The purpose of the National Collaborative for Bio-preparedness (NCB-P) is to enhance biosurveillance and situational awareness to better inform decision-making using a statewide approach. EMS represents a unique potential data source because it intersects with patients at the point of insult or injury, thus providing information on the timing and location of care. North Carolina uses a standardized EMS data collection system, the Prehospital Medical Information System (PreMIS), to collect information on EMS encounters across the state using the National EMS Information System (NEMSIS) template (1) . Since NEMSIS is planned to be incorporated by EMS agencies in every state, an EMS-based approach to biosurveillance is extensible nationally.