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Journey to 2050: A Call to Action for Policy-Makers

Underpinning EMS Agenda 2050’s vision for a people-centered EMS system are six guiding principles intended to influence decision making and ultimately how we progress as a profession. EMS systems must be:

  • Adaptable and innovative; 
  • Inherently safe and effective;
  • Sustainable and efficient;
  • Socially equitable; 
  • Integrated and seamless; and
  • Reliable and prepared.1 

Achieving this vision intended to unify our profession will only be possible if we stay true to those principles when making policy choices and lobbying the elected officials and regulators who help steer the profession.

At the heart of EMS Agenda 2050 is a value-based approach to EMS calling for policies that will support comprehensive quality EMS care delivered by highly educated and capable clinicians, drive sound research, and further integrate EMS into public health and healthcare systems. Dozens of potential actions for policy-makers are included inside the pages of EMS Agenda 2050—we urge all in EMS to read the vision, reflect on the content, and consider its principles when crafting any policy that impacts our profession.

There is no single entity that can make all this happen. What good is an excellent education system if a local EMS agency fails to demand excellence? Where is the value in research if state regulations prohibit or slow the adoption of new practices even after they’ve been shown effective? How will we achieve integration of EMS into public health when the subject gets barely a nod in the typical EMT class? Why do we talk about overtime in EMS as a mandatory means of getting by rather than a potential cause of dangerous levels of fatigue? 

Changes Needed

One policy change foundational to achieving EMS Agenda 2050 is mandating and funding EMS as an essential service. Additionally, opportunities exist to standardize the delivery of EMS and the credentialing process across jurisdictions. All levels of governance must acknowledge EMS as a partner in public safety and part of healthcare systems. 

At the EMS Agenda 2050 National Implementation Forum last fall, healthcare executive and paramedic Bill Atkinson said, “As the skill set rises and the quality of decision-making impacts life or limb or cost in this era, EMS must have a broad enough education and experience to be a thinker beyond technical checklists.”2 

Today EMS struggles to clearly demonstrate its value, even as the rest of healthcare pushes toward measuring quality and tying reimbursement to it. It is easy to imagine this shift will influence EMS sooner rather than later. This will essentially hold EMS accountable to patient outcomes and transparency, not just response times or scene times that have little correlation. Why wait for the implementation of pay-for-performance to focus on outcomes? EMS has an opportunity to begin working toward accountability for patient-centered outcomes and transparency. 

Better integration of people-centered medical records is also a critical need and opportunity for policy-makers at all levels to improve care. Examples exist where patient health records are shared across health systems. Improved access to patient records will help ensure patients are transported to the most appropriate facility and receive appropriate care tailored to their needs. Actions can be taken at the local, state, and national levels to facilitate this process, including the establishment and support of health information exchanges as well as making it easier to locate and match records.

Who’ll pay for all of this? That question came up often during the EMS Agenda 2050 process. The answer isn’t clear, but several possibilities exist. Billions of dollars are being invested in healthcare information technology, and some EMS systems have found ways to benefit. The key, once again, is demonstrating value—if we prove we’re a partner who can improve the effectiveness and efficiency of healthcare, we’ll get a share of funding. But more resources and bigger budgets do not always yield better results or more efficient systems. 

The question we all should be asking concerns outcomes and how we can best leverage or reallocate our current resources. It is always easy to ask for additional resources and a bigger budget; it is much more difficult to take a hard look at how we maximize the resources we currently have and avoid costly, ineffective activities—even those to which we’ve become accustomed. But if we are to be truly people-centered, that is the sort of prism through which we have to view EMS every day. 

Fully Committed

Achieving EMS Agenda 2050 is going to take work from all of us and support from our partners. “We need people who are fully committed to getting it right, not for themselves, but right for the people we serve,” said Atkinson. “It is our job to get it right—it is not an option. It will require skilled leadership and education to foster career paths and develop leaders committed to building people-centered EMS systems.”2

The creation of EMS Agenda 2050 is just the beginning. It provides a framework to help guide each of us as we work together to turn the vision into reality. We must work to evaluate our policies and regulations at every level to ensure they are in line with the guiding principles and are helping us achieve our goal of a truly people-centered EMS system. It is now up to our profession, working closely with regulators and policymakers, to make that happen. 


1. EMS Agenda 2050 Technical Expert Panel. EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services,

2. National EMS Implementation Forum, 2018,

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

Andy Gienapp, NRP, is EMS administrator for the Wyoming Department of Health’s Office of Emergency Services. Previously he served as a field supervisor with Hamilton County (Tenn.) EMS. He is a U.S. Army veteran with nearly 18 years of active and reserve service in a variety of positions and locations, including a tour     in Iraq.

Derek Bergsten, MPA, CFO, CEMSO, MIFireE, is chief of the Rockford (Ill.) Fire Dept.

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