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Emergency Medical Service: Disruptive Innovation in the Fire and Emergency Service

Many economists will say that what destroyed or crippled Blockbuster, Borders, Yellow Cab and Kodak was a concept called disruptive innovation. This concept was defined by Clayton Christensen, a professor of business administration at Harvard Business School, as “a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.”

In the case of Blockbuster, they failed to recognize the significance of online movies. Netflix understood! Borders didn’t see disruptive innovation coming when the concept of buying books online was developed, but Amazon understood!

Yellow Cab thought this new concept called Uber would never grab hold, but millions now have the Uber app on their phones. Kodak did not see the significance of digital media storage for pictures; many other startups certainly saw it.

The result is that when these new solutions took over, they replaced those historic, celebrated, and venerable leaders.(1) An interesting question is, Did they see these disrupters coming? If they did, did they fail to see the significance of those change agents?

Things are certainly changing, and the pace of those changes is staggering. In the June 2016 Trends article titled “The Fourth Industrial Revolution Gains Momentum” a list was published titled “Tipping Points Expected to Occur by 2025.”(2) This article predicts a significant chance that such things as the first robotic pharmacist, the first 3D printed car, the first transplanted 3D printed liver and widespread use of driverless cars will occur in just seven years!

Many more disruptive startup companies are coming, and we will likely see more historic leading companies (such as Sears) crumble as a result.

In the August 2018 edition of Trends Magazine, a statement was made that “aside from education, no sector of the U.S. economy is more in need of revolutionary transformation than healthcare.”

One can deduce that disruptive innovation is coming to healthcare and that is where the fire and emergency service will certainly be impacted.

Across the United States, 64% of calls to fire departments require emergency medical services.(3) EMS as a component of healthcare is a significant component of today’s fire-service mission. We know this, but are we truly paying attention to what is happening in the world of healthcare for which EMS is a part?

In May 2017, the Denver Business Journal(4) covered a story where AMR contracted with Lyft to provide non-emergency patient transportation. Clearly a cheaper option for transportation when compared to an ambulance ride. This may be considered a prime example of disruptive innovation when a lower priced alternative to current products and services is introduced!

Since 1966, groups of fire-service leaders from the IAFF, IAFC, large and small municipal fire chiefs, and other fire organizations have met every 10 years and published a report titled Wingspread, named after the Wingspread Conference Center in Racine, Wisconsin. Each of these reports looks intently into the future of the fire service and provides several recommendations.

The 1966 Wingspread I report led to the formation of the U.S. Fire Academy and the U.S. Fire Administration.(5) The recent Wingspread VI report, published in 2016, made a charge under recommendation #2 that “As guardians of life safety, the United States fire and emergency services must expect, embrace and adapt to change … to be competitive and sustainable in a changing environment, agencies must become change agents rather than reactionaries.”(6)

It is vital to note the message: to be competitive and sustainable we must become change agents and not reactionaries.

In the same report, under recommendation 14, it states “The United States fire and emergency services must adapt its emergency medical resources into a more robust, integrated mobile healthcare system.”

The more common term for this concept is mobile integrated healthcare or MIH. In Hospitals and Health Networks, MIH, also known as community paramedicine, was touted as a solution to hospital emergency overcrowding. Over the last five years, many articles have been published about MIH and many EMS providers have implemented such innovative delivery systems.(7)

To bring home the need to innovate within the fire service, even the International City and County Managers Association, in its “In Focus” publication, stated that “the existing EMS response model has failed to evolve as community needs for emergent and non-emergent healthcare delivery have changed.”(8)

Things are changing and the fire service must pay attention. We must see what is on the horizon and not ignore the significance of developing disruptive innovators, lest we or a portion of the services we provide go the way of Blockbuster.


Learn more about MIH and how to implement it in the Mobile Integrated Healthcare Handbook.


  1. “Value Based Business Models Disrupt Global Heath Care,” Trends Magazine, August 2018.
  2. “The Fourth Industrial Revolution Gains Momentum,” Trends Magazine, June 2016.
  3. U.S. Fire Administration, “Fire Department Overall Run Profile as Reported to the National Fire Incident Reporting System (2016)” August 2018: Volume 19, Issue 5.
  4. Ben Miller, “AMR Lyft Make Patient Transportation Deal.” Denver Business Journal, May 29, 2017.
  5. Wingspread VI, Introduction, page 1, 2016.
  6. Wingspread VI, Statements of National Significance to the United Stated Fire and Emergency Services, 2016.
  7. AJ Heightman, “The Time Has Come for Mobile Integrated Healthcare,” JEMS, July 7, 2014.
  8. International City and County Managers Association, In Focus 2015: Volume 47, Number 1.


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