PHOENIX — As EMS and healthcare leaders gathered at the Pinnacle 2025 EMS conference, the theme at many sessions, including “EMS and healthcare, are we in critical condition?,” was clear: the systems built to serve communities are stretched thin — and the future depends on how the profession evolves to meet compounding challenges.
Rosemary H. Wurster, DNP, RN, FACHE, senior vice president, chief nurse executive of Bayhealth in Dover Delaware; and Fred W. Wurster III, MS, NRP, senior associate, Fitch & Associates, summarized the last 20 years of change in healthcare, and how we can reflect on lessons learned through those changes, and apply them to the future.
Consider 2005 vs. 2025:
- Post 911 — Post Covid
- Hurricanes Katrina and Rita — Multiple natural disasters
- Emergence of the term “ED overcrowding” — Telehealth and remote patient monitoring
- Medicare Part D— One Big Beautiful Bill
Memorable quotes
- “If we’re not investing in the human capital of our organization, we’re not going to survive.” — Fred Wurster
- ‘Lawmakers do not know what it looks like to take care of people. They don’t know what it looks like to hop on a truck at 2am and have no idea what you’re going to be facing. It’s up to us to let them know” — Rosemary Wurster
- If you’re not collaborating with your hospital system, you’re failing” — Fred Wurster
- If you’re not on the bus, you’re under the bus when it comes to technology” — Rosemary Wurster
Following are top takeaways from their discussion.
Workforce turnover and support
One top concerns transcends healthcare silos: workforce instability. As Fred Wurster noted, traditional incentives like sign-on bonuses have lost their power: “Forget the carrot and stick.” Instead, he called for direct investment in employees — through fair pay, manageable schedules and access to wellness resources.
The Wursters agree health equity must shape both patient care and workforce policy. Rosemary stressed the difference between health equality (everyone gets the same thing) and health equity (everyone gets what they need) and the importance of understanding those differences.
Fred echoed this, applying the concept to leadership development. Rather than telling someone, if you don’t like it here, go somewhere else, understand that everyone, including your workforce, is bringing baggage with them, he noted. “If we’re not investing in the human capital of our organization, we’re not going to survive ... human capital and health equity are words that go together like peas and carrots.”
Financial instability and infrastructure loss
Both speakers detailed the financial deterioration of healthcare systems. Hospital closures — especially in rural areas — have crippled access. Closures increase EMS transport times, requiring more resources, more training and contributing to systemwide burnout. As Rosemary Wurster warned, “You’re in the overtime zone, with longer transports and sicker patients.”
EMS is facing aged equipment, unsustainable training costs and minimal financial reserves. Agencies need to build financial stability, not rely on temporary labor or stopgap solutions.
Tech disruption and documentation overload
Technological advancement has transformed care delivery — from paper to wireless ECGs, from physical assessments to drone-deployed whole blood. But these advancements have not all been smooth.
Despite these frustrations, both speakers emphasized that technology is moving fast and the profession must stay ahead — or risk being left behind.
Rosemary Wurster highlighted the advancements in just documentation with the introduction of artificial intelligence tools. “I can’t run fast enough to keep up with hospital documentation,” she related.
Capacity management and collaboration gaps
Hospital overcrowding and EMS wall times remain unsolved. But the root problem, Fred Wurster argued, is a lack of joint planning. Rosemary Wurster described how successful systems bring EMS leaders to the decision-making table, particularly when managing complex discharge and social support processes. Rural systems, she said, especially need social workers, community paramedicine and street medicine teams to fill in the gaps, but the biggest first step is getting EMS in on the conversation with hospital leaders.
Political awareness and policy advocacy
One message was blunt: policymakers don’t understand EMS or healthcare. It’s up to providers to bridge that gap. Fred Wurster gave a grassroots example: a conversation over lemonade turned into a rural farm safety initiative — getting a tourniquet on every tractor — but the key to launching that program was finding the right decisionmaker to connect with and starting that conversation, in this case the president of the farm bureau. “If you’re not regularly connecting with every policymaker in your community, it’s a problem,” he noted.
Preparing for what’s next
Looking forward, both presenters stressed preparation — financially, operationally and politically, and investing in:
- Clinical evolution: Whether it’s preparing for the next pandemic, ebola, swine flu
- Our people: Connecting via stay interviews, check-ins
- Financial stability: Have a rainy day fund
Whether it’s the next pandemic or a workforce crisis, leaders need self-governance, engagement with policy and succession planning. “Develop yourself, and develop your bench,” Rosemary urged. “We can predict a lot — but not everything.”
EMS and healthcare are at a tipping point. Sustaining these systems will require bold action, smarter planning, collaborative models and deeper investments in people.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.
