Every profession’s members eventually reach a point where they have to stop asking, “What have we always done?” and start asking, “What should excellence look like now?”
EMS has reached that point.
For decades, we have measured ourselves largely by how quickly we arrived, how many patients we transported, and how many ambulances we could keep on the street. Those measures were appropriate for a profession that was still establishing itself. They helped build systems, justified resources and created accountability.
But the profession has evolved.
Today, EMS is expected to improve cardiac arrest survival; manage sepsis and stroke; support behavioral health; deliver blood products before patients reach the hospital; reduce unnecessary emergency department utilization; participate in clinical research; navigate increasingly complex reimbursement systems; recruit and retain an exceptional workforce; and demonstrate value to taxpayers, healthcare systems and elected officials.
In other words, modern EMS isn’t simply an emergency transportation service anymore. It’s a healthcare delivery model.
The problem is that many of us are still using yesterday’s scorecard.
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Perhaps the clearest illustration of how EMS has changed is this: among the high-performing systems participating in the 2026 AIMHI Benchmark Survey, only 37.3% of responses receive a lights-and-sirens response. Today’s leading EMS organizations increasingly define excellence not by getting to every call as fast as possible, but by getting the right resources to the right patient at the right time.
That’s one of the reasons the Academy of International Mobile Healthcare Integration (AIMHI) recently released its 2026 High-Performance/High-Value EMS Benchmark Survey. The report isn’t intended to identify “the best” EMS system or become another collection of interesting statistics to admire before filing it away in a desk drawer.
Its purpose is much more important. It asks a deceptively simple question: What do the highest-performing EMS organizations actually have in common? The answers are fascinating. They are also encouraging.
What high-performing EMS organizations measure
Perhaps the biggest surprise is what doesn’t seem to matter nearly as much as many of us have assumed.
The participating organizations look remarkably different on paper. Some are public utility models. Others are governmental agencies. Some are hospital-based. Others operate under franchise agreements. They serve communities ranging from dense metropolitan areas to expansive regional systems. Their organizational charts look different. Their governance structures look different. Their political environments certainly look different.
Yet despite those differences, they consistently exhibit the same leadership behaviors and organizational priorities. They invest heavily in quality improvement. They embrace external accreditation. They measure patient experience alongside clinical outcomes. They participate in research. Workforce development is viewed as a strategic priority, rather than simply an HR function. And they understand that financial stewardship is every bit as important as clinical excellence.
That’s an important lesson for communities considering major EMS system changes.
We often spend enormous amounts of time debating organizational models — as though changing the governance chart will somehow create better patient outcomes.
The AIMHI report suggests something different.
Excellence appears to have much less to do with who owns the ambulances than with how leaders manage them.
Another theme running throughout the report is that high-performing organizations have become extraordinarily good at measuring themselves. That may sound obvious, but it represents a profound shift in EMS.
Not long ago, quality assurance often meant reviewing charts after something went wrong. Today, many leading organizations maintain sophisticated clinical dashboards, routinely monitor cardiac arrest outcomes, measure patient satisfaction through independent organizations, track workforce trends, evaluate operational efficiency and continuously compare their performance against objective benchmarks. They aren’t waiting for problems to become obvious; they’re looking for opportunities to become incrementally better every day. The report describes this evolution as EMS moving from measuring activity to measuring outcomes, including clinical excellence, patient experience, workforce stability, operational efficiency and financial sustainability.
That evolution may be one of the profession’s greatest achievements. After all, every mature profession measures outcomes. Healthcare does. Aviation does. Manufacturing does. Professional sports teams do.
Benchmarking isn’t about proving you’re good. It’s about discovering how you can become better.
The report offers a refreshing perspective on one of the profession’s biggest concerns: the workforce.
Almost every EMS conference today includes discussions about staffing shortages, recruitment challenges and retention. Those challenges are real. Yet the benchmark report reveals that several participating agencies are reporting stable — or even improving — applicant pipelines despite the same labor market pressures affecting everyone else.
That finding should give every EMS leader pause. Perhaps workforce success isn’t simply about demographics. Perhaps it’s also about culture.
Organizations known for exceptional leadership, strong clinical programs, meaningful professional development and employee engagement tend to become places where people want to work. Reputation has become one of the most valuable recruiting tools in EMS, and the report reinforces that investing in people is not just a workforce strategy — it’s an organizational strategy.
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Financial stability
The financial findings may be even more relevant to today’s environment.
Let’s face it — there aren’t many standing ovations at EMS conferences for presentations on cost of service delivery, payer mix and revenue cycle. That’s unfortunate, because financial sustainability may be one of the defining leadership challenges of the next decade.
The benchmark report paints a vivid picture of the disconnect many EMS leaders experience every day. Medicare and Medicaid account for the majority of patients served by participating agencies, yet those programs do not generate a comparable share of patient revenue.
That reality means every agency must become increasingly sophisticated in managing reimbursement, optimizing revenue and demonstrating responsible stewardship of public dollars. Financial performance is no longer simply the finance director’s responsibility. It has become an essential competency for every EMS executive.
Because agencies that cannot sustain themselves financially cannot sustain clinical excellence either.
The power of transparency
Perhaps the most important aspect of the report, however, isn’t any individual statistic.
It’s the spirit behind it. Think about what these organizations have done. They voluntarily opened their books. They shared clinical outcomes. They shared operational data. They shared financial metrics. They shared workforce challenges. They did so knowing that benchmarking isn’t always comfortable. That kind of transparency says something important about leadership. Confident organizations don’t benchmark because they think they’re perfect. They benchmark because they know they aren’t. Continuous improvement begins with the humility to ask, “How are others doing this better than we are?”
That’s a powerful lesson — not just for EMS agencies, but for every public organization.
Defining excellence
Which brings us to why we believe this report deserves an audience far beyond EMS chiefs and medical directors. City managers. County commissioners. Hospital executives. State EMS officials. Legislators. Healthcare policymakers.
These are the people making decisions that shape EMS systems for decades. Yet many have little objective information about what distinguishes a high-performing system from an average one. Too often, discussions about funding, staffing, deployment, accountability or system design are driven by anecdote, local tradition or the loudest voice in the room.
This report offers something much more valuable: evidence. It demonstrates that high-performance EMS isn’t defined by a single metric, a particular governance model or a larger budget. It’s defined by disciplined leadership, measurable outcomes, a commitment to improvement and the willingness to learn from peers.
In many ways, that’s what benchmarking has always been about. Not competition, but collaboration.
The EMS profession has never lacked dedicated people. We’ve always had extraordinary clinicians, innovative leaders, and organizations willing to push the boundaries of what’s possible. What we’ve often lacked is a common definition of excellence.
The 2026 AIMHI High-Performance/High-Value EMS Benchmark Survey helps provide one.
And in a profession changing as rapidly as ours, that may prove to be its most valuable contribution of all.
