Download Nomination Form

Online Nomination Form


Criteria for Consideration

Nominees must meet certain criteria to be considered for acceptance to the National EMS Memorial.

  • Nominee must have been performing EMS duties at the time of death. ( EMS duties include, but are not limited to, transporting patients, treating patients, performing extrication procedures, rescue operations, and may include attending meetings, public appearances, or other related functions.)
  • Nominees must not have been previously honored by the National EMS Memorial Service.
  • Nominee must have been a currently certified/licensed provider and/or affiliated with an established EMS agency.
  • Nominee must have followed established safety regulations, local protocols, and standard operating procedures.


The National EMS Memorial is open to any individual who loses his or her life while performing an EMS related duty. 
This includes individuals who may not be medically licensed or certified but who are nonetheless valuable members of the EMS team. Just a few examples would be drivers, pilots, and other support personnel. The deciding factor is not certification but rather that they were part of the EMS team and were actively involved in a medical rescue or other EMS related duty as a primary function at the time of loss, and that the nominee meet all other criteria listed above.

The National EMS Memorial Service recognizes that with the wide variety of provider levels and the vast number of EMS delivery models currently in use in the United States, it would be virtually impossible to write a definitive policy as to who is eligible in a given situation. The Memorial endeavors to be inclusive of all EMS personnel and has therefore put procedures in place to individually review each nomination for eligibility. If you remain unsure as to an individual’s eligibility, we encourage you to submit the nomination to us for a determination.

Preparing a Nomination

After determining that the deceased does indeed meet the National EMS Memorial Service’s Criteria, the next step is to download/request the Nomination Packet.

It is important that the information requested on the Nomination Form be supplied as completely and accurately as possible. As the memorial does not consider incomplete nominations, missing materials and incomplete or inaccurate information will delay the processing of a nomination and could delay an individual’s acceptance to the Memorial.

Ideally, the nomination of an individual to the Memorial should be a cooperative effort of the nominees’s family and agency. While we understand that circumstances sometimes make this impossible, every effort should be made to include the family of the nominee in the process if someone other than a family member is making the nomination.

The National EMS Memorial Service maintains a national network of Regional Coordinators who are available to assist you in the nomination process. You need only contact us to arrange for such assistance.Once you have completed the nomination form, you should gather any and all documentation supporting the line of duty status of the death. Some cases are fairly straightforward and others are more complex.

Sometimes however, cases that initially seemed straightforward turn complex. We therefore recommend that all nominations be submitted with as much supporting documentation as is possible. 
Examples of “supporting documentation” include, but are not limited to: Worker’s Compensation determinations, local, state or federal Public Safety Officers benefit or recognition program determinations, letters of determination of Line of Duty Death from the nominee’s EMS agency, local or state EMS memorial acceptance, press and media reports, etc. Supporting documentation should also include (3-4) photos of the nominee as well as their agency patch.

In cases where the nominee survived the initial line of duty trauma, illness or exposure, but later succumbed to long term complications from that line of duty trauma, illness or exposure, you should also include a determination from the attending physician indicating a direct relationship between the immediate cause of death and the line of duty trauma, illness or exposure.
All nominations should also be accompanied by a copy of the nominee’s death certificate, clearly indicating the cause(s) of death.

Submitting a Nomination

Once the Nomination Form is complete and all other required materials and supporting documentation is ready, 3 complete copies of the information should be made. One should be retained by the person making the nomination. One should go to the nominee’s family and the another to the nominee’s agency.

The original should then be submitted to:

National EMS Memorial Service
P.O. Box 279
Oilville, VA 23129-0602

Please use a delivery confirmation method.



Nomination Deadline

All nominations for any given year’s Memorial Service must be received by us on or before the 31st of December prior to the Memorial Service. Any nomination received after December 31st will be considered for the following year’s Memorial Service.

As the preparations for, and production of the National EMS Memorial Service require a certain amount of lead time, there can be no exceptions made to this policy.

The Determination Process

Upon receipt, each nomination is distributed to all members of the National EMS Memorial Service Board of Directors for investigation and consideration. The goal of these investigations is straightforward, and that is to determine if the nominee and the circumstances surrounding his or her death fall with the criteria established for inclusion in the National EMS Memorial.

The results of the investigations are reported to the Criteria Committee which then presents its finding and recommendations to the Board of Directors and, when appropriate, places the nomination before the Board for a vote.


In the event the nomination is not accepted, the individual(s) submitting the nomination will be notified in writing. The notification will include the reasons the nomination was declined.All declined nominations are due to a finding by the Memorial Service that the nominee did not meet our criteria. Most often this means that we found that the nominee was not “actively involved in a medical rescue or other EMS related duty as a primary function” at the time of his or her death.

Any appeal of a negative decision should include new information, documentation and/or other evidence which directly bears on the negative finding indicated in the notification and which has not been previously considered by the Memorial Service. Submitting a nomination on appeal which is basically identical to the initial nomination will likely result in the same determination.
Should such new information come to light, you may appeal a negative decision to the Board of Directors on a one time basis. The Board’s determination after such a second review is final.

Nomination Packet Download

The packet used to nominate an individual to the National EMS Memorial Service is available from the link below. The forms are in Adobe Acrobat format and require the free Adobe Acrobat Reader to view, complete and/or print.

Download Nomination Form

Please remember: All nominations for any given year’s Service must be received by us on or before December 31.
It is important that the individual(s) making this nomination complete all, or as much of the nomination form as possible. Missing data will delay the processing of the nomination and could delay the nominee’s inclusion in the Service for a full year.