and have been approved in multiple states and counties.
The rationale is straightforward: opioid overdoses frequently progress to respiratory and cardiac emergencies. Without modern resuscitation equipment, EMS clinicians cannot provide the level of care required to save lives.
Data systems and technology upgrades
Another major area of expansion involves EMS data infrastructure.
In Longview, Washington, for example, the fire department is seeking opioid settlement funds to implement a new overdose response data platform. The system would help guide response strategies, improve analytics and support alternative transport decisions — an increasingly important tool as EMS agencies work to reduce unnecessary emergency department visits.
States are also enhancing data integration between EMS and public health systems to improve overdose tracking and resource allocation.
These investments reflect a broader trend: opioid settlement funding is not just supporting equipment purchases but enabling EMS agencies to modernize their operations and participate more fully in coordinated public health strategies.
Expanding EMS roles through mobile units and alternative transport
Settlement funding has also supported innovative EMS models that go beyond traditional 911 response.
Opioid funds are helping agencies launch mobile units, expand community paramedicine programs and even support paramedic scholarships to address workforce shortages.
Some states are also expanding EMS transport options, allowing clinicians to take patients to urgent care centers, mental health clinics or other non-emergency facilities. This reduces strain on emergency departments and ensures individuals receive more appropriate care.
These models reflect a shift toward proactive, community-based EMS engagement — an approach that aligns closely with the settlement’s emphasis on prevention and early intervention.
Workforce development and training
The opioid crisis has placed enormous emotional and operational burdens on EMS clinicians. Settlement funding has increasingly been used to support:
• Mental health and wellness programs
• Overdose response training
• Recruitment and retention initiatives
• Scholarships for EMS education
These investments acknowledge that EMS clinicians are not only responders but also secondary victims of the opioid epidemic, facing repeated exposure to trauma and high-stress situations.
A sustainable path forward
Opioid settlement funding will continue for 11 to 18 years, depending on the settlement source. This long-term horizon gives EMS agencies a rare opportunity to plan strategically rather than reactively.
However, sustainability remains a concern. Settlement funds are finite and many EMS agencies worry about building programs they cannot maintain once the funding ends. Still, the current moment offers a powerful chance to strengthen EMS systems in ways that will outlast the settlement period — through better data, stronger training pipelines, modern equipment and more integrated public health partnerships.
Conclusion
The expansion of opioid settlement funding for EMS represents a profound shift in how communities understand and support emergency medical care. What began as a legal remedy for pharmaceutical misconduct has evolved into a catalyst for EMS modernization and resilience.
By investing in equipment, data systems, workforce development and innovative response models, states and counties are not only improving overdose response but strengthening the entire emergency care infrastructure.
For EMS agencies long accustomed to doing more with less, opioid settlement funding has become a transformative force — one that is reshaping the future of prehospital care and saving lives in the process.
