A new report from the Indiana Department of Homeland Security makes nearly 30 recommendations for how the state can improve the emergency medical response infrastructure. The recommendations fall into several broad categories, including funding, safety and workforce.
The report covers a range of issues that have affected emergency medical services for decades.
State EMS Director Kraig Kinney said while the issues may not be new, this report is the first time Indiana has formally identified them. He said there’s been a spotlight on emergency medical services in recent years, making this a good time to create a blueprint for the future of EMS in Indiana.
“COVID kind of highlighted that there are some challenges we need to address,” Kinney said. “I really do think now's an opportunity we can actually do something about these things, not just identify them.”
Kinney said the report will act as a guide for the next several years as the state works to improve the EMS system — but that doesn’t mean the agency will only use the findings and recommendations within the report.
“We're going to see new challenges and new opportunities open up. And we have to be agile and adapt to our surroundings,” Kinney said. “This report is a tool to get there, but we also have to be aware of the moment and how things are happening around us.”
The report includes 19 findings, with 28 recommendations. The recommendations also cover operations, essential functions, education and training.
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Some of the findings include the absence of an EMS code of ethics and concerns about how jurisdictional boundaries affect response time.
“It's important that we have better operation,” Kinney said. “And those are artificial boundaries — so, yes, your asset may cover a response out of your territory, but in the end, someone's going to cover a response when you need it as well. And so we think that we can do this by doing better dispatching systems.”
Almost all of the recommendations focus on what IDHS, the EMS commission and the governor’s office can do to "stabilize and improve EMS.” Kinney said the report could also be useful to other stakeholders, such as other state agencies, legislators and providers.
Kinney said his primary takeaway from the creation of this report is how many issues could be solved with better communication among different stakeholders.
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For example, the report also highlighted a number of concerns around EMS training. In addition to cost creating a barrier to EMS training, many areas of Indiana do not have quality and accessible EMS training. Kinney said working with other agencies could help students access training and work with the legislature to continue EMS Readiness Funding opportunities.
“When we look, there are other state agencies, the Department of Workforce Development has programs that can help with EMS education,” Kinney said. “The Department of Education has programs in high schools, but we don't communicate with them.”
Additional findings in the report include Indiana’s poor test performance on national standardized EMS tests, lack of accessible EMS operations data and insurance reimbursements that don't cover the cost of providing care. Some of the solutions Kinney said IDHS will consider are increased transparency and continued conversations about improving EMS funding.
Kinney said the biggest challenge in implementing the recommendations will be ensuring the state has adequate resources, especially as the landscape of what EMTs and paramedics provide shifts.
He also said what might appear to be a workforce shortage is more about how resources are allocated.
“We do have a little bit of a workforce shortage, but when you look at our numbers, they are on par,” Kinney said. “It's just that we are using numbers in other places that we haven't before. Like, they're filling roles in hospitals, things of that nature that's kind of reassigned to people. And so I think, right now, making sure that we have adequate resources for everyone in the state is the biggest challenge that we have.”
The 2025 EMS report was the initial priority project after the EMS Division was established within IDHS in 2023. The findings and recommendations were developed by a workgroup of stakeholders, including provider associations, education leaders and state officials.
Abigail is our health reporter. Contact them at aruhman@wboi.org.