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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
For decades, EMS leaders have called for meaningful engagement from state and federal policymakers. In 2025, that call was finally answered. The EMSIntel.org dataset revealed a nationwide uptick in legislative attention, regulatory activity and political engagement focused directly on EMS. The year marked a turning point in how governments view the role, structure and strategic needs of the ambulance system.
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Several states created or expanded EMS commissions with authority to examine workforce shortages, system financing, deployment models and performance standards. These commissions became focal points for policy proposals, ranging from workforce incentives to regional coordination reforms.
In parallel, rural health transformation programs began delivering targeted funding to counties struggling to maintain even a single 24-hour ambulance. Several states passed legislation to require reimbursement for treatment in place as a covered service for state-regulated health insurance. TIP legislation was reintroduced in Congress, an acknowledgement that not every EMS call requires transport and that outdated reimbursement rules impose clinical and financial burdens on agencies.
Counties asserted more influence over performance-based contracting. Some demanded improved accountability from providers. Others requested state-level oversight to ensure transparency in system performance.
There were renewed discussions in Washington about creating a federal EMS office with authority and resources, recognizing that EMS remains one of the few critical public safety functions without a central regulatory home. There continues to be a “tug of love” for our national office as some believe EMS sits in healthcare, others public safety, while some realize that access to transport dollars keep us at NHTSA. This debate will inevitably continue into 2026 and beyond, even to EMS 2050!
This sudden surge in policymaker interest did not occur because EMS became more convenient to support. It occurred because the system became impossible to ignore. Communities watched ambulance providers collapse. Agencies struggled to hire paramedics. Hospitals boarded patients in hallways for hours, tying up ambulance crews. These operational failures became public realities. Policymakers responded because the public demanded it.
The implication for leaders entering 2026 is profound. Policy windows do not open often, and they rarely stay open long. This is a moment when EMS can influence reimbursement reform, workforce legislation, regulatory alignment and system design. The worst possible outcome would be silence.
Leaders who remain engaged will shape the framework that guides EMS for years to come. Those who do not may find themselves governed by policies written without field insight.
Engagement does not require a full-time lobbyist. It requires showing up when asked, submitting public comments, educating legislators and connecting local challenges with national patterns. Policymakers respond to voices that bring clarity and data. EMS now has both.
Leader resolution for 2026: Commit to one act of policy engagement. Influence follows participation.
