Flex Monitoring Team (FMT) members from the University of Southern Maine are conducting a multi-year evaluation of the Emergency Medical Services (EMS) Supplemental funding grant. In this briefing paper, the authors examine the first-year implementation efforts of the eight grantees. Four of the grantees are developing sustainable models of care, and four grantees are identifying rural EMS quality measures and improvements in data reporting. We look at the impact of COVID-19 on their projects, challenges they encountered, and factors that helped them address these challenges and facilitate implementation. We discuss the role of the State Flex Program, and conclude with recommendations to support the evaluation of project activities over the remainder of the funding cycle.