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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
This closing installment draws together the national findings revealed by EMSIntel.org and distills them into a leadership blueprint for 2026.
The first three articles painted a picture of a system under stress. Funding instability, market volatility and rapid policy change are now the norm rather than the exception.
For EMS leaders, the challenge is clear. It is no longer enough to maintain operations. The profession must evolve.
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Financial instability demands decisive action. Leaders must accept that relying solely on long-held myths about EMS delivery is no longer possible.
Further, the reliance on only transport revenue as a sole source of revenue to support EMS delivery will not be sustainable for most communities.
Communities across the country are adopting new revenue sources and changing EMS delivery models because they have no other choice. Agencies that continue using outdated deployment models and financial structures will encounter staffing failures, deteriorating response capacity and declining system health.
Market volatility now demands strategic foresight, not optimism. Provider exits, takeovers, mergers and even full system collapses are no longer rare events; they are becoming routine.
Leaders must build continuity plans that preserve service delivery, regardless of which organization happens to hold the contract at any given moment.
The communities that experienced the most severe disruption this year were often those that assumed their provider would always remain stable. Market forces drive business decisions that do not always align with political expectations, whether that means undercutting prices, refusing to subsidize unsustainable contracts or simply confronting the fiscal reality of doing business.
Financial performance metrics must be grounded in the genuine cost of service delivery. EMS is a business — like it or not — and leaders must become competent finance managers. The surprises are rarely surprises at all; they can be forecast.
If you do not know your cost per call or your unit-hour cost, you are building systems on the wrong narrative. And when that happens, people can die, and systems can and do go broke. It is easy to talk about response times as the problem, right up until the moment you are in charge and discover that hitting the target while missing the point is how systems fail.
Provider safety must become a strategic imperative. Ambulance thefts, assaults, fatigue related incidents, and operational injuries continue to rise. These are not simply personnel issues. They are system stability issues. Agencies that do not protect their people will continue to lose them.
The path into 2026 requires courage, deliberate planning and a willingness to confront uncomfortable truths. EMS is entering a transformation period. Leadership will determine whether that transformation strengthens or weakens the profession.
Leader resolution for 2026: Redesign your delivery model based on evidence-based research and local data. Add a new sustainable funding mechanism. Show up in policymaking spaces. Invest in at least one measurable safety improvement.
