EMS at the edge: Inside a year of reckoning and redesign

As EMS closes out 2025, host Rob Lawrence is joined by Matt Zavadsky (PWWAG) and Rodney Dyche (Patient Care EMS Solutions) for their second annual EMSIntel.org “year in review” conversation — a fast-moving tour through the biggest stories shaping the EMS profession. Drawing from the EMSIntel news log (now 3,849 stories as of the morning of recording), the trio connects what’s making headlines to what EMS leaders are experiencing on the ground: unstable economics, governance pressure, system redesign and rising operational risk. The discussion lands on several recurring themes: economic sustainability as the dominant issue; the real-world politics of tax levies and “essential service” designations; the ongoing obsession with response times (and what they cost); preventable ambulance thefts escalating in severity; and the importance of measuring and publishing clinical outcomes and meaningful performance metrics. The through-line: communities are being forced into more honest conversations about what they can afford — and what EMS should look like going into 2026. | SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond Memorable quotes “Having a thoughtful conversation about what your system needs to look like on the go forward is paramount.” — Rodney Dyche “If you don’t talk about yourself, somebody else will, and then you don’t control the narrative.” — Rob Lawrence “Our No. 1 focus really needs to be on the economic sustainability of these systems because we are past the breaking point.” — Matt Zavadsky “Response times equals speed; speed equals crashes.” — Rob Lawrence “These theft incidents are … in almost all cases, 100% preventable by an aftermarket device … probably for 100 or $150.” — Rodney Dyche “Response times are expensive. The shorter that you want your response times, the more money it’s going to take.” — Matt Zavadsky “Across every provider type … the fee-for-service revenue is 50% to 60% below the cost of providing service. So when somebody says to you, ‘I can do this for free,’ ask more questions.” — Matt Zavadsky “Response times are used as a cudgel.” — Rodney Dyche Episode timeline 01:11 – Rob introduces the end of 2025 reflection and 2026 look-ahead; welcomes Matt Zavadsky and Rodney Dyche for the second annual EMSIntel year-in-review. 02:26 – Rodney reports the EMSIntel log count (“3,849 as of this morning”); Rob explains EMSIntel’s purpose: curating national EMS stories to identify themes and brief stakeholders. 04:13 – Matt names the year’s biggest issue: economic sustainability; the fiscal model is broken and impacts everything else. 06:32 – Matt walks through the “AnyTown EMS” trajectory: communities can’t sustain old models, must define service levels, use system intelligence, and redesign for a modern “2028 model.” 09:06 – Matt cites the Medicare/RAND cost collection findings and warns that fee-for-service revenue sits far below actual costs; “ask more questions” when someone promises “free.” 10:12 – The group discusses communities pursuing tax levies and essential-service framing; Rodney contrasts places that pass funding measures with places that don’t, and highlights local politics and competing priorities. 11:52 – Matt clarifies that “essential service” means different things to the public versus statute; agencies need trust, transparency and real community education to succeed at the ballot box. 13:50 – Rodney describes the “cost of readiness” misunderstanding (public sees mileage, not readiness); Matt pushes proactive reporting (monthly/quarterly/annual) to build credibility. 15:35 – Matt pivots to response times: they’re expensive, clinically relevant in a small fraction of cases, and should be approached with evidence-based expectations and better triage/EMD practices. 18:14 – Rodney connects hot responses to preventable intersection crashes and modern driver realities; the discussion frames safety risk as a growing operational storyline. 20:21 – Matt adds an editorial caution that crashes are not confined to any one sector; points to recent examples including serious injuries during responses. 22:37 – Rob returns to ambulance thefts; Rodney calls most thefts preventable; Matt argues the basic lock discipline exists already and presses for stronger accountability and accreditation-style best practice. 26:11 – Rob flags downstream legal and regulatory risk (litigation exposure after stolen-unit crashes; DEA-controlled substances security implications). 26:52 – Rodney raises staffing; notes fewer staffing stories than 2024 but questions whether the situation is truly better; mentions earn-to-learn pipeline concerns. 28:13 – Matt describes the shift toward tiered deployment and greater EMT utilization, reducing pressure to staff large numbers of paramedics for calls that don’t require that level. 30:17 – Matt emphasizes outcomes and meaningful performance metrics; argues many systems still report the wrong measures and should lead with clinical metrics, patient experience, and quality indicators. 31:08 – Rodney reinforces that response times get weaponized in governance decisions; notes boards can be swayed by “advanced skills” narratives rather than outcome data. 33:25 – Forward-looking wrap: Matt highlights daily calls from communities that “can’t afford this anymore” and urges leaders to seize the redesign opportunity; Rodney echoes the need for planning and honest community conversations. Additional resources: AAA & AIMHI EMS Media Log: EMS Intel Fast & spurious: America keeps losing ambulances and the fix is cheap Callouts, chaos and career killers: The biggest EMS stories of the year Enjoying EMS One-Stop? Email [email protected] to share feedback or suggest guests for future episodes.