It takes a system to save a life – reflections from EMS2025

The gender (in)equality in paramedicine?

The paramedic profession has seen a steady and long-time increase of female paramedics entering the field. This is also true in Nordic countries, as presented in our poster. Meanwhile, females working in paramedic work and in the EMS continue to face challenges related to career progression and advancement opportunities [Hanna-Osborne, 2022; Mausz et al, 2023; Ulrich et al, 2023], and also high frequencies of direct and indirect sexual harassment [Cassidy et al, 2023; Hanna-Osborne, 2022; McCann et al, 2024; Yoo et al, 2019]. Females as EMS leaders and medical authority figures was a topic addressed in the “Women In EMS”-session during EMS 2025, highlighting how being a female in EMS can be a real challenge, not only related to practicalities of maternity leave and motherhood, but also when in positions of authority. The session highlighted that when belonging to an ethnic minority or identifying as LGBTQI, cultural stereotyping, biases and imposter syndrome was clear among females in EMS authority. As noted in a recent commentary by Ericsson et al [2025], there also seems to be negatively skewed attitudes towards leadership behavior in females, with “assertiveness among female paramedics being described as ‘bossy behavior’, while oversight of female team members has also been reported in paramedic team communication” [Ericsson et al, 2025]. All this is a worrisome trend considering the need for a strong and inclusive profession. As to how these phenomena are prevalent in the Nordic countries, where gender equality is perhaps more structural than in other Western countries, remains a topic for further research. This is something the JEDI in EMS research group, where Arcada is a central partner, is also currently investigating.

The future of EMS is technology and AI, or is it?

As expected, artificial intelligence, machine learning and large language models were prominently featured in the conference's scientific programme. As in many other disciplines, professionals and researchers within emergency medicine are studying the new, emerging technologies and asking how they might benefit the profession, the EMS systems, and the patients. A handful of abstracts regarding research and implementations of AI tools in EMS were presented, although it seems we are at the stage where we do not yet know what possibilities or drawbacks AI will bring – the rapidly developing technology itself being a moving a target. A scoping review by Mallon et al. [2025] explored possibilities of leveraging artificial intelligence to improve patient outcomes in low- and middle-income countries. The authors concluded that while there are promising initiatives to improve, for instance, resourcing, ambulance placement, and planning, there are still challenges regarding adapting these tools to sociocultural contexts and available health care resources, and that these tools are thus not yet ready for patient contact.

Practical applications of AI and machine learning have been found within medical dispatch. Tonje Søraas Birkenes (Laerdal Medical) spoke on the development of an AI assisted video communication system built around a retrieval-augmented generation model that is being used to interpret conversations and video during emergency calls to provide real-time advice and documentation. Preliminary results have been promising, as the system has been tested on staged emergency calls involving actors and make-up, although some generated advice is still irrelevant or repetitive. Peter Hill of Karolinska Institute presented a poster on using machine learning to analyse emergency call recordings to find markers for high-risk time-sensitive conditions.  Predictive modeling may improve triage accuracy, resource allocation, and ultimately improve patient safety.

The rise of paramedic professionalism

A strong profession needs active research to thrive, and that was evident in the high volume and quality poster presentations during the congress, most of them paramedic-led projects. In contrast, it also became evident that the educational level of paramedics varies greatly within European countries. This was noted in an earlier paper by the European Paramedic Curriculum, or EPaCur project [Duason et al, 2021] and further exemplified during EMS 2025 in presentations of EMS systems, where resource-heavy, often physician-led support was needed to compensate for apparently lower-trained paramedic units. Such examples were in stark contrast to other presented systems, such in Netherlands, where higher paramedic education (a nursing degree) led to higher volumes of non-conveyed patients (up to 40%), i.e. patients treated or assessed on scene. This matches the Finnish statistics. A summarising article, by Simpson [2025], highlights the emergent themes and development of contemporary paramedicine, the need to leave behind old paradigms and embedded cultural norms and conceive of new capabilities. To achieve this, we in the Nordic countries might benefit from a collective voice and vision for paramedicine through shared networks and research programs. Arcada is part of the NordParamedics network and  EPaCur project. Perhaps the future is a Nordic College of Paramedicine?

We are ever more oriented by the increasing complexity of care in paramedicine, developing needs of our patients and the changing security landscape of our contemporary time, as well as the necessity for stronger professionalism of paramedicine. This increasingly fast-paced change is not something we can or even should try to build by ourselves; that would be a Sisyphean task. "It takes a system to save a life" is the central motto of EMS Europe, and that sets the tone of the future of our EMS systems quite well; we are all part of the system. Let's see where we are in two years at EMS2027.

We, the authors, would like to thank EMS Europe for organising this great and inspiring conference in the beautiful city of Stockholm. Participation in EMS 2025 was made possible through external financing by Kulturfonden, whom we would also like to sincerely thank.

Christoffer Ericsson, PhD, Degree Programme Director of EmergencyLead Master’s Programme

Niko Loimijoki, MHc Emergency Care, Degree Programme Director of Emergency Care

Hannes Similä, MPed, BHc Emergency Care, Senior Lecturer in Emergency Care

References

Cassidy A, Hunt B, McFarlane A, Beovich B. (2023). The experiences of reporting sexism toward female paramedics in Australian ambulance services: A scoping review. Australian J Social Issues. 2023;58:855–73. https://doi.org/10.1002/ajs4.283  

Dúason, S., Ericsson, C., Jónsdóttir, H.L. et al. (2021). European paramedic curriculum—a call for unity in paramedic education on a European level. Scand J Trauma Resusc Emerg Med 29, 72 (2021). https://doi.org/10.1186/s13049-021-00889-z  

Ericsson, C., Lindström, V., Andersen, J.V. et al. (2025). Gender (in)equality in nordic ambulance services: do ambulances have glass ceilings?. Scand J Trauma Resusc Emerg Med 33, 45 (2025). https://doi.org/10.1186/s13049-025-01358-7  

Hanna-Osborne S. (2022). You will never be as good as we are’: a qualitative study of women paramedics’ experiences of sex-based harassment in an Australian ambulance service. Br Paramed J. 2022;7(2):1–7. PMID: 36451708

Mausz J, Salvis S, Arseneau-Bruneau D, Donnelly EA. (2023). Women’s participation in leadership roles in a single Canadian paramedic service. Prehospital Emerg Care. 2023;27(8):1083–7. https://doi.org/10.1080/10903127.2023.2231568   

McCann-Pineo M, Keating M, McEvoy T, Schwartz M, Schwartz RM, Washko J, Wuestman E, Berkowitz J. (2024). The female emergency medical services experience: A mixed methods study. Prehospital Emerg Care. 2024;28(4):626–34. https://doi.org/10.1080/10903127.2024.2306248 . 

Schroeder, D. C et al (2023). KIDS SAVE LIVES: Basic Life Support Education for Schoolchildren: A Narrative Review and Scientific Statement from the International Liaison Committee on Resuscitation. Circulation, 147(24), 1854–1868. https://doi.org/10.1161/CIR.0000000000001128  

Simpson P. (2025). The future(s) of paramedicine. Paramedicine. 2025;0(0). doi:10.1177/27536386251346856

Ulrich A, Williams J, Clarke V. (2023). Female paramedics’ attitudes towards career progression in the ambulance service. J Paramedic Pract, 2023;15(6).

Yoo J, Kim JH, Yoon J, Kim SS. (2019). Sexual harassment and its relationship with depressive symptoms: A nationwide study of Korean EMS providers. Am J Ind Med. 2019;62(1):74–9. https://doi.org/10.1002/ajim.22924