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By Douglas M. Wolfberg

President John Quincy Adams said that a leader is anyone who inspires others to do more, dream more and become more.  EMS is highly regimented and often focused on levels of licensure, supervisory vs. field provider status and other indicia of rank and title. But leadership need not be constrained by such classifications.  Any EMS professional can be an EMS leader under the formula handed down to us by President Adams.


Anyone who is a leader or aspires to leadership in this profession must read this important work.  EMS owes Donnie Woodyard a debt of gratitude for documenting our history and illuminating the future course for the profession. EMS in the United States: Fragmented Past, Future of Opportunity is a magnificent and monumental work. 


Those who have been involved in EMS for a long time often refer to themselves (and are often referred to by others) as “EMS dinosaurs.” Though EMS dinosaur status does not have a precise unit of measurement, as someone who has been involved in EMS for 45 years as of this writing, I suppose I qualify. I’ve also had the privilege of close associations with the generation of EMS dinosaurs that came before me, some of whom were acknowledged “founding fathers” of the EMS profession. So, I have had a front row seat, either as a direct participant, or as a recipient of firsthand accounts, of EMS throughout almost its entire modern history. I’ve come to terms with my EMS dinosaur status, largely because it allows for an unparalleled vantage point from which to assess the state of affairs of a profession to which I have dedicated my entire working life.  


I answered my first ambulance call in 1978. For the first 30 years, I can say with the benefit of hindsight that the pace of progress in EMS was glacial at best. Nothing, it seemed, was revolutionary – it was barely evolutionary – and painfully so.  Many practices – both operationally and clinically – were done simply because “we’ve always done it this way” (which Admiral Grace Hopper correctly said was “the most dangerous phrase in the language”).  While EMS still clings to some of these anachronisms (red lights and sirens, anyone?), we’ve entered, and are firmly entrenched in, the era of evidence-based practices. The implications have been profound.


In comparison to the snail’s pace of progress in EMS I witnessed in my first 30 years, I believe that the past 15 years have been a time of breathless and exciting change.  How energizing it has been to see the unflinching gaze of data and evidence topple so many sacred cows. Everything we do deserves fresh scrutiny. Why does everyone who calls 911 require a full EMS response?  Why do we run “hot”? Why does every response require transport to an acute care hospital? Can some conditions be effectively managed outside the hospital?  Can some patients be transported to destinations other than acute care hospitals to effectively manage their conditions? Can telehealth play a role in more appropriately providing out of hospital care? 

EMS outwardly looks like public safety.  Our vehicles have markings, lights and sirens – and our people wear uniforms - that connect us by appearance to our fire and police counterparts. But make no mistake: EMS is healthcare. Some EMS systems over the past 15 years have reengineered themselves as participants in the broader community healthcare system. And herein is the exciting future that lies ahead. For a profession that started modestly as a “ride to the hospital” with minimally trained first-aid attendants, EMS is becoming community-based healthcare.  “EMS providers” are becoming practitioners. “Crew members” are becoming clinicians. 


These are truly momentous times in EMS.  To use a golf metaphor (strange, since I’m not a golfer), I often wish I wasn’t already on the “back nine” of my career. I’d like to help shape the next 45 years of our profession. I’ve always thrived on change, and what’s in store for EMS is exciting. Being an EMS leader in such times of change can be enthralling and satisfying. 


Though I hope I have a bit more to contribute, the future belongs to the next generation of EMS leaders, and the ones after that. But past is prologue. To build a future we must understand the past.  We must learn from our failures as well as from our successes. The future of EMS will be what you – our future leaders - make it. This book is your roadmap. Study our history and then go out and make EMS history anew. 

Mechanicsburg, Pennsylvania
July 2023

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