SAN DIEGO — What happens when the systems EMS depends on simply stop working?
That question framed the opening keynote at Pinnacle 2026, where historian, professor and bestselling author Dr. William R. Forstchen challenged attendees to think beyond routine disasters and consider how their agencies would respond during prolonged failures of power, communications, healthcare infrastructure and supply chains.
Known for his “One Second After” series, Forstchen’s message to EMS leaders was direct: Preparedness is not about fixating on unlikely scenarios. It is about being ready to lead when the systems, resources and outside assistance agencies normally depend on are no longer available.
| NEW RESOURCE: What Paramedics Want in 2026
Memorable quotes
Forstchen used a mix of history, fiction and direct questions to challenge attendees to reconsider what true preparedness requires:
- “I think we take almost everything for granted.”
- “The civilizations that get wiped out couldn’t believe it was possible.”
- “Those who have ability have moral obligations. I look in this room and I feel darn secure right now.”
- “I hope that 30 years from now, my grandchildren think I was a little bit nuts.”
Top takeaways
Following are four key lessons for EMS leaders from Forstchen’s opening keynote:
1. Modern society is more fragile than many realize
Forstchen shared how interconnected infrastructure — including electricity, communications, healthcare, transportation and supply chains — creates cascading vulnerabilities during large-scale disruptions.
Like his novels, he framed the discussion by time frames. He invited the audience to imagine just the first 24 hours after a large-scale grid disruption — from the car accidents, the cardiac arrests, the immediate crises — to the midnight-8 a.m. shift at the nursing home that night. How many nurses would fail to report because they were caring for their own families, their cars would not start or the roads were blocked? How long would backup power last? What would happen when ventilators stopped working, oxygen supplies ran out and there were no longer enough staff members to manually ventilate patients?
2. Preparedness is a leadership responsibility
Forstchen argued that leadership could become a community’s most important resource during a prolonged catastrophe.
“Somebody is going to have to step forward and help the community take control of the situation,” he said.
Preparedness, therefore, extends beyond written plans, equipment caches and emergency exercises. Agencies need leaders who can establish priorities, organize limited resources, communicate clearly and maintain public trust under extreme conditions.
“You have to have a hierarchy of leadership,” Forstchen said.
His challenge to attendees was to consider who would make decisions if normal government, communications and mutual-aid structures were unavailable — and whether those leadership roles are understood before a crisis begins.
3. EMS must plan for operating without its normal systems
Most EMS disaster plans focus on the first minutes or hours of an incident. Forstchen asked attendees to consider what happens when disruption lasts for weeks, months or longer.
During the session, attendees responded live to the question: Does your organization regularly exercise for a long-duration infrastructure failure? The responses reflect the preparation gaps:
- 7%: Yes
- 15%: Occasionally
- 78%: No
Forstchen encouraged EMS leaders to discuss how their agencies would function without reliable communications, fuel deliveries, hospital capacity, electronic records, supply shipments or outside assistance. “Most of what you encounter is local,” Forstchen said, noting that even after Hurricane Katrina, assistance began arriving almost immediately from across the country. But consider what would happen if there was no help to come.
The goal is not to predict every possible scenario. It is to identify assumptions built into existing plans and determine which operations could continue when those assumptions no longer hold.
4. Communities must prepare to care for their caregivers
Emergency responders cannot remain on duty indefinitely if their families lack food, shelter, medical care or security.
Forstchen urged communities to include first responders’ families in continuity planning. Regardless of their commitment to the job, in the event of a lasting, large-scale disruption, public safety professionals cannot remain devoted to their posts if their children or other family members are at risk.
Communities that ensure responders and their families are supported will receive a significant return on that investment, he said. Trained responders would be among the most important resources during a prolonged crisis.
Planning for their needs is not an employee benefit. It is part of maintaining the community’s response capability.
The leadership challenge
Forstchen’s keynote set the tone for Pinnacle by encouraging leaders to look beyond day-to-day operational challenges and consider how their organizations would function when the systems they depend on no longer exist. His message reinforced that resilience begins long before a disaster — and that leadership, planning and adaptability will determine how agencies respond if the unthinkable becomes reality.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.
