Reports · Policy briefs · Toolkits · Newsletter

Research, policy briefs and toolkits from TPF

The Paramedic Foundation (TPF) produces analysis, policy frameworks and governance tools for emergency medical services (EMS) professionals and decision-makers. The work rests on field experience. It is built to publication standards and to hold up under close review. Curriculum resources for community paramedicine programs are at CommunityParamedic.org. Research on safety in ultra-endurance sports is published through Ultra-Endurance Sports Science & Medicine (UESSM), a co-initiative of TPF principal Nick Nudell.

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Accredited online courses created by a TPF subject matter expert

TPF work product

Current and forthcoming deliverables

Publicly funded deliverables are published openly. Work done under a private contract stays confidential, as the client agreement requires. All TPF deliverables are available with a digital object identifier (DOI) or stable URL where published.

Policy brief
The Distribution Problem: Why Rural EMS Failure Is a Structural Issue, Not a Workforce Shortage
An analysis of what keeps rural EMS from lasting, with county-level financial models from Colorado. It shows 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
A ready-to-use toolkit for designing community paramedicine (CP) programs in rural and frontier settings. It includes a survey tool, a framework for measuring outcomes, and an assessment of partner pathway requirements. It draws on experience evaluating programs in several states.
The Paramedic Foundation · In development
Fitzsimon et al. (2023), Renfrew County hybrid care model, BMJ Open
Policy brief
TIP/TAD Legislative Language: A State Implementation Guide
Model statutory language, frameworks for medical oversight, Medicaid State Plan Amendment strategy, and a state-by-state map of regulations for Treatment in Place and Transport to Alternate Destination (TIP/TAD) programs. It is built from analysis of state models already enacted.
The Paramedic Foundation · Forthcoming
CMS ET3 Final Evaluation Report (2025)  ·  H.R. 4011 (Congress.gov)

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Peer-reviewed work

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

A selection of peer-reviewed and policy papers written or co-written by TPF principals and by subject matter experts in its network. Indexed articles link to the publisher of record by DOI. The list is not complete.

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, 30(6), 739–751. 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). 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
Peer-reviewed
Validation of the Simplified Motor Score in the Out-of-Hospital Setting for the Prediction of Outcomes After Traumatic Brain Injury
Thompson, D. O., Hurtado, T. R., Liao, M. M., Byyny, R. L., Gravitz, C., & Haukoos, J. S. (2011). Annals of Emergency Medicine, 58(5), 417–425. https://doi.org/10.1016/j.annemergmed.2011.05.033
Research
Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services
Jonk, Y., Milkowski, C., Croll, Z., & Pearson, K. (2023). [Chartbook]. Maine Rural Health Research Center, University of Southern Maine. https://digitalcommons.usm.maine.edu/ems/16/. Nikiah G. Nudell is acknowledged as a contributor.
Policy
Community Paramedic Impact Survey: An Analysis of Four South Carolina Programs
Nudell, Stephen, Herbert, Craig, and Wingrove (2023). South Carolina Office of Rural Health engagement deliverable.
Editorial
Destination Is an Intervention: Why SOF Medics Must Own Capability-Based Evacuation Planning
Baines, E. M., Kretz, E., Remley, M. A., Denis, B., Maksimenko, Y., Green, K., Anderson, K., Hewitt, C. W., Czarnik, J., & Jenkins, D. A. (2026). Journal of Special Operations Medicine. https://doi.org/10.55460/J.Spec.Oper.Med.2026.MRLR-9F19

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

Newsletter

Governing Care

Governing Care newsletter by Nick Nudell
Governing Care

Governing Care is a newsletter written by Nikiah G. Nudell, PhD(c), MS, MPhil, NRP, WP-C, Chief Operating Officer of The Paramedic Foundation. Each article uses evidence and governance analysis to look at the questions paramedicine faces as an institution. Each is written independently and fully cited. When an article informs TPF’s consulting or policy work, the TPF deliverable says so.

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The Orchestra Nobody Auditioned, Part Two: The Mistakes Nobody Hears
The post The Orchestra Nobody Auditioned, Part Two: The Mistakes Nobody Hears appeared first on American College of Paramedics.Read more
Date: 2026-09-13
Source: Governing Care
By Nick Nudell
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

About TPF publications

Common questions

Where can I read TPF’s published work?

Papers by TPF principals and by subject matter experts in its network appear in a number of peer-reviewed journals. These include Prehospital Emergency Care, Annals of Emergency Medicine, BMJ Open, CJEM, Rural and Remote Health, and the Journal of Special Operations Medicine. The Maine Rural Health Research Center’s 2023 ambulance deserts chartbook (Jonk et al., 2023) is available from the University of Southern Maine digital repository. Governing Care, Nick Nudell’s daily newsletter on EMS governance and policy, is on LinkedIn. Policy briefs now in development will be posted here when complete.

What is Governing Care and who writes it?

Governing Care is a newsletter written by Nikiah G. Nudell, PhD(c), MS, MPhil, NRP, WP-C, Chief Operating Officer of The Paramedic Foundation. It uses evidence and governance analysis to look at the questions paramedicine faces as an institution. It is published daily and had 1,308 subscribers as of June 2026. Each article is written independently and fully cited, and is editorially independent of TPF’s consulting projects. When an article informs TPF consulting or policy work, the deliverable says so.

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

Yes. TPF takes on consulting projects from state agencies, regional EMS bodies, hospital systems, county governments and community organizations. Publicly funded deliverables are published openly. Work done under a private contract stays confidential, as the client agreement requires. All TPF deliverables are available with a DOI or stable URL where published. Your first consultation is free.

Commission a report or engage TPF: Start a conversation →

Commission a report or engage TPF

TPF takes on consulting projects from state agencies, regional EMS bodies, hospital systems and community organizations. Every project begins with a free conversation about scope.

Start a conversation About TPF