I have closely monitored the National Emergency Medical Services Advisory Council (NEMSAC), its activities and meetings on behalf of the organizations I work with for over a decade now, and have also reported on their activity here at EMS1.
A year ago, NEMSAC was effectively wiped clean. The entire sitting Council was dismissed, ending the normal cycle of staggered appointments and interrupting work already underway. At the time, the concern was not simply that people had lost their seats; it was that years of institutional knowledge, developing advisories and continuity had disappeared with them.
| MORE: NEMSAC dismantled: Inside the fallout shaking federal EMS policy
Fast forward to August 2026, and the latest NEMSAC meeting offered the clearest indication yet of what has replaced that council. The answer is not simply the old NEMSAC restarted. This is a reworked body, with new members, new leadership, a new committee structure and a much more clearly defined set of federal priorities. In many respects, this was the first real look at NEMSAC 2.0.
So, what did we learn from this first look at NEMSAC 2.0, and is there reason to be optimistic?
A new leadership team
Dr. Michael Thomas was elected chair, with Dr. Nicholas Cozzi elected vice chair. Dr. Thomas represents private EMS and disclosed his role on the American Ambulance Association Board of Directors, while Dr. Cozzi represents EMS physicians.
I know Dr. Thomas well, and regard him as a friend and colleague, and I think NEMSAC members made an excellent choice in voting him in. He understands the ambulance industry, the operational realities facing services and the pressures that sit behind policy discussions that can sometimes appear more straightforward from Washington than they do from the front seat of an ambulance. He also has the temperament to lead a group containing very different interests and perspectives, and I fully expect him to be a strong chair.
The Thomas-Cozzi combination is also interesting. One brings an operator’s perspective, the other a physician’s. That seems appropriate because nearly every significant issue now in front of NEMSAC crosses those boundaries.
Blood products are clinical until somebody has to stock them, distribute them and pay for them.
Treatment in place is innovative medicine until somebody asks who reimburses the ambulance.
AI is exciting until somebody asks whether the underlying data is any good.
This council will need both lenses.
Three new committees
The previous NEMSAC committee structure has been replaced by three new subcommittees:
- Clinical Excellence: charged with issues including prehospital blood, pediatric burn and trauma care, education, professionalism, safety, continuous quality improvement and outcomes.
- Systems Innovation: tasked with national expansion of blood programs, military-civilian casualty care integration, vehicle extrication research, resilience, sustainability and preparedness.
- Integrated Informatics: focusing on data linkage, advanced automatic crash notification, standardized 911 protocols, and connecting EMS data with other emergency response and healthcare information systems.
The important part is not simply the names. It is that the federal government has been very clear about what it wants this new NEMSAC to work on. That is a noticeable change from the council that preceded it.
The new body is certainly being invited to advise government, but government has also supplied a fairly specific initial work program. The challenge will be balancing those federal priorities with the broader issues the EMS community needs NEMSAC to raise in return.
Blood has moved from “should we?” to “how do we?”
Prehospital blood dominated much of the meeting and appears prominently in the work of two of the three new committees. FICEMS is also preparing a formal request asking NEMSAC for advice on how to accelerate national adoption.
The federal ambition was stated clearly: between now and 2028, the objective is to rapidly expand prehospital blood transfusion across the country.
That tells us the debate has moved on. The question is no longer simply whether blood belongs in the prehospital environment. Increasingly, the questions are how to scale it, how to fund it, which patients should receive it, how smaller and rural systems participate, how products are distributed and how outcomes are measured.
Those are much harder questions, but they are the right ones.
Interestingly, the council itself quickly recognized that blood does not fit neatly into one committee. The clinical science clearly belongs within Clinical Excellence, while logistics, distribution and program scaling sit naturally within Systems Innovation. Informatics will then be needed to demonstrate who received blood and what happened to those patients.
That overlap may become an early test of whether the new NEMSAC structure can operate collaboratively, rather than as three separate silos.
CMS may have opened the more important door
For ambulance providers, the CMS report-out was perhaps the most interesting of the federal updates.
CMS discussed its previous work recognizing blood administration within ALS2, but then moved into the much larger issue of supporting care delivered outside the hospital that does not necessarily result in an ambulance transport. At the same time, CMS acknowledged the statutory reality EMS knows all too well: the Medicare ambulance benefit remains largely built around transportation. That is one of the central contradictions in modern EMS.
We increasingly ask ambulance services to become mobile healthcare providers:
- Treat the patient at home.
- Navigate them toward the right level of care.
- Reduce unnecessary ED use.
- Participate in MIH.
- Help avoid hospital readmissions.
Then the payment system asks: where did you transport them?
NEMSAC members clearly heard the opportunity. Alternative destinations, treatment in place and reimbursement all surfaced later during strategic planning, with Thomas himself noting that treatment in place was an issue he had considered raising directly with CMS.
That is an area I will be watching closely. Blood may be the most visible federal priority today, but changing what Medicare is prepared to pay ambulance services to do could be far more transformational in the long term.
Outcomes, not just activity
The meeting also contained an encouraging shift in how members talked about data. AI, hospital offload times, patient outcomes and data linkage all appeared in the discussion. Members talked about connecting the patient journey from the 911 call through the EMS response, hospital treatment and eventual outcome.
That is where EMS needs to go. We have spent decades measuring the things we can easily measure: response time, scene time, transport time, turnaround time and unit availability. All matter operationally, but none tells us whether the patient actually got better.
The more valuable questions are what happened next.
- Did the stroke patient receive thrombectomy?
- Did the STEMI patient reach the cath lab?
- Did the hemorrhaging patient survive?
- Did the person treated at home remain safely at home?
- Most importantly, did the actions taken by EMS change the outcome?
NHTSA’s discussion of prehospital blood reflected the same thinking. Officials said they are not only watching how often blood is administered, but also how many patients meet the criteria to receive it and what their outcomes are, with particular interest in pediatric hemorrhagic shock.
That is a much more meaningful definition of success.
My one continuing concern: pace
My concern with NEMSAC has never really been about the people around the table. If I am being perfectly honest, I still have an issue with the “A” in NEMSAC — Advisory, but, more importantly, it is also about the speed at which government processes move compared with the tempo of the world EMS now operates in.
AI is moving at extraordinary speed.
Clinical evidence changes quickly.
Blood programs are expanding.
New care models are developing.
Workforce problems, hospital capacity and reimbursement pressures require operational decisions today, not 2 years from now.
Government is necessarily more deliberate. There are advisory processes, public meetings, approvals, legal requirements and rulemaking procedures, and many of those safeguards exist for good reason. But there is also an obvious risk: if it takes 2 or 3 years to answer a question EMS has already been forced to solve in 6 months, the advice can arrive after the world has moved on.
That is not a criticism of Drs. Thomas, Cozzi or this new council. It is arguably one of their greatest challenges. How does a federal advisory body remain thoughtful, credible and properly deliberative while still moving quickly enough to remain relevant?
Now we see where it goes
A year ago, the question was whether NEMSAC would return. It has, and that is a positive development. The new council has experienced people around the table, a clearly defined structure and a leadership team I think can do very well. Dr. Thomas in particular brings a grounded EMS industry perspective that should be valuable when clinical ambition meets operational reality, which it inevitably will.
I now want to see where this goes. I want to see whether treatment in place, reimbursement, workforce and system sustainability rise alongside the already prominent priorities around blood, data and clinical innovation. I want to see whether the council can rebuild the continuity lost last year while establishing an identity of its own.
And, perhaps most importantly, I want to see whether the machinery of government can move fast enough to keep the work relevant. The old NEMSAC left unfinished business on the table. The new one has taken its seat. Now the work begins.
