College teaching was my side hustle when I was on the job as a paramedic/firefighter. This summer, I updated EMS 3300: Foundations of EMS Systems, an upper-division university course I teach online for Idaho State University. The amount of work needed was much more than I planned.
The EMS Systems course has been taught at three universities. I have been through four textbooks, five learning management systems, and many initiatives to better engage students. The Fall 2026 version of the course for Idaho State University barely resembles the original course I developed for The George Washington University.
No Textbook
When the National Fire Academy issued the Fire and Emergency Services Higher Education (FESHE) EMS Model curriculum, textbook publishers responded as they did with the earlier Fire Science curricula, providing one or two textbooks for every course. There were 16 textbooks covering the FESHE EMS curriculum. Unfortunately, the market for EMS textbooks is tiny. By Spring 2023, there were three FESHE EMS textbooks with 2015 to 2017 copyright dates. About 50% of their content was obsolete. The publishers said that they were not planning to update or replace these textbooks. EMS 3300 went textbook-free in Fall 2024.
Working Backward To Develop Content
Rewriting the course without a textbook required looking backward. What content would satisfy the course objectives (measurable outcomes of the student competency) and stay within the course description and the curriculum goals? Peer-reviewed research, industry or special interest group white papers, trade journal articles, and webinars provide current information in place of the textbook. Linking them together for an online course meant that the lectures became longer and many of the slides became wordier. Last summer, I crowdsourced EMS 3300 on LinkedIn to update course content.
Using Simulation To Demonstrate Student Competencies
EMS 3300 provides the “big picture” of EMS by creating a commercial 9-1-1 and interfacility ambulance service to demonstrate course competencies, including staff scheduling and fleet replacement. We start by evaluating a Request for Proposal to replace a hospital-based ambulance service supplemented by community volunteer ambulances with a single ambulance service system serving a two-county suburban-rural jurisdiction. Each week, the students apply the concepts or processes covered in the lecture to the fictional River County EMS through an individual assignment, small group exercise, or a graded problem-solving assessment.
The Only Constant is Change
I thought that last summer’s crowdsourcing provided a nice bolus of updated content for the textbook-free course. This summer I planned to coast with a few course tweaks, like finding a new state contract showing the cost of purchasing or remounting an ambulance.
Yikes, I was wrong. Five of the 14 lectures needed major rewrites. The introduction to the 2026 AIMHI High Performance / High Value EMS Benchmark Survey describes the current EMS industry environment:
Emergency Medical Services is undergoing one of the most significant periods of transformation in its history. Workforce shortages, rising operating costs, reimbursement challenges, increasing clinical complexity, and growing expectations for patient-centered care are fundamentally changing how EMS systems are designed, managed, and evaluated. At the same time, EMS has expanded well beyond its traditional role as a transportation service, becoming an essential component of the healthcare continuum, public health infrastructure, and community resilience. (AIMHI, 2026, p. 1)
AIMHI’s benchmark report release inspired this post. On July 10th, I completed my course update for EMS 3300 and loaded the lectures, PowerPoints, and the peer-reviewed journal articles, industry white papers, trade journal articles, and links to webinars onto the ISU learning management system. The AIMHI benchmark was issued July 30th. Had to update two lectures, one assignment, one mid-term exam problem, and add the AIMHI 2026 benchmark survey document as required reading.
Oh, and while doing the final edit of this article, I watched a great interview of Hilary Gates and Bob Davis, 6 Minutes to Live: Why Your ZIP Code Can Determine Cardiac Arrest Survival on Derek Hanley’s The DOHP Signal. https://youtu.be/C4e4edSN5t0
We are living in interesting times.
AIMHI (2026) 2026 AIMHI High Performance / High Value EMS Benchmark Survey: Organizational, Operational, Clinical and Financial Benchmarks from North America’s Leading EMS Systems. Academy of International Mobile Healthcare Integration. https://aimhi.mobi/benchmarking-resources/
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