I'm in Hawaii (as a Firefighter). We did a full NREMT class as part of our Academy (Honolulu Fire) including ridealongs with EMS and hospital clinicals, and got NR certification.
However, HI state EMT requires additional education hours and requirements above and beyond NR (so we're limited to EMR/First Responder scope of practice as a Dept, even the guys who came in from EMS and are State Licensed...).
There IS talk of there being a bridge course to go from NREMT to State EMT, apparently it comes and goes, and I dont know too much about what it entails, nor if it's only available because we took NREMT in state or available to anyone with NR/out of state certs.... I need to do more research into that myself as I have been thinking about getting state licensed myself.
Just general info, AMR is pretty much the only private ambulance I've seen here. City&County of Honolulu (Oahu) we have our own third service municiple EMS Agency (although guys in the FD who also work part time for AMR say roughly a quarter of their calls are backup 911 for the City, the rest are BLS, ALS, CCT transfers, although they're first in at the airport as well).
(Edit to add, seems fairly related to the topic:
http://www.hawaiinewsnow.com/2019/0...ce-years-is-helping-ease-strain-ems-slightly/
Honolulu EMS just within the last couple weeks opened up its first new EMS unit on the island in 6 years. There's now 19 full time (24 hr a day) EMS units and 2 part time (noon to midnight 12hr) units..)
Kauai and Maui Counties use AMR as their EMS provider,
Hawaii County (Big Island) Fire runs the EMS there with Firefighter/Paramedics, and AMR once again providing backup and transfers.
Only other ambulances I've seen are Fed Fire (who covers the military bases, idk how much they're on the other islands, but here on Oahu they have a fair sized presence)