I was asked recently, “what’s different about EMS today from when you started?” That got me thinking and while much has happened in the clinical treatment of patients, most for the better, it is simply amazing to me that many of the operational, business and leadership challenges that EMS faced in the late 1970s and early 1980’s still exist today.

Why has so little progress been made, you ask? Because as an industry we are our own worst enemy. We are fragmented, often represent ourselves poorly to legislators, policy makers and even our communities. We do not present ourselves as a well-organized, business-oriented group of providers.

Firefighters and police are better understood, they advocate better for themselves, and they provide a unified front.  EMS…not so much.  ALS, BLS, hospital-based, investor owned, fire/municipally run, volunteer, non-profit, EMT, Advanced EMT, paramedic…of course everyone but us is confused.

With the possible exception of reimbursement concerns, the myriad provider types present their different needs and agendas to governing bodies, and when faced with a variety of requests from an industry that is not well understood to begin with, decisions get deferred.

I was quoted extensively in an EMS World article on issues facing the industry in 2002, wrote a follow-up article for them in 2012, and if I were to refresh it again in 2026, very little has changed.  What industry can you name that has been relatively stagnant for almost 25 years?

EMS is in dire need of clarity!

Staffing

Finding and keeping enough staff is still a challenge as people enter the industry often viewing EMS as a ‘stepping stone’ rather than a career.  We suffer injuries at a higher rate than our fire and police colleagues. We are only beginning to recognize the long-term impact of cumulative stress on the workforce but are still reluctant to fund programs to help. And a lack of pay parity and career ladders deter our rising stars from staying.

The key to solving the staffing issue is creating a workplace that inspires pride in the profession.  This means respect from leadership, a wage above that of the average fast-food chain, providing well maintained equipment, rewarding and encouraging self-improvement and environments where respect for each individual is seen as part of something larger in the community. It’s a mindset change for many who still see EMS as a stepping stone…it’s not, and for those who have that view, it’s time to adapt or retire (there I said it).

Funding

The root of most of our issues is a chronic lack of funding. Many agencies’ leaders don’t take a business-like approach when asking for funding.  Developing a comprehensive budget, building a case with defensible facts and being transparent about their finances develops credibility in the long run.

Almost without exception, when our clients have presented well documented response and service delivery facts, clearly explained the revenue realities, built a comprehensive operating budget and capital replacement plan and answered the tough questions as a partner with their community, support has been forthcoming.

A recent client outcome resulted in a community stepping up with just over $1.5 million in capital support plus an annual operating subsidy based upon a top-to-bottom agency analysis, open-book discussions of finances and a willingness to be a long-term partner rather than an organization stacking budget meetings making demands and threats.

Respect

“EMS is simply the red headed stepchild, that’s how it is” (no offense to redheads).  I have heard, and once even repeated, this statement.  Well, the truth is that we put ourselves in this position.It’s time to stop playing the victim and step out of the shadows and proudly tell our story.  Respect is earned – but to earn it our constituents, politicians, other health care partners and the public, need to hear about our accomplishments from us consistently.

Effective self-promotion MUST be a mandatory part of every EMS organization’s DNA moving forward.  In the academic world professors are told ‘publish or perish’…a mantra EMS needs to adopt starting today.

Strong Leadership

The word is leadership NOT management.  Almost anyone can manage an organization, what EMS needs are leaders, those who set an expectation and then lead by example.

A great book for anyone interested in leading is Leaders Eat Last (https://amzn.to/4bN4LZj) by Simon Sinek. If you won’t read the whole book, which you should, read chapters 17 & 18 about culture and leadership.

Every organization should be developing its next cadre of leaders, building depth on the bench.  My personal philosophy is that the #1 job of every leader is to develop their people, including their own replacement.

In conclusion, EMS is a wonderful profession. It is a business.  It deserves respect and to change our industry we have to begin individually improving both from within ourselves as leaders and our organizations and begin consistently telling our collective stories outside our walls.