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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 the country, EMS systems experienced a turbulent and sometimes chaotic year marked by provider exits, contract failures, facility closures and sudden operational transitions. The EMSIntel.org dataset showed a steady rhythm of organizational instability, from national companies withdrawing from long-standing markets to smaller regional agencies closing their doors without warning.
For many local governments, the news came suddenly and left them scrambling to build contingency plans while relying on neighboring agencies or fire departments for temporary coverage.
| WATCH: Hyper-turbulent times: EMS economics and AI guardrails with Matt Zavadsky and Dr. Shannon Gollnick
This instability did not affect only private providers. Volunteer ambulance squads dissolved when membership fell below sustainable levels. Fire-based systems absorbed transport responsibilities to stabilize regional coverage. Hospitals took over EMS delivery in several regions, stepping in where private or municipal agencies struggled to meet response time expectations. Counties openly questioned whether relying on a single contracted provider left them too exposed to operational risk.
Some districts decided to bring EMS delivery in house, displacing long-serving, successful providers, often on the unproven claims of “better, faster, cheaper,” which often turned out not to be the result.
The promises of the wealth of avarice and significant immediate performance improvement have shown time after time to be an unachievable fallacy and is the scourge of inviting consultants in to simply tell you that what you are thinking is a good idea. Others began aggressively renegotiating transport contracts to include performance guarantees, penalties or escape clauses.
The competitive landscape also shifted. Long-time incumbents lost bids they once won easily. New market entrants fought for footholds. Consolidation accelerated as smaller organizations sought mergers or acquisitions to achieve financial stability. Even agencies with historically strong reputations found themselves struggling with workforce shortages, rising costs and shrinking margins. The broader pattern was unmistakable. EMS has entered a period where market instability is not an occasional event, but a structural condition.
Communities increasingly recognized that contracts alone did not guarantee continuity. A franchise agreement cannot force an agency to continue operating if it is financially insolvent or unable to staff ambulances.
A provider that appears stable one year may become vulnerable the next.
Leaders must therefore plan for system continuity with the same seriousness that hospitals apply to emergency operations planning.
In this new environment, the agencies that thrive will be those that build redundancy, align regional resources, strengthen mutual aid agreements and create real contingency plans for provider failure. Waiting until a contract collapses is no longer an acceptable strategy.
The future of EMS market stability will depend on building systems based on science and local data on patient acuities and outcomes. This will require community education about the realities of EMS response volume, not the myths many stakeholders believe.
Leader resolution for 2026: Determine what level of service is really needed, and how we can transform the system to enhance clinical proficiency, operational effectiveness, and financial sustainability.
