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Journey to 2050: Education as the Foundation for the Future

The original EMS Agenda for the Future, published in 1996, described education as one of the 14 core attributes of EMS systems.1 These visionary authors described innovation and collaboration as ways to increase interdisciplinary and bridge programs as well as degree options for EMS professionals.

A few years later NHTSA and HRSA supported the EMS community in the development of the EMS Education Agenda for the Future: A Systems Approach.2 This document created a framework for EMS education still in use today; the recent development of a revised National EMS Scope of Practice Model and the current effort to revise the EMS Education Standards and Instructional Guidelines are two examples of the lasting impact of the EMS Education Agenda.

In creating EMS Agenda 2050, we focused on principles.3 EMS has changed as the profession has matured; in many ways those foundational attributes in the 1996 Agenda have become accepted building blocks of EMS systems. There is, always, more work to do to implement them successfully, and in working toward that EMS Agenda 2050 is framed around one central vision of people-centered EMS guided by six principles. 

Some readers initially asked, “Where is education?” because this vision covered EMS education across all its principles but did not have one section focused on education alone. EMS Agenda 2050 makes it clear that education is a major component, perhaps even the most critical piece, of EMS systems in the future. Embedded throughout each page are references to the education and training of EMS professionals and clinicians.4 Here are some examples of how education is integral to the adoption of each of EMS Agenda 2050’s six guiding principles:

Inherently safe and effective—All levels of EMS education must be evidence-based and focused on harm reduction. A truly people-centered EMS system will take advantage of novel methods of providing education, including delivery of “just in time” information and taking advantage of technologies that enhance the educational experience.

Integrated and seamless—EMS Agenda 2050 stresses the importance of the interdependence between EMS and our partners in public safety and healthcare. EMS education must teach why, when, and how to coordinate with these partners, as well as how to collect, access, and use data from across the healthcare continuum. In addition, education itself must become more interprofessional to ensure EMS clinicians learn both with and from the people they need to work with to advance the health and safety of their patients and communities.

Reliable and prepared—Although some people associate “reliability” and “preparation” with staffing, resources, response times, and other operational aspects, EMS Agenda 2050 recognizes that the foundation of a prepared system is education. That includes a strong academic background for the highest levels of clinicians as well as potential new clinical and professional pathways for advancement in their careers through education. EMS education systems also must become more consistent, ensuring clinicians meet the highest standards of care across the country. 

Socially equitable—Research has revealed inequities in healthcare, including EMS care. One such inequity stems from clinicians being uncomfortable treating pediatric patients or not having the proper education and tools to treat other patient populations. Unconscious bias also impacts care, leading to discrepancies in how we treat people based on culture, race, gender, socioeconomic status, and other factors. Addressing these topics in EMS education is critical to ensuring clinicians recognize how bias and inequity impact care and how to overcome them. 

Sustained and efficient—Creating a sustainable and efficient EMS system will require significant advances and commitment in how EMS is funded as well as how clinicians are compensated. Achieving this will also require EMS clinicians and leaders who are educated not only in operations but also in finance and the healthcare marketplace. In addition, a more efficient system will educate clinicians in the field and in communications centers to better triage patients in order to avoid unnecessary and often high-cost care.

Adaptable and innovative—In the past EMS education largely focused on teaching clinical pathways and treatments, while sometimes ignoring the possibility the evidence might change and the truths learned in class might no longer be true years later. A people-centered EMS system will require a culture of lifelong learning and education that develops higher-order thinking skills to make sense of new evidence and science and integrate it into every level of EMS licensure. EMS clinicians must have a strong clinical education as a foundation but also need to learn how to create, interpret, and use new information as the pace of change led by innovation in medicine and technology continues to accelerate.

Call for Action

EMS Agenda 2050 builds upon the groundbreaking work of the original EMS Agenda for the Future and Education Agenda, continuing their call for both initial and ongoing education to evolve along with science and evidence.

Achieving this vision will require champions within academic institutions as well as from throughout the healthcare continuum, public safety partners, professional EMS organizations at all levels, state officials, and the current EMS workforce. 

One of the keys to reaching the goals of EMS Agenda 2050 will be the delivery of EMS education in academic settings, facilitated by teams of properly trained and prepared educators. Students and mid-career professionals should be exposed to multiple content experts instead of what is most often a sole EMS instructor. Support systems and access to academic resources must be in place for students to give them the greatest chance at success.

Technology is also opening the door to making high-quality education and other resources available in places where they once were not. This technology, however, must be used in ways supported by evidence and to enhance the educational experience, not simply to facilitate more convenient or less expensive options.

The importance of hands-on learning and team-building skills must not be forgotten, as they become even more critical in the people-centered system described in EMS Agenda 2050.

Innovate and Collaborate

EMS Agenda 2050 sets out a vision intended to unite the EMS community around a singular purpose: creating an EMS system that is inherently safe and effective, integrated and seamless, reliable and prepared, socially equitable, sustainable and efficient, and adaptable and innovative. Achieving this vision will require deliberate actions at every level: EMS agencies, local and state governments, national associations, federal agencies, and individuals like you. 

The time has come to innovate and collaborate to elevate our pedagogy from merely training technicians to educating clinicians and professionals. Educators and others with a stake in how EMS clinicians are educated must consider how to incorporate the guiding principles of EMS Agenda 2050 into the education systems of today and tomorrow to empower the EMS workforce and strengthen our interdependent relationships with our partners in public safety and healthcare. The future of EMS education belongs to each of you—it’s time to lean into that future.  


1. Steering Committee. Emergency Medical Services Agenda For The Future. Washington, D.C.: National Highway Traffic Safety Administration, 1996; 

2. EMS Education Task Force. EMS Education Agenda for the Future: A Systems Approach. Washington, D.C.: National Highway Traffic Safety Administration, 2000; 

3. EMS Agenda 2050 Technical Expert Panel. EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services. Washington, D.C.: National Highway Traffic Safety Administration, 2019; 

4. Leggio WJ, Neeley King K, Gienapp A, et al. Executive Summary of Educational Content from EMS Agenda 2050. Preh Emerg Care, 2019. 

William Leggio, EdD, NRP, is assistant professor and paramedic program coordinator at Creighton University. He served on the technical expert panel for EMS Agenda 2050. Reach him at

Kyra Neeley King, MEd, EMT-P, a lieutenant with the Fire Department of New York, currently serves as a fire commissioner liaison. She was a member of the technical expert panel for EMS Agenda 2050.

Michael S. Gerber, MPH, NRP, is a senior consultant with the RedFlash Group and a paramedic in the Washington, D.C., area. He served as a writer and project team member for EMS Agenda 2050.


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