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The EMS Intel Series: Throughout 2025, the EMS profession experienced a level of volatility that no single agency could fully view from its local vantage point. When hundreds of news stories from across the country were aggregated and analyzed through www.EMSIntel.org, an AIMHI and AAA project that tracks real-time developments affecting EMS, an unmistakable national picture emerged. The stories were not scattered anomalies. They were chapters in a single narrative about systems reaching structural limits, while simultaneously being forced to evolve.
Communities struggled to fund basic EMS readiness. Large private providers exited long-held contracts, while smaller agencies either merged, dissolved or were absorbed into larger systems. In rare circumstances, often after irrefutable data from advocacy groups, state and local policymakers began giving EMS the kind of attention it has requested for decades. And throughout it all, leaders were left to stabilize operations in real time while the ground shifted beneath them.
This series presents four linked essays based on the EMSIntel.org dataset, each exploring one of the major national themes of 2025 and ending with a clear leadership resolution for 2026.
Read Part 1: Funding on fire: EMS funding is broken — and communities are done pretending it’s not
Read Part 2: On shaky ground: Communities are rethinking who delivers care — and how to protect against the next sudden shutdown
Read Part 3: When policymakers finally showed up: 2025 marked a rare turning point as lawmakers moved on workforce incentives, TIP reimbursement and contracting reform
Read Part 4: Leading into 2026: The four actions every EMS leader must take
Across America, the EMS funding model is cracking in plain sight. Throughout 2025, city councils, county boards and township supervisors reached the same uncomfortable conclusion.
They can no longer financially sustain ambulance coverage at the levels communities have come to expect, relying on a brittle combination of transport billing, volunteerism and municipal subsidy.
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The past year produced story after story of communities turning to levies, millage increases, sales tax proposals, first responder fees, subscription programs, transport rate hikes and repeated attempts to write off uncollectable EMS bills. Each action represented a community trying to keep its system afloat for just one more year.
The underlying truth is unavoidable. EMS is the only essential public safety function expected to fund itself by billing the person who needs help. That model may have worked when call volume was lower, labor was cheaper and volunteer participation was high. It is not working today.
Agencies are struggling to recruit and retain staff. Equipment and vehicle costs have risen sharply. Payer mix has deteriorated. Hospital offload delays have tied up units for hours at a time, driving overtime and eroding deployment efficiency. Meanwhile, insurance reimbursement still assumes a world where EMS exists to transport patients and nothing more.
|MORE: From 73 to 33 minutes: How Sacramento reinvented patient offload times
Across rural America, communities publicly acknowledged that they could not maintain ambulance readiness without new tax support. Many were frank enough to say that failure to pass a levy would mean losing local coverage entirely. Suburban areas created new service fees to offset the sharp increase in non-transport EMS calls that currently generate little fee for service revenue. The result was the same everywhere: The gap between the cost of readiness and the reimbursement for transport widened further.
Some regions responded with creativity. Counties experimented with subscription models. Others used general fund allocations previously reserved for police or fire. A handful explored economic development revenue as a long-term stabilizer. Yet most communities simply raised taxes because all other options had already been exhausted.
Those communities brave enough used evidence-based research and local data to right-size service delivery by changing to tiered deployment models and strategically changing response time expectations.
The variations in approach mattered less than the underlying message. The current EMS funding and deployment models will not carry the profession into the next decade.
The EMSIntel.org dataset shows that these local headlines were not isolated events. They reflected a national recognition that the traditional funding structure is collapsing. Unless EMS embraces diversified revenue, strategic advocacy and sustainable financial planning, and an honest assessment of system design and deployment, the cycle of crisis will continue.
Leaders entering 2026 have a choice. They can hope the system stabilizes on its own, or they can build a new foundation — one built on clinical, operational and financial realities. Hope has not served EMS well. Intention must replace it.
Leader resolution for 2026: Add at least one new sustainable funding source. Transport billing alone cannot support a modern EMS workforce.
