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Late in the summer of 1981, President Reagan signed comprehensive cost containment legislation that converted 25 Department of Health and Human Services (DHHS) [formerly the DHEW] funding programs into seven consolidated block grant programs [58]. EMS was included in the Preventive Health Block Grant, along with seven other programs such as rodent control and water fluoridation. Individual states were then left to determine how much money from the block grants would be distributed locally. Although existing EMS programs were temporarily guaranteed minimal support, a state could later decide to withdraw all block grant money from one or more regional EMS programs. This concept, simply a fundamental premise of conservative federal government, evolved quite differently in each state. As with decisions regarding how to implement clinician levels and assure competence, the funding process was generally quite political, with little direct input from the public or the EMS or medical communities.

The 1976 Forward Plan for the Health Services Administration made it clear that, by 1982, all federal EMS system financial support would end, and regional EMS programs would be the responsibility of the regional agencies. The federal role was to be “one of technical assistance and coordination” [59]. These changes significantly curtailed federal funding for EMS program development and evolution.