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Journey to 2050: The First Step on a New Journey

Through this bimonthly column series, EMS World offers practical strategies derived from the NHTSA EMS Agenda 2050 initiative. Learn more at

It wasn’t an easy assignment: At the first meeting of the group tasked to put together a new EMS Agenda for the Future, the facilitator, Mike Taigman, told us to set aside the specific issues facing EMS today. While we knew these topics would heavily influence the new vision, whatever it might look like, we wanted to start with the end in mind: What should EMS systems look like in 2050, without the constraints of what they look like today?

I’ll admit, I struggled. After several decades of dealing with EMS issues in the here and now—as an emergency physician, EMS medical director, president of a national EMS organization, and now a federal official—it was difficult to think past the immediate challenges facing state and local systems. That was just one of the reasons I was glad to have a great team of volunteers on board as the EMS Agenda 2050 technical expert panel. Those 10 individuals, inspired by conversations with hundreds of others, created a truly motivating vision for the future, a vision that in the end addresses some of today’s concerns but also takes us boldly forward. 

Only through an effort that included contributions from such a wide range of people, from EMS veterans already retired to students just beginning their careers, could we create a vision that could advance the EMS profession. The process took more than two years, and hundreds of people contributed. Here are just some of the ways:

  • 248 pages of comments on the federal request for information prior to the launch of EMS Agenda 2050; 
  • Nearly 150 applicants for the 10 spots on the technical expert panel;
  • More than 250 written comments during public comment periods;
  • Nearly 800 registrants for the four EMS Agenda 2050 regional public meetings, and hundreds more who participated at town halls and sessions at national EMS conferences.

I was around for the creation of the original EMS Agenda for the Future a little more than two decades ago, and I am confident EMS Agenda 2050 will have just as profound an impact on our profession as its predecessor. The EMS Agenda for the Future told us what fundamental building blocks EMS systems needed, many of which now seem so obvious that you might question why we ever had to include them: universal access to 9-1-1, robust communication systems, and physician medical direction, just to name a few. But prior to the EMS Agenda for the Future, many EMS systems lacked the basic resources we take for granted. While we have not achieved every recommendation made by the original agenda’s authors, we have come a long way since the mid 1990s.

Six Guiding Principles

One of the first actions of the technical expert panel was to discuss whether to follow the same format as the original agenda. They chose to take a different approach not because the original framework didn’t succeed but in fact because it did. With many of the “fundamental attributes,” as the 1996 Agenda for the Future called them, in place in most U.S. EMS systems, it was time for the profession to mature to one that not only provides acute out-of-hospital care, but one that provides it in a people-centered fashion.

From that discussion came the six guiding principles of EMS Agenda 2050. While the document provides specific recommendations, each of which was debated and dissected, the key elements are these six principles. After all, the only thing we can be sure of is that we don’t know exactly what EMS will look like in 30 years. Technology changes more rapidly every day. Political and financial structures continue to evolve as well. But the core tenets of a people-centered EMS system will remain the same: They will be inherently safe and effective; integrated and seamless; reliable and prepared; socially equitable; sustainable and efficient; and adaptable and innovative.

The creation of EMS Agenda 2050, while a major accomplishment, is simply one step toward the development of EMS systems that achieve these goals. Now it’s up to all of us to make it a reality. As the members of the panel that put together EMS Agenda 2050 wrote, “Achieving this vision will require deliberate actions of stakeholders at every level of EMS… The guiding principles illustrated in EMS Agenda 2050 should guide all your decisions, from day-to-day EMS care and operations to systemwide strategic efforts. The future of people-centered EMS is in your hands.”

Throughout 2019 EMS World will feature a series of articles describing how EMS systems and clinicians can turn the EMS Agenda 2050 vision into a reality. Stay tuned.  

Jon Krohmer, MD, is director of the National Highway Traffic Safety Administration Office of EMS.

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