I know that pay is a hot topic in EMS, and i see people comment on Facebook job postings all the time "I aint working for $XX/hr" So what is a realistic expectation for hourly pay in EMS? EMTs bring a 140ish hour technical cert and no HS requirement to the table. ALS may or may not have an Associates Degree. The comparison seems to be in vs out of hospital staff, but our EMTs and ER techs are generally around the same wage. ALS does usually make less than an RN but RNs need a bachelors degree.