Book excerpt: "EMS in the United States: Fragmented Past, Future of Opportunity" is the first comprehensive Desk Reference for aspiring EMS leaders, managers, and government officials. Written from the perspective and experience of a state and national EMS leader, the book provides an exploration into the evolution, current state, and future of Emergency Medical Services (EMS) in the United States. From the humble origins of EMS to the impact of influential visionaries, Hollywood, and determined community volunteers, this book provides a deep dive into the rich, often overlooked history. The author, a respected state and national EMS leader, also leverages his experience to explain different service delivery models, financial challenges, and the significance of insurance and billing. The text delves into key aspects of personnel management, touching on recruitment, retention, mental health, and a professional code of conduct. As a resource for emerging EMS leaders, the book guides the reader through state regulation and administration, providing an introduction to interstate compacts, investigations, enforcement, and public protection. In its final sections, the book outlines leadership lessons, stakeholder engagement, and change management in the EMS environment. Amidst rapidly emerging issues like health equity, aging populations, and the advent of telehealth, the book posits that understanding our past is vital to navigating the future. By appreciating the influence of historic decisions on our present situation, we can forge an opportunity-rich future for EMS in the United States. As both a reference book and a history guide, this is an indispensable tool for anyone involved in or interested in the evolution and future of EMS.