Based on Tennessee Code Annotated (T.C.A.) §§ 7-61-101–104, a city or county may provide ambulance service as a governmental activity or may regulate this service through license, franchise, or contract for services to be provided by private operators or nonprofit general welfare corporations such service provided by private operators or non-profit, general-welfare corporations. No county may provide, license, franchise, or contract for ambulance service within a city or in another county without approval from the city’s governing body, and the same restriction applies to cities. Counties and/or cities may establish interlocal agreements in order to provide ambulance services for another entity.

State regulation of emergency medical service agencies and licensing of emergency medical personnel is provided in the Emergency Medical Services Act of 1983 and rules promugated by emergency medical services board. There are five levels of emergency medical care provider certification in Tennessee: Emergency Medical Responder (EMR), Emergency Medical Technician (EMT), Advanced Emergency Medical Technician (AEMT), Paramedic, and Critical Care Paramedic.

The complete Rules of the Tennessee Department of Health, Bureau of Health Licensure and Regulation, Division of Emergency Medical Services concerning the provision of emergency medical services by ambulance and first responder agencies may be found at: https://www.tn.gov/health/health-program-areas/health-professional-boards/ems-board.html