3,874 Headlines Telling the Wrong Story: What the EMS Media Log Really Reveals

Here is a number that should change how you think about EMS: In 2024, a single pharmaceutical product — Merck's Keytruda — generated $29.5 billion in revenue. That same year, the entire U.S. ambulance services industry — every ambulance, every paramedic, every 911 response in every community in the country — generated approximately $22 billion.

One cancer drug that didn't exist before 2014 now out-earns the entire national EMS system by more than 30%.

If EMS had a money problem, that comparison would make no sense. Healthcare is a multi-trillion-dollar ecosystem. Money flows freely to services that are positioned inside it. Keytruda generates $29.5 billion not because cancer treatment is inherently more important than emergency medicine, but because it is positioned inside the healthcare value chain — integrated into oncology workflows, connected to clinical outcomes, reimbursed as medicine. EMS generates $22 billion because it is positioned outside that value chain — categorized since the 1970s as transportation to medical care rather than the provision of medical care, reimbursed per mile, disconnected from the health record, and largely invisible to the healthcare system it serves.

EMS doesn't have a money problem. EMS has a value, positioning, and messaging problem.

And now, thanks to a remarkable five-year data initiative, we can prove it.

The EMS Media Log

Since January 2021, the EMS Media Log — a collaboration between the American Ambulance Association (AAA) and the Academy of International Mobile Healthcare Integration (AIMHI) — has been systematically tracking and categorizing local and national media reports related to EMS delivery across the United States. The initiative, powered by EMSIntel.org and sponsored by Prodigy EMS, represents one of the most comprehensive efforts ever undertaken to document EMS system challenges in real time. Key figures behind the effort include Matt Zavadsky (AIMHI / PWW Advisory Group) and Rob Lawrence (California Ambulance Association / Pro EMS / AAA Communications Committee).

The data is extensive. But the conventional reading of it — as evidence that EMS needs more money — misses the deeper lesson entirely.

Read the Headlines Again — Carefully

The surface-level reading of this data is simple: 78.4% of articles cite funding or staffing challenges, therefore EMS needs more funding and better staffing. That reading is understandable. It's also a trap.

It's a trap because it accepts the premise that EMS is a service that naturally struggles for money — that the baseline condition of emergency medical services is financial precariousness, and that the job of EMS leaders is to perpetually beg for scraps from local tax levies, Medicaid reimbursement adjustments, and one-time grants.

But step back and ask a different question: why does a system that makes over 60 million patient contacts a year — more than any hospital system in the United States, including HCA Healthcare — generate less revenue than a single pharmaceutical product?

The answer isn't funding. The answer is how EMS has been categorized — and how it has categorized itself — for over fifty years. Since the 1970s, EMS has been more closely aligned with transportation to medical care than the provision of medical care itself. That categorization shapes how EMS is reimbursed, how it is regulated, and how its value is measured. It is reimbursed for miles traveled, not for clinical encounters. Its data doesn't flow into patient portals. Its care records rarely reach the patient's physician. The only artifact most patients receive after an interaction with EMS is the bill. And in many parts of the nation, it's even how EMS internally sees itself — as a ride to the hospital, not as the first clinical encounter in a patient's care continuum.

In a healthcare system where money follows value, EMS has never been positioned to articulate its value in the language that system understands.

Every closure documented in these 3,874 articles, every staffing shortage, every tax levy a community scrambles to pass — these aren't evidence of a funding crisis. They are symptoms of a positioning failure that is decades old.

The Symptom Log

When you reframe the Media Log data through this lens, the tag distribution tells a different story. The two dominant themes — funding (1,359 articles) and staffing (1,247 articles) — aren't separate problems. They're the predictable downstream effects of a service that has been classified, priced, and regulated as transportation while being expected to deliver medicine.

Services that are positioned as transportation get reimbursed like transportation. Services that get reimbursed like transportation can't pay competitive healthcare wages. Services that can't pay competitive wages can't recruit or retain clinical professionals. Services that can't staff ambulances can't generate the revenue to remain viable. The entire cascade documented across these five years of coverage begins with a single structural defect: EMS is not positioned where it belongs.

Response time challenges account for 502 articles — but the more important question is why EMS measures response times at all. Response time is a transportation metric. It measures how quickly a vehicle arrives. Every time an EMS system publishes a response time report, it reinforces to the public, to policymakers, and to the healthcare system that EMS exists to quickly respond and get you to a hospital. It is the metric of a taxi service, not a clinical discipline.

And the data undercuts even the premise behind it. NEMSIS — our own national EMS database — shows that of the 81.6 million EMS incidents tracked between 2017 and 2020, only 18.9% were emergent or higher acuity. Roughly four out of five EMS patient contacts are for lower-acuity complaints — patients who do not need lights-and-sirens transport to an emergency department and who would often be better served through alternative care pathways: telehealth triage, community paramedicine, urgent care referral, or treat-in-place protocols. Yet EMS continues to measure its performance by how fast it gets everyone — regardless of acuity — to a hospital. That's what a transportation system does. A healthcare system would measure clinical outcomes, patient disposition appropriateness, and whether each patient received the right care in the right setting.

Tax levies and special funding measures (344 articles) represent communities scrambling for local solutions to a national positioning problem. And the 201 takeover reports and 158 closures document the end state — what happens when the financial math of a healthcare service priced as transportation simply stops working.

The Keytruda Comparison

This is where the Keytruda comparison matters most. Keytruda didn't exist before 2014. Pembrolizumab was approved by the FDA in September of that year. In just over a decade, it scaled from zero to $29.5 billion in annual revenue — not because cancer immunotherapy is more important than keeping a community's 911 system running, but because it was designed from day one to operate inside the healthcare value chain.

Keytruda is integrated into oncology treatment protocols. Its outcomes are tracked in electronic health records. Its value is measured in clinical endpoints — progression-free survival, overall survival, tumor response rates. Insurance covers it because the data proves it works. Physicians prescribe it because it is woven into the workflows and evidence base they use every day.

Now consider EMS. More than 60 million patient contacts per year. Clinical decisions made under extreme time pressure. Interventions that save lives daily. And yet: the data we generate rarely reaches the patient or their care team. We are not integrated into health information exchanges. We are not measured by clinical outcomes. We are measured by response times — a transportation metric — and reimbursed by the mile.

We don't need to ask why Keytruda generates more revenue than EMS. We need to ask why we've accepted a positioning that makes that outcome inevitable.

The revenue gap is only part of the story. The clinical gap may be even more consequential. As I explored in a recent JEMS article on preparing EMS for the next era of patient care, the FDA has approved over 3,000 new medications since 1993 — and EMS clinicians are encountering patients on these complex therapies daily, without the AI-powered decision support tools that hospitals already rely on. The same positioning failure that keeps EMS revenue below a single drug's sales also keeps EMS clinicians disconnected from the clinical tools that would help them manage the medications those revenues fund. Hospitals use platforms like IBM Micromedex, Epic's embedded AI, and MedWise to flag drug interactions and guide prescribing in real time. EMS clinicians — making high-stakes pharmacological decisions under time pressure — have nothing comparable.

Where EMS Sits: The Positioning Gap in Context

The Keytruda comparison isn't an outlier. It's a symptom of a pattern that becomes clearer when you stack EMS against other essential services and healthcare entities — all of which have a structural home that EMS lacks.

HCA Healthcare — a single hospital corporation — operates roughly 190 hospitals and reports approximately 44 million patient encounters annually. EMS makes over 60 million patient contacts per year. More encounters, fewer resources, a fraction of the revenue. HCA generates over $70 billion annually because it is positioned inside the healthcare reimbursement infrastructure. Its encounters produce billable clinical data that flows through EHRs, feeds quality metrics, and generates revenue across the full continuum of care.

Now look outside healthcare entirely. Public K-12 education costs approximately $950 billion annually — funded through a dedicated structure of state and local taxes, federal allocations, and clear public mandate. Law enforcement exceeds $100 billion in annual spending, backed by municipal tax authority and embedded in every local government budget. Even local parks and recreation agencies spend over $41 billion annually and generate $201 billion in economic activity — with a recognized infrastructure that employs 326,000 people across more than 10,000 agencies.

Every one of these services has something EMS does not: a structural identity that matches its function. Education is funded as education. Policing is funded as public safety. Hospitals are reimbursed as healthcare. EMS — which delivers clinical medicine under the most time-critical conditions in the entire care continuum — has been categorized as transportation to healthcare and funded accordingly.

The positioning gap isn't just about money. It's about what money represents: a society's declaration of what it values. Education is valued at nearly a trillion dollars a year because it has a structural identity and dedicated funding streams. A single hospital system is valued at $70 billion because it sits inside the healthcare value chain. EMS is valued at $22 billion — for 60 million patient contacts — because it has never been given a structural home that matches what it actually does.

This is not a problem that more levy campaigns will solve. This is a classification problem, a positioning problem, and ultimately a messaging problem. Until EMS is repositioned inside the systems where value is recognized and funded — healthcare, public safety infrastructure, or both — the gap documented in these 3,874 headlines will only widen.

A Crisis That Grew — and Kept Growing

When tracking began in early 2021, coverage was sparse — the project logged just 212 articles that first year as the methodology took shape. By 2023, the log was tracking nearly 1,000 articles per year. In 2025, that number climbed to 1,192 — a pace exceeding 100 articles per month for most of the year.

This sustained growth isn't media hype. These are local newsrooms documenting what's happening in their own communities — and what's happening is the predictable result of a service that has never been positioned to capture the value it creates.

Where the Stories Come From

The geographic distribution of coverage is revealing. New York leads with 313 articles, followed by Pennsylvania (254), California (252), Ohio (171), and Texas (162). When adjusted for population, smaller states like Maine, Idaho, Alaska, and Delaware show some of the highest per-capita rates — reflecting the disproportionate impact on rural and small-state EMS systems where the positioning failure hits hardest.

The closure and takeover data mapped by state tells the story of communities where the math finally broke: California (37 reports), Pennsylvania (35), New York (25), Texas (24). States like New Hampshire (15 reports for a state of 1.4 million) show the concentrated devastation of system failures in smaller communities.

No Off-Season for a Structural Problem

The monthly trend data from 2023 through 2025 shows remarkable consistency — sustained coverage at 80–120 articles per month, month after month, year after year. Coverage doesn't spike around legislative sessions or seasonal events and then fade. This is the signature of a structural problem, not a cyclical one. There's no off-season for a positioning failure.

The Real Story These Headlines Tell

For those familiar with the full timeline of EMS history on this site, the Media Log data is the contemporary chapter of a very old story. The fundamental problem — that EMS grew up as a fragmented patchwork of local solutions, categorized as transportation to healthcare rather than as healthcare itself, and excluded from the infrastructure it serves — has been the profession's central challenge since the 1966 NAS-NRC white paper first described the ambulance system as a national disgrace.

What's changed is not the problem. What's changed is the cost of leaving it unresolved. In an era of AI-powered clinical tools, real-time data integration, outcome-based accountability, and a healthcare system that increasingly expects every discipline to participate as a full partner — the positioning gap becomes an existential threat. As I've written on EMS-AI.com, the question is no longer whether EMS is medicine. It is. The question is whether EMS will be structured, funded, and held accountable as medicine — or whether we will continue living between two identities until the market, the regulators, or the disruptors make the choice for us.

The EMS Media Log doesn't document a funding crisis. It documents 3,874 symptoms of what happens when a healthcare service is positioned as transportation.

The value of the EMS Media Log is not just the data — it's the evidence base it creates for a different conversation. Not "how do we get EMS more money?" but "how do we reposition EMS inside the healthcare ecosystem where the money already is?" The former leads to incremental lobbying for marginally better reimbursement rates. The latter leads to structural transformation — the kind that turned a nonexistent cancer drug into a $29.5 billion product in a decade.

Explore the Full Dataset

The categorized data from the EMS Media Log has been cited in publications including ICMA's PM Magazine and used by national EMS organizations in Congressional communications. The full interactive dashboard — with filters by state, date, tag, and keyword — is available at EMSIntel.org. Additional reports and analysis are available through AIMHI's news page.

Key Facts

Frequently Asked Questions

Data source: EMS Media Log, a collaboration between the American Ambulance Association (AAA) and the Academy of International Mobile Healthcare Integration (AIMHI), powered by EMSIntel.org and sponsored by Prodigy EMS. Data as of January 31, 2026. Keytruda revenue data from Merck & Co. 2024 Annual Report (SEC Filing, February 2025). U.S. ambulance services market estimate from IBISWorld (2025). NEMSIS patient acuity data from NEMSIS Version 3 database (81.6 million incidents, 2017–2020) as reported in Maguire et al., "Non-Emergency Utilization of EMS: Contributing Factors," University of Nebraska Medical Center (2021). HCA Healthcare data from Definitive Healthcare / Medicare Cost Report (2024). Analysis and commentary by Donnie Woodyard, Jr.