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With healthcare workers getting many of the first vaccine distributions, how can vaccinations be coordinated for off-site emergency medical services (EMS) personnel?

Last modified on 17 December 2020

What our experts say

The prioritization of initial COVID-19 vaccinations varies widely from location to location, with decisions being made at the federal, state, county and facility level. Emergency medical services (EMS) personnel are often included among the groups receiving the highest priority for the first shipments of the COVID-19 vaccine. Since the initial supply is not sufficient to vaccinate everyone within the highest priority groups, however, difficult decisions are being made about who is to receive the COVID-19 vaccines first. Some places are choosing to include EMS personnel outside of hospitals, such as in the fire department, in the first wave of COVID-19 vaccinations. Other places are distributing their first shipments of the COVID-19 vaccine straight to hospitals first. Decision-makers for each location can set priorities by taking into account public health guidance as well as data about their specific context regarding what resources are available and what are the most urgent needs. 

Several public health frameworks exist and have informed decision-makers, including the U.S. Centers for Disease Control and Prevention (CDC), as they set their vaccination priorities for COVID-19. 

In John Hopkins University’s framework for COVID-19 vaccine priority groups, Tier 1 includes front-line EMS personnel and Tier 2 includes other essential workers such as personnel in fire and police departments. In the National Academies of Medicine preliminary framework for equitable allocation of the COVID-19 vaccine, Phase 1a’s earliest “jumpstart phase” includes first responders like EMS, police and fire personnel. Depending on which public health frameworks are used, there can be differences in the recommendations for when to include EMS personnel outside of a hospital, such as in a fire department. 

Additionally, the U.S. CDC previously made suggestions for sub-categorization of Tier 1 vaccine distribution when there is an “extremely short supply” during a pandemic of other diseases, such as influenza. The proposed ranking of groups within Tier 1 in this situation is:

  1. Front-line inpatient and hospital-based health care personnel caring for sickest persons; health care personnel with highest risk of exposure
  2. Deployed and mission critical personnel who play essential role in national security
  3. Front-line EMS
  4. Front-line outpatient health care personnel, pharmacists and pharmacy technicians, and public health personnel who provide immunizations and outpatient care
  5. Front-line law enforcement and fire services personnel
  6. Pregnant women and infants aged 6 -11 months old
  7. Remaining groups within Tier 1, including but not limited to: inpatient and outpatient healthcare personnel not vaccinated previously; public health personnel; other EMS, law enforcement, and fire services personnel; manufacturers of pandemic vaccine and antiviral drugs

While this guidance can be a point of reference for some locations seeking to decide how to allocate vaccinations to EMS personnel outside of hospital settings (who in this case might be categorized in group 3 or 7, depending on their involvement in front-line care), there are some notable differences that should be taken into account for COVID-19, compared to influenza. For example, COVID-19 has been especially deadly for older adults in long-term care settings, which is why long-term care residents and personnel are among the top tier priorities for COVID-19 vaccinations according to U.S. federal recommendations. 

While the specific prioritization of EMS personnel outside of hospital settings may vary depending on the location, it is important for decision-makers to have a plan for how to vaccinate non-hospital-based EMS personnel and communicate this plan with transparency.

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Context and background

Following the approval of the Pfizer and BioNTech vaccine in the U.S. on December 11, 2020, the first shipments of the vaccine are being given out across the country, allocated based on the adult population in each state. The U.S. Centers for Disease Control and Prevention (CDC) voted to give first priority to healthcare workers, including emergency medical service (EMS) personnel, and residents of long-term care facilities under Phase 1a of vaccinations. While federal guidance is being provided, the specific vaccination plans and priorities are determined by state governments and can vary widely at each location. 

According to an analysis of state vaccine prioritization plans by the Kaiser Family Foundation in early December 2020, 7 states are departing from the U.S. CDC’s Phase 1a recommendations in some way, and more than 20 states are providing “further sub-prioritization rankings or criteria” within Phase 1a. The Kaiser Family Foundation also notes that even with state criteria, “decisions about how to allocate limited initial vaccines…will mostly be left to facilities.” 

In some states, the first shipment of COVID-19 vaccinations have been distributed mainly to hospitals, leaving questions about how Tier 1 healthcare personnel outside of hospital settings will be prioritized for vaccination. For example, some EMS personnel provide emergency and front-line care based at a fire department, nonprofit, or municipality rather than at a hospital. On December 1, 2020, four major fire service organizations (International Association of Fire Chiefs, International Association of Fire Fighters, National Association of State Fire Marshals, and National Volunteer Fire Council) released a joint statement requesting state governors and health officials to give firefighters and EMS personnel priority access to COVID-19 vaccines.

In Washington D.C., it was reported that 5 members of D.C. Fire and EMS were the first to receive the COVID-19 vaccine, whereas in California it was reported that an emergency room nurse was one of the first to receive the COVID-19 vaccine although “paramedics, EMTs and others providing emergency medical services” are also included within the state’s Tier 1 priorities for Phase 1a. EMS personnel outside of hospital settings may be prioritized differently during Phase 1a of COVID-19 vaccinations depending on the location. 


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  1. The Advisory Committee on Immunization Practices’ Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020 (U.S. CDC)
  2. Interim Considerations for COVID-19 Vaccination of Healthcare Personnel and Long-Term Care Facility Residents (U.S. CDC)
  3. Overview of Vaccine Equity and Prioritization Frameworks (U.S. CDC)
  4. Influenza (Flu): Vaccination of Tier 1 at All Pandemic Severities (U.S. CDC)
  5. How are States Prioritizing Who Will Get the COVID-19 Vaccine First? (Kaiser Family Foundation)
  6. How Different States Will Approach COVID-19 Vaccine Distribution (NPR)
  7. Major fire service organizations call for priority access to COVID-19 vaccines (FireRescue1)
  8. D.C. Fire and EMS Identifies First Ones to Receive COVID-19 Vaccination (FireFighterNation)
  9. Kaiser Permanente nurse in East Hollywood among 1st in California to receive COVID-19 vaccine (ABC7 Eyewitness News)
  10. CDPH Allocation Guidelines for COVID-19 Vaccine During Phase 1A: Recommendations (California Department of Public Health)
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