EMS Experts Expect 2026 to be a Challenging Year

What will 2026 be like for the EMS sector in the United States? According to four experts who spoke with EMS World, it will be a challenging year for many reasons. Here are the issues and trends that they point to.

Attracting and Retaining the Right Staff

Finding and keeping qualified personnel at the low wages offered in EMS will be a major concern in 2026. “Getting people and keeping them here is hard,” said Jason Peasley, Rockport (Maine) Fire Chief. “[That’s because] we're all pulling from the same pool of people in this small area.”

“Successful recruitment and retention will continue to be a differentiator of EMS agency success,” said Steven Kroll, Executive Director of Delmar-Bethlehem EMS and National Association of EMTs’ Advocacy Committee Chairperson. “Public policymakers are paying more attention to EMS workforce challenges, but the solutions are long-term and expensive. Until we get systemwide solutions, the success of individual agencies will be localized.”

Money Remains an Issue

Chronic underfunding of U.S. EMS agencies is expected to continue in 2026, and—when compared to rising costs—become worse.

“One of the trends that I see, and I think the government shutdown brought it to light a little bit, was the changing landscape in terms of reimbursement for EMS and specifically for transportation to and from hospitals for our patients,” said Lt. Erik Christensen, Coordinator with the Northern Lake County (Illinois) Mobile Integrated Healthcare (MIH) team. “I see the costs of our services continuing to increase and really outpacing inflation.”

On a national scale, “The upcoming federal Medicaid reductions are going to put major stress on hospitals and how they fare will have a big impact on EMS,” Kroll said. “Agencies that count on federal agency grants to fund innovation, equipment, and expansion may find themselves having to compete for smaller pools of funds with more uncertainty and much longer lead times. This may require EMS agencies that have counted on federal grants to adjust their strategies to reduce expenses and look for other sources of funding, such as local government support, foundations, and philanthropy.”

It will be important for EMS agencies to pay attention to shifts in their payer mix in 2026 and beyond.

“Federal Medicaid and Affordable Care Act subsidy changes will have an impact on the number of persons enrolled in both programs in the coming years,” explained Kroll. “There are predictions that EMS will see a significant uptick in the percentage of patients that are uninsured and unable to pay for care.”

Daniel R. Gerard, Immediate Past President of the International Association of Emergency Medical Services Chiefs (IAEMSC) and EMS Coordinator with Alameda Fire (California) explained that overall, “The One Big Beautiful Bill will shape services across the entire spectrum, regardless of service delivery type, when changes in eligibility for Medicaid and retroactive payments take effect after November 2026. Coupled with loss of dual-eligible coverage for Medicare under the bill, and the uncertainty of supplemental payments for the Affordable Care Act, we may face a tidal wave of uninsured patients in the near future.”

Shifting Federal Responsibilities

Other possible shifts in Washington’s role in health and public safety may also increase stress on U.S. EMS agencies, such as the Administration for Preparedness and Response (ASPR) under the Department of Health and Human Services, and the Federal Emergency Management Agency (FEMA), Gerard said. As priorities for these agencies shift, regional governments will need to consider new ways of coordination, training, standards, and funding, he said.

“Active engagement, not only with federal partners, but between a multitude of non-government organizations, state, and local governments will be essential in order to be able to mount and maintain a response to the variety of natural and man-made events that have challenged the human race since the beginning of time,” Gerard said. “The learning curve is unforgiving, the rate of change is relentless, and the costs—relative to the patients we care for, the public as a whole, and our telecommunicators and EMS clinicians—can be cataclysmic when we’re forced to pivot on a dime.”

More Demands on EMS Personnel

The push to treat patients experiencing mental health issues with nonconfrontational Crisis Response Teams rather than police is widely seen as a positive change in public safety practices, and one that will continue to gain ground in 2026. But there is a potential downside, explained Kroll.

“We are seeing an increase in crisis response teams as part of the EMS system of care, either as an additional, but separate provider or as a unit within the EMS system,” he said. “This will catapult EMS into the behavioral health provider by default. [As a result], deescalation training will become an essential element of initial EMT, AEMT, and paramedic education, as well as the onboarding process and competencies for every EMS agency across the United States.”

Adding this extra training and its associated responsibilities to EMS work will likely increase on-the-job stress in 2026.

“The mental health burden carried by our current providers is [being] further exacerbated in the community paramedic space,” Gerard noted. “We prepare individuals to become EMS clinicians with the precept that the patient encounter is finite. For professionals working in the community paramedic space, it’s much different. We may have encounters with them three, four, five times a week—in some cases every day—for several hours at a time. We become vested in their success. We suffer in their failure. We don’t prepare our EMS clinicians for the mental stressors of these experiences by any stretch of the imagination, and we need to do better.”

Blood Use in EMS to Continue

On the positive side, the administration of blood transfusions to EMS patients is expected to increase in 2026, as more agencies adopt this life-saving practice.

“The use of blood in the field by EMS is a critical juncture in improving survivability from major trauma,” Gerard said. “As more services add blood, the ability to provide blood and blood products in the field is on the same level as having the ability to access an AED for a patient in cardiac arrest.”

Defining Success

Faced with these issues, trends, and pressures in 2026, U.S. EMS providers may have to reconsider “what constitutes success” in an ever-more challenging operational and financial environment.

“How we define success, what a value-based system of care entails, and what is the value we provide to the community, are essential questions, and there are answers that we need to put forth in 2026,” Gerard said. “The formula for value is Value = (Quality of Care + Patient Outcomes) ÷ Total Cost of Care. As we struggle to meet changes in reimbursement from Medicaid and any potential changes related to the Affordable Care Act, it will be critically important to define our value, why we should be paid what we are paid, and provide the service we provide based on the outcomes from the structure and process we have put into place.”

Will 2026 Be Better or Worse than 2025?

Clearly, there is a lot for the U.S. EMS sector to deal with in 2026. But the same was true in 2025 and the years before. So perhaps the question that really matters is—will 2026 be better or worse?

“The jury is still out on better or worse,” Kroll replied. “Medicaid changes may push financially vulnerable EMS agencies into insolvency. But the changes will take place over a series of years and the biggest impact may very well come further down the road.”

“I don't know that it'll be better,” Christensen said. “We're anticipating increases in call volume, but we're hoping that there's some sort of relief with greater amounts of referrals to the MIH program to provide that relief on the 9-1-1 side, because MIH is a nonemergency scheduled service. I see it worse just being in terms of reimbursement—again, our costs are outpacing inflation [and] the anticipated increases or announced increases from CMS as well as from private insurance. And so from a reimbursement landscape, I think it's probably going to be the same as [it was in 2025], if not a little worse.”

“I don't see any significant changes, negative or positive,” Peasley said. “I think the only negative would be the billing with Medicaid and Medicare. It's out of our control, so I think that would be the only concern that could potentially affect all of us.”

“There are some elements of change that will determine whether or not 2026 is better or worse that will happen rapidly,” Gerard said. “For instance, there’s the increasing use of AI for everything from writing better patient care reports and assistance with 9-1-1 call screening, to determining the diagnosis and treatment recommendations at the scene of an EMS response.”

But he is sure about one thing occurring in 2026: “Changes in Medicaid and the ACA will directly affect our system of care, and may force communities to consider unique mechanisms to pay salaries and meet our obligations for our accounts payable,” he said. “This may represent a transgenerational shift to a future of immense success or catastrophic failure.”

Gerard closed his 2026 forecast on a philosophical note. “Disparities in EMS response times, survival rates for trauma, stroke, cardiac arrest, and STEMI, rural EMS coverage, or behavioral health access represent the unfinished work of the profession,” he said. “EMS will never be perfect, it will never be complete, but that is OK. We wake to a new sunrise every day, and every day presents a new opportunity to do better.”