1. Staffing Shortages & Burnout
Continuing nationwide EMS workforce shortages
Mandatory overtime and reduced time between shifts
Fatigue impacting safety and patient care
Difficulty recruiting and retaining new medics
Burnout from high call volume and low pay relative to responsibility
Paramedics feel stretched thin, and many worry the shortage will worsen.
What Providers Can Do
Set personal boundaries (say no to excess OT when possible)
Use PTO intentionally—before crisis-level fatigue hits
Cross-train others to distribute workload
Join wellness, staffing, or scheduling committees at their agency
Speak up early when workload or fatigue creates safety risks
Document unsafe conditions for leadership review
What Agencies Can Support
Predictive scheduling
Recruitment bonuses
Mental health days
Station staffing models that reduce forced overtime
2. Violence Against EMS Providers
Increasing reports of assaults on EMS crews
More unstable, behavioral-health related calls
Lack of police availability for co-response
Inconsistent agency protections and protocols
Many medics cite personal safety as one of their top fears for 2025.
What Providers Can Do
Request law enforcement early—even if it feels “overcautious”
Use body positioning, escape paths, and radio pre-alerts
Take available de-escalation and self-defense training
Advocate for “assault on EMS = felony” protections if their state lacks them
Report every incident to build administrative awareness
Agency Supports Needed
Mandatory scene safety training
GPS-linked duress buttons
Policies for withdrawing from unsafe scenes
3. Increasing Call Complexity
Emergency calls are more medically complex than ever due to:
Sicker populations staying home longer
More chronic disease
Expanded scope (e.g., advanced airway, critical-care transports)
High-acuity behavioral-health emergencies
Overdose waves (opiates, xylazine, fentanyl analogues, polydrug)
Paramedics worry about being asked to manage ICU-level care in the field with limited support.
What Providers Can Do
Engage in ongoing micro-learning (short refreshers daily/weekly)
Review high-risk/low-frequency skills monthly (RSI, OB, peds, IO, etc.)
Request case reviews with medical directors
Use cognitive offloading tools (decision cards, phones/tablets, apps)
What Agencies Can Do
Provide simulation and airway labs
Ensure protocols reflect modern evidence
Provide mobile learning platforms (like DistanceCME)
4. Hospital Offload Delays
ER overcrowding continues nationwide
Crews stuck at hospitals for 1–4 hours
Units unavailable for emergency coverage
Increased pressure from supervisors and dispatch
Offload delays are one of the biggest system stressors for field providers in 2025.
What Providers Can Do
Document every excessive delay (for administration & system reform)
Use downtime for charting, equipment checks, hydration, or quick resets
Communicate early with charge nurses about bed status
Work with EMS officers to rotate crews off long delays when possible
System-Level Solutions
EMS hallway/triage nurses
Offload teams
Community paramedic diversion programs
5. Pay & Career Progression
EMS wages lag behind other healthcare roles
High stress vs. low compensation
Limited advancement without leaving field operations
Some states still lack pay protection or incentive programs
Medics worry EMS will remain undervalued compared to law enforcement, fire, and nursing.
What Providers Can Do
Build skills that increase earning power (critical care, FP-C, CCP)
Move into specialty teams:
CCT
Flight
Tactical EMS
MIH/CP
Negotiate raises using documented achievements
Join professional associations to advocate statewide
System-Level Solutions
Pay standards
State incentive programs
Tuition reimbursement
Career ladders
6. Mental Health & PTSD
Continued high levels of cumulative trauma exposure
Limited access to culturally competent EMS mental-health services
Fear of job repercussions if they seek help
High national suicide risk among first responders
Many medics are calling 2025 the “year EMS must face its behavioral-health crisis.”
What Providers Can Do
Make mental health appointments proactively—not reactively
Use peer-support teams
Build decompression habits after high-stress shifts
Separate personal identity from “every call outcome”
Keep a circle of non-EMS relationships
Check out www.distancecme.com/stress
Agency Responsibilities
Provide culturally competent therapists
Remove stigma from mental health reporting
Offer annual mental health checkups
7. Scope Changes, Protocol Updates & Training Requirements
Rapid changes in stroke systems, cardiac care, and trauma standards
Requirement to stay current despite limited training time
Concern about liability if protocols aren’t followed perfectly
Patchwork of state-by-state regulatory differences
Medics want clarity and consistency across EMS systems.
What Providers Can Do
Keep a personal “protocol tracker” (notes on updates, changes, reminders)
Ask for clarification rather than assume
Practice rare skills—even dry practice—weekly
Use flowcharts and checklists during high-risk situations
Agency/Medical Director Supports
Yearly structured protocol refreshers
Simulation scenarios
Open office hours with medical directors
8. Technology Pressures
New ePCR mandates
Difficult or glitchy software
Increased documentation workload
Body-worn camera discussions in some states
AI protocols and triage systems emerging
Providers worry technology will help leadership more than field operations.
What Providers Can Do
Create templates inside the ePCR to speed charting
Provide feedback—with examples—to IT and administrators
Master shortcuts in their specific reporting system
Advocate for field-provider input in software decisions
Agency Supports
Buy EMS-friendly tablets and mounts
Provide real training—not just “learn as you go”
9. Public Expectations & Media Pressure
Patients expect EMS to act like mobile ERs
Social media scrutiny of EMS incidents
Concern about being filmed during calls
Rising litigation trends
The fear of complaints and lawsuits is higher than ever.
What Providers Can Do
Chart thoroughly and factually (avoid emotion or assumptions)
Use structured assessments every time (OPQRST, SAMPLE, Cincinnati, etc.)
Ask dispatch for upgrades/clarifications early
Calm, professional tone—especially if filmed
Carry personal professional liability insurance (optional protection)
Agency Supports
Refreshers on risk management
Clear social media–filming policies
10. EMS System Sustainability
Aging fleets and equipment shortages
Rising call volume with no added units
EMS agencies struggling financially
Fear that communities will lose EMS coverage if systems collapse
Many medics worry that EMS as a profession is at a breaking point.
What Providers Can Do
Be part of the advocacy voice: attend EMS week at the state capitol
Submit issues through official channels
Participate in quality improvement committees
Mentor new providers to strengthen the workforce
System-Level Solutions
Sustainable funding models
MIH programs
Resource-sparing protocols (treat/no transport, telemedicine, etc.)
