2025 EMS Trends from 12 Industry Leaders

Kevin E. Frisch

CEO, Banquest Payment Systems

The medical transportation industry is adapting to the needs of a more tech-savvy population that values convenience and immediacy in their financial interactions. Modern patients and their families increasingly prefer seamless payment methods that align with their everyday digital experiences—whether it’s a single-click transaction using stored payment methods or mobile-friendly options that eliminate the need for phone calls or emails. In response to this demand, we have collaborated with dozens of ambulance companies over the past year to fully integrate payment systems into their workflows. These efforts ensure that paying invoices is as effortless as possible, allowing patients and families to focus on care rather than administrative tasks.

Dale Loberger

Chief at GRVFD

This could be an especially difficult year to forecast with a new federal administration looking to make significant changes, but the president-elect has been very clear about his policy priorities. Some of his promises relate to deregulation, spending cuts, and increased tariffs.

While the federal focus is not on EMS directly, healthcare in general will be targeted for some real changes. A general mood toward deregulation could allow for some new strategies of EMS delivery to be implemented. You can expect to see the trend of fire departments competing for contracts held by third-service EMS providers to continue with a promise to reduce local expenses. However, it is the spending cuts recommended for direct assistance programs that might have the most impact. We can anticipate a greater public dependence on EMS services with the possibility of less scheduled primary care being supported. Tariffs are also likely to have a direct effect on agencies by driving up the direct costs of many consumable expenses with many suppliers of goods being located outside of the US.

In general, it is also likely that rigid response time standards continue to lose their stranglehold on contract requirements. We are starting to see new criteria related to event outcomes beginning to replace a drive to just get to the scene quickly. With fewer federal dollars supporting EMS in reimbursements, it will be up to local governments to sustain EMS initiatives while we likely face increasing volume due to reductions in aid to poor families.

Greg Friese, MS, NRP

Editorial Director, EMS1

The 2020s are half-over and EMS faces many of the same challenges it faced at the start of the decade – difficulty retaining high-performing field providers, too few people entering the career field and inadequate funding to provide reliable and high-quality service. Despite these headwinds, some high-performing EMS services are finding a way to reduce the risk of opioid overdose, transport patients to alternative care destinations and partner with law enforcement and mental health professionals to best serve those in mental health crisis. To join these top performers in 2025, all EMS agencies need to secure and stabilize their funding, collaborate or merge with neighboring agencies and inform their stakeholders of their successes and challenges.

Scott Moore 

Senior Consultant & Show Host, Moore EMS Consulting

The new Presidential administration will bring with it significant changes in the workplace from a regulatory perspective. Over the last few years, we have seen significant action from both federal and state regulators. OSHA proposed the first update to rules impacting EMS and first responder agencies in 44 years. As we begin a new year and new administration, EMS leaders can expect dramatic changes in workplace oversight priorities. It will be critical that EMS leaders more deeply engage with their compliance efforts.

Maggie Adams

President, EMS Financial Services

EMS leaders will continue to look for opportunities to improve revenue and reduce costs. Going into 2025, treatment without transport coverage will grow as Medicaid plans recognize its value. I recommend investigating how to bill for these services. The new year will continue the need to meet the financial expectations of all levels of the workforce. Providers do not need the unexpected financial hit of a billing audit or a review of staff licensing requirements. My best advice for the coming year is for providers to check that their house is in order. We have the arrival of a new administration, and we do not yet know the impact (if any) on existing fraud and abuse oversight efforts – or if oversight will be expanded. Recent OIG work plan efforts affected both emergency and non-emergency providers. Therefore, take 2025 as an opportunity to clean up if necessary.

Outsourced billing continues to be a trend. It would be prudent for providers to look at billing (both Medicare and Medicaid). There has been consolidation and mergers among billing organizations. Whether billing in-house or outsourced, now is the time to audit documentation and billing for compliance. On another front, some organizations have had to pay back money because transports were performed by personnel whose credentials were not up to date. Ensure all staff credentials and training requirements are current so that no money needs to be paid back to third-party payers because a crew member was operating without proper licensure. The response to a government audit on any of these topics is costly and time-consuming. Look under the hood to see that all the issues that could potentially impact reimbursement or income are current. With assurance that financial matters are clean, providers will have more bandwidth to focus on operational and staffing issues that best support their communities.

Chris Cebollero

Head of Operations, QuickMedic.

For the past few years there has been a certain amount of uncertainty in EMS. We are making strides to tackle those subjects which include reimbursement, recruiting, retention, and the MIH/CP transition. Even though we are making strides, they are slow going. Now we have a new fox in the henhouse and that is the booming use of AI in everything we do. What does the future of AI in EMS look like? I do not want to offer an answer, instead we need to now be anticipatory as to what we want to use AI for in EMS.

With just a shrug of the shoulder, initial and continuing education will make incredible strides in the AI universe. I was talking to a cardiologist friend of mine, and he just installed an AI documentation tool in his clinic. He walks into the room, begins his assessment and AI does all his documentation for him. Will this work in EMS? Let’s make it work in EMS. We have to remember that we are dependent on CMS for reimbursement, ensuring that our charts are completed correctly is a big deal. With all the trends in EMS, this is a great time to be happy and excited about the future. What does the future look like when it comes to AI? Whatever we want to create it to look like.

Samuel Scheller, MBA, NRP

CEO, Guardian Elite Medical Service (NV)

The EMS industry continues to adapt to a rapidly changing landscape. In the coming year, we anticipate a growing focus on mental health support for EMS professionals, the integration of advanced data analytics for improved patient care, and the expansion of community paramedicine programs to bridge gaps in healthcare access. As challenges like staffing shortages and rising operational costs persist, innovative solutions and collaboration will be critical to ensuring we continue to provide high-quality emergency care.

Nancy Magee

EMS Educator, consultant, conference speaker at MEDIC Training Solutions LLC

Last year, rising EMS costs, revenue, and solvency were the focus of my commentary.

To date, not much has changed.

Various EMS entities have lobbied state and local governments for many years with limited success and have achieved no cohesive national plan for a structured approach or sustainable funding because they have been barking up the wrong tree.

Lobbyists and advocacy groups are frankly out of time to continue bickering among themselves about minutia and pleading with policy makers whose main concern is unfunded mandates, task forces, focus groups and other red tape which only succeeds in preventing any money actually allocated to ever reach the local services or support the boots on the ground who are in dire need of help.

The priority for 2025 needs to be public education. Recruitment, staffing, salaries, funding, and clinical progression cannot happen without public support.

Tip O’Neil, the 47^th speaker of the House of Representatives famously opined “All politics is local’”. Recognizing “People want to be heard” resulted in his losing only one election in over 50 years of public service.

This year’s election has proven that American voters have voiced their frustration at not being heard and demonstrated an enduring proclivity for voting in their self-interest- the cost of gas and eggs, freedom from fears real and imagined ranging from job security to physical safety- the kitchen table issues that directly affect them.

 EMS needs to become a kitchen table issue by creating awareness at the local level.

The average American’s current interest and awareness of EMS can be described using an analogy:  The flat tire:  Didn’t think it would happen to them without warning. Believed their car had a safe spare, or did not want to invest the money for a product they might never need. The result? Limp down a dangerous road for the short term on a temporary donut, or potentially find that the trunk is empty, the AAA card is expired, and no one is coming to help.

Except not having EMS is more than an inconvenience-it can be a matter of life and death

Rural volunteer agencies, municipal services and for-profit mega ambulance corporations must accept the responsibility for educating the communities they serve on the role of EMS. They need to be transparent and realistic in describing their current capabilities and the options available to the community. Individual services must be prepared to explain how the EMS system works, the associated costs, and the risks associated with potential system failure. Providers who want their profession to become a thriving career field with opportunities for growth and salaries commiserate with the knowledge, risk, responsibility and essential nature of EMS need to stop complaining and do the work it takes to help make it happen.

Public perception studies consistently indicate that people recognize the importance of EMS and expect timely and effective emergency care, consider EMS an essential service, and are generally supportive of ensuring necessary funding. Voters, not politicians!

Ambiguous threats about the collapse of the system are unlikely to connect with the day-to-day interests of average Americans. Make it personal. Politicians understand that acting on issues that positively affect the voter’s lives are what keeps them in office.

Every agency should have an action plan for 2025 focused on making access to emergency service a personal issue for every individual in their response area. Being ubiquitous and relentless in pursuing opportunities to inform and involve the people you serve is the fastest way to turn the tide on sustainability. The rest can then follow.

Mark Tenia

Public Relations/Media Manager, Richmond Ambulance Authority

In 2025, one of the key trends we will see in EMS will be the rise of AI-powered crisis communication and real-time community engagement.

As EMS agencies face increasingly complex emergency situations, the ability to communicate quickly and effectively with the public will become even more critical. AI-driven tools and platforms will help EMS organizations automate and enhance their communication strategies, ensuring they provide timely updates during emergencies, manage public perceptions, and address community concerns.

Some ways this will manifest include:

1. Real-time Social Media Monitoring and Engagement: EMS agencies will use AI to track social media and other digital platforms, identifying potential crises or public concerns in real-time. This will allow them to respond faster to misinformation, provide up-to-date information during major incidents, and engage with the community more effectively.
2. Crisis Response Automation: EMS will increasingly rely on AI systems that can automatically send out pre-scripted responses to common questions during crises, minimizing delays and human error while ensuring clear and consistent messaging.
3. Personalized Communication: Using data analytics, EMS providers will be able to target specific segments of the population with tailored messages, whether for public health campaigns, safety tips, or updates on ongoing emergencies. This personalization will improve community trust and engagement.
4. Collaborative Platforms: EMS will integrate communication tools with local government agencies, law enforcement, and healthcare providers, enabling a unified and seamless flow of information during critical situations. This collaborative approach will not only ensure faster decision-making but also improve public perception of EMS as a part of a coordinated effort in community safety.

As these technological advances become more integrated, EMS agencies will become more adept at proactively managing their reputations, fostering stronger community ties, and ensuring public trust remains high in 2025 and beyond.

Jim Karras

EMT, Principal of The Karras Group

Although inflation may slow in the coming years, costs will continue to rise in 2025. A growing number of states have implemented Minimum Wage ordinances that are tied to automatic adjustment formulas based on changes in the consumer price indexes for their geographic areas.

Direct Labor costs are the highest cost line item on the balance sheet for most EMS organizations.

The incoming federal administration and congress have indicated a desire to reduce the federal deficit by cutting spending. Specifically, members of congress and the senate, have echoed the president-elect’s comments about finding savings at CMS in both the Medicare and Medicaid programs. This will no doubt result in revenue reductions or at a minimum, hamper revenue increase for many ambulance services throughout the country.

While in many other sectors automation is one method to reduce costs, in EMS, we are reliant on direct labor as a service industry. But we can employ technology to create efficiencies that result in savings to the bottom line!

Management teams should review all departments in their operations to assess where enhancements in the deployment of technology can reduce direct labor costs. Obvious places could include dispatch processes, billing tasks, quality assurance review, performance review, ePCR systems, data transfer, employee credentialing management, fleet management documentation, inventory management control, and so much more. The good news is there are plenty of high caliber vendors that support EMS organizations with high quality technology solutions tailored to our industry’s unique needs.

Whether your service is a two-ambulance fleet or a 1,000-ambulance fleet, in 2025, it will be crucial for all EMS organizations to review their systems to see what technologies are available to assist them to eliminate mundane tasks that their employees dread, and that will lower direct labor costs. In doing so, it might make both the crew and the accountant smile, at least for a little while!

About The Karras Group

Founded in 2005 and based in Mount Pleasant, Michigan, The Karras Group is a nationwide public safety consulting firm offering practical solutions for ambulance services, EMS organizations and related entities. To learn more about The Karras Group visit thekarrasgroup.com.

Matt Koslosky

NEMT Transportation Solutions Expert

Organizations collect vast amounts of data during their daily operations. This data empowers them to operate more efficiently, meet regulatory standards, provide better service, enhance patient care, manage costs, and ultimately grow in a competitive landscape. In 2025, data-driven strategies will continue to foster improvement, adaptability, and innovation.

Omar Masri

CEO, Mamori.io

A major trend I see is that there is a perfect storm brewing to challenge EMS organizations both economically and organizationally.  First, you have Health insurance providers and government regulations squeezing transport provider revenue.  Second, you have rising inflation increasing operational cost and staff stress levels. Finally, you have the unrelenting growth of cyberattacks aimed at extorting money from EMS organizations and disrupting business continuity because they are usually soft targets with valuable health data.

At Mamori.io we recognize that running an EMS organization is becoming increasingly challenging and stressful, and that is why we are focused on helping EMS organizations protect themselves from modern cyberattacks with a comprehensive, easy to deploy, and cost-effective all-in-one data security solution. Our mission is to remove the stress of cybersecurity from EMS business owners. Traumasoft is using Mamori.io to secure its valuable data, and we are happy to help all their partners and customers do the same. For small businesses under 20 users, we offer our comprehensive data security solution for free.