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5 reasons millennials are better prepared to lead EMS

The 10th anniversary of EMS1 is a great time to recognize the positive attributes millennials bring to EMS as they drive prehospital care into its second 50 years


Leaving a legacy of quality in the hands of smart, conscientious and capable leaders is a worthy aspiration for every field provider and EMS manager.

Photo/Greg Friese


For much of the 10-year existence of EMS1, how to manage, educate or engage millennials has been a common article proposal. The authors of these proposals are almost always well over 50-years-old and often times have a matching PowerPoint slide deck for a conference presentation. They eagerly generalize the alleged failings of millennials – short attention span, too many interests, constant desire for feedback and 24/7 attachment to digital devices – as they fondly reminisce about the top traits of the generation to which they belong.

I think it’s a natural progression for every generation of adults to lament kids these days or look back at their cohort as teens and twentysomethings with rose-colored glasses. Most of us also think about how our departments, organizations, squads or agencies will persist after we have left.

Leaving a legacy of quality in the hands of smart, conscientious and capable leaders is a worthy aspiration for every field provider and EMS manager. But this worry isn’t unique to EMS. Perhaps the anxiety about millennials is more front of mind for us because the initial generation of EMS leaders is just now handing off leadership to the next generation of EMS professionals.

As I look forward to the next 10 years for EMS1 and the future of prehospital health care, I am unabashedly optimistic. Instead of being worried, here are the five reasons I am hopeful for the future of EMS under the stewardship and leadership of millennials.

1. Millennials are the best educated EMS workforce ever

As millennials enter the workforce, they are more likely than any previous generation to have completed an accredited paramedic program, learned from EMS instructors who had a college degree and are more likely to have an associate’s degree in EMS or a related discipline. Across all academic disciplines and career fields, millennials are more likely to have a college degree than previous generations. Millennials who entered EMS with a certificate or associate’s degree are also choosing to stay in EMS after earning a bachelor’s degree – because opportunities exist or they are able to create niches that combine their EMS and academic passions.

The curriculum of EMS education programs is likely the best it has been since its earliest days. Many early paramedics tell harrowing survival stories about their training’s heavy focus on anatomy and pathophysiology, patient contacts and demanding instructors. But as EMS grew, the ranks were populated by certification mill graduates completing the lowest possible requirements to meet the demands of employers.

Now, National EMS Education Standards, integrated out-of-hospital scenarios that prepare students to become team leaders and formalized field training officer programs are pushing the foundation knowledge and job-readiness of new paramedics to higher and higher levels. Millennials enter the workforce with more EMS-specific training and having completed more general education than any previous generation.

2. Millennials report to EMS-centric leaders

The first paramedics reported to fire chiefs and entrepreneurs. A career of fighting and preventing fires is a great crucible for learning leadership. Just like running a successful funeral home is a terrific way to hone skills to sustain a small business. But neither of those career paths is the best possible preparation for leading a fire department’s EMS division or being the operations director for a private agency that outgrew its mortuary services roots and now has five or 50 ambulances on the road.

Millennial EMTs and paramedics are more likely to report to supervisors who worked on the streets and understand the challenges and rewards of transporting patients around the clock. Managers who have risen through the ranks as paramedics are more likely to apply their experience to create training and advancement opportunities for the EMS providers they supervise. Chiefs who once ran ambulance calls are better advocates for funding and initiatives to improve EMS provider work conditions.

3. Millennials make evidence-based treatment decisions

A millennial EMT might go their entire career without having to cajole or coerce an ambulating motorist into a standing takedown. A millennial paramedic is more likely to limit intravenous fluids administered to a trauma patient than rapidly infuse two liters of normal saline.

The early decades of prehospital patient care were heavy on modifying hospital practices for field use or providing treatments based on little to no evidence of efficacy. Fortunately for our patients, millennials don’t have either the burden of “we’ve always done it this way” practices shouldered by previous generations or the inhibition to question why a treatment is indicated or a policy is applied.

Millennials, unlike any previous generation of EMS providers, will benefit from mounting evidence for the optimal treatment of time-sensitive conditions like sudden cardiac arrest, stroke, sepsis and respiratory compromise. Clinical research data will be complemented by patient outcome data from within the service as well as nationally available data about patient outcomes.

A group of tech-savvy and analytically-minded millennials are sure to chart a future for EMS that combines evidence from peer-reviewed research, patient outcomes and patient satisfaction. Delivering the right care to the right patient at the right time will create tremendous value for communities.

4. Millennials have unlimited opportunities for EMS specialization

For a large number of EMTs and paramedics, EMS has long been a stepping stone to another career field. It’s OK and always will be OK for a Texas man to be an EMT for 40 years or for a Wyoming high school student to become an emergency physician after a few years in EMS. Many paramedics have made the jump from EMS to lawyer, but millennials are ushering in a new era of paramedics cross-training into other high-demand professions.

For career advancement, increases in responsibility and compensation, millennials are less likely to have to leave EMS than previous generations. In this decade and beyond, EMS educators are less likely to be field professionals relegated to the lecture hall by on-the-job injury. Instead, EMS education is a destination for paramedics who are pursuing or have already earned advanced degrees and want to multiply the impact of their clinical expertise, patient advocacy and communication skills.

Community paramedicine, a sub-specialty of EMS, didn’t exist 10 years ago when EMS1 was founded. Millennial EMS providers have access to training, certification and expanded scope of practice to assess and treat patients in their homes without transport.

EMS agencies because of population growth, as well as service area expansion and mergers, have a growing organizational leadership chart to better define and solve the challenges they are facing. The same is happening in fire-based EMS.

Millennials, because of their field experience and likelihood that they already hold a college degree, are the best-positioned generation of EMS providers to acquire the additional training in health care economics, data analytics, human resources, computer programming, finance or business administration to help their agencies solve their most pressing problems. As an added benefit, millennials, because of an academic lifetime of group education projects, have experience leading teams and working collaboratively.

5. Millennials care for their colleagues

There is no doubt that EMS can be stressful and mentally, physically and emotionally exhausting. I don’t know if it’s any more common or likely for an EMT to have traumatic stress or for a paramedic to be burned out today than it was 25 or 50 years ago.

What’s more common though is our awareness of burnout and traumatic stress. Millennials have leveraged the power of social networks, peer-reviewed evidence and digital tools to connect with and support one another. The Code Green Campaign – founded and operated by a group of millennials – is one of several efforts specifically focused on first responders and their mental health.

Millennials are leading the charge on connecting people who may feel alone to peers, educating all EMS providers on treatment resources and reminding caregivers and mental health clinicians that PTSD is treatable and recoverable. One-to-one interactions and peer support teams are real world, analog expressions of millennials caring for other EMS providers.

Millennials are the future of EMS (and EMS1)

Millennials: the longest-serving EMTs and paramedics in your organization are rapidly retiring. Appreciate their accomplishments, honor their experience, build off their successes and be intentional about learning from them. It will make you a better caregiver and give reassurance to an elder about the future of the organization after they are gone.

Finally, you are driving the future of prehospital care. Move professional conversations forward in online communities, send your article ideas to and keep connecting with one another at conferences and in real-life gatherings.

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.