Reports · Policy briefs · Toolkits · Thought leadership

Publications and resources

TPF produces analysis, policy frameworks, and governance tools that practitioners and decision-makers can actually use. TPF’s work is grounded in field experience, built to publication standards, and designed to hold up under scrutiny. Curriculum resources for community paramedicine programs are hosted at CommunityParamedic.org. Research on ultra-endurance sports safety is published through UESSM, a co-initiative of TPF principal Nick Nudell.

30+
Peer-reviewed and policy publications by TPF principals
Journal articles, reports, monographs
1,308
Governing Care newsletter subscribers
Published daily · As of June 2026
13
Peer-reviewed journal articles by Nick Nudell
JACC, JRH, Paramedicine, AJEM and more
250K+
Public safety professionals reached through team education
Verified from team CV data

TPF work product

Current and forthcoming deliverables

Publicly funded deliverables are published openly. Work produced under private contract is held confidential per client agreement. All TPF deliverables are available with a DOI or stable URL where published.

Policy brief
The Distribution Problem: Why Rural EMS Failure Is a Structural Issue, Not a Workforce Shortage
Structural analysis of rural EMS sustainability with Colorado county-level financial modeling. Demonstrates why efficiency measures close only 13% of the structural funding gap and what evidence-based alternatives look like.
The Paramedic Foundation · 2026 · Forthcoming
🔗 Supporting data: Colorado EMS financial models (NCRETAC)
Toolkit
Community Paramedicine Program Design and Outcomes Measurement Toolkit
Implementation-ready toolkit for CP program design in rural and frontier settings. Includes a validated survey instrument, outcomes measurement framework, and partner pathway requirements assessment grounded in multi-state program evaluation experience.
The Paramedic Foundation · In development
🔗 Fitzsimon et al. (2022) Renfrew County evaluation
Policy brief
TIP/TAD Legislative Language: A State Implementation Guide
Model statutory language, medical oversight frameworks, Medicaid State Plan Amendment strategy, and state-by-state regulatory mapping for Treatment in Place and Transport to Alternate Destination programs. Built from analysis of enacted state models.
The Paramedic Foundation · Forthcoming
🔗 CMS ET3 Final Evaluation Report (2025)  ·  H.R. 4011 (Congress.gov)

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TPF accepts consulting engagements from state agencies, regional EMS bodies, hospital systems, and community organizations. Engagements begin with a free scoping conversation.

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Peer-reviewed work

Selected peer-reviewed publications by TPF principals and subject-matter experts

A representative selection of peer-reviewed and policy publications authored or co-authored by TPF principals and members of its subject-matter expert network. Indexed articles link to the publisher of record by DOI. This is not a complete list.

Peer-reviewed
Mobile Integrated Health Care and Community Paramedicine: A Position Statement and Resource Document of NAEMSP
Ulintz, A. J., O’Connor, L. C., Heffern, T. M., Rowe, J., Rollman, J. E., Wingrove, G., Zavadsky, M., Wilcox, M. R., & Goldberg, S. A. (2025). Prehospital Emergency Care. Advance online publication. https://doi.org/10.1080/10903127.2025.2541899
Peer-reviewed
The Development of Community Paramedicine: A Restricted Review
Shannon, B., Eaton, G., Lanos, C., Leyenaar, M., Nolan, M., Bowles, K.-A., Williams, B., O’Meara, P., Wingrove, G., Heffern, J. D., & Batt, A. (2022). Health & Social Care in the Community, 30(6), e3547–e3561. https://doi.org/10.1111/hsc.13985
Peer-reviewed
Frontier and Remote Paramedicine Practitioner Models
O’Meara, P., Wingrove, G., & Nolan, M. (2018). Frontier and remote paramedicine practitioner models. Rural and Remote Health, 18(3), 4550. https://doi.org/10.22605/RRH4550
Peer-reviewed
Relevance of Assessment Items in Community Paramedicine Home Visit Programmes: Results of a Modified Delphi Study
Leyenaar, M. S., Allana, A., Sinha, S. K., Nolan, M., Agarwal, G., Tavares, W., & Costa, A. P. (2021). BMJ Open, 11(11), e048504. https://doi.org/10.1136/bmjopen-2020-048504
Peer-reviewed
Paramedics Assessing Patients With Complex Comorbidities in Community Settings: Results From the CARPE Study
Leyenaar, M. S., McLeod, B., Jones, A., Brousseau, A.-A., Mercier, E., Strum, R. P., Nolan, M., Sinha, S. K., Agarwal, G., Tavares, W., & Costa, A. P. (2021). CJEM, 23(6), 828–836. https://doi.org/10.1007/s43678-021-00153-4
Peer-reviewed
What Do Community Paramedics Assess? An Environmental Scan and Content Analysis of Patient Assessment in Community Paramedicine
Leyenaar, M. S., McLeod, B., Penhearow, S., Strum, R., Brydges, M., Mercier, E., Brousseau, A.-A., Besserer, F., Agarwal, G., Tavares, W., & Costa, A. P. (2019). CJEM, 21(6), 766–775. https://doi.org/10.1017/cem.2019.379
Research
Validation of the Simplified Motor Score by Paramedics for the Prediction of Outcomes Following Traumatic Brain Injury
Thompson, Hurtado, et al. — Annals of Emergency Medicine, 2011.
Research
Ambulance Deserts: Geographic Disparities in Emergency Medical Services Access
Jonk, Nudell, et al. — Maine Rural Health Research Center, 2023. View the Ambulance Deserts story map. Cited by CBS News, PBS NewsHour, USA Today, and the Commonwealth Fund.
Policy
Community Paramedic Impact Survey: An Analysis of Four Programs
Nudell, Stephen, Herbert, Craig, and Wingrove — 2023. South Carolina Office of Rural Health engagement deliverable.
Research
Destination Is an Intervention: Why SOF Medics Must Own Capability-Based Evacuation Decisions
Baines, Green, et al. — Journal of Special Operations Medicine, 2026 (in press).
Research
Snakebite Envenomation Clinical Practice Guideline (CPG ID: 81)
Champion, et al. — Joint Trauma System / Defense Health Agency, 2026.

Full publication records for individual team members are linked from each profile on the Team page.

Thought leadership

Governing Care

Governing Care newsletter by Nick Nudell
Governing Care

Governing Care is a newsletter written by Nick Nudell, PhD(c), MS, MPhil, NRP, WP-C — Chief Operating Officer of The Paramedic Foundation. Each article applies rigorous evidence and governance analysis to paramedicine’s most pressing institutional questions, independently authored and fully cited. Where articles inform TPF’s consulting or policy work, that connection is made explicit in the relevant TPF deliverable.

Subscribe to Governing Care on LinkedIn → 1,308 subscribers
The Orchestra Nobody Auditioned, Part One: What Boléro Taught Me About Paramedicine
The post The Orchestra Nobody Auditioned, Part One: What Boléro Taught Me About Paramedicine appeared first on American College of Paramedics.Read more
Date: 2026-07-26
Source: Governing Care
By Nick Nudell
The Hard Work Is the Point
The post The Hard Work Is the Point appeared first on American College of Paramedics.Read more
Date: 2026-07-01
Source: Governing Care
By Nick Nudell
Who You Think You Are
The professional identity paramedicine forms in its practitioners shapes what they notice, what authority they claim, and what kind of clinical reasoner they can become. It forecloses or enables every other cognitive domain in this series. This closing article argues that governance is responsible for the professional self it produces,Read more
Date: 2026-07-01
Source: Governing Care
By Nick Nudell
Thirty Years On: A Report Card on Paramedicine
The post Thirty Years On: A Report Card on Paramedicine appeared first on American College of Paramedics.Read more
Date: 2026-05-31
Source: Governing Care
By Nick Nudell
Lost in Translation
Every paramedic has handed a patient off and felt part of the call disappear in the transfer. This article examines sensemaking and narrative compression as the third cognitive domain of expert prehospital practice, and why the translation at handover is always lossy. The post Lost in Translation appeared first onRead more
Date: 2026-05-05
Source: Governing Care
By Nick Nudell
Two Minds on One Call
The crew of two is the basic clinical unit of prehospital paramedicine. Whether two practitioners function as a shared cognitive system or as two individuals on the same ambulance is a governance question. This article examines team cognition, shared mental models, and psychological safety as the fifth cognitive domain ofRead more
Date: 2026-05-04
Source: Governing Care
By Nick Nudell
The Managed Scene
Before anyone asks what the patient's chief complaint is, an experienced paramedic has already begun managing the scene as an emotional system: the frightened patient, the pacing family member, the partner who can hear what you say. This article examines multi-agent emotional regulation as cognitive work, and what governance hasRead more
Date: 2026-05-03
Source: Governing Care
By Nick Nudell
The Scene Is the System
The scene is not a backdrop. It is part of the cognitive system. This article examines distributed cognition and scene structuring as the second cognitive domain of expert prehospital practice, and what governance owes to the conditions it creates. The post The Scene Is the System appeared first on AmericanRead more
Date: 2026-05-03
Source: Governing Care
By Nick Nudell
The Pattern and the Patient
Expert paramedics do not primarily follow protocols. They recognize patterns. This article examines recognition-primed decision making as the first cognitive domain of expert prehospital practice, and what directive governance misses by measuring compliance instead. The post The Pattern and the Patient appeared first on American College of Paramedics.Read more
Date: 2026-05-03
Source: Governing Care
By Nick Nudell
Two Ways of Knowing: The Epistemological Foundation of Paramedicine
Expert paramedicine is governed nomothetically and practiced idiographically. This article names that epistemological divide, maps it to the cognitive architecture of prehospital practice, and argues that closing the gap is a governance problem, not a training one. The post Two Ways of Knowing: The Epistemological Foundation of Paramedicine appeared firstRead more
Date: 2026-05-01
Source: Governing Care
By Nick Nudell
The Intelligence Illusion: AI governance in paramedicine
The post The Intelligence Illusion: AI governance in paramedicine appeared first on American College of Paramedics.Read more
Date: 2026-04-24
Source: Governing Care
By Nick Nudell
AI Governance in Paramedicine: A Profession-Wide Imperative
The post AI Governance in Paramedicine: A Profession-Wide Imperative appeared first on American College of Paramedics.Read more
Date: 2026-04-24
Source: Governing Care
By Nick Nudell
Unengineered: A Governance Argument for EMS Workforce Protection from First Shift to Last
The post Unengineered: A Governance Argument for EMS Workforce Protection from First Shift to Last appeared first on American College of Paramedics.Read more
Date: 2026-04-22
Source: Governing Care
By Nick Nudell
Governing the Augmented Paramedic, Part III: The Global Wager
The post Governing the Augmented Paramedic, Part III: The Global Wager appeared first on American College of Paramedics.Read more
Date: 2026-04-22
Source: Governing Care
By Nick Nudell
Governing the Augmented Paramedic, Part II: The Startup Problem Rural EMS Cannot Solve Alone
The post Governing the Augmented Paramedic, Part II: The Startup Problem Rural EMS Cannot Solve Alone appeared first on American College of Paramedics.Read more
Date: 2026-04-22
Source: Governing Care
By Nick Nudell

About TPF publications

Common questions

Where can I read TPF’s published work?

TPF principal publications appear in journals including Health Affairs, Annals of Emergency Medicine, the Journal of Special Operations Medicine, and others. The ambulance desert research (Jonk et al., 2023) is available as a story map from the Maine Rural Health Research Center. Governing Care, Nick Nudell’s daily newsletter on EMS governance and policy, is available on LinkedIn. Policy briefs currently in development will be posted here upon completion.

What is Governing Care and who writes it?

Governing Care is a newsletter written by Nick Nudell, PhD(c), MS, MPhil, NRP, WP-C — Chief Operating Officer of The Paramedic Foundation. It applies rigorous evidence and governance analysis to paramedicine’s most pressing institutional questions, published daily with 1,308 subscribers as of June 2026. Every article is independently authored, fully cited, and editorially independent of TPF’s consulting engagements. Where an article informs TPF consulting or policy work, that connection is made explicit in the relevant deliverable.

Can TPF produce a commissioned report for my agency or program?

Yes. TPF accepts consulting engagements from state agencies, regional EMS bodies, hospital systems, county governments, and community organizations. Publicly funded deliverables are published openly. Work produced under private contract is held confidential per client agreement. All TPF deliverables are available with a DOI or stable URL where published. Initial consultations are free.

Commission a report or engage TPF: Start a conversation →

Commission a report or engage TPF

TPF accepts consulting engagements from state agencies, regional EMS bodies, hospital systems, and community organizations. All engagements begin with a free scoping conversation.

Start a conversation About TPF