LEXINGTON, Ky. — Named one of Forbes’ Top Futurists, Heather E. McGowan has advised Fortune 500 boards, high-growth start-ups, universities and governments on how to adapt “at the speed of possibility.” A two-time bestselling author (“The adaptation advantage” and “The empathy advantage”), she specializes in translating big, fast-moving trends (e.g., technological disruption, demographic shifts, AI augmentation) into practical strategies leaders can act on today.
But for the EMS audience at the 2025 American Ambulance Association Annual Conference, McGowan opened not with data or theory, but with her own medical crisis. On May 23, 2019, she arrived at a Boston hospital in compensatory shock, vomiting and passing blood. Surgeons would later discover a rare Dieulafoy’s lesion, transfuse 30-plus units of blood, and perform three endoscopies and an interventional-radiology embolization before declaring her stable.
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“I’m alive,” she said, holding up the photo her wife took of her unconscious in the ambulance, “because strangers in uniforms showed up.” McGowan’s gratitude framed the rest of her keynote address: a call for EMS to re-examine how it recruits, relates and retains its people in an era of relentless change.
The Swiffer lesson: Stop polishing yesterday’s problems
McGowan’s first case study came from consumer products. When Procter & Gamble’s researchers watched families mop floors, they noticed no one complained about time wasted rinsing dirty mops — yet everyone did it. The insight spawned the Swiffer, a billion-dollar product nobody asked for because customers couldn’t imagine it. EMS faces a similar trap, and “build a better stretcher” is the wrong route if the deeper need is help patients feel safe and seen during their worst 30 minutes on Earth. Leaders who re-frame the question discover opportunities competitors never spot — whether that’s tele-triage for non-transport calls, VR training that lowers cognitive load or redesigned uniforms that communicate calm rather than authority.
Generation Z: Delay, disruption and digital fluency
Much of McGowan’s keynote centered on Gen Z — now the largest cohort entering EMS classrooms. Consider their context:
- Have no memory of life before 9/11 or the “forever wars”
- Grew up amid the 2008 financial crisis, school-shooting drills and a 24-hour climate countdown
- Hit high-school milestones on Zoom during COVID-19
- Watch more YouTube than network TV and learn skills via TikTok tutorials
By age 25, far fewer members of Gen Z own cars, homes or wedding rings than Boomers did. Yet, they are the most educated, diverse and values-driven generation on record. To hire and keep them, McGowan urged EMS leaders to embrace the 5 Ms:
- Money. Ensure compensation is competitive and transparent; pay secrecy is a relic
- Mission. Embrace a clear societal purpose; EMS has an edge here
- Meaning. Feature day-to-day tasks that build competence and pride
- Mentorship. Provide visible pathways from EMT, to medic, to leadership
- Membership. Cultivate a culture of belonging, both on and off shift
Ignore any one M and Gen Z will shift to an employer (e.g., Amazon, Tesla, the fire service) that offers the full set.
Burrito justice and the loneliness epidemic
McGowan’s strangest story involved a woman who threw a burrito at a quick-service worker, landed in court, and received an “empathy sentence:” 6 months working in that same restaurant. The judge’s reasoning: civility is cracking, and punishment without perspective won’t fix it.
Statistics back him up. The U.S. is in a “friend recession.” Between a quarter and a third of adults say they have no close friends, up from just 3% in 1990, McGowan shared, and chronic loneliness increases mortality as much as smoking 15 cigarettes a day.
For EMS agencies, that deficit shows up as siloed crews, brittle teams and patients who call 911 because they have no one else. Creating micro-communities at work — crew breakfasts, peer-support check-ins, cross-shift mentorship — doesn’t just improve morale; it saves lives.
Hermit crabs and capacity building in the AI era
On the tidal flats where McGowan grew up, hermit crabs queue from smallest to largest, swapping shells up the line so every crab gains protection. The metaphor is perfect for today’s AI-augmented workplace. Roles mutate faster than curricula can keep up; careers now span multiple technological eras. Alvin Toffler’s warning resonates: “The illiterate of the 21st century will be those who cannot learn, unlearn and relearn.”
McGowan predicts hiring will tilt from credentials to behaviors. Skills matter — no one wants a TikTok-taught intubator — but curiosity, discipline, pro-social collaboration and resilience will outscore static resumes. EMS educators already see it: students who treat every after-action review as a growth lab soar past classmates coasting on past clinical hours.
Mental fitness and emotional literacy
If agile learning is oxygen, mental fitness is muscle. McGowan cited research showing employees rate their manager as the single greatest influence on their mental health — equal to a spouse, greater than a therapist. Yet most frontline leaders were promoted for technical prowess, not emotional literacy.
Borrowing from psychologist Sven Hansen, she outlined a 3-step routine any supervisor can model:
- Name it. Expand vocabulary beyond mad, glad, sad to the 47 emotions Brené Brown catalogues in “Atlas of the heart”
- Claim it. Separate what you can control (your response) from what you cannot (the intoxicated patient, the 12-hour offload delay)
- Reframe and respond. Choose a wiser action after the limbic surge passes — perhaps tomorrow
Teaching crews to run that loop underpins error reduction, conflict de-escalation and long-term wellbeing.
Leadership’s new social contract
Industrial-era leadership promised loyalty for security. That contract shattered in the last recession. McGowan proposes a replacement: transparency, trust and hope. Gallup’s global surveys show “hope” now ranks as the No. 1 quality people seek in leadership — especially among Gen Z. EMS chiefs who articulate a convincing “why,” admit what they don’t know, and involve crews in co-creating solutions build reservoirs of discretionary effort money can’t buy.
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The take-home for EMS
EMS is not merely in the care business; it is in the connection and expectation-management business.
- Re-frame problems at their human root, not their legacy workflow
- Design recruitment, retention and training around the 5 Ms
- Treat loneliness as a clinical and organizational hazard
- Hire — and promote — for behaviors that thrive amid volatility
- Make mental-fitness drills as routine as equipment checks
- Lead with transparent pay, rock-solid purpose and a visible path forward
Heather E. McGowan’s closing slide read: “Solve tomorrow’s problems today.” For EMS, that means building systems — and humans — so adaptive that when you roll up to the next Dieulafoy’s patient, saving them is remarkable only to the outside world. Inside, it is simply how we work now.
