Prehosp Emerg Care. 2026 Jan 22:1-12. doi: 10.1080/10903127.2026.2619038. Online ahead of print.
ABSTRACT
OBJECTIVES: Emergency medical services (EMS) workforce challenges impact prehospital care provision in many United States communities. One potential strategy to address this challenge is for clinicians to actively promote the EMS profession. However, there is limited data regarding the likelihood of EMS clinicians recommending others to join the EMS profession. We aimed to describe professional promotion among EMS clinicians and factors that impact their likelihood of recommending.
METHODS: We performed a cross-sectional analysis of nationally certified civilian EMS clinicians (ages 18-85) recertifying between 10/2023 and 04/2024. Applicants completed a voluntary survey regarding EMS professional promotion measured using the Net Promoter Score®. This validated tool measures the likelihood of recommending a field to others (classified as promoters, passives, or detractors). Surveys were merged with demographic and workplace characteristics from the National EMS Certification database. We calculated descriptive statistics (n, %) and (median, interquartile range [IQR]) and performed multivariable logistic regression (odds ratio, 95% confidence interval) to identify factors associated with likelihood of promoting EMS by clinicians, including age, sex, race, certification, education, years experience, agency and service type, and self-reported burnout and job satisfaction as covariates.
RESULTS: We included 33,335 clinicians for analysis (response rate = 28.8%); respondents reflected the nationally certified EMS population (male [74.2%], non-Hispanic White [86.1%], median age 36 [IQR: 29, 49], patient care [90.8%]). Promotion score distribution balanced between promoters (33.8%), passives (33.1%), and detractors (33.1%), yielding a NPS = 0.7 (possible range: -100 to +100), indicating near-zero net promotion. Odds of promoting EMS across agency types were lower than fire agencies (p < 0.05). Odds of promotion were also lower for higher education levels (associate [0.90,0.82-0.98], bachelor’s [0.80,0.73-0.87]; [referent: ≤high school/General Educational Development]) and more years experience (3-7 [0.86,0.81-0.93], 8-15 [0.76,0.70-0.82], >15 [0.83,0.75-0.91]; [referent: 0-3]). Clinicians reporting burnout had significantly lower odds of promoting EMS (0.31,0.29-0.33), while clinicians with high levels of job satisfaction had increased odds of promoting EMS (6.27,5.08-7.74).
CONCLUSIONS: Demographic and workplace characteristics are significantly associated with the likelihood of EMS clinicians promoting the profession. The observed associations with satisfaction and burnout suggest areas that may warrant further investigation regarding their relationship to professional promotion and broader workforce dynamics.
PMID:41569613 | DOI:10.1080/10903127.2026.2619038
