She reflects on stepping into the role as “walking onto a fast-moving train,” immediately confronted with major incidents, severe weather and system pressures, while simultaneously building her leadership team and setting direction for the future.

| MORE: ‘We have to right the ship’: FDNY commissioner doubles down on EMS pay parity

The conversation explores the unique structure of FDNY, where the Commissioner operates as the executive leader “almost like CEO of the company,” while operational command sits with the Chief of Department.

Bonsignore is clear-eyed about the scale and demands of the system: over 2.2 million runs annually, with 1.6 million EMS-related, reinforcing her long-held position that EMS must be treated as an essential service with appropriate funding and career pathways.

Drawing on her experience leading through the COVID-19 pandemic and responding on Sept. 11, 2001, she emphasizes resilience, communication and presence — being visible in stations, honest with staff and committed to supporting those who “leave their own families behind to go serve a stranger.”

Bonsignore also addresses criticism of her appointment directly and without hesitation, framing it as a misunderstanding of the Commissioner’s role and the realities of modern emergency response. She underscores that FDNY is both fire and EMS, and that her career — spanning 9/11 response, pandemic leadership and decades of frontline service — positions her to lead the entire enterprise.

Looking ahead, she speaks to the need for infrastructure investment, workforce stabilization, mental health support, and the thoughtful adoption of technologies such as AI and body-worn cameras. As FDNY approaches the 25th anniversary of 9/11 and the nation’s 250th year, her focus remains clear: support the workforce, strengthen the system, and prepare the department for the next generation of service.

• “Walking into a position like this is like walking onto a fast-moving train.”

• “I understand the ground level challenges that go on because I lived them.”

• “The commissioner is the administrative level, almost like CEO of the company.”

• “We’re responding to over 2.2 million runs a year … 1.6 million of those runs are EMS-related runs.”

• “We have to stabilize our system … it’s time that EMS is finally treated as an essential service.”

• “I will always tell you the truth. You may not like my truth, but I will give it to you.”

• “The decision of a first responder is to leave their own families behind … to go serve a stranger.”

• “They are literally your heroes … they will put their lives on the line for you.”

• 01:10 – First 100 days as Commissioner — “fast-moving train”
• 02:30 – Career journey and EMS roots shaping leadership
• 04:30 – Workforce trust, credibility and lived experience
• 06:30 – Pay parity and EMS as an essential service
• 09:00 – Structure of FDNY — Commissioner vs. operational command
• 11:30 – Setting direction and stabilizing the organization
• 13:30 – Relationship with the Mayor and political leadership
• 17:30 – Addressing criticism and misconceptions
• 19:30 – Leading through COVID — scale, innovation, mutual aid
• 23:30 – Morale, resilience and leadership presence
• 26:30 – Recruitment and retention challenges
• 30:30 – AI and future innovation in EMS
• 32:30 – Behavioral health response and BeHeard program
• 36:30 – First responder mental health and support systems
• 38:30 – Violence against EMS and workforce protection
• 41:00 – Body-worn cameras and transparency
• 43:30 – 9/11 reflections and legacy
• 50:30 – Commemoration planning and future outlook

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Moving beyond the “sticker on the truck,” Sarah reframes CAAS as a living, breathing process — one that drives internal improvement, organizational alignment and long-term sustainability. From its origins within the American Ambulance Association in the 1990s, to the latest Version 4.0 standards, the conversation highlights how CAAS provides a unified, industry-driven framework that elevates agencies from compliant to high-performing.

Rob brings a practitioner’s perspective, reflecting on his own experience navigating multiple accreditation cycles, emphasizing how CAAS becomes a “guiding light” for governance, clinical care and operational excellence.

Together, they explore the structure of the standards, the application journey, and the cultural readiness required to succeed.

The key takeaway is clear: accreditation is not a project with an endpoint — it’s a continuous process that strengthens organizations from the inside out, identifying risks, improving systems, and ultimately delivering better care to patients and communities.

Episode timeline

01:30 – Origins of CAAS and need for unified standards

03:30 – Breakdown of CAAS standards (admin, clinical, operations)

06:30 – Deep dive into operational standards and structure

10:30 – Rob’s real-world experience with accreditation

12:30 – Accreditation as a process vs. project

16:00 – Value proposition: internal vs. external benefits

18:30 – Cost vs. value — and the risk of not being accredited

22:00 – Step-by-step accreditation journey (readiness → submission → review)

28:30 – Site visits and peer collaboration

31:30 – Resources, support and how to get started

34:30 – Final reflections and leadership call to action

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In the first half, General Robert Neller brings a military leader’s lens to universal leadership truths: lead yourself first, remember that everyone is watching, stay humble, listen better and understand that decisiveness matters. His message is simple and sharp. People want leaders who will set the example, make the call when it matters, and balance standards with empathy.

| MORE: EMS Leadership Institute — AI and the future of EMS

In the second half, NEMSMA President Dr. Hezedean Smith reflects on a successful launch for the conference and looks ahead to where EMS leadership must go next. He frames this association as a growing home for mentorship, shared learning and strategic thinking, while also pointing to the disruptive forces already reshaping the profession:

• Artificial intelligence

• Redesigned systems

• Recruitment and retention pressures

• The possibility of autonomous ambulance operations

Taken together, the episode is both a leadership masterclass and a forward look at an EMS profession that cannot afford to stand still.

Episode timeline

00:39 – Rob sets the scene from the inaugural NEMSMA conference in Northern Virginia.

00:51 – Rob introduces General Neller as the opening keynote speaker.

01:38 – General Neller explains his leadership “roadmap,” beginning with leading yourself first.

03:38 – Rob and General Neller discuss how leaders are always being watched.

06:04 – Advice for the newly promoted EMS lieutenant: growth takes time, ask for advice, study and learn.

08:11 – General Neller reflects on what he wishes he had known earlier in his career: be a better listener.

09:41 – The “don’t eat the cake” story becomes a lesson in humility and example-setting.

11:42 – General Neller discusses when leaders must consult and when they must simply decide.

13:22 – Final leadership theme from General Neller: empathy strengthens standards rather than weakening them.

17:04 – Rob returns with Dr. Hezedean Smith, President of NEMSMA.

17:18 – Dr. Smith describes the early success of the inaugural conference and strong turnout.

18:12 – Dr. Smith confirms planning is already underway for next year because the event has outgrown the venue.

19:25 – Discussion shifts to the future direction of EMS leadership and system design.

19:49 – Dr. Smith highlights AI, system redesign, and recruitment and retention as major themes.

20:47 – Dr. Smith talks about self-driving ambulances, solar-powered systems and rapid technological change.

21:38 – Dr. Smith emphasizes that technology must make providers’ work easier, not harder.

22:22 – Rob asks why people should join NEMSMA.

22:28 – Dr. Smith outlines mentorship, information sharing and rapid organizational growth.

23:13 – Dr. Smith closes by reaffirming NEMSMA’s role in the EMS leadership space.

23:46 – Rob signs off from what he calls an “amazing time” at the conference.

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| MORE: ‘Six Minutes to Live': Mini-documentary spotlights cardiac arrest care crisis

The conversation begins with the stark reality that every minute without CPR and defibrillation reduces survival by 10%, and then widens into a larger discussion about injustice, geography and system performance.

Bob reflects on his landmark USA Today investigation into EMS disparities across the country, while Hilary explains why this issue remains deeply personal and why communities, not just medical systems, must be part of the solution.

The episode then turns from problem to action. Hilary and Bob describe how Six Minutes to Live is using storytelling, advocacy, community partnerships and public training to drive change, especially through bystander CPR education, school-based training and public access defibrillation.

From Santa Cruz to the Resuscitation Academy in Seattle, the emphasis is on making the simple feel possible: hands-only CPR, early defibrillation and empowering ordinary people to act. The result is more than a nonprofit or a campaign. As Rob notes, this is a movement.

Memorable quotes

• “For every minute that a person's heart has stopped, their chance of survival decreases by 10%.” — Hilary Gates
• “Life and death is defined by geography.” — Bob Davies
• “There are vulnerable, voiceless people living on the margins who need a voice.” — Hilary Gates
• “The main way that people save more lives is they care.” — Bob Davies
• “Every podcast that Hillary and I are involved with is actually sponsored by R&D. Rip off and duplicate, show up, take our stuff, go and save lives with it.” — Rob Lawrence

Additional resources

• Six Minutes to Live
• Six Minutes to Live mini documentary

Episode timeline

• 01:34-02:14 – Rob Lawrence introduces the episode and welcomes Hilary Gates and Bob Davies.
• 02:21-03:21 – Hilary Gates shares her background as an educator turned paramedic and cofounder of Six Minutes to Live.
• 03:48-08:14 – Bob Davies recounts his experience as a paramedic and journalist, including his USA Today investigation into EMS performance disparities.
• 08:24-10:50 – Rob asks what has changed in 20 years; Bob discusses the enduring formula, new technology and the energy of younger clinicians.
• 11:08-13:02 – Hilary explains why Six Minutes to Live was founded and frames cardiac arrest survival as an issue of injustice and community responsibility.
• 13:13-17:08 – Rob asks what Six Minutes to Live is and how it fits among other advocacy organizations; Bob and Hilary describe its role as a connector and storyteller.
• 18:04-18:39 – Rob resets the conversation and asks what the organization is doing now.
• 18:50-20:47 – Hilary describes the Santa Cruz partnership, community CPR training and support from donors and local agencies.
• 21:12-23:47 – Bob highlights their upcoming workshop at the Resuscitation Academy in Seattle and the power of systems that care enough to measure and improve.
• 24:00-25:20 – Rob offers a transatlantic explainer connecting Eisenberg, Utstein and UK ambulance response standards.
• 25:24-28:41 – Hilary discusses community myths about CPR and AEDs, and the need to simplify action for laypeople.
• 28:48-31:02 – Bob outlines what is next: documentaries, deep listening, connecting voices and helping movements grow organically.
• 31:17-33:01 – Rob and Hilary talk about creating local champions, liability concerns and getting communities to act.
• 33:13-34:47 – Rob asks the closing question; Hilary urges EMS clinicians to become local champions for simple lifesaving actions.
• 35:22-37:20 – Bob closes with a call for EMS professionals to confront the “little secrets” they know and act on them.

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In this edition of EMS One-Stop, Rob Lawrence is joined by NAEMT President, Chris Way, to preview EMS on the Hill (March 25–26, 2026) and explain why this event matters now more than ever: EMS is where most Americans first enter the healthcare system, and the care delivered in the field is no longer “drive-you-to-the-hospital medicine.”

Chris and Rob also unpack what’s changed — the scale of collaboration across national organizations and the discipline of going to Capitol Hill with aligned priorities and a shared message. They walk listeners through the event flow (Education Day, briefings, Hill visits, awards and reception), the importance of working relationships with staffers, and the advocacy “ask” that could reshape the future: reimbursement for treatment in place, mobile integrated healthcare/community paramedicine, and sustainable support for initiatives like prehospital blood. The throughline is simple: show up, speak with one voice, and translate momentum into legislative wins.

Additional resources:

• EMS on the Hill Day

• One voice, one profession — EMS leaders open summit with call for unity and coordinated action

• 00:00 – Chris Way frames the goal: becoming a trusted, go-to EMS resource for lawmakers

• 00:52 – Why EMS on the Hill matters; EMS as the front door of healthcare; call to action

• 02:16 – Advocacy theme and EMS on the Hill as the seminal D.C. event

• 03:27 – Kansas City summit recap; commitment to making it annual; “stronger together”

• 05:39 – Evolution of EMS on the Hill into a multi-organization partnership; one message

• 08:24 – Logistics overview begins: dates, hotel, education day, briefings, awards

• 10:16 – How to succeed in legislative meetings: reading the room, time limits, staffer relationships

• 17:14 – Priority bills: treatment in place, MIH/CP, whole blood, NAMSP priorities

• 21:02 – “This is ongoing” collaboration: monthly cross-organization calls, broader coordination

• 24:05 – Chris shares his recommended approach: prep, priorities, cards/coins, questions, follow-up

• 27:34 – Rob’s add-ons: photos after meetings, tagging lawmakers, comms/PR value

• 28:59 – Final logistics recap; what to expect as a first-timer at state tables

• 30:37 – Chris closes: unprecedented partnership, focus to “get this done”

• 31:14 – Rob plugs state-level advocacy (CAA Stars/Capitol Day)

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In the first half, Rob Lawrence sits down with Bill Seifarth, CEO of the National Registry of EMTs, to unpack what the Registry is today; how its mission has evolved; and why partnerships, research and continued competence sit at the heart of public trust when 911 is called.

In the second half, returning guest Patrick Pianezza joins Rob to talk Code 3, the top streaming EMS movie’s impact on providers and families and what comes next.

Across both conversations, the theme is unmistakable. When EMS organizations collaborate, align messaging and show up as one voice, the profession becomes harder to ignore and easier to support. The summit becomes more than a meeting. It becomes a signal.

• 1:02 – Introduction of Bill Seifarth; brief personal bio and career path
• 2:01 – “National Registry 101”: Bill explains the mission and what the Registry does
• 2:53 – Research focus: the Registry’s fellowship and EMS research priorities
• 3:31 – “Bread and butter”: entry-level and continued competence assessment and why it matters to the public
• 4:33 – Rob notes the Registry’s growing national presence; Bill outlines advocacy-through-partnership
• 5:08 – Preview of next year’s summit; participation in EMS on the Hill and NCSL with multiple EMS orgs in one booth
• 6:33 – Why the summit matters: state associations and national partners coming together under one roof — it’s a sold-out inaugural event; education, networking and shared experience highlighted
• 10:52 – Next stop: EMS on the Hill; “hunting in a pack”
• 12:20 – Bill’s closing: partnership, collaboration, synergy and supporting the profession
• 13:38 – Transition: Rob introduces Patrick Pianezza, co-writer of Code 3
• 14:41 – Patrick reflects on the film’s reception — especially among working providers
• 15:33 – Patrick shares the origin story: a “homework assignment” turned full-length film
• 17:39 – Where to watch: Apple/Amazon to rent or purchase; streaming on Hulu; performance metrics shared
• 18:30 – What’s next: pitching a TV series and interest in a sequel; realities of funding and IP ownership
• 21:33 – Discussion of the “Mr. President” scene and the intentional visual tension-building
• 24:19 – Patrick addresses feedback and the goal: honest portrayal and conversation-starting, not villainizing partners
• 27:41 – Leadership pipeline point: great clinicians aren’t automatically great leaders; mentorship matters
• 30:15 – Closing theme returns: one voice, fewer scattered voices, more impact for the profession
• 31:20 – Rob wraps: summit takeaways, guests, and a final nudge to watch Code 3

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for future episodes. 

In the first half, Linda breaks down her newly published (open-access) qualitative paper, provocatively titled “It’s not bullying if I do it to everyone,” drawn from UK NHS “Med Twitter” responses: a raw, heartbreaking window into the red flags of toxic workplace culture, how bullying is experienced in the eye of the beholder, and why incivility and silence are not just HR problems — they’re patient safety threats.

In the second half, Linda brings listeners into the UK’s evolving admission alternative world: frailty care at home, urgent community response models, and the increasingly important interface between EMS and community-based teams. She explains the UK’s SPOA (single point of access) concept, why she dislikes the term “admission avoidance,” and how ED crowding and access change the risk-benefit equation for hospital vs. home.

Rob connects the dots back to the U.S. reality — reimbursement, APOT/wall time, treatment-in-place policy — and why this work is becoming a shared challenge on both sides of the Atlantic.

00:51 – Rob opens, recaps NAEMSP in Tampa and recent content.

02:25 – Rob introduces Linda as the “triple threat” (emergency medicine, primary care/GP, geriatrics) and tees up two-part discussion.

05:39 – Rob introduces Linda’s paper: “It’s not bullying if I do it to everyone.”

06:13 – Linda explains why toxic culture is increasingly visible and how the tweet prompt became a dataset.

07:33 – “Flash mob research group” forms; Linda explains social-media-to-qualitative methodology and limitations.

10:03 – Rob asks about bias; Linda clarifies purpose: insight, not representativeness.

16:39 – Linda defines gaslighting and why it’s so destabilizing.

18:21 – Reactions to publication; resonance, sharing and uncomfortable self-reflection on learned behaviors.

20:18 – The “16:55 Friday email” as a weapon — and as an accidental harm.

23:29 – Leadership as “the sponge” — absorbing pressure rather than passing it down.

25:27 – “One thing right now”: know the impact your words can have, especially on vulnerable staff.

26:41 – Rob on “pressure bubbles,” micro-movements and atmospherics: how leaders shift climate without realizing it.

30:53 – SPOA explained: single point of access and urgent community response behind it.

33:03 – EMS interface: calling before conveyance to find safe pathways to keep patients at home.

35:47 – Linda on mortality risk of access block/long waits and how that reframes risk decisions.

37:19 – Evolving models: primary care-led response vs. hospital at home approaches.

39:34 – Clinical myths challenged: oral antibiotics sometimes non-inferior to IV in conditions we assumed needed admission.

40:34 – Outcomes: hospital at home trial signals safety and fewer patients in institutional care by 6 months.

42:00 – Telemedicine/telehealth: underutilized but useful; when you still need a senior clinician in person.

44:50 – Closing takeaways: read the paper (with trigger warning); admission alternative work is deeply satisfying.

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode. 

In this episode of EMS One-Stop, host Rob Lawrence welcomes John Sammons, an advanced practice paramedic with Wake County EMS, a peer support team member and a key leader in the NAEMT Lighthouse Leadership Program. John sits at the intersection of system design and human performance, helping build the kind of operational and cultural scaffolding that keeps clinicians effective, healthy and coming back tomorrow.

| MORE: Peer support teams: How to build trust and maximize effectiveness

This week’s conversation goes beyond “be more resilient” and into the practical realities of burnout, moral injury, mentoring and culture, including the role of frontline and unofficial leaders in shaping what “normal” looks like inside an agency. John also shares the Wake County approach to peer support: presence first, then resources, plus the power of finding your people: your team, your tribe, your board of directors.

• “We have folks that don’t stay in the profession. We have folks that leave. We have folks that unfortunately develop substantial mental health crises up to and including, unfortunately, suicide in our profession.”

• “What an amazing privilege that we’re invited into somebody’s home to take care of them and to figure it out.”

• “Every one of those people expects to call 911 and have an expert show up and solve the problem.”

• “I work to live, I don’t live to work. And that’s a great philosophy to have.”

• “Everybody goes home ... but there should be an addendum on the bottom of it that says, ‘but everybody comes back tomorrow.’”

• “Nobody gets us like we get us.”

• “Leadership is action, not a title.”

• “Everybody has their bucket, and everybody’s bucket can only hold so much.”

• “Nobody got into this because we wanted to be crusty and angry and miserable and difficult to be around.”

00:40 – Rob opens the episode and introduces John Sammons and the theme: resilience and beyond

02:05 – John’s “Sammons 101” bio: Wake County APP, peer support, Lighthouse Leadership involvement

03:01 – Burnout data and why it matters for retention and wellbeing

04:16 – Wake County’s Advanced Practice Paramedic Program: the “three Rs”

05:03 – John’s post-COVID turning point: “I’m done ... I don’t want to do this anymore”

06:12 – What brings John back to work: purpose, people, privilege, challenge

09:16 – Prevention and balance: identity beyond the job, sleep, nutrition, purpose

12:15 – Peer support in practice: presence, triage, in-house clinician, canines, statewide resources

17:09 – Podcast/vodcast reminder and John’s slides supporting the discussion

18:14 – NAEMT Lighthouse Leadership: why relationships and peers are the real multiplier

20:39 – Mentorship as a resilience strategy: formal programs and informal investment

24:25 – Culture: administration vs frontline leaders vs unofficial leaders

28:06 – Closing reflections: remembering why we got into EMS

30:36 – Final takeaways

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for future episodes. 

Sophie is a critical care ground paramedic, flight paramedic, educator and president of the Tennessee Association of EMS Providers (TAEMSP), and she brings a provider-first lens to everything from leadership visibility, to mental health and pay equity.

Together, Rob and Sophie dig into why Sophie started creating content in the first place (hint: burnout and the need to connect), how social media can be used as a force for good, and what “healthy” EMS culture should look like in practice. Sophie shares practical advice for crews and leaders alike:

• Be human

• Say the uncomfortable thing

• Stop normalizing harm

• Build systems that “care back” for the people doing the work

• “We're just working in systems that haven't yet learned how to care back for the provider.” — Sophie Fuller

• “Management by walking about. Don't be stuck in the office. Don't say my door is always open because that relies on people coming in to see you. Get out and go and see them.” — Rob Lawrence

• “We love this job and that distracts us from the fact that it's also hurting us.” — Sophie Fuller

• “Just because it's normal doesn't mean it's healthy.” — Sophie Fuller

• “We confuse trauma with tradition.” — Sophie Fuller

Additional resources:

• Follow Paramedic Sophie on:

  • YouTube

  • Tik Tok

• “The Next Shift : A mentorship workbook for EMTs and Paramedics” | E-Book, by Sophie Fuller

• “To Err is Human: Building a Safer Health System” - PubMed

01:00 – Rob introduces Sophie Fuller (“Paramedic Sophie”) and frames the influencer vs. “effluencer” concept

02:14 – Sophie’s origin story: graphic design → hospital tech → EMT → volunteer fire → paramedic → critical care → flight

06:16 – TAEMSP: why Tennessee needed a provider-level association and the shift toward legislative advocacy

08:05 – Why she started with social media: two full-time 911 jobs, low pay, burnout and the need for an outlet/connection

09:32 – Defining EMS burnout: the “jar on the shelf” and cumulative strain that becomes chronic fatigue

13:26 – Sophie’s guidance to providers: vulnerability, telling the truth and not letting naysayers silence needed conversations

16:00 – Sophie’s message to leadership: don’t be the “Wizard of Oz” — show up, communicate and stay connected to crews

20:26 – EMS culture: self-sacrifice, silence, “earning your place through suffering,” and confusing trauma with tradition

23:10 – Sophie’s book “The Next Shift”: a field guide to “learn, lead and last” in EMS

26:03 – Mistakes and “just culture”: reporting, mentoring, anonymous reporting systems, and learning vs. blame

32:08 – Closing challenge: stop normalizing harm; speak up for culture and patient care

33:14 – Where to find Sophie online and how large her platform has become

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode. 

Dr. Dorsett frames the discussion around the central aim of quality improvement:

• Are we doing a good job?
• Are we delivering the best possible care?
• How do we get better?

From pediatric vital signs to traumatic brain injury (TBI) fundamentals, she walks listeners through what the report reveals, what it can’t reliably measure yet, and why some of the “sexy” procedures are too rare to serve as useful system-wide metrics.

The conversation highlights a recurring theme: fundamentals matter most. Dr. Dorsett explains how measures like complete vital signs and avoiding secondary brain injury in TBI (hypoxia, hypotension, hyperventilation) can drive meaningful outcomes — even during relatively short prehospital intervals.

She also points out where current measurement approaches unintentionally create documentation burden for clinicians, arguing that systems should do more of the “figuring out” (like trauma center designation and prenotification capture) without requiring extra clicks.

The episode closes with a call to action: anyone can join NEMSQA, contribute to the work, and help shape what EMS quality measurement becomes next.

Memorable quotes from Dr. Maia Dorsett

“I think the most fundamental question in quality improvement is, are we doing a good job?”

“I think part of the value of this report is specifically looking at those things and saying what should we be measuring using NEMSIS data or how should things be integrated into that database so that the answers are there rather than needing to be documented on each individual case?”

“If there's one thing that you're going to take away from this trauma report is that, the sexy stuff is important, but it happens rarely. And if you want to improve care in your system, it's about the fundamentals of good care.”

Additional resources

• NEMSQA 2025 Report Release
• EMS One-Stop: Leading through momentum: Dr. Douglas Kupas on steering NAEMSP

Episode timeline

00:31 – Rob welcomes listeners; introduces the 2025 NEMSQA measures discussion and notes prior episode with Dr. Jeff Jarvis

01:10 – Dr. Dorsett joins; holiday surge discussion and flu impact on EDs and admissions

03:08 – Dr. Dorsett explains her role as co-chair of NEMSQA’s Measure Analysis and Research Committee; trauma focus of the 2025 report; pain measures not included due to active research

05:00 – NEMSIS scale and opportunity: extracting meaningful measures from a massive national dataset

05:35 – Dr. Dorsett on what NEMSIS measures well vs. what it shouldn’t force clinicians to document (system should determine trauma center status)

07:46 – “HALO procedures” table: why rare interventions shouldn’t become national quality measures

10:17 – Trauma 08: complete vital signs; pediatric gap (adults ~93% vs pediatrics ~85% in discussion)

14:22 – TBI measures: preventing secondary brain injury; why fundamentals outperform “sexy” fixes; correction rates for hypotension/hypoxia discussed

21:39 – Trauma 04: trauma triage criteria and transport to trauma centers; why national measure looks low; documentation field limitations

24:17 – State collaboration comparison: using state trauma center designation data shifts performance dramatically (often 75–90%+ in examples)

26:55 – Trauma 14: hospital prenotification; importance and measurement challenges (multiple modalities, inconsistent capture)

30:01 – Rob raises operational/policy concerns about trauma alerts and incentives; Dr. Dorsett adds nuance about local criteria variation

33:22 – Closing: Dr. Dorsett’s “fundamentals matter” takeaway; impact at scale

34:44 – Dr. Dorsett plugs joining NEMSQA as an individual/agency; committees are open

35:31 – NAEMSP Tampa preview; Dr. Dorsett: “The people” are why she goes — leaves energized with new ideas

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode. 

He shares what he’s learned about the presidency, the value of NAEMSP’s leadership “bench strength,” and why advocacy and coalition-building across national EMS organizations has become more coordinated, more strategic and more essential.

The conversation then turns to what’s immediately ahead: the NAEMSP Annual Meeting in Tampa (late January), including pre-conference courses, the flagship Medical Director’s Course, and a packed scientific program. Kupas highlights a keynote focused on transforming battlefield trauma care; major research programming through oral abstracts and hundreds of posters; and high-impact sessions spanning clinical care, operations, legal issues, and international perspectives — reinforcing why the Tampa meeting remains a must-attend event for anyone serious about the science and future of EMS.

00:00 – Rob tees up NAEMSP Annual Meeting growth as a “good problem to have” 00:50 – Welcome/Happy New Year 2026; Dr. Kupas introduced as first guest of the year 01:45 – Year one as NAEMSP president: what’s surprised Dr. Kupas, pace of work, governance “bench strength” 04:26 – NEMSAC termination: what happened, what NAEMSP hopes comes next 07:02 – Building the pipeline: medical student/resident interest group, travel support ideas 08:47 – “Hot off the press:” NAEMSP accepted into WHO Acute Care Action Network 10:08 – Advocacy “hunting as a pack:” overlapping national orgs, EMS on the Hill coordination 12:40 – Why Hill visits work: stories, staffers and why first-timers matter 16:48 – “White hat” advocacy and patient-centered priorities; ED wall time as a key issue 20:07 – Tampa preview: “It’s not just for docs,” NAEMSP membership structure 22:11 – Pre-cons overview: Medical Director’s Course, QI workshop, MIH, ventilation, blood, TECC 23:55 – Keynote: Dr. Frank Butler and special intro by Dr. Bob Mabry; Grand Rounds obstetric focus 27:45 – Major legal session format and why legal content draws a crowd 29:28 – Space constraints and future planning: small convention centers; San Diego “buyout” scale 31:49 – Research explosion: oral abstracts, posters, receptions; better ways to access abstracts 34:39 – “Meat of the conference:” operations, clinical topics, international speakers/learning 36:49 – Closing question: Bill details

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode. 

Building on last week’s data-and-trends conversation , this episode pivots into “the world according to Jimmy Apple” and his alter ego, the EMS Avenger, exploring what’s made providers lean in, push back or flat-out declare “enough is enough.”

| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond 

From burnout and workforce conditions to AI-assisted ECG interpretation and the rise of microlearning, the conversation lands on a central theme: the future of EMS isn’t just protocols — it’s people, technology and how we choose to learn, adapt and debate. Jimmy also names his “paper of the year” on spinal immobilization, explains how he handles disagreement without falling into “quicksand arguments,” and previews a packed 2026 speaking calendar — plus a relaunch of his podcast.

• “If we can just verify that you’re retaining the information, that’s much more important than the veracity of how long it took you to get that information.” — Jimmy Apple

• “You can catch more flies with honey than you can with vinegar.” — Jimmy Apple

• “That’s the future; is that literally, we’re going to swipe it, absorb it and swipe away again.” — Rob Lawrence

• “My paper of the year is the paper that was published on spinal mobilization … It does not support the use of backboards as anything other than an extrication tool.” — Jimmy Apple

• “I think that a big push that I’m making this year is to really start talking about the EMS provider as the person.” — Jimmy Apple

• 00:56 — Rob welcomes listeners, references year-in-review data and notes ambulance thefts continue to trend.

• 01:38 — Rob brings Jimmy back and asks for a quick summary of Jimmy’s year and growing reach, and the top themes Jimmy has seen.

• 04:12 — Jimmy identifies provider conditions and mindset as the dominant theme and describes discussion of collapse/collapsing systems.

• 06:12 — Jimmy explains social media as the pulse point and highlights burnout, anger and provider frustration.

• 06:52 — Jimmy pivots to technology’s growing role and EMS resistance to tech encroachment in practice.

• 07:23 — Rob connects the tech thread to conference observations (Axon, AI). Jimmy gives examples (AI 12-lead, apps) and argues tech advancement shouldn’t be rejected due to “skill deterioration” fears.

• 09:34 — Rob asks Jimmy’s “how do you explain complex concepts quickly?” Jimmy uses the Michelangelo anecdote to describe stripping concepts to essentials; critiques padded, time-gated education.

• 12:29 — Jimmy argues for education credit models that recognize microlearning and self-directed learning if retention can be verified.

• 14:04 — Rob asks for standout research; Jimmy discusses RSI/induction agent considerations, pressors debate and prehospital antibiotics.

• 16:47 — Rob and Jimmy preview NAEMSP’s annual meeting (“research Disney”), value of posters, networking and clinical depth.

• 18:26 — Jimmy names spinal immobilization evidence review as his “paper of the year” and explains its conclusions.

• 21:36 — Rob asks how Jimmy handles disagreement/detractors with a larger platform — Jimmy describes disagreement as healthy, focuses on respectful pushback and staying anchored in data.

• 29:00 — Final question: Jimmy emphasizes “provider as person,” healing the clinician and a sponsored podcast relaunch in January.

• Meet the EMS Avenger: Saving lives with kindness and content. TikTok sensation and pediatric critical care paramedic Jimmy Apple shares his rise in EMS education, battling misinformation with heart and hustle

• Jimmy Apple’s “paper of the year:” Millin MG, Innes JC, King GD, Abo BN, et al. “Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries — A NAEMSP Comprehensive Review and Analysis of the Literature.” Prehosp Emerg Care. 2025 Aug.

• Connect with Jimmy Apple, better known as The EMS Avenger:

  • TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger

  • Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger

  • X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger

  • Facebook — Join the group for discussions and shared insights: EMS Avenger community

  • Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series

• AAA & AIMHI EMS Media Log: EMS Intel

Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Drawing from the EMSIntel news log (now 3,849 stories as of the morning of recording), the trio connects what’s making headlines to what EMS leaders are experiencing on the ground: unstable economics, governance pressure, system redesign and rising operational risk.

The discussion lands on several recurring themes: economic sustainability as the dominant issue; the real-world politics of tax levies and “essential service” designations; the ongoing obsession with response times (and what they cost); preventable ambulance thefts escalating in severity; and the importance of measuring and publishing clinical outcomes and meaningful performance metrics. The through-line: communities are being forced into more honest conversations about what they can afford — and what EMS should look like going into 2026.

| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond

• “Having a thoughtful conversation about what your system needs to look like on the go forward is paramount.” — Rodney Dyche
• “If you don’t talk about yourself, somebody else will, and then you don’t control the narrative.” — Rob Lawrence
• “Our No. 1 focus really needs to be on the economic sustainability of these systems because we are past the breaking point.” — Matt Zavadsky
• “Response times equals speed; speed equals crashes.” — Rob Lawrence
• “These theft incidents are … in almost all cases, 100% preventable by an aftermarket device … probably for 100 or $150.” — Rodney Dyche
• “Response times are expensive. The shorter that you want your response times, the more money it’s going to take.” — Matt Zavadsky
• “Across every provider type … the fee-for-service revenue is 50% to 60% below the cost of providing service. So when somebody says to you, ‘I can do this for free,’ ask more questions.” — Matt Zavadsky
• “Response times are used as a cudgel.” — Rodney Dyche

• 01:11 – Rob introduces the end of 2025 reflection and 2026 look-ahead; welcomes Matt Zavadsky and Rodney Dyche for the second annual EMSIntel year-in-review.
• 02:26 – Rodney reports the EMSIntel log count (“3,849 as of this morning”); Rob explains EMSIntel’s purpose: curating national EMS stories to identify themes and brief stakeholders.
• 04:13 – Matt names the year’s biggest issue: economic sustainability; the fiscal model is broken and impacts everything else. 06:32 – Matt walks through the “AnyTown EMS” trajectory: communities can’t sustain old models, must define service levels, use system intelligence, and redesign for a modern “2028 model.”
• 09:06 – Matt cites the Medicare/RAND cost collection findings and warns that fee-for-service revenue sits far below actual costs; “ask more questions” when someone promises “free.”
• 10:12 – The group discusses communities pursuing tax levies and essential-service framing; Rodney contrasts places that pass funding measures with places that don’t, and highlights local politics and competing priorities.
• 11:52 – Matt clarifies that “essential service” means different things to the public versus statute; agencies need trust, transparency and real community education to succeed at the ballot box.
• 13:50 – Rodney describes the “cost of readiness” misunderstanding (public sees mileage, not readiness); Matt pushes proactive reporting (monthly/quarterly/annual) to build credibility.
• 15:35 – Matt pivots to response times: they’re expensive, clinically relevant in a small fraction of cases, and should be approached with evidence-based expectations and better triage/EMD practices.
• 18:14 – Rodney connects hot responses to preventable intersection crashes and modern driver realities; the discussion frames safety risk as a growing operational storyline.
• 20:21 – Matt adds an editorial caution that crashes are not confined to any one sector; points to recent examples including serious injuries during responses.
• 22:37 – Rob returns to ambulance thefts; Rodney calls most thefts preventable; Matt argues the basic lock discipline exists already and presses for stronger accountability and accreditation-style best practice.
• 26:11 – Rob flags downstream legal and regulatory risk (litigation exposure after stolen-unit crashes; DEA-controlled substances security implications).
• 26:52 – Rodney raises staffing; notes fewer staffing stories than 2024 but questions whether the situation is truly better; mentions earn-to-learn pipeline concerns.
• 28:13 – Matt describes the shift toward tiered deployment and greater EMT utilization, reducing pressure to staff large numbers of paramedics for calls that don’t require that level.
• 30:17 – Matt emphasizes outcomes and meaningful performance metrics; argues many systems still report the wrong measures and should lead with clinical metrics, patient experience, and quality indicators.
• 31:08 – Rodney reinforces that response times get weaponized in governance decisions; notes boards can be swayed by “advanced skills” narratives rather than outcome data.
• 33:25 – Forward-looking wrap: Matt highlights daily calls from communities that “can’t afford this anymore” and urges leaders to seize the redesign opportunity; Rodney echoes the need for planning and honest community conversations.

Additional resources:

• AAA & AIMHI EMS Media Log: EMS Intel
• Fast & spurious: America keeps losing ambulances and the fix is cheap
• Callouts, chaos and career killers: The biggest EMS stories of the year

Enjoying EMS One-Stop? Email editor@ems1.com to share feedback or suggest guests for future episodes. 

Rob is joined by Tony O’Brien and James Robinson from the National EMS Memorial Foundation to provide a clear, candid update on where the project stands, why it matters, and what still needs to be done.

From the Weekend of Remembrance to the dream of a year-round place of solace and reverence in the nation’s capital, this conversation lays out the long road from idea to reality — and why EMS, as James puts it, truly deserves this.

Tony and James walk listeners through the 24-step federal Commemorative Works Act process, the hard work of narrowing 312 potential sites down to three, and the current push to reauthorize the Foundation’s federal authority through House Resolution 2196 and Senate Bill 2546.

They explain the preferred site in front of the Hubert H. Humphrey Building (HHS), the partnership with MIT’s School of Architecture and Urban Risk Lab on a powerful design, and the practical realities of funding, sponsorship and bureaucracy.

Most importantly, they end with a clear call to action for the EMS community: contact your elected officials, donate what you can, and help spread the word so that a permanent memorial to EMS can finally take its place in Washington, D.C.

• EMS Memorial

• EMS Memorial Bills:

  • HR 2196 

  • S2546 

• 2025 National EMS Weekend of Honor recognizes 29 fallen EMS workers

• ‘Never forgotten’: 2025 Moving Honors procession honors 29 EMS providers lost in the line of duty

00:44 – Rob introduces the episode, sets the scene for a revisit of the National EMS Memorial effort, and welcomes guests Tony O’Brien and James Robinson.

01:30 – Tony and James share their backstories.

03:53 – Tony explains the origins of the Foundation at the Weekend of Remembrance/Weekend of Honor and the realization that EMS needs a permanent memorial people can visit year-round.

06:54 – James outlines the Commemorative Works Act, the 24-step process, and how the Foundation has reached step 15-16 over roughly 15 years.

07:54 – Tony details the grueling site-selection work: visiting 312 sites, environmental and noise studies, traffic and solitude considerations, and narrowing to three candidate locations.

10:48 – James describes the need for an Act of Congress to begin, Congressman Stephen Lynch’s early sponsorship, and the 2018 authorization that started a 7-year clock — complicated by the pandemic and federal shutdowns.

13:12 – Tony explains how the initial authorization expired, the need for reauthorization and the most recent Senate subcommittee hearing on federal lands where James testified.

16:41 – James and Tony frame the new bills: Senate Bill 2546 and House Resolution 2196, their bipartisan sponsors and the push for more co-sponsors.

19:49 – Tony lays out the three-point call to action: contact Congress, donate via EMSMemorial.org, and follow/share @EMSMemorial on social media.

23:06 – Tony describes the three remaining sites and why Independence Ave. & 3rd St SW, in front of HHS, is the preferred location.

24:42 – Tony highlights the pro-bono design work by MIT’s School of Architecture and Urban Risk Lab, and the deep engagement with providers, families and survivors.

26:32 – James explains the historical nexus of EMS with HEW/HHS and why the Humphrey Building plaza offers the right reverence, proximity to the Capitol and connection to EMS history.

29:01 – Tony and James discuss next steps: reauthorization first, then finalizing site and design to approach major sponsors with clear answers on location, look and cost — while acknowledging the project has been bootstrapped so far.

32:03 – Tony reassures donors: the Foundation is a 501(c)(3), the board are all volunteers with only necessary professional services paid from donations.

33:13 – Tony gives shout-outs to the National EMS Memorial Service and the National EMS Memorial Bike Ride, and explains how the three organizations’ missions align.

37:12 – Rob recaps the journey, reinforces the call to action, and closes the show with thanks to Tony and James and a reminder to visit EMSMemorial.org and like/subscribe to EMS One-Stop.

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

Fresh off the longest federal government shutdown in history, Rob and Matt unpack what the hyper-turbulence in Washington really means for EMS: suspended Medicare extenders, disrupted grant programs, agencies taking out loans just to meet payroll and training programs put on hold.

They break down NAEMT’s flash poll on the shutdown’s impact, the promise of the Treatment in Place (TIP) legislation, and why associations “hunting as a pack” on Capitol Hill matters more than ever.

Along the way, they spotlight EMSIntel.org as a national barometer of EMS funding, staffing and response time crises, and issue a clear call to action for providers, billers and leaders to use association tools to contact their members of Congress.

| MORE: Government reopens: What EMS providers need to know right now

In the second half, Rob is joined by Dr. Shannon Gollnick, paramedic, EMS leader and organizational psychologist, to explore how artificial intelligence is reshaping EMS — right now.

Shannon makes the case that AI is “not the future; it is the present,” and that agency leaders must urgently build literacy, policies and guardrails around its use. They dig into the difference between HIPAA-compliant, embedded AI in ePCR systems, and risky open tools like ChatGPT, touching on hallucinations, embedded code and emerging Medicare fraud-detection programs.

| MORE: Artificial to augmented intelligence. How Dr. Shannon Gollnick wants EMS to work smarter, not harder

Rob and Shannon talk about AI as a powerful but potentially dangerous tool — “like having a tiger” — and outline practical steps for chiefs:

1. Ask: “Do we have an AI policy?”

2. Define what AI can and cannot be used for

3. Insist that every AI-generated work product is double-checked by a human before it hits the record

• “We weren't here to actually scare you off it. We're here to let you know that it's here, but it's like having a tiger, right? We all love to have a tiger, but it has to be contained in some sort of guard, otherwise it's going to run rife and cause havoc, and we don't want that.” — Rob Lawrence

• “This is part of the hyper-turbulence that's occurring in EMS right now.” — Matt Zavadsky

• “So I think the message for the profession right now is, now is not the time to put your foot on the brake. It's time to put your foot on the gas.” — Matt Zavadsky

• “We put the fun into function.” — Dr. Shannon Gollnick

• “I think it's important to understand that AI is not the future. It is the present. We are currently here right now. And it's nothing to be afraid of.” — Dr. Shannon Gollnick

• “If you're not doing it, I promise you that your staff is doing it and they're playing around with AI.” — Dr. Shannon Gollnick

• “Guardrails don't exist from a congressional standpoint. They don't exist from a regulatory standpoint. The technology is moving far too fast. So we as agency leaders have to take the lead in putting up some of those guardrails.” — Dr. Shannon Gollnick

• “There are ePCR software out there that are using proprietary AI that will use AI-generated narratives. And that absolutely is 100% good to go. What we don't want to see is our crews putting in their ChatGPT to have ChatGPT write their narrative.” — Dr. Shannon Gollnick

• “ChatGPT has embedded code inside of it that you can't see, but that code is there ... so what we're kind of afraid to do is to say, hey, what happens 6 months from now, 8 months from now when Medicare does an audit, they run your ePCRs and find all of this embedded code from ChatGPT ... you open yourself up for a lot of compliance issues.” — Dr. Shannon Gollnick

Additional resources:

• EMS Intel EMS News Tracker

• American Ambulance Association Advocacy

• NAEMT Advocacy

• EMS shutdown survival: What leaders need to know now

• Charting the future: How AI is rewriting the EMS narrative

Episode timeline:

00:21 – Rob introduces guest Matt Zavadsky

02:02 – Rob recaps the 40-plus-day federal government shutdown, questions about reopening, and his upcoming return to Capitol Hill for renewed advocacy

02:02 – Matt frames the shutdown as part of the “hyper turbulence” in EMS; explains the regulatory suspensions, pauses in Medicare extenders and grants, and how cash-flow uncertainty forced some agencies to take out loans just to make payroll

03:04 – Matt details NAEMT’s flash poll (408 agency responses) showing suspended training and grant-funded programs, and warns of a possible repeat shutdown around January 30

03:54 – Rob and Matt discuss the reopening of government, ongoing bipartisan work, and the risk that everything “comes to a grinding halt” again if Congress can’t agree

04:51 – Matt explains why NAEMT released the shutdown-impact poll even as government reopened and stresses the need to keep pushing for permanent relief from Medicare extenders and advancement of key bills like Treatment in Place (TIP)

06:03 – Matt outlines the House and Senate TIP companion bills and why Medicare paying for treatment in place is better for patients, EMS, the health system and the Medicare trust fund

06:54 – Rob notes broad association/provider support and professional lobbyists on the Hill; Matt stresses that field providers, administrators and billers must still use association legislative portals to send letters to Congress

08:08 – Matt describes a surge in communities reevaluating their EMS delivery models because of staffing, finance and subsidy challenges — “a great time to be an EMS consultant”

09:09 – Rob introduces EMSIntel.org as a curated clearinghouse of EMS news, used to show communities they aren’t alone; describes failed tax measures and funding referenda

10:15 – Matt cites EMS Intel data: ~85% of stories each month involve funding, staffing or response times; Rob and Matt stress the ubiquity of these themes from big cities to small towns

11:09 – Rob highlights mutual aid tensions and taxpayers questioning why they “pay to send our resources somewhere else;” both emphasize that hyper-turbulence and funding gaps are national issues

13:23 – Rob resets the scene from the EMSpire conference and recaps Matt’s Hill update before introducing Dr. Shannon Gollnick

14:41 – Shannon gives his backstory: in EMS since 1996, paramedic since 2002, progression into EMS leadership, doctorate in organizational psychology and focus on how organizations function

15:14 – “We put the fun into function.”

15:24 – Rob invites Shannon to talk AI, calling it “the specter we are embracing everywhere,” and references HIPAA concerns; Shannon opens with the core message: AI is not the future, it’s the present, and nothing to be afraid of

16:03 – Shannon urges leaders to build AI literacy, noting that if agencies aren’t using it, their staff and the younger generation already are

16:28 – Shannon emphasizes policy and procedure: AI guardrails aren’t coming from Congress or regulators, so agency leaders must define how AI will be used and where its limits are

16:55 – Rob reminds listeners that AI in EMS isn’t new, citing early monitor rhythm interpretation in the UK; Shannon underscores that crews already use AI tools and that unmanaged cut-and-paste practices can create billing and compliance risks

17:24 – Shannon explains the dangers of using open tools like ChatGPT for ePCR narratives: potential PHI exposure in a “black box” system and AI hallucinations generating plausible but false patient information

18:21 – Shannon describes how AI “wants to answer your question and make you happy,” leading to made-up details, and shares examples from testing minimal-input scenarios that returned overly detailed, inaccurate narratives.

19:03 – Shannon calls ChatGPT “kind of a snitch,” explaining embedded code markers that fraud detection tools — and increasingly Medicare’s AI-based “Wiser” program — can use to identify AI-written content in documentation

19:59 – Shannon warns about retrospective audits and compliance exposure if ChatGPT-coded narratives are found in ePCRs, noting that AI rules are still emerging and tech is outrunning regulation

20:51 – Rob summarizes the mixed message: AI is here and being built into devices and software, but there are real dangers. They discuss data going “to the cloud” — which Shannon defines as “somebody else’s computer.”

21:24 – Shannon frames AI as a powerful tool that can “put a lot of holes in the wall” if misused; he references fraudulent AI uses and deepfakes as emerging issues

22:05 – Shannon compares AI’s impact to the internet’s paradigm shift; Rob gives a “spoiler alert” about his own workflow using transcripts and ChatGPT agents, and notes the importance of reading and checking any AI-generated output

22:45 – Shannon reinforces that AI makes mistakes and cannot understand human context; he uses his “How you doing?” Joey Tribbiani vs. Tony Soprano example to illustrate contextual nuance

23:06 – Rob expands the context point with the “Friends”/“Sopranos” slide and reminds listeners that once AI-written words are published, “you said it.” Shannon highlights the WebMD effect and AI-driven self-diagnosis risks.

24:02 – They note that ChatGPT can generate long, complex diagnoses without sufficient patient context, leading to errant or misleading outcomes if misused clinically

25:00 – Rob summarizes: AI is here and, used correctly, is a good thing; advises chiefs to ask their teams, “Do we have an AI policy?”

25:27 – Shannon outlines what an AI policy should contain: acknowledgment that AI is here; clear, non-fearful framing; specificity on what decisions AI can support; and clarity on which tools (e.g., embedded EPCR AI) are allowed versus prohibited uses of ChatGPT

26:17 – Shannon stresses AI should not be used for clinical decision-making or clinical narrative writing; its role should be administrative only, and all outputs must be double-checked

Enjoying the show? Email editor@ems1.com to share feedback or suggest a guest for a future episode. 

Dr. Smith draws from first-hand perspective from the ground, detailing catastrophic damage to homes, utilities, roads and communications — which compounded the workload and emotional burden for Jamaica Fire Brigade (JFB) firefighters and EMS providers.

Dr. Smith highlighted the Brigade’s Amazon Wish List effort, which aims to route essential personal items and operational supplies directly to affected JFB members and stations to sustain continuity of operations and support responders’ families.

After the break, Dr. Smith switched hats as the newly elected President of NEMSMA to outline the association’s renewed momentum:

• New association management support

• Expanded member services and credentials

• The inaugural NEMSMA Leadership Conference

The NEMSMA Leadership Conference will take place in Washington, D.C., March 23-24, 2026, intentionally adjacent to EMS on the Hill to create a leadership-plus-advocacy “two-fer.” Highlights include keynote Gen. Robert Neller (Ret.), plus a deep bench of EMS leaders and educators.

• “Many homes destroyed, utility systems interrupted, critical infrastructure in terms of communities having the ability to communicate, leaving thousands displaced, even fire stations having operational challenges as it relates to communication and interoperability ... ”

• “I stayed in the local fire station. I wanted to be there with the men and women on the ground, to make sure that I had that communication, that constant contact with them.”

• “My focus will be on the firefighters and ensuring that we get enough supplies to go directly to the firefighters.”

• “We want to tear down silos. We want to redefine leadership and ensure that we continue to collaborate across this globe.”

• Jamaica Fire Brigade – Amazon Wish List

• National EMS Management Association (NEMSMA)

• NEMSMA Leadership Conference: Washington, D.C., March 23-24, 2026

• EMS on the Hill, March 25-26, 2026, Arlington, Virginia

• International Journal of Paramedicine

• EMS One-Stop: General Robert Neller on ethical leadership and adaptability

00:46 – Quick industry/policy update

01:27 – Set-up: Hurricane Melissa overview; impact stats and current situation

02:12 – Welcome Dr. Hezedean Smith

02:26 – Dr. Smith’s backstory: Jamaica roots, USAF medic, Orlando FD, two fire chief roles, GES Consulting, Caribbean EMS focus

04:20 – First reactions to Melissa: scale of damage; compounded human toll

05:58 – Deployment cadence: aligning with JFB command, CDEMA, national EOC; travel hurdles; rapid integration on arrival

08:28 – Why existing relationships matter; staying in-station with crews; supporting leaders and frontline needs

11:13 – Call to action: Amazon wish list for responders’ personal and operational needs; distribution via JFB logistics

13:20 – Specific needs (PPE, boots, clothing, hygiene, basic medical supplies) and the ongoing recovery realities

17:46 – NEMSMA — new president, renewed energy, new AMC, who NEMSMA serves

20:14 – Board/leadership shout-outs; programs (FTEP, ACPE), member services, momentum

22:49 – Conference preview (Mar 23–24, 2026, D.C.): theme — disruptive leadership; Gen. Robert Neller keynote; speaker lineup; proximity to EMS on the Hill

26:29 – IJOP collaboration and research-to-podcast pipeline; communications and sponsorship improvements

28:29 – Closing thanks; unified call to support JFB and engage with NEMSMA initiatives

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

In this episode of the EMS One-Stop podcast, we tackle the fast-moving realities of a federal shutdown and what it means for EMS finance, reimbursement and day-to-day operations.

Rob Lawrence sits down with Solutions Group’s Asbel Montes — a veteran of EMS reimbursement and policy expertise — to decode where Congress is (and isn’t), what CMS’s temporary claims hold really means, and how ambulance services can protect cash flow while preparing for potential reprocessing chaos if extenders aren’t promptly restored.

Beyond the headlines, Montes lays out a pragmatic playbook: build a Plan B for cash continuity, align with your billing team on reprocessing workflows, and model exposure across payers tied to the Medicare fee schedule. The conversation then widens to balance billing — why federal change is unlikely soon and why state-level action is delivering practical protections — before closing with leadership lessons on adaptation, data and telling EMS’s story as a guide, not the hero.

Memorable quotes from Asbel Montes

“Our extender expired — that’s that additional payment that we get from Medicare of that 2%, 3%, 22.6% — it expired September the 30th, and it was tied to the House-approved CR that went over to the Senate.”

“We’re solutions givers, as we say here at Solutions Group, not crisis managers. And if you have a plan, I can at least execute a plan.”

“What turned out to be a smaller amount, now the cost associated with it, you started to really understand the complexities that really happened in people’s AR.”

“If this lasts longer than 15 days … then I would basically have a plan in place. So I would be trying to find out from my billing team … what is your contingency plan to ensure I don’t see a hiccup in cash moving forward?”

“The only way government can really invoke change is to make it hit where it hurts. And that’s what’s going on right now. They’re hitting the pocketbook and our industry is grappling with it right now.”

Additional resources

• Asbel Montes: The government shutdown’s ripple effect on healthcare
• The Leadership Lab with Asbel Montes

Episode timeline & key moments

00:21 – Why the shutdown matters to EMS reimbursement and operations

01:21 – Montes’s 101: role at Solutions Group; 28 years in EMS finance and policy

02:40 – Historical context: number and length of shutdowns; current Hill outlook

03:48 – The ambulance extenders expired (2% urban, 3% rural, 22.6% super-rural); CMS claims hold window

05:03 – Planning posture: realistic timelines; “we’re solutions givers, not crisis managers”

06:12 – Back-of-the-napkin math: short-term dollars vs. long-term reprocessing burden

07:43 – 2015–2016 déjà vu: retroactive fixes and the heavy lift for back-office AR

10:26 – Secondary impacts: VA eligibility, appeals, enrollments during a prolonged shutdown

11:11 – The “three-legged stool” for leaders: (1) have a plan with billing; (2) reconcile accounts & patient balances; (3) prevent cash-flow lag if more than15 days

14:06 – Framing the moment: “hurricane shutdown” response and recovery mindset

15:43 – Balance billing at the federal level: committee work, political pain and why movement is unlikely soon

18:19 – State action wins: consumer protections and access; examples of Medicare-indexed approaches

20:24 – Why ground ambulance stayed out of federal NSA; local regulation and state primacy

22:42 – “All politics are local”: using EMS’s public visibility to advocate for patients and providers

23:09 – Adaptation over preservation: seize the 6-18 month window; let data and clinicians lead reform

27:13 – Lawrence’s “Darwinism” takeaway: adaptation as survival

28:31 – The Leadership Lab podcast: purpose, cadence and upcoming guests; Montes’s leadership journey

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

Known worldwide for his role as Dwight Schrute in The Office, Wilson has stepped into the world of EMS, portraying the life of a burned-out paramedic with both grit and humor. In the conversation, Wilson reflects on the process of bringing this story to life, his ride-along experiences in Los Angeles, and the powerful realities he uncovered about our profession.

More than just a performance, Rainn has become an unexpected advocate for EMS. He speaks candidly about the underfunding of frontline providers, the emotional toll of the work and the sheer humanity that comes with being welcomed into people’s lives during their most vulnerable moments.

Alongside the serious themes, he reminds us that Code 3 is also a comedy — one that captures the gallows humor, camaraderie and resilience medics carry with them on every shift.

| MORE: Why ‘Code 3’ might be the most honest EMS film yet. From a ticking salary counter to fourth-wall confessions, this EMS road movie isn’t just another Hollywood take. It’s a love letter, a warning and a mirror.

• “Most of all, I just fell in love with the character of Randy.”

• “Bottom line, the fact that first responders are getting basically what people that work at Starbucks are getting paid really blew my mind.”

• “Well, one thing I never thought of, maybe stupidly so, is how vulnerable everything is because you're going into people's homes and they're in crisis.”

• “I think Rob, no one should be allowed to graduate from high school without their kind of basic CPR training.”

• “Everything about EMS — the tone, the vibe, the gallows humor, certainly all the technical medical elements, the burnout, the camaraderie, the idea that there's a mission here — they do it because they love it.”

• “Well, it was an honor to learn about this world and to make a movie that these workers are excited about and proud of.”

• “I want to say from the bottom of my heart, you know, ‘thank you. Thank you for your work. And, you know, I think it's grossly underappreciated, but, you know, America needs you.’”

00:26 – Rainn Wilson on the vulnerability of entering people’s homes in crisis

00:57 – “All we want to do is save your life. Some of you don’t make it easy.”

02:53 – Rainn’s first impressions of the “Code 3” script

03:38 – Falling in love with the character of Randy

04:22 – Discovering the realities of EMS work and shocking pay disparities

06:09 – Lessons from Wilson’s Los Angeles ride-along

10:12 – Wilson on CPR training and why everyone should learn it

12:29 – “We’re essentially a tube and a pump.”

13:11 – Rehearsals and the importance of portraying EMS medicine accurately

15:09 – On burnout, PTSD and the need to support medics’ mental health

18:08 – Using “Code 3” salary comparison as an advocacy tool

19:07 – Wilson praises Rob Riggle’s ED doctor role and its realism

20:41 – Cherishing the chance to shed light on EMS

21:10 – Reminder that the film is also a comedy — “a good old time with a bucket of popcorn”

22:25 – Final message: “America needs you. Keep saving lives.”

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

The film stars Rainn Wilson (“The Office”), Lil Rel Howery (“Free Guy”) and Aimee Carrero (“Elena of Avalor”), delivering a powerful performance that captures both the pressures and the humanity of EMS work. Using real-world experiences and stories from the field, “Code 3” highlights the passion, dedication and emotional toll experienced by EMS professionals every day. From burnout, to systemic challenges, the movie invites the public into the high-stakes world of emergency medical services, showing both the challenges and the heart behind the uniform.

Patrick and Rob discuss not only the storytelling process, but also the personal experiences that informed the movie. Pianezza candidly shares the emotional toll of EMS work, the reality of burnout and the importance of mental health support for first responders.

This episode is both a celebration of the dedication of those who serve in 911 and a call for awareness and gratitude for the vital work they perform. “Code 3” opens in selected cinemas on Sept. 12, 2025.

Memorable quotes

• “I remember going to one of my old bosses and saying, ‘I think I'm burning out.’ The reaction I got was this dark chuckle … ‘We're all burnt out. Get back on the truck.’ That kind of festering mentality is not healthy.” — Patrick Pianezza

• “Six out of six people that I have worked with have unfortunately [died by] suicide, and the suicide rates for first responders is double that of the regular population … which is a statistic we need to fix.” — Patrick Pianezza

• “And it is … a good representation of life on the truck, on the street, with a guy who’s clearly burned out; but a person that cares, that has passion, commitment and will always do the right thing.” — Patrick Pianezza

• “There was no way to confront the story without talking about salaries, without talking about reimbursements … No one's gonna see a movie about Medicare, Medicaid, but we are as honest as we can be.” — Patrick Pianezza

• “This movie is nothing more than a gratitude tour for everyone who works in 911 … I’ll be a broken record here: thank you for what it is that you do because it matters. I’ve been in those boots and I’m here to tell you thank you.” — Patrick Pianezza

• “And as I say in my review, those who know me know my ability to take tactical naps during movies. Well, this one got two eyes open and absolutely five stars.” — Rob Lawrence

00:00 – Introduction: Rob Lawrence introduces Patrick Pianezza and the film “Code 3” starring Rainn Wilson

02:31 – Origins of “Code 3:” How the project started and the vision behind telling an authentic EMS story

05:01 – Creative team & casting: working with actors, crew and Rainn Wilson

08:01 – On-the-Street authenticity: translating real EMS experiences into the film

12:01 – Depicting burnout: emotional and mental challenges in EMS work

16:01 – Mental health & seeking help: Autobiographical elements and confronting burnout

20:01 – Systemic issues: salaries, Medicare, and Medicaid reimbursement challenges

24:01 – Impact on families & relationships: emotional toll beyond the job

27:01 – Personal reflection: Patrick’s journey, struggles and growth in EMS

29:01 – Gratitude tour: purpose of the film and acknowledging EMS professionals

32:01 – Closing thoughts: film release details, upcoming trailer and final messages of appreciation

Enjoying the show? Send an email to editor@ems1.com to share feedback or suggest guests for upcoming episodes. 

Together, they outline the role of NEMSAC as the sole statutory advisory body connecting EMS to the federal executive branch, describe the hundreds of volunteer hours that went into shaping advisories, and discuss what happens now that years of hard work and documents have been pulled from EMS.gov.

This episode sets the record straight, provides a clear explainer of the process, and captures the disappointment — yet determination — of leaders committed to moving EMS forward despite this setback.

Additional resources:

• How NEMSAC is composed — who sits on the council and what types of expertise are represented

• The NEMSAC’s statutory role advice/briefings at the federal level

• NEMSAC’s key accomplishments

01:08 – Rob introduces the breaking news: NEMSAC dissolved

02:22 – What is NEMSAC? Brenden explains its statutory role

04:52 – How does NEMSAC differ from associations? Direct advisory to the executive branch

06:42 – Appointments, terms and how continuity usually worked

08:44 – The depth of work: meetings, subcommittees, advisories, letters

11:23 – Examples of major advisories and public comment process

14:27 – Shock: key advisories removed from EMS.gov

19:13 – Explainer: FICEMS and how advisories flow through federal government

26:25 – How members felt when dismissal was announced

30:18 – What happens to unfinished advisories and research

34:20 – Associations’ role in keeping the work alive

35:50 – The advisory each guest is most proud of

39:41 – Lessons learned: influence, unified voice, process

43:25 – Final reflections: leadership, advocacy, and what comes next

Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode. 

Joining Rob is longtime EMS leader and current CAAS GVS Administrator Mark Postma, who walks us through the origins of the standards, their national adoption and what’s new in the latest update.

From ambulance remounting, to structural safety testing, Mark explains how GVS 4.0 has evolved to keep pace with manufacturing realities, supply chain delays and operational needs. The conversation then shifts to a shared passion for protecting fleet assets.

Rob and Mark dissect the shockingly frequent problem of ambulance theft and how a $200 automatic immobilization device can prevent a $250,000 vehicle from disappearing — without relying on crews to remember to lock it.

Additional resources:

• CAAS GVS V4.0 – Ground Vehicle Standard

• Commission on Accreditation of Ambulance Services (CAAS) – The New Standard in Mobile Healthcare

• Ambulance thefts in the U.S. surge: Over 40 stolen rigs in 18 months

• 6 ways to safety-proof your EMS fleet

• "It’s no good going to City Council or to your board of directors on day 365 and saying, ‘I need a new truck for New Year day one’ — that’s not going to happen." — Rob Lawrence

• "The ground vehicle standard has become the standard that most vehicles are being built to and that state EMS officials are using." — Mark Postma

• "We spend a lot of time thinking about where things go in the box … add one more thing to your checklist: can the vehicle indeed be immobilized?" — Rob Lawrence

• "There’s just no reason why ambulances are being stolen with the current technology that’s out there." — Mark Postma

00:45 – Rob introduces the topic: GVS 4.0 and ambulance theft concerns

01:34 – Mark introduction and CAAS GVS role

04:11 – How the CAAS standards were developed and adopted by 35-plus states

06:09 – Comparing CAAS GVS to NFPA ambulance standards

06:48 – The rise of remounting, especially during COVID supply shortages

10:26 – Discussion of ongoing vehicle delivery delays and need for replacement planning

15:04 – What’s new in GVS 4.0 — major changes and safety structure updates

19:38 – Ambulance theft statistics and the GVS anti-theft requirement

22:28 – Automatic immobilization and why manual systems fail

23:57 – Mark shares success story: zero thefts since installing devices

26:17 – Exceptions in standards and why state inspectors must enforce anti-theft

27:42 – Final thoughts on making anti-theft part of fleet planning

Enjoying the show? Email editor@ems1.com to share feedback and suggest future guests. 

| MORE: How North Dakota EMS is confronting rising pediatric mental health crises 

Whether it's addiction medicine, rural HIV/HCV treatment or skilled nursing interventions, this team is shifting paradigms on what EMS can and should be doing.

Rob is joined by four key voices from the Prisma Health MIH program:

• Luke Estes, director of MIH

• Dr. Mirinda Gormley, epidemiologist and biostatistician

• Wes Wampler, community paramedic specializing in addiction and infectious disease

• Parker Bailes, community paramedic and research contributor

Together, they unpack how passion meets data to drive change, how to earn trust in communities overlooked by traditional systems, and why this work isn’t just novel — it’s necessary. This is EMS in its truest public health form.

• “You delivered the goods—data-driven, community-connected care — and that’s what EMS in 2025 needs more of.” — Rob Lawrence

• “When you see some of your people who have a passion for a certain pathway in EMS, you try to give them the reins and say, you're gonna do some good.” — Luke Estes

• “One of the big things that we learned from his study was that we really needed to go out and make sure everybody was aware that addiction is a disease.” — Mirinda Gormley

• “If we can gain their trust, there’s a lot more that we can kind of weasel our way into to help them solve and get them on a healthier trajectory.” — Wes Wampler

• “Walking into the (care) facility with the mindset of, ‘I'm going to do everything I can to keep you here,’ was a big shift for me.” — Parker Bailes

• “If we can set them up to be successful after they leave the hospital, I think that's the best way to get them reengaged with the hospital.” — Wes Wampler

• “As their leader … all I have to say is, what do you need? I'm here to support you.” — Luke Estes

• EMS Clinician Perceptions on Prehospital Buprenorphine Administration Programs: Prehospital Emergency Care: Vol 29 , No 4

• Implementation Barriers of Prehospital Buprenorphine Administration Programs in the United States: A Scoping Review: Prehospital Emergency Care: Vol 29 , No 4

• Using Community Paramedicine to Treat Hepatitis C Virus in Upstate South Carolina - PMC

• Luke Estes BA, NRP, CCEMTP, PNCCT, FP-C, CP-C | LinkedIn

• Wesley Wampler | LinkedIn

• Support for harm reduction by community EMS

• How does a community re-imagine compassion to avoid crisis whenever possible?

• Breaking barriers: Hennepin EMS leads the way in safely implementing buprenorphine

00:51 ­– Introduction to Prisma Health MIH & guests

03:00 – Luke Estes overview of MIH models (ETS, SDOH, addiction)

05:00 – Dr. Gormley’s public health journey, data-opioid focus

08:00 – Buprenorphine pilot design and research outcomes

10:15 – Challenges: bias, stigma, barriers to addiction care

13:00 – Funding and sustainability conversation

14:00 – Wes Wampler on daily workflow in addiction medicine and HCV care

17:00 – Building trust with vulnerable populations

18:30 – Parker Bailes discusses traditional CP role and skilled nursing interventions

21:45 – Alternative destinations, lab draws and high-acuity decisions

25:30 – Training: internal education, ultrasound, medication management

28:15 – Prisma’s med school connection and disaster response evolution

30:00 – State-level partnerships: SC EMS Assn, FEMA typing, CP strike teams

31:56 – Academic next steps from Dr. Gormley: scaling, publishing, process evals

35:26 – Final reflections from Luke Estes: passion, team strength and mission

38:00 – Rob’s call to action: “If you want your own Prisma team — start now.”

Enjoying the show? Email editor@ems1.com to share feedback or suggest future guests. 

| More: What the EMS Counts Act means for dual-role EMS providers 

In this conversation, Rob pulls back the curtain on the man behind the mobile screen — exploring Jimmy's journey from electrician to pediatric critical care paramedic, and now, one of EMS's most watched and listened-to voices.

Listeners will gain deep insight into Jimmy’s origin story, his social media strategies, his refusal to let bad information go unchallenged, and his passionate belief that “Saving lives begins with kindness.” The pair also tackle:

• Content creation advice for EMS agencies

• The challenges of tone and accuracy in short-form video

• How to maintain compassion in the face of a toxic work culture

This episode is part masterclass in communication, part call to action for the future of EMS — and all heart.

• “Saving lives begins with kindness. That is my motto, it is my philosophy.”

• “You have to package something down to its bare essence … there's some nuance lost, but you have seconds to keep people's attention.”

• “My goals going forward are to support people who are acting in good faith while correcting the misinformation.”

• “Generally speaking, you will draw the engagement that you're looking for. If you're putting out content in good faith, you'll get good faith engagement.”

• “We are responsible for ourselves and how we respond … and I believe we need to respond to everything that is happening in the world today with kindness.”

00:54 – Rob introduces Jimmy Apple, aka the EMS Avenger

01:20 – Jimmy’s background: from electrician to EMS

03:30 – The grandfather conversation that changed his life

04:50 – How pathophysiology sparked a love for learning

05:40 – Birth of the EMS Avenger: from student favorite to TikTok influencer

06:55 – Ginger Locke’s advice that redirected Jimmy’s podcast path

08:04 – Compressing content: "from textbook to bumper sticker"

10:00 – The content hook: “Are we getting rid of normal saline?”

11:00 – How Jimmy selects topics: research, news, curiosity and requests

13:00 – Hot topics in EMS: cricothyrotomy, TXA, ketamine, provider safety

14:40 – Rob discusses EMSIntel.org and ambulance theft data

16:00 – Can EMS agencies do what Jimmy does? The risks and the realities

18:30 – "Stop the finger": creating content that captures attention

20:00 – Rob on the risks of public messaging and backlash

21:00 – Calling out misinformation: the line between education and shame

23:00 – Jimmy’s growing reach across TikTok, Instagram and Facebook

24:45 – Managing Facebook’s deeper comments and nuanced conversations

26:45 – Jimmy’s rule: “Engage only with good faith”

27:50 – Final thought: EMS must rediscover kindness

29:00 – Closing remarks and where to follow Jimmy Apple online

• Connect with Jimmy Apple, better known as The EMS Avenger:

  • TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger

  • Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger

  • X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger

  • Facebook — Join the group for discussions and shared insights: EMS Avenger community

  • Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series

• AAA & AIMHI EMS Media Log: EMS Intel

Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Recorded live at the 2025 Kentucky EMS Leadership Academy, this episode explores the evolution, design and impact of the Leadership Academy on Kentucky’s rural EMS landscape. The discussion dives into the Academy’s origins, structure, statewide reach and its mission to prepare the next generation of EMS leaders in some of the most resource-challenged communities in the country.

From the realities of low-volume, underfunded rural services, to the inspiring stories of leadership growth and resilience, this episode offers a thoughtful examination of the challenges facing EMS in Kentucky and beyond. Rob reflects on leadership principles drawn from his military and EMS career, while Scott provides a blueprint for how to build and sustain EMS talent in small communities. Together with Amelia’s thoughtful moderation, this episode highlights how mentorship, structured learning and network-building are transforming rural EMS leadership — one cohort at a time.

• The Bridge Podcast (Contains additional discussion)

• Center of Excellence in Rural Health: Established to address health disparities in rural Kentucky

• Asking the big questions: Industry leaders weigh in on celebrating EMS Week amidst the forces shaping the EMS landscape

• Cultivating the next generation of EMS: Leadership development, emotional intelligence and the importance of mentorship

“We’re promoting people above their level of competency — not because they’re not good, but because we haven’t prepared them for what’s next.” — Rob Lawrence

“We saw early on that EMS professionals were great at clinical care, but we were missing the leadership piece.” — Scott Helle

“Effective communication is the core of good leadership. You can’t lead without it.” — Amelia Holliday

“My six principles: pride, integrity, learning, humor, service and courage. They guide everything I do.” — Rob Lawrence

“It costs money to build people. That’s why we provide this Academy at no cost to participants.” — Scott Helle

“It’s hard to run EMS in a state where many counties don’t even have a tax base to support it.” — Scott Helle

“You’re always leading. Once you start, it never stops. People are always watching and listening.” — Rob Lawrence

“We’re not just building leaders — we’re building mentors, networks and future change-makers.” — Scott Helle

“Nobody becomes a good leader because they want power. The best leaders are those who understand the responsibility.” — Amelia Holliday

00:18 – Introduction to the Kentucky Leadership Academy and crossover with The Bridge Podcast

02:29 – How the Academy was formed and why it was needed

05:00 – Structure of the Academy, application process and regional representation

08:11 – EMS 2050, developing next-gen leaders, and avoiding the Peter Principle

11:00 – The importance of non-clinical leadership education

13:36 – Funding challenges in rural EMS, tax base realities and sustainable operations

17:41 – Rural EMS dynamics, local politics and the true cost of readiness

21:25 – Hospital closures and extended transport times — national rural EMS challenges

24:11 – Leadership is constant: visible, energetic and principle-driven

28:14 – Rob’s military leadership values and the weight of being observed

32:35 – Leadership as service and the power of building trust within teams

34:58 – Rob’s group dynamics “icebreaker” exercise and lessons on leadership styles

39:33 – Mentorship benefits both ways: mentees gain confidence, mentors renew purpose

44:49 – Academy success stories and graduates becoming leaders elsewhere in EMS

46:44 – Closing comments and podcast wrap-up with Amelia and Rob

Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

| More: From 73 to 33 minutes: How Sacramento reinvented patient offload times 

The conversation ranges from her move from Boston to California and the regulatory culture shock that followed, to Lifeline’s recent CAAS accreditation push and the wider potential of AI-driven tools to boost recruitment, retention, compliance and patient safety.

In the second half, Rob and Danielle expanded the conversation from tools to leadership strategy, focusing on how EMS agencies can better support staff in high-pressure, multi-jurisdictional environments.

Thomas shares how her team tackled issues like protocol confusion, inconsistent policy knowledge and language barriers — not by adding more training sessions, but by rethinking how information is delivered, accessed and retained on the front lines. She emphasizes the importance of aligning education with the way today’s workforce learns, communicates and engages — especially during the critical first days of employment.

The episode closes with a preview of Danielle’s upcoming AAA conference presentation with Carly Strong, which challenges perceptions of gender in EMS leadership and spotlights the untapped potential of inclusive, thoughtful organizational development.

• “If you can, as the leader in an EMS organization, figure out how to enhance not only that first 80 hours, but that team member experience.” — Danielle Thomas

• “As everybody listening knows, I'm sure that every new policy probably has somebody's secret name attached to it because of what happened.” — Rob Lawrence

• “It honestly solves our recruitment and retention issues because they want to come to work.” — Danielle Thomas

• “I happen to believe that [AI is] an on-the-train or under at the moment kind of thing … we now have to move forward. It's part of our life. We have to embrace it and we have to employ it.” — Rob Lawrence

• “The left coast is more highly regulated and so I was not used to the labor laws in California and I was not used to the way that the local EMS authorities work.” — Danielle Thomas

• “I think every company I've worked at that that was a thing and so we had to create a solution to the problem we had, which was information overload.” — Danielle Thomas

• 01:25 – Welcome to Danielle Thomas

• 02:56 – East-to-West move and California’s regulatory maze

• 4:12 – Lifeline EMS footprint across Los Angeles, Orange and Riverside Counties

• 6:27 – The policy-overload dilemma in multi-county operations

• 10:01 – InCheck: turning 800 pages into actionable intel

• 14:53 – From AI skeptic to evangelist — programming county-specific protocols

• 18:30 – Five operating modes explained (Rampart, Angel, Nova, L-Chat Narrative)

• 28:00 – 100-language instant translation with Nova

• 34:51 – Building the tool in-house; cost and compliance advantages

• 38:43 – Preview of AAA Conference session, “Just one of the guys”

• 41:33 – Final takeaways: enhancing the first 80 hours and keeping crews engaged

• 42:44 – Closing remarks

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

First up is International Paramedic Day, taking place on July 8, 2025. Now in its third year, the day honors the contribution of paramedics across the world and draws its inspiration from the birthday of Dominique-Jean Larrey, the father of battlefield ambulance care. Lewis explains how the day has grown from 50 initial partners to over 150 global organizations, with this year’s theme being “Unity and community.” The day aims to raise awareness of the profession, share innovations and bring together the global paramedic community.

MORE | How community paramedicine is thriving in the UK: Dr. Linda Dykes and Rom Duckworth discuss trans-Atlantic lessons in emergency management

In the second half of the show, Lewis delves into the structure and significance of the College of Paramedics, which represents nearly half of the UK’s registered paramedics. He describes how the UK paramedic profession is regulated and protected by law, with a rigorous educational pathway that now includes the potential for prescribing paramedics and direct-to-primary-care tracks.

Rob and Lewis explore how paramedics in the UK are increasingly working beyond emergency ambulances — in GP surgeries, urgent care centers and academic roles. Their conversation offers a rich comparison point for U.S. EMS leaders seeking to elevate paramedicine through autonomy, education and broader clinical roles.

• “This is not a commercial platform — this is about us celebrating us.” — Lewis Andrews, on the ethos of International Paramedic Day

• “Let’s not reinvent the wheel, but let’s look at what the wheel is for the environment that it’s required to roll in.” — Lewis Andrews, on global EMS collaboration

• “The title ‘paramedic’ is protected by law in the UK — you can’t simply do a first aid course and call yourself one.” — Rob Lawrence

• “Autonomy — in a word — that’s what makes a prescribing paramedic.” — Lewis Andrews, on expanding paramedic roles

• “We’re also promoting the profession to those who don’t yet know they want to be in the profession.” — Lewis Andrews, on recruitment and professional identity

• “We have a career framework … that actually shows that you can develop from that day one newly qualified right through to a consultant paramedic, chief paramedic, director, professor.” — Lewis Andrews

00:55 – Introduction to International Paramedic Day (IPD) and its origins

02:17 – Why July 8 was chosen: Dominique-Jean Larrey’s birthday

03:02 – Growth of IPD from 50 to over 150 partners

05:06 – 2025 theme: “Unity and community” and sub-objectives

06:45 – How to participate: share stories, use hashtags (#UnityAndCommunity and #IPD2025), connect globally

08:58 – The global nature of IPD and U.S. partners’ involvement

11:25 – Promoting awareness and the importance of celebrating paramedics

12:50 – Part 2 — The role of the College of Paramedics

14:09 – Overview of College functions: CPD, representation, research, advocacy

18:15 – Registration with HCPC, protected title and the regulator’s role

21:12 – Paramedic education in the UK: degree pathways, demand and cost

23:46 – Discussion on streaming directly into primary care roles

27:09 – Career framework: from graduate paramedic to chief paramedic/professor

30:16 – Prescribing paramedics: autonomy and improved patient experience

33:08 – Recap and call to action: visit www.internationalparamedicsday.com

34:17 – Like, subscribe and engage

ADDITIONAL RESOURCES

• International Paramedics Day Resources

• UK College of Paramedics

• The standards of proficiency for paramedics

RATE & REVIEW

Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

First, the trio unpack the launch of the new PWW|AG/EMS|MC EMS Financial Index, a quarterly report leveraging billing and revenue cycle data from over 1,500 agencies nationwide. This unprecedented benchmarking tool allows EMS leaders to measure performance against regional and national trends, uncovering actionable insights into billing strategies, reimbursement rates, payer mixes and the economics of service delivery. It’s a critical step in helping agencies justify their value and improve their financial sustainability.

Next, the discussion turns to MedPAC — the Medicare Payment Advisory Commission — and its controversial response to cost data submitted by ambulance services under the CMS Ground Ambulance Data Collection System. Doug Wolfberg explains how MedPAC discarded over half of the data, labeling higher-cost services — often rural or government-run — as outliers. This move could justify lower or stagnant Medicare fee increases, potentially devastating many providers.

Finally, attention shifts to the “One Big Beautiful Bill” moving through Congress and now on its way to the Senate that would eliminate or severely restrict enhanced Medicaid funding mechanisms, such as supplemental payments and provider taxes. If passed, this legislation would reduce reimbursement for millions of transports, triggering funding crises across EMS systems — particularly in states like California and Illinois. The episode delivers a clear message: EMS leaders must prepare, advocate and act now.

00:41 – Rob introduces the three main topics: the PWW|AG/EMS|MC EMS Financial Index, MedPAC’s response to ambulance data and a major federal bill impacting Medicaid

01:59 – Part 1 — PWW|AG/EMS|MC Financial Index

03:37 – Matt explains that the index is built using data from over 1,500 EMS agencies via EMS|MC

05:43 – The importance of regional benchmarking

08:22 – First major finding: dramatic variation in ALS billing rates across regions

09:30 – Key insight: agencies that bill more tend to collect more revenue — agencies are encouraged to determine their true cost of service and align billing accordingly

12:37 – Collection percentage is debunked as a misleading metric; focus should be on dollars collected

15:36 – ALS vs. BLS billing levels explained, with a look ahead to Q2’s emergency-only data set

18:48 – How EMS agencies can better engage with insurers to cover non-transport and MIH services

20:46 – Part 2 — MedPAC

22:24 – Doug outlines how MedPAC discarded over half of the reported ambulance cost data

25:00 – Explanation of which data was discarded and why — primarily high-cost, rural and government-based services

28:22 – Doug asserts MedPAC is using cherry-picked data to suppress reimbursement increases

30:10 – Rob and Doug emphasize that EMS gave MedPAC quality input, but MedPAC is producing garbage output

32:08 – Doug outlines what MedPAC will do next and what EMS leaders must do in response

34:40 – Strong call to action: educate Congress, use real CMS data and don’t accept MedPAC’s narrative

36:59 – Doug emphasizes the importance of evidence-based deployment strategies for financial sustainability

37:31 – Part 3 — “One Big Beautiful Bill”

38:19 – Matt outlines how the bill would drastically limit Medicaid supplemental payments

39:43 – Federal/state Medicaid match rates explained with California as an example

42:51 – The looming reckoning: local governments may have to pay to maintain current EMS service levels

46:02 – Matt warns that the bill could trigger PAYGO cuts to Medicare as well

47:16 – Agencies are urged to plan now, talk to their communities and adjust operations

48:06 – Doug adds that pressure on U.S. senators, especially in red states, could still influence the bill

51:26 – Close and call to action

This episode underscores that EMS cannot remain reactive — leaders must proactively use data, engage legislators and educate their communities on the true cost of care. The EMS Financial Index, the MedPAC dismissal, and the pending bill all point to a critical need for informed, strategic advocacy.

Funded by the Infrastructure Investment and Jobs Act, SS4A aims to prevent roadway fatalities and enhance post-crash care. With $5 billion available nationwide and $900 million still on the table for FY25, this conversation is a call to action for EMS agencies across the country.

Chief MacCue shares the story of how his department, in collaboration with neighboring EMS and police agencies, secured $2.4 million in SS4A funding for a project focused on innovative vehicle alert systems, prehospital health information exchange and groundwork for whole blood deployment.

From demystifying the grant application to defining success metrics and compliance reporting, this episode breaks it all down — turning policy into practice, and complexity into impact.

Memorable quotes

• “I was pretty taken back by the statistic that 40% of these patients were alive when EMS arrived and later died. Those are patients that are talking to us that are no longer living after a crash.” — Robbie MacCue
• “This isn’t free money. It comes with reporting requirements, match funding and responsibility — but there’s help out there, and it’s absolutely worth it.” — Robbie MacCue
• “Our goal is to go upstream to the source of the problem. How do we stop the bleeding? How do we stop some of these accidents from actually happening?” — Robbie MacCue
• “We put a two-page narrative together that generated a $3,000,000 regional application … based on simple principles about statistics.” — Robbie MacCue
• “Post-crash care is definitely a missing element in the Safe System Approach … and EMS needs to be part of the solution, not just the response.” — Robbie MacCue
• “You don’t have to have all the solutions right away. You just have to have the initiative to get with other like-minded people.” — Robbie MacCue
• “This project isn’t just for crashes. It will also help us with high-utilizer patients and improve reimbursement accuracy by connecting data silos.” — Robbie MacCue
• “Somebody emailed me in the week to say that the EMS One-Stop podcast is the podcast that’s able to turn a very complex EMS topic into a car bumper sticker. So there you go. If we’re doing that and we can achieve that, then we’re getting somewhere.” — Rob Lawrence

• 00:00-02:00 – Intro to SS4A and the scale of available funding ($5B)
• 02:00-04:00 – Why post-crash care matters: 42% of patients alive at EMS arrival die later
• 04:00-07:00 – How Colonie EMS discovered and approached the SS4A opportunity
• 07:00-10:00 – Building a regional grant application and tripling the funding
• 10:00-13:30 – Overview of the proposed project – transponder tech, health information exchange and whole blood
• 13:30-17:00 – Specific technology being explored and integration challenges
• 17:00-20:00 – Working with MPOs, consultants and navigating acronyms
• 20:00-25:00 – Finding the 20% match, leveraging in-kind contributions and funding timelines
• 25:00-30:00 – Federal reporting requirements and budgeting with SF-424A
• 30:00-35:00 – The big goal: Closing the outcome data loop and EMS-hospital data sharing
• 35:00-40:00 – Measuring success, from whole blood to vehicle alerts
• 40:00-42:30 – Robbie’s final advice: “Don’t be intimidated — reach out and apply.”

ADDITIONAL RESOURCES

• SS4A Application Portal & Resources: Safe Streets and Roads for All (SS4A) Grant Program | US Department of Transportation
• NHTSA’s Office of Emergency Medical Services | EMS.gov
• Lexipol Grants Support
• Metropolitan Planning Organizations (MPOs) database

The conversation covers everything from how EMS Compact came to be, to the significance of national registry standards, disaster response logistics, interstate licensure, and even leadership lessons from Woodyard Jr.’s latest book project, “Leadership in action: The Wisdom and stories of EMS innovators”. Whether you're a field provider or policymaker, this episode is a must-listen for understanding how collaborative legislation can shape the future of EMS.

In the episode, Woodyard Jr. candidly addresses the ongoing debate in North Carolina over transitioning from a state-only EMS certification exam to exclusive use of the National Registry. Woodyard Jr., while respectful of North Carolina’s long-standing EMS tradition, emphasizes the importance of national consistency. He acknowledged that the proposed legislation needed amendments, particularly around grandfathering existing providers, but stood firm in his belief that a single, legally defensible national standard is essential for provider mobility and professional integrity. Drawing on real-world examples, Woodyard Jr. described how providers are often caught off guard when relocating — only to discover their credentials aren't accepted elsewhere. “Maintaining a state-only exam is harmful to individuals,” he said, calling for unified testing standards that support workforce movement and strengthens the profession nationwide.

Memorable quotes from Donnie Woodyard Jr

• “Every EMT and paramedic in the United States should go through a fingerprint background check. You know, babysitters have to do it. Teachers have to do it. EMS personnel absolutely should do it.”
• “Maintaining a state-only exam is harmful to individuals. It limits their mobility.”
• “When you waive that requirement for licensure, you actually are removing essential elements of public protection and accountability.”

Timeline

00:21 – Rob introduces the series on national EMS associations and welcomes Donnie Woodyard, Jr.

01:55 – Woodyard, Jr.shares his EMS journey from volunteer in Virginia to international disaster medicine and state leadership

03:41 – What is the EMS Compact and how does it work?

06:38 – Challenges of multistate EMS licensing pre-Compact

08:00 – Explaining the driver’s license analogy and compact accountability

11:17 – EMAC vs. EMS Compact for disaster response and liability concerns

15:31 – National Registry and grandfathering provisions

17:30 – Arkansas joins as the 25th compact state

18:56 – Model legislation and how states join the compact

21:22 – What REPLICA stands for and its legislative origin

22:20 – What California (and other non-compact states) should consider

24:33 – National Registry debate: North Carolina’s challenges and Woodyard, Jr.’s response

27:52 – Mobility, workforce attrition and job-sharing innovation

30:11 – The Commission and national EMS-coordinated database

35:17 – Final thoughts on fragmentation, collaboration and EMS unity

36:41 – Woodyard, Jr.’s leadership book, EMS charity support and Secretary Panetta’s forward

41:08 – Closing remarks and contact information

Additional resources

• Learn more about the EMS Compact
• “Leadership in action: The Wisdom and stories of EMS innovators”, by Donnie Woodyard Jr.
• “The future of emergency medical services: Artificial intelligence, technology & innovation”, by Donnie Woodyard Jr.

This annual report provides a powerful, real-world snapshot of national EMS trends — drawing on more than 14 million anonymized records to surface opportunities for clinical and operational improvement.

The conversation dives into key metrics that move beyond response times and into areas like pain management, opioid overdoses, airway confirmation, obstetric emergencies, whole blood use, pediatric behavioral health and high-utilization patient populations.

Throughout the episode, Drs. Myers and Crowe share the motivation behind each metric, explain how the data was gathered and analyzed, and reflect on how EMS agencies can use these insights to guide better care delivery and system design. From confronting equity in pain management, to pushing forward innovations like buprenorphine administration and whole blood programs, this is a compelling call to turn data into meaningful change.

Timeline

01:08 – Overview of the ESO EMS Index and its intent

02:59 – Origins of the report and data methodology

05:46 – Database scale: 14M+ records, 3,000+ agencies

07:14 – Metric 1: Pain management for long bone fractures

10:53 – Documentation, AI in EMS, and future documentation tools

14:30 – Metric 2: Suspected opioid overdose and buprenorphine use

18:51 – Best practices, COWS scoring, and naloxone delivery strategy

21:31 – Metric 3: Invasive airway confirmation using waveform capnography

28:06 – Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)

34:34 – Metric 5: Prehospital whole blood surveillance

40:22 – Metric 6: Pediatric behavioral health and substance use disorder cases

44:54 – Metric 7: High utilization patient group (HUG)

52:48 – Final thoughts, calls to action, and Rob’s reflections

55:47 – Episode wrap-up and subscription reminder

Despite the proven benefits of blood transfusion in the field, their research uncovers the alarming reality that less than 1% of eligible patients receive prehospital blood products. This conversation dives into the study’s methodology, key findings and the significant barriers EMS systems face in implementing blood transfusion protocols. The discussion also touches on the evolving role of EMS in trauma care, regional variations in blood product access, and the future of prehospital blood transfusion programs.

Dr. Carico and Dr. Levy break down their work and reflect on the data, explaining how the study used National Emergency Medical Services Information System (NEMSIS) data to identify trauma patients who would have benefited from blood transfusions.

The episode delves into the operational challenges EMS systems face in obtaining and administering blood products in the field, the financial and logistical obstacles, and the potential life-saving impact of more widespread adoption of these protocols.

Timeline

00:00 – Intro and welcome: Rob Lawrence introduces Dr. Matt Levy and Dr. Christine Carico, setting up the discussion on prehospital blood product use

03:00 – Study overview: Dr. Carico explains the methodology of the study, focusing on the use of NEMSIS data and the inclusion criteria for the patient population

07:00 – Key findings: Dr. Carico reveals the key findings of the paper, including the low percentage of eligible patients receiving prehospital blood products

11:00 – Barriers to implementation: Dr. Levy discusses the main barriers to the widespread implementation of blood transfusion protocols in the field, including access to blood, logistics and training

17:00 – Regional variations: The speakers touch on the regional disparities in blood product availability and the differences in protocols across the country

23:00 – Data challenges: Dr. Levy and Dr. Carico discuss the challenges related to data accuracy, particularly in terms of blood product documentation

27:00 – Cost and reimbursement: Dr. Levy addresses the financial aspects of blood product programs, including cost, reimbursement challenges and funding opportunities

32:00 – The future of blood transfusion in EMS: Dr. Levy envisions the future of prehospital blood transfusion programs, including the potential for shelf-stable blood products and regional blood supply systems

37:00 – Closing thoughts: Both guests offer their final thoughts on the importance of continued research and data collection, and the need for EMS to embrace a more integrated role in acute care

Additional whole blood resources

• Carico C, Annesi C, Clay Mann N, Levy MJ, et al. “Nationwide trends in prehospital blood product use after injury,” 2025. Transfusion – Wiley Online Library
• Tracking the whole blood landscape as updated guidelines allow EMS to carry and administer whole blood
• EMS One-Stop: Stop the bleed, fill the tank – The New Orleans EMS blood program
• Insider analysis: Delaware’s statewide whole blood rollout sets a new EMS standard
• Whole blood in EMS promises a revolution in resuscitation: How one county agency is saving lives with prehospital transfusions
• Matthew Levy | LinkedIn
• Christine Carico | LinkedIn

Loscar provides insights into disaster management and preparedness in a region where EMS operations are stretched across vast, remote territories. The conversation also touches on how to plan for the unexpected, especially in an environment with limited resources and harsh geographical challenges. This episode delves into the logistical challenges faced by EMS in the face of volcanic activity and offers critical lessons in disaster management.

TIMELINE

• 00:22 – Rob Lawrence welcomes Deputy Director Tracey Loscar and sets the stage for a discussion on disaster management in Alaska

• 02:10 – Loscar gives a brief overview of Mat-Su Borough and its proximity to Mount Spurr

• 04:01 –Loscar discusses her transition from Newark, New Jersey, to Mat-Su Borough and the challenges of EMS in rural Alaska

• 06:00 – Lawrence and Loscar discuss the vast distances and limited resources available in the region

• 08:01 – Loscar explains the preparations for the potential ash fallout from Mount Spur, including messaging to the community and respiratory protection

• 10:04 – The conversation shifts to the nature of volcanic ash and the practical challenges it presents to infrastructure, vehicles and personal health

• 14:36 – Loscar shares lessons learned from previous seismic events, such as the 2018 earthquake, and emphasizes the importance of clear communication during disasters

• 17:06 – Lawrence and Loscar discuss EMS liaison roles and the need for better coordination between dispatch, EDs and field teams

• 18:01 – Loscar talks about the current status of the Mount Spur eruption, with no immediate risk but preparations ongoing, and discusses how Alaskans stay calm and prepared in the face of frequent natural events, from earthquakes to volcanic eruptions

• 20:03 – Loscar highlights the importance of including pets in emergency plans, emphasizing the need for respiratory protection for animals

• 21:00 – The role of pantyhose in volcano preparedness

RATE AND REVIEW

Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Kuhlmann discusses the importance of understanding both internal and external customer service in EMS, emphasizing the need for a healthy organizational culture to ensure the best patient care. She reflects on the profound impact that first responders can have on individuals, drawing from her own experiences and personal tragedies to highlight the emotional resilience required in the profession.

Rob also speaks with Page Wolfberg & Wirth’s PWW/AG Principal Doug Wolfberg, long-time EMS lawyer and educator, about lessons learned from working in and around law enforcement during patient care. Wolfberg provides actionable insights into how EMS professionals can better collaborate with police officers, ensuring that patient care remains a priority while navigating complex, high-stress situations.

Together, Kuhlmann and Wolfberg offer invaluable perspectives on fostering better patient advocacy, maintaining professional integrity and refining EMS protocols to adapt to new challenges.

MEMORABLE QUOTES

• “How many careers, professions are there that, more often than not, you can make somebody's worst day their best?" — Catherine Kuhlmann

• "If you want to know what's going on in your hospital, ask housekeeping. Patients will not remember that you worked your butt off for 45 minutes to restart their heart … but they will remember that you tucked their feet in with a blanket underneath it." — Catherine Kuhlmann

• "You have to have a healthy department in order to continue to be healthy. And a lot of times when people think that they have problems with an individual and their agency, sometimes it’s not actually a problem with the individual, it’s with the agency." — Catherine Kuhlmann

• "We have a duty to the patient. We're not there to help the police. We're there to advocate and treat the patient." — Doug Wolfberg

• "EMS cannot subordinate judgement to law enforcement. If a police officer says give this guy some juice and put him to sleep, we first have to do an assessment and figure out if clinically that's the right thing." — Doug Wolfberg

ADDITIONAL RESOURCES

• ABC 360 and XI Conference is Page Wolfberg & Wirth Advisory Group’s all-day workshop for EMS leaders, chiefs, HR managers and compliance professionals.

• Vodcast: Lessons from the McClain case: Protecting first responders and improving EMS practices

• Balancing care and collaboration: Key lessons from EMS and law enforcement interactions

TIMELINE

00:37 – Catherine Kuhlmann introduces herself, detailing her extensive background in EMS, law enforcement, and as a justice of the peace. Rob then highlights the key themes of Kuhlmann’s keynote speech, which revolves around the importance of understanding the "why" in EMS.

02:16 – Kuhlmann discusses the importance of organizational culture in retaining quality personnel and how many individuals leave — not due to the work itself — but because of the agency's culture. Kuhlmann talks about the personal fulfillment that comes from EMS work, sharing a story about a young girl she saved who later became a doctor.

06:13 – Kuhlmann introduces the concept of "Murphy," a problematic employee in the agency, and suggests that sometimes these individuals may reflect a deeper organizational issue.

08:12 – Kuhlmann emphasizes the importance of communication, advising that EMS leaders should hold honest, one-on-one conversations with problematic staff before resorting to exit interviews.

12:04 – Kuhlmann reflects on the small gestures that have a lasting impact on patients, highlighting how seemingly minor acts of compassion can leave a lasting impression.

14:03 – Rob and Kuhlmann discuss the concept of bedside manner in EMS, stressing the importance of treating patients with dignity and respect. Kuhlmann closes with a powerful message about EMS professionals’ responsibility to treat others’ families with the same care and respect as they would their own.

21:06 – Rob Lawrence introduces Doug Wolfberg, who returns to discuss lessons on collaborating with law enforcement in EMS.

22:05 – Wolfberg explains the need for scenario-based training in chaotic environments to build muscle memory and advocate for patients.

23:11 – Wolfberg discusses the importance of EMS maintaining independent clinical judgment, even when law enforcement may request specific actions.

24:03 – Wolfberg stresses the need for clarity in determining whether a patient is in custody and how this affects EMS protocols.

25:06 – Wolfberg explains the importance of advocacy in EMS, particularly in law enforcement scenarios, and the significance of body camera footage for ensuring accountability.

27:13 – Wolfberg shares the potential consequences for EMS professionals who fail to act empathetically or professionally, especially when caught on body camera.

29:15 – Wolfberg speaks about the future of ABC 360, including their upcoming conferences and certifications.

Previously on EMS One-Stop

In this episode of the EMS One-Stop podcast, Dr. Dave Williams discusses an exciting new master's-level course designed for EMS and fire leaders, focused on advanced improvement science.

Along with Mike Taigman, Dr. Williams is leading this program, which aims to equip leaders with the tools and methods necessary to achieve results-driven improvement in their EMS systems. Over the course of 12 months, attendees will work on real-world projects, gaining the skills needed to make data-driven decisions and improve patient care outcomes within their organizations.

Dr. Williams also dives into the core concepts of improvement science, including understanding of variation and the importance of creating organizational systems that support sustainable improvements. He shares insights into the curriculum, the significance of benchmarking and how the course will help EMS leaders tackle systemic challenges by applying proven improvement methodologies. This conversation also touches on the future of EMS leadership and how innovation in data management, process design and leadership will shape the profession moving forward.

02:22 – Dr. Williams explains the background of the course, highlighting how it builds on improvement science to drive better results in EMS systems. He and Mike Taigman aim to teach EMS leaders to use data and evidence to improve patient care outcomes.

06:16 – Quality improvement: Dr. Williams discusses the gap in EMS leadership regarding quality improvement, emphasizing that quality needs to be integrated into the leadership team’s responsibilities, not treated as a separate function.

11:01 – Why data matters: The conversation shifts to the importance of data in EMS improvement efforts. Dr. Williams highlights how collecting and analyzing data helps organizations understand system performance and drive change.

15:43 – The fleet management example: Rob shares a fleet management story where data was used to improve vehicle downtime, highlighting the real-world impact of using improvement science to solve practical challenges.

19:29 – Project-based learning in the course: Dr. Williams elaborates on the project-based nature of the course, explaining how each participant will bring a real-world project that directly impacts their organization and use improvement science to solve it.

23:09 – Practical applications: Dr. Williams talks about how the course will blend online learning with in-person workshops, providing practical tools and methods that participants can apply to their projects throughout the year.

31:08 – Course logistics: Dr. Williams discusses course deadlines and important dates, including the application deadline of April 18, 2025; and the course's first workshop in September 2025.

54:05 – ROI and the course's value: Dr. Williams emphasizes the return on investment for attending the course, explaining that solving organizational problems through improvement science will ultimately save money and improve results for EMS services.

1:00 – Final thoughts: Rob and Dr. Williams close the conversation by reiterating the uniqueness of the course and its potential to reshape EMS leadership through the application of improvement science.

ADDITIONAL RESOURCES

• Next-level improvement science: New master-level course equips EMS and fire leaders with advanced improvement science skills

  • Course application deadline: April 18, 2025

  • Course start date: July 22, 2025

  • Workshop dates: September 2025; February 2026

• Mastering data and EMS performance metrics with Mike Taigman: Exploring how data informs change, improves clinical outcomes and drives leadership decisions

• Improve EMS quality with a model that works: The simple yet powerful Model for Improvement holds the key to making real changes to an EMS organization

00:00 – Introduction to Dr. Dan Patterson

Dr. Patterson’s background and how his clinical experience as a paramedic informs his research on EMS safety and sleep health

04:30 – The Impact of Shift Work and Fatigue on EMS Providers

Discussing the direct effects of fatigue on EMS professionals, including medical errors, cognitive performance and decision-making

10:00 – The Science of Sleep in EMS

Why sleep is critical for EMS personnel and the unique challenges they face in getting adequate rest during shift work

15:00 – Development of Safety Measurement Tools

Dr. Patterson explains the creation of safety tools to track fatigue, sleep health and workplace injury rates in EMS settings

20:30 – Experimental Studies and Interventions

Overview of studies testing novel approaches to mitigating fatigue, including practical solutions and interventions in EMS environments

25:00 – Creating a Safety Culture in EMS

The role of leadership and teamwork in reducing fatigue-related errors and fostering a culture of safety in EMS organizations

30:00 – Key Takeaways and How Agencies Can Implement Changes

Final thoughts on how EMS agencies can integrate Dr. Patterson's findings and create healthier, safer work environments for their teams

This discussion highlights key infectious diseases, including H5N1 (avian flu/bird flu), Mpox (previously known as monkeypox), Ebola, Marburg, Lassa fever and seasonal flu, providing EMS personnel with essential knowledge and safety protocols in light of ongoing global health concerns.

Throughout the episode, Dr. Isakov offers insights into the latest outbreaks, the importance of vaccinations, and strategies for responding to potential infectious disease threats. He stresses the necessity of remaining vigilant and prepared for high-consequence diseases while maintaining optimal patient care.

From the evolving threat of H5N1 to the resurgence of seasonal influenza, Dr. Isakov ensures that EMS professionals are equipped with the most relevant and up-to-date information needed to protect both themselves and their communities.

Summary of key infectious diseases covered by Dr. Isakov

H5N1 (avian influenza/bird flu): Dr. Isakov provides an update on the H5N1 outbreak in poultry and dairy herds, stressing the importance of limiting human exposure and watching for potential mutations that could lead to human-to-human transmission.

Mpox (Clade 1B): Dr. Isakov discusses the risk of Mpox, particularly Clade 1B, which remains prevalent in Central Africa but has now spread to other countries, including the United States. He highlights the importance of identifying travel history and unusual rashes, along with strict protective measures for EMS clinicians.

Ebola and Marburg: These diseases continue to present a risk, with smaller outbreaks currently ongoing in Uganda (Ebola) and Tanzania (Marburg). Dr. Isakov notes the importance of being prepared to identify and isolate individuals who may have been exposed during travel to these regions.

Lassa fever: Dr. Isakov points out the ongoing concern of Lassa fever in West Africa and emphasizes that EMS professionals should be on alert for symptoms in travelers who have visited affected regions.

Seasonal influenza: The seasonal flu outbreak is particularly severe this year, and Dr. Isakov underscores the importance of vaccination, especially for vulnerable populations, to reduce serious illness and hospital strain.

Timeline

00:00 – Introduction to the episode and guest, Dr. Alex Isakov

01:33 – Uupdate on Mpox (Clade 1B) and its global spread

05:24 – Ebola and Marburg outbreaks: ongoing concerns in Uganda and Tanzania

08:01 – Lassa Fever in West Africa and its impact on EMS professionals

13:05 – The importance of travel vaccinations for high-risk areas like malaria zones

15:13 – Mystery illness in the Democratic Republic of Congo and the investigation into its cause

17:01 – H5N1 and avian influenza concerns, including potential human transmission risks

22:02 – Severity of the current seasonal flu outbreak and vaccination recommendations

25:24 – EMS community's role in flu and measles vaccination advocacy

29:05 – Discussing surge conditions and excess mortality during pandemics

32:01 – Closing remarks, including updates on new NITEC EMS resources

Additional infectious disease resources

• National Emerging Special Pathogens Training & Education Center
• Emergency Medical Services (EMS) Featured Resources | NETEC
• Symptoms of Malaria | Malaria | CDC
• Lassa Fever Suspected in Death of U.S. Traveler Returning from West Africa | CDC Newsroom
• CDC A(H5N1) Bird Flu Response Update February 26, 2025 | Bird Flu | CDC
• Mpox | Mpox | CDC
• Healthcare Workers: Could it be Ebola?

Schmider details how Texas identified a 40% non-utilization rate among certified EMS professionals, successfully secured state funding, and launched an innovative recruitment and retention campaign. With over 10,915 new personnel added since 2019, this program serves as a model for other states struggling with EMS workforce shortages. This episode is full of actionable insights for EMS leaders, policymakers and recruiters alike.

• "We were seeing about 40% of our certified people — licensed paramedics, EMTs, advanced EMTs — were not using their skills on an ambulance."
• "We worked with our associations here in Texas, the Texas EMS Alliance and the Texas Ambulance Association. They went and met with some legislators, worked the room a bit, and we got $21 million of federal dollars through the state to us for 2 years to put in place a recruitment and retention program."
• "We pushed out 3,152 scholarships. An EMT scholarship was worth $2,000, an advanced EMT scholarship was $3,200 and a paramedic scholarship was $8,000. The money went directly to the education program, not to the student. They had 1 year to complete their training and then had to serve 96 hours a month on an ambulance — either as a paid or volunteer position — for 1 year at the EMT level and 2 years at the paramedic level."
• "We spent $1.5 million on an advertising campaign throughout the state of Texas. We hired a media company to develop commercials, billboards and social media campaigns. The use of social media was incredible — 50 million views over 2 years, which was an incredible number. We never expected that."
• "The second thing people do [when considering EMS careers] is they watch us as EMS professionals. Do I want to work with these people? Do I want to be a part of this? I once saw two EMTs standing on the back of an ambulance smoking a cigarette at an event. I went up to them and said, ‘Are you kidding? What message are we putting out when we do stuff like that?’ We have to think about our image."
• "People leave the EMS profession for two reasons: money or the way they’re treated. Depending on which survey you look at, it could be money first or treatment first, but it’s always those two reasons."

00:08 – Rob Lawrence introduces guest Joe Schmider, Texas EMS director

00:26 – The EMS staffing crisis and how COVID-19 accelerated workforce shortages

01:36 – How Texas used data to identify a 40% EMS non-utilization rate

02:51 – How Texas EMS leaders secured $21 million in funding

04:31 – Structuring EMS scholarships and training requirements

06:41 – The success of the recruitment campaign: 3,152 scholarships awarded

08:46 – How Texas reached 50 million views in its EMS recruitment campaign

11:16 – EMS workforce retention: The challenges of pay and treatment

13:46 – Addressing rural EMS shortages and workforce gaps

16:01 – How Texas EMS associations helped advocate for change

18:21 – The future of EMS funding and advocacy efforts

21:01 – Lessons from corporate retention strategies: What EMS can learn from HEB grocery stores

24:01 – The importance of EMS provider wellness: Texas’ Wellness Wednesday initiative

26:01 – Final takeaways: Lessons for other states and EMS leaders

28:01 – Closing thoughts and how to access Texas EMS resources

• Connect with Joe Schmider: joseph.schmider@dshs.texas.gov/512-484-5470

• Texas EMS Careers and Education

General Neller shares his perspective on leading under pressure, making critical decisions, and fostering an ethical and resilient organizational culture. With decades of military leadership experience, he provides actionable insights that apply not only to the armed forces but also to EMS, law enforcement, and fire and rescue personnel.

Throughout the episode, General Neller emphasizes the importance of training, adaptability and the role of leadership in guiding organizations through times of uncertainty. He highlights the significance of ethical leadership, followership and how leaders must take responsibility for failures while empowering their teams.

The discussion also explores the impact of emerging technologies, such as AI and body-worn cameras on public safety, and the crucial need for ongoing training despite staffing and funding challenges. This thought-provoking conversation delivers key takeaways for current and aspiring leaders across all branches of public safety.

• “Making decisions is part of your training — you’re expected to make them, and you have to do it in critical moments.”

• “If I could wave a magic wand, I’d put everyone at 110% staffing so they had the time to train properly.”

• “The leader’s job is to set the example — how you carry yourself, how you treat others, and how you communicate matters.”

• “Good leaders anticipate. They don’t just react — they look ahead and keep their teams informed.”

• “Followership isn’t blind obedience; it’s about understanding the mission, contributing ideas, and executing effectively.”

• “Accepting responsibility is a core tenet of leadership — when things go wrong, the leader must own it.”

• “Change is inevitable, and good leaders learn to embrace it while preparing their people for what’s ahead.”

• “Take care of yourself — physically, mentally and morally — because leadership starts with personal discipline.”

• “As a leader, you have to accept that sometimes you’ll make the right call, and things still won’t go your way — that’s part of the job.”

• “You have to train and rehearse because time spent on reconnaissance is seldom wasted.”

• “The worst thing you can hear as a leader is that ‘you don’t care’ — your people need to know that you do.”

• “To build culture and cohesion, you set the example — you take the physical fitness test, you wear the uniform properly, and you carry yourself the right way.”

• “Good leadership is not about the complete suppression of ideas — if you have time, get input, because someone might have a better idea than you.”

• “If you have good followers, being a leader is significantly easier — if you don’t, it’s a challenge every day.”

• “Change is inevitable — if you’re not evolving, you’re not making progress, and that’s a problem.”

Beggan and Pellow discuss the complex legal and systemic issues surrounding the incident, including communication breakdowns, inadequate training, and the challenges faced by EMS and fire personnel when operating in chaotic environments. They also address the broader implications for EMS professionals, highlighting the importance of proper documentation, the use of body-worn cameras, and the need for stronger inter-agency collaboration between police and EMS teams.

This interview provides invaluable insights into the case and the steps necessary to improve EMS practices moving forward.

Beggan and Pellow share their experiences navigating the criminal and civil aspects of the case, emphasizing the importance of understanding the limitations and constraints that EMS providers face in high-pressure situations. They also advocate policy changes, such as enhanced training, better resource allocation and the introduction of body-worn cameras to protect both first responders and the patients they serve.

Their passionate discussion sheds light on the need for reform within EMS, encouraging listeners to reflect on their own practices and consider how they can contribute to a safer and more effective emergency response system.

• "First responders are people who run towards difficulties and trauma when many run away, and to see somebody be charged in this situation and the fallout from it ... has become a very strong passion for myself and for Mike." — Shana Beggan

• "You take somebody – basically the bottom of an entire healthcare system – and say, let's blame this person, let's criminalize this. That is the wrong thing to do." — Mike Pellow

• "I think that we need to allow for honest conversations in a safe way, not a blame-the-finger approach." — Shana Beggan

• "We need to be better at helping first responders, not making them look over their shoulders and thinking, ‘Where am I going to get whacked in the back of the head if something goes wrong?’" — Mike Pellow

• "We perform the way we train, and here the training was poor. We condone or even promote what we fail to address." — Shana Beggan

1. Improve documentation practices. Ensure that EMS providers document not only their actions, but also their thought processes. This can help prevent misinterpretation of their actions in high-stress situations and provide valuable context in legal proceedings.

2. Advocate for body-worn cameras. Implement body-worn cameras for EMS teams to improve transparency, protect first responders, and provide better evidence for both patient care and legal purposes. However, ensure that funding for such programs comes from appropriate sources, rather than placing additional strain on already underfunded EMS budgets.

3. Enhance training and protocols. EMS and police departments should collaborate on joint training sessions, focusing on clear communication, proper patient handoffs, and how to handle complex situations, like excited delirium. Ensure that protocols are updated regularly and that training is implemented in real-world scenarios.

01:48 – Introduction: Rob Lawrence introduces the episode and guests Shana Beggan, Esq.; and Mike Pellow, Esq.

04:21 – Case background: Pellow provides a brief overview of the Elijah McClain case, the charges against the paramedics, and the current status of the case.

07:10 – Communication breakdowns: Beggan discusses the major issues surrounding communication between police and EMS, particularly the lack of information shared between the different teams at the scene.

10:35 – Documentation and reporting: Beggan and Pellow emphasize the importance of documentation in EMS, especially in legal situations, and discuss how inadequate reporting and the failure to document actions and decisions contributed to the case.

12:01 – Body-worn cameras: Pellow advocates for the use of body-worn cameras in EMS to provide better documentation and protect both patients and responders.

19:25 – Police and EMS collaboration: Beggan and Pellow discuss the importance of training police and EMS teams together to improve coordination and response.

28:00 – Legal implications and criminalization of EMS: Beggan and Pellow discuss the growing trend of criminalizing medical practice in EMS and the need to protect providers from unjust legal consequences.

46:11 – Support from fire leadership: Beggan shares the support from the Aurora fire chief, who highlighted systemic failures and underscored the importance of better training and protocols.

50:57 – Closing remarks: Rob thanks Beggan and Pellow for sharing their insights and the discussion closes with a focus on the need for systemic change within EMS and emergency response. 

Chief Salmeron provides a detailed account of the incident, the immediate EMS response, and the coordinated efforts with law enforcement and hospitals to manage the mass casualty incident.

The conversation also delves into the psychological impact on EMS personnel, the value of training and preparedness, and lessons learned from handling such a large-scale event.

Chief Salmeron emphasizes the importance of communication, mutual aid and the mental wellbeing of first responders, offering insights into how New Orleans EMS plans to support its teams in the long recovery process ahead.

• “You don’t teach that level of decision-making in EMT class. Telling a family member or police officer that you can’t help their loved one is one of the hardest things you’ll ever do.” — Chief Bill Salmeron
• “The recovery from an incident like this doesn’t take days or weeks – it takes years.” —Rob Lawrence
• “I told my team to go back to headquarters. I needed to put eyes on every single one of them and make sure they were OK.” — Chief Bill Salmeron
• “Situational awareness and incident command are critical. It’s about restoring order from chaos.” —Rob Lawrence
• “What we do is a unique calling. It’s critical to appreciate and take care of each other and ourselves.” — Chief Bill Salmeron
• “This episode is a masterclass for anyone planning for mass casualty incidents. Listen, learn and prepare.” —Rob Lawrence

00:21 – Introduction to the episode and overview of 2025’s challenging start, including the New Year’s Day tragedy in New Orleans 01:22 – Chief Salmeron describes the initial setup and EMS operations in the French Quarter 03:26 – Incident details: the truck’s path, immediate EMS response, and the scale of injuries 06:01 – Incident command and mutual aid coordination, including the deployment of 13 ambulances 09:43 – Managing hospital capacities and patient transport logistics during the MCI 15:11 – The discovery of explosive devices and the role of EMS in securing and retreating from the scene 23:01 – Post-incident response: staff debriefings, mental health support and lessons learned 33:31 – Preparing for future events like the Super Bowl and Mardi Gras under heightened security 41:06 – Five key takeaways for leading and managing mass casualty incidents 50:28 – Closing thoughts and appreciation for first responders’ dedication and resilience

Additional resources

• New Orleans EMS

Sunny shares her expertise on meteorological trends, the challenges of preparing for severe weather events, and the evolving role of EMS in managing climate-induced emergencies. From hurricanes and polar vortices, to the implications of electric vehicle adoption during extreme weather, this episode is packed with actionable insights for public safety leaders and EMS professionals.

Rob and Sunny explore the complex interplay between extreme weather and emergency response, emphasizing the importance of proactive planning and reliable information sources. Sunny delves into the science behind weather phenomena like atmospheric rivers, Rex blocks and heatwaves, connecting them to real-world challenges faced by first responders.

During this edition of EMS One-Stop discover the tools, resources and strategies Sunny recommends for staying ahead of severe weather impacts on both infrastructure and personnel, and gain practical advice for improving communication with the public during weather crises, ensuring safety and minimizing risk.

Key quotes from this episode

“The uneven heating of our planet is amplifying weather events, making them stronger and more unpredictable.” — Sunny Wescott

“The weather affects everything – and for EMS leaders, preparation isn't optional, it's essential.” — Rob Lawrence

“We’re seeing infrastructure pushed to its breaking point by weather extremes – things we couldn’t anticipate when they were built.” — Sunny Wescott

“Sometimes, the hardest command decision is telling your crews, ‘We’re hunkering down now.’ It’s the right call, but it’s never an easy one.” — Rob Lawrence

“Your life means so much more than the possessions inside your home. Evacuate early – it’s always the safest choice.” — Sunny Wescott

“Let’s face it: weather is as much a part of public safety planning as personnel and resources.” — Rob Lawrence

“Weather preparedness isn’t just about forecasts; it’s about collaboration, data sharing and breaking down silos across sectors.” — Sunny Wescott

Timeline

00:24 – Rob’s introduction and reflections on weather in the UK and US

01:22 – Sunny explains global weather patterns and their cascading impacts

03:32 – Sunny describes her role at DHS and how critical infrastructure is assessed against weather risks

11:13 – Hurricane trends, preparedness and landfall impacts for 2025

20:00 – EMS-specific challenges during extreme heat and cold, including effects on equipment and personnel

24:04 – How to interpret long-term weather forecasts and model reliability

30:06 – Operational decisions during extreme weather events, like grounding helicopters and using resources wisely

36:06 – Final thoughts on misinformation, insurance concerns, and public safety resilience

Additional resources

• EMS in a changing climate: Understanding the impact of extreme weather
• Snowfall Reports from past events
• Annual Lightning Report 2024 – Xweather
• NWS Probabilistic Precipitation Portal
• National Fire News | National Interagency Fire Center
• AirNow Fire and Smoke Map
• Incidents | CAL FIRE
• Evaporative Demand Drought Index (EDDI): NOAA Physical Sciences Laboratory
• Zoom Earth | Live Weather Map & Hurricane Tracker
• Nullschool Earth :: a global map of wind, weather, and ocean conditions
• National Weather Service

The discussion dives into the motivations, challenges and successes of implementing this technology. From its initial deployment on tactical medic teams in 2018, to its current broader rollout, Chris shares the journey of navigating legal frameworks, staff buy-in and operational logistics. The conversation also highlights how body-worn cameras enhance patient care documentation, bolster staff safety and provide an unbiased account of events, positioning them as an emerging industry standard.

This episode offers practical advice on policy development, procurement processes and operational use cases, including their application during Mardi Gras and high-acuity events. With the aim to demystify the implementation process, Chris emphasizes the importance of collaboration, adaptability and using technology to improve EMS practices. Rob and Chris also discuss future goals for the program, funding challenges, and the potential for body-worn cameras to become a cornerstone of EMS operations nationwide.

The report begins with the following robust Foreword: “NEMSQA is not satisfied with the state of airway management safety in EMS. As you will see, the data clearly shows that we can do much better across our industry! Partnering with experts and EMS agencies around the country, NEMSQA is leading the second national EMS Quality Improvement Partnership (EQuIP), the Airway Management Collaborative to put the new NEMSQA airway measures to work.”

“Enhancing airway management one measure at a time” is the sequel to the Lights and Siren Collaborative and will utilize the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The goal of the project is to support national improvement in the safety and effectiveness of invasive airway management by focusing on two goals:

1. Reducing the adverse events, such as peri-intubation hypoxia and hypotension
2. Improving the use of waveform capnography to confirm and monitor all invasive airways

Rob and Dr. Jarvis discuss the report and actions individuals and their agencies should take to improve their personal and organizational airway management and patient outcome results.

Find more EMS One-Stop episodes here!

This in-depth discussion explores the development and execution of the New Orleans EMS blood program, focusing on packed red blood cells (PRBC) and the challenges, successes and ongoing research surrounding cold blood administration in trauma and medical emergencies. New Orleans EMS is leading the charge in pushing the boundaries of pre-hospital blood, providing innovative solutions for penetrating trauma, GI bleeds and other critical cases.

Dransfield and Dr. Rayburn share the journey of New Orleans EMS in implementing the program, including their logistics, lessons learned and the vital impact of their interventions on patient outcomes.

The episode emphasizes the collaboration between EMS and trauma centers as well as blood suppliers to reduce mortality rates, while also tackling key questions, such as the supply chain, funding and future research.

Memorable quotes

"For every minute we delay blood administration, there's an 11% increase in mortality – this isn't just a theory; it's life and death." — Dr. David Rayburn

"We were topping the charts in the wrong categories – violence and stuff like that. So, our medics were frustrated with the old scoop and run. We're not just scooping and running anymore. We're providing definitive care." — Tom Dransfield

"We’re seeing no change in temperature for patients receiving two units of cold PRBCs in the pre-hospital environment, and that’s groundbreaking." — Dr. David Rayburn

"If we’re doing blood, we’re literally saving lives. But without reimbursement, it’s an uphill battle." — Rob Lawrence

"Our paramedics are pushing the envelope – it's no longer just about trauma; we’re now treating GI bleeds, OB cases and renal patients with blood administration." — Dr. David Rayburn

Find more episodes: https://www.ems1.com/ems-one-stop

Together they discuss the five activities for organization’s leaders to provide the structure to begin working on making quality their strategy.

These activities are centered on:

1. Purpose

2. Viewing the organization as a system

3. Obtaining information

4. Planning to improve

5. Managing improvement efforts

These five activities form a system for the leaders of an organization to focus their learning, planning and actions.

• "Leadership's job is to build systems where staff can be rock stars and bring their best selves every day." — Dr. Dave Williams

• "Understanding your purpose as an EMS agency, like being responsible for cardiac arrest survival, is essential in improving performance." — Dr. Jon Studnek

• "Our secret weapon in improvement is the Plan-Do-Study-Act (PDSA) cycle, where we learn fast by making low-risk, small-scale changes." — Dr. Dave Williams

• "These five activities are the key elements that leaders should be engaging with to drive their organizations forward." — Dr. Jon Studnek

01:14 – Dr. Dave Williams shares his background in quality improvement and EMS

02:12 – Dr. Jon Studnek introduces himself and talks about his journey in EMS leadership

03:56 – Dr. Williams discusses his book, “Quality as an Organizational Strategy” and its origins, and outlines the five core activities of quality as an organizational strategy

15:02 – Dr. Studnek describes implementing the quality framework in EMS, using cardiac arrest survival as a real-world example

23:36 – Rob and Dr. Studnek discuss interconnectedness in EMS systems and fleet maintenance

30:00 – Dr. Williams explains how small-scale changes using the PDSA cycle help improve EMS operations

35:00 – Final thoughts from Dr. Studnek on leadership and quality as a guide for day-to-day work

Together, they discuss two key publications – “Joint Position Statement on EMS Performance Measures Beyond Response Times” by Kupas and Zavadsky, et al., and the White Paper from the National EMS Quality Alliance in Collaboration with FirstWatch, titled, “Taking the Pulse of your System – Performance Measurement for Improvement.”

Lawrence and Taigman explore how data informs change, improves clinical outcomes and drives leadership decisions. Whether you’re a seasoned leader or new to the field, this conversation provides essential insights into how EMS organizations can better utilize data to elevate their services.

Rob and Matt discuss the statement in detail, examining all of the recommended metrics, the reasons for placing them in the paper and why response times are not recommended as a primary measure of system performance.

Rob and Matt begin by discussing the signatories of the statement – in particular, the sign off from the International City/County Managers Association (ICMA) and the pivotal role they play in ensuring EMS delivery in their communities.

The many associations that joined the statement recommend that communities and governments modernize EMS performance assessments by evaluating various domains with key performance indicators (KPIs). These KPIs should be measured, tracked over time, benchmarked against similar EMS systems or national data and regularly published for local community stakeholders.

Rob begins by discussing his real-life experience with an H5N1 outbreak in the UK as an ambulance service leader, and Dr. Isakov discusses the current H5N1 emergence in the U.S.

The discussion covers the current U.S. H5N1 outbreak, bird and swine flus, and the spillover from bird to mammal populations. They also address three recent U.S. cases of H5N1 among agricultural workers. They go on to discuss signs and symptoms of H5N1, index of suspicion, the Hierarchy of Controls in infectious diseases, universal and standard precautions, and fit testing respirators. They also cover resources available at NETEC.

Dr. Isakov concludes with a roundup of other global issues, including viral hemorrhagic fever (VHF), Ebola, Marburg and smallpox.

The Jack Stout EMS Fellowship, endowed by FirstWatch, aims to empower emerging EMS leaders by equipping them with the knowledge and skills necessary to guide EMS systems effectively in the future. Developed by FirstWatch in cooperation with the Fitch EMS Foundation, the Fellowship underscores the commitment to leadership development and community service. Named in honor of Jack Stout, a pioneer in high-performance EMS systems, the Fellowship teaches principles such as people-centered leadership, data-driven decision-making, improvement science and systems thinking.

As the chosen Fellow, Meeks will attend the 2024 Pinnacle EMS Leadership Forum, participate in either the Fitch Ambulance Service Manager or Communication Center Manager program, and benefit from a customized mentorship led by Mike Taigman, renowned for his contributions to EMS quality improvement. This comprehensive program not only honors Jack Stout’s legacy but also ensures that his visionary principles continue to shape the future of EMS.

Additional resources

• IHI Framework for Improving Joy in Work | Institute for Healthcare Improvement

• The Jack Stout EMS Fellowship, endowed by FirstWatch

• Pinnacle EMS leadership conference

The Cape Fear MIH Team is composed of four community paramedics, one social worker and a peer support specialist. The team focusses in particular on overdoses/request for substance use treatment, suicide related calls – ideation/attempts as well as youth calls related to mental health and substance use, and also EMS referrals and associated case management.

Fayetteville is home to Fort Liberty and Pope Army Air Base, and is the sixth most populous city in North Carolina with a high number of uninsured and underinsured patients. Fifteen percent of Cumberland County’s population is military-affiliated and it is the third busiest EMS system in North Carolina. Cumberland’s affiliated ED, CFVMC Emergency Department, had 90,595 visits in 2021 for adults, and 30% of those (27,300) were for behavioral-health related issues, creating the need for a Behavioral Health service line employing community paramedics.

In addition to discussing their mobile integrated healthcare system, Grovdahl also shares about the North Carlina whole blood programs and their progress.

Rob spent time with several conference faculty.

• EMS lawyer Matt Streger joins Rob to discuss just culture, HR issue spotting, leadership communication and employee engagement.

• Kevin Collopy joins Rob to discuss the outstanding prehospital training being delivered to medics in Ukraine and also discusses this years “Stand and Deliver” new speaker event (a now annual event held as EMS World Expo).

• Rob discusses whole blood and its national rollout with Dr. Randall Schaeffer and David Grovdahl.

• To close, Peter Dworsky of the National EMS Safety Conference provides an overview of the current top EMS industry safety themes.

Enjoying the show? Email editor@ems1.com to send in guest suggestions, episode feedback or questions for our host. 

In this episode of the EMS One-Stop podcast, host Rob Lawrence welcomes back Matt Zavadsky to discuss the latest development in the move to fund treatment in place and the recent disclosure from CMS about the potential savings to Medicare identified in the analysis of the limited ET3 program.

Matt discusses the potential legislative moves regarding EMS funding, highlighting bipartisan support and urging listeners to engage with elected officials to support bills benefiting EMS.

The conversation underscores the need for sustained advocacy efforts and highlights the level of interest shown by key policymakers.

Rob and Matt also discuss the recent developments in the City of Fort Worth and the decision to absorb MedStar into the Fort Worth Fire Department, emphasizing the need to ensure equitable treatment for EMS personnel transitioning to new roles.

“We can officially say that the net savings to Medicare after they pay EMS and after they pay the tertiary provider telemedicine, whatever it is, is still $550 to $570 per enrolled ET3 participant. And when you do the math, that's a billion dollars or more of savings to the Medicare program, which now CBO can use to evaluate the benefit, economically of doing a treat, no transport, treatment-in-place model. So it's big news.” — Matt Zavadsky

“Nobody benefits from a knock-down, drag-out fight. But as you indicated, there are now people in the community and people across the country that are saying why and what does this mean? We don't have all those answers, but again, it's the decision from the folks who are elected to represent the community and if that's what they want to do, that's great. Our role is to try and do as much as we can to maintain a transition into a new provider system that keeps those core tenants – the high performance, high value mobile, integrated healthcare, flexible deployment. All those things that have really made the system a world class EMS system, even though it might say something different on the side of the ambulance and the employees might be wearing a different uniform.” — Matt Zavadsky

“It's going to be a long transition – 12 to 18 months, and it's not just branding and rebranding, it's really infusing the culture of a group of people who are used to doing 7-10 calls in 12 hours and used to having things operate with a certain cadence that's going to be totally different when they start a different type of organization.” — Matt Zavadsky

00:00 – Introduction

02:15 – ET3/TIP: Challenging CMS outcome data

03:15 – Cost savings per intervention

04:00 – CMS data showing net savings to Medicare

04:30 – Congressional Budget Office score based on savings

06:00 – Net savings of a billion dollars or more

07:00 – Applying this new information for the good and benefit of the industry

09:00 – Congress is, is what Congress does

10:40 – Meeting with Congress to push TIP

14:30 – Fort Worth and the PWW Advisory Group

14:50 – Fort Worth economies and level of service

17:30 – Matt Zavadsky to join the PWW Advisory Group

19:15 – The staffing issues as Med star staff transit to the FD fire department

21:00 – Ensuring the staff is protected

25:00 – Call to action-how we communicate all value to elected officials

26:00 – Final Thoughts

About our guest

Matt Zavadsky is the former chief transformation Officer at MedStar Mobile Healthcare, formerly the exclusive emergency and non-emergency public utility model EMS system for Fort Worth and 14 other cities in North Texas.

Coming to MedStar in 2008 as the operations director, Matt made significant changes to the EMS delivery model, and in 2010, successfully eliminated the need for the tax subsidy that MedStar had been operating on since its inception in 1986. He has helped guide the development and implementation of numerous innovative programs with healthcare partners that have transformed MedStar fully as a Mobile Integrated Healthcare (MIH) provider, including high utilizer, CHF readmission reduction, observational admission reduction, hospice revocation avoidance, 911 nurse triage programs and partnerships with home health agencies. He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation,” published by Jones and Bartlett Publishing.

He has 42 years’ experience in EMS and holds a master’s degree in Health Service Administration with a graduate certificate in Healthcare Data Management. Matt is a frequent speaker at national conferences and has consulted on numerous EMS issues, specializing in high-performance EMS operations, finance, mobile integrated healthcare, public/media relations, public policy, transformative economic strategies and EMS research.

Dr. Racht, chief medical officer of Global Medical Response; and Zavadsky, chief transformation officer for the Metropolitan Area EMS Authority (MedStar Mobile Healthcare) discuss the evidence and the key issues they conveyed to the committee.

Dr. Racht's testimony included:

• The significant advancements made in emergency medicine over the past decades, leading to reduced mortality and disability rates for patients.

• The importance of updating Medicare reimbursement rates for ambulance services, which have not been revised for over 20 years.

• Advocating for wholesale reform of Medicare's coverage of emergency medical services to align with contemporary practices, such as covering treatment in place and transportation to alternative healthcare sites.

Matt Zavadsky's testimony included:

• The impact of CMS payment policies on EMS, which incentivize unnecessary transportation of patients to the emergency room.

• Innovative programs initiated by EMS agencies to prevent unnecessary 911 calls and navigate patients to appropriate care settings.

• Legislative changes required to provide EMS with flexibility in patient navigation, including treatment in place and transport to alternate destinations.

• The challenges faced by ambulance services nationwide, especially in rural areas, exacerbated by the COVID-19 pandemic.

“We are the front of the frontline in medicine.” — Dr. Ed Racht

"Our coordinated and integrated EMS and healthcare system now gives gravely injured patients ... the opportunity for rapid surgical intervention and a chance at full recovery." — Dr. Ed Racht

"Emergency healthcare professionals pride ourselves on our ability to dramatically decrease morbidity and mortality from unexpected and sudden illness and injury." — Dr. Ed Racht

"CMS payment policy is such that we are incentivized to transport every 911 patient to the ER because that is the only time we get paid." — Matt Zavadsky

"Ambulance services are a vital component of our local and national healthcare and emergency response systems." — Matt Zavadsky

"Innovative EMS agencies ... have initiated patient-centric programs designed to prevent 911 calls and navigate patients to the most appropriate care setting." — Matt Zavadsky

"Ambulance services across the nation, especially in rural areas, are facing unprecedented challenges." — Matt Zavadsky

0:05 – Introduction

0:55 – Guest introduction

1:40 – Explaining the Ways and Means Committee

2:30 – We are being noticed!

3:40 – Preparing for a congressional hearing

5:40 – The impact of having a congressional hearing in an EMS location

5:58 – The genuine interest of the committee members

9:00 – Dr. Ed Racht testimony to the Congressional Ways and Means Committee

14:24 – Matt Zavadsky testimony to the Congressional Ways and Means Committee

20:52 – Dr. Racht and Zavadsky’s reactions to the evidence they gave and the feedback

29:00 – Zavadsky’s key points he wished to reinforce during his evidence session

31:45 – Balanced billing, patient protections and removing the patient from the middle of the process

32:50 – Independent Dispute Resolution (IDR) and its challenges.

38:29 – Questions for Secretary Becerra on Capitol Hill

44:00 – Final thoughts

45:00 – A call to action to become one and present a united front “When we unify, we are unstoppable.”

48:00 – You the listener are the great politician

“Honorable but Broken: EMS in Crisis” is a documentary film exploring the world of EMTs and paramedics, the collapse of the EMS system, and what needs to be done to save it. Narrated by six-time Golden Globe and two-time Primetime Emmy award winning actress, Sarah Jessica Parker, “Honorable but Broken” raises awareness of the systemic collapse of EMS and advocates for change.

In this episode of the EMS One-Stop podcast, host Rob Lawrence chats with producer Bryony Gilbey about the documentary that is now completed and available for streaming. Gilbey hopes the impactful, hard-hitting documentary will serve as a briefing and education tool for our elected officials and members of the general public.

As Gilbey notes, “It’s no good any longer just throwing up your hands and saying that’s just the way EMS is; it’s no good saying it’s someone else’s problem; it’s something we all need to work on, as a civilized society we need to address this issue and we need to do it quickly.”

The 60-minute documentary is now available on demand, streamed by Prodigy EMS and it is hoped that it will be used at local, state and national levels to bring attention to the issues we are facing.

Top quotes from this episode

• “I expected to tell a story; I did not think that it would have quite this reaction” — Bryony Gilbey
• “We now all have not many degrees of separation to somebody who has had some sort of PTSD, who has had to leave the job because of the pressures of work and dare I say ultimately taken their lives and that is incredibly sad.” — Rob Lawrence
• “It all comes down to three words – all in favor – if we don’t get the vote, we don’t get the money, we don’t get the change.” — Rob Lawrence

Episode contents

00:48 – Documentary teaser

01:18 – Introduction/Bryony Gilbey

02:16 – The “Honorable but Broken” back story

05:46 – How did Gilbey view EMS and its issues

08:15 – The finished product and how can we view it

10:24 – A federal screening on Capitol Hill

11:30 – Reaction from elected officials

13:16 – John Mondello/emotional trauma

14:00 – Eileen Mondello – John’s mother

15:25 – Reaction to Eileen Mondello – “It never gets easier’

17:00 – He wasn’t the first, he isn’t the only and sadly he won’t be the last

22:00 – Other featured speakers in the documentary and their powerful messages

22:30 – Recruitment, retention and retirement

24:35 – What is the cost of a human life to a politician?

26:25 – Educating the legislators and the public

28:00 – The cost of readiness

29:05 – Reimbursement doesn’t add up

31:00 – The hospital side of things – Beckers Review on Hospital closures and adding to ambulance and hospital deserts

31:30 – Call to action and the legislative agenda

35:30 – Sarah Jessica Parker

39:00 – How and where to view via Prodigy EMS

39:50 – Final thoughts

About our guest

With a prolific career spanning several decades, Bryony Gilbey is a seasoned director, producer and freelance writer/editor, distinguished for crafting compelling narratives across various media platforms. As the director/producer for the impactful EMS documentary, “Honorable but Broken: EMS in Crisis,” Gilbey has showcased an unparalleled ability to guide projects from inception to completion.

Gilbey previously worked with the Nexstar Media Group, Inc. as a freelance writer/editor. Here, she demonstrated versatility by producing feature pieces on health and lifestyle topics for Tribune Publishing and contributing to BestReviews.com.

Gilbey also served as an associate producer at Mary Murphy & Co. from 2005 to 2012. During this period, she played a pivotal role in the production of the PBS American Masters documentary "Hey Boo," centered around Harper Lee. In the early 2000s, Bryony worked as a Producer/AP at ABC News Productions, where she produced documentaries on medical breakthroughs in neonatal care for Discovery Health.

The foundation of Bryony’s career was laid during her time as an associate producer at “60 Minutes,” CBS News, from 1995 to 2000. Working closely with producers and correspondents, she contributed to the creation of original news stories.

Throughout her extensive and diverse career, Bryony Gilbey has consistently demonstrated a passion for storytelling, a keen journalistic instinct, and an unwavering commitment to delivering content that informs and resonates with audiences worldwide.

Resources

• “Honorable but Broken: EMS in Crisis”
• NAEMT's Advocacy program
• AAA’s Advocacy program

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Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

The American Ambulance Association and the Academy of Mobile Healthcare Integration (AIMHI) collect, collate, categorize and share weekly EMS-based news stories widely with many national organizations and associations, including NHTSA, USFA and NAEMT.

The information contained in the news tracker allows officials and EMS leaders to brief and educate journalists and elected officials, as well as the public as to the current plight of EMS. EMS is delivered on a local level and those experiencing issues with their service can believe it is just them suffering funding shortages, staffing challenges, hospital delays or general poor performance. The tracker can be used to demonstrate that the issues are occurring on a wider regional, state, national and, in some cases, international level.

In this episode of the EMS One-Stop podcast, host Rob Lawrence, who also heads up the AAA-AIMHI news collation effort, welcomes fellow news collator, Rodney Dyche of Patient Care EMS; and AIMHI Education Committee Chair, Matt Zavadsky, chief transformation officer at MedStar Mobile Healthcare. Rob, Rodney and Matt examine EMS news and current trends, and discuss how these themes can be used to inform, influence and educate.

Top quotes from this episode

• “There's a perverse ‘incentive’ about response time … if you have the target of 8:59, you arrive on time and the patient dies; that's a success. If you arrive in 9:01 and the patient lives; that's a failure. That's absolute garbage” — Rob Lawrence
• “There was a quote from Dr. Clawson in a news story that was done in Minneapolis, and I love his quote. He says, ‘there is no evidence that using red lights and sirens have saved more lives than they've taken.’” — Matt Zavadsky
• “Every week in this great country, an ambulance is stolen either from hospital or from scene – that's avoidable.” — Rob Lawrence
• “Stop being timid. Stop licking your wounds. Get out in your community, talk to your elected officials. Talk to your city managers or county administrators – very factually, not emotionally. There will be time for emotions, but give them the facts and let them know what it's gonna take to resuscitate their EMS delivery system.” — Matt Zavadsky

Episode contents

00:23 – Guest introduction

02:06 – AAA/AIMHI News Tracker and story categories

04:22 – A resource to brief the press and elected officials

04:30 – Operational challenges across many states

05:50 – Massive sign-on bonuses – robbing Peter to pay Paul

06:30 – Staffing and funding issues

08:40 – Communities/local governing bodies facing the fact that they are running out of money, and their EMS isn’t free

09:40 – Transitioning from a volunteer to a paid system

11:00 – Explaining EMS economics to your elected officials

11:50 – Has anyone died? Bring data

13:30 – EMS systems closing

15:30 – “Elected officials get nervous deciding to allocate funding to a service that they haven't had to fund or haven't, haven't had to fund to this certain level in the past.”

18:40 – Response time

19:25 – Increase in low acuity calls

20:30 – Service design

22:50 – Single- versus double-paramedic crewed trucks

25:04 – MEDIC Charlotte – Taking bold steps within categories of response

27:00 – The rate of ambulance crashes across the county at intersections

27:47 – If you are not the ambulance driver … who is?

29:49 – There is no evidence that using red lights and siren have saved more lives than they've taken!

30:30 – Stolen ambulances

32:59 – Supply chain and vehicle availability

34:00 – Rurality and ambulance deserts

35:00 – Violence against providers

37:00 – Responding to patients in crisis/agitated patients

38:00 – How to use the media log in your locality to good effect

40:00 – Final thoughts

About our guests

Matt Zavadsky is the chief transformation officer at MedStar Mobile Healthcare, the exclusive emergency and non-emergency public utility model EMS system for Fort Worth and 14 other cities in North Texas that provides service to 436 square miles and more than 1 million residents and responds to over 170,000 calls a year with a fleet of 65 ambulances. MedStar is a high performance, high value EMS system, providing advanced clinical care with high economic efficiency.

Zavadsky is also immediate past president of the National Association of EMTs, and chairs their EMS Economics Committee. He is an appointed committee member to the Joint Commission’s Home Care Professional and Technical Advisory Committee (PTAC), and the Lewin Group’s Hospital Outpatient Quality Reporting (HOQR) Program Stroke and AMI Expert Work Group developing metrics for use in value-based purchasing measures for emergency departments. He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation.”

Rodney Dyche is director of compliance and responsible for risk management with PatentCare EMS Solutions. PatientCare EMS Solutions is a multistate EMS solution, and additionally provides a hybrid online training program and owns a remount facility. As a teenager, Dyche began his EMS career in rural Missouri. He has had multiple system experiences in addition to rural EMS, including MAST (Kansas City, Missouri), REMSA (Reno, Nevada) and Mercy (Las Vegas). In 2010, he became an internal consultant to Paramedics Plus until its sale in 2018. During that time, he led several high-level projects, to include the timely transition of the purchase of Paramedics Plus. Rodney resides in East Texas and in his spare time is a licensed HAM radio operator, and enjoys fishing, off-roading and reading.

Resources

• AAA-AIMHI news collation tracker
• Analysis of Ground Ambulance Crash Data from 2012 to 2018

The American Ambulance Association recently held its annual AAA Stars of Life event in Washington, D.C. The American Ambulance Association’s Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession.

While in Washington, EMS One-Stop Host Rob Lawrence interviewed AAA President Randy Strozyk, on the aims and objectives of the stars program and the 2023 Legislator of the Year. Rob also spoke with AAA Medical Director Dr. Gerad Troutman, who is AAA’s first medical director. Finally, Rob chats with AAA Immediate Past President, Shawn Baird, on the Federal Balanced Billing legislation and the role that AAA and others are playing in protecting both the patient and EMS agencies.

Top quotes from this episode

“Every provider is out to make a difference, but to actually be recognized for it, which you don’t often get the opportunity to have, makes it that much more of an honor to be selected for something like this” — Paramedic Erica Brockman

“AAA stars and hundreds of thousands of people like you are the beginning of the healing process. When somebody is hurt, somebody is wounded, somebody is scared, it is the EMT that first touches that patient and then begins to transport into the healthcare system when the rest of the healthcare system can then kick in to what it does, but it would not start unless it begins with you.” — Senator Bill Cassidy

“Think about when Covid hit, at 0200 in the morning, we were the ones that came, we were the ones that had to deal with a whole new level of challenges, not only Covid, but we had to deal with the fact that people didn’t want to go to the hospital, so we were providing levels of care, interfacing, making sure that people had connections. I see that as a bright future to how EMS will progress in the next decade” — AAA President Rany Strozyk

“I’m really passionate about patients called 911 looking for solutions to a problem and that solution is not always an ambulance to take them to an emergency department, so we try to impact their care differently, especially lower acuity patients, because we now have all the technology and tools to treat them in place with our paramedics or EMTs on site of even treating them utilizing a navigation program from the 911 system, the PSAP and maybe get them to an urgent care or virtual care doctor, where they can be cared for right in their home. Patients love it and the best thing is it really puts the ‘E’ back in EMS and allows us to save those emergent resources that need those most.” — Dr. Gerad Troutman, AAA medical director

“We will be coming back to Congress with a recommendation that ground ambulance not be rolled into the No Surprises Act. That (if we were included) would be devastating to access for care.” — Shawn Baird, immediate past president, AAA

Episode contents

00:21 – Opening: Erica Brockman

01:02 – Introduction: Rob Lawrence

01:36 – Randy Strozyk, president, American Ambulance Association

05:12 – Key areas of legislation for 2023/24

08:07 – Presentation of Legislator of the Year: Senator Bill Cassidy

11:00 – Dr. Gerad Troutman, AAA medical director

17:00 – Federal Balanced Billing Committee: Shawn Baird

18:35 – Summary and close

Additional resources

 The full bios for all of the AAA Class of 2023 Stars of Life can be found here.

Listen to next: Alexia Jobson, Dr. Peter Antevy, Brian Maloney, Doug Wolfberg and more join the EMS One-Stop podcast to discuss takeaways from the show

About our guests

Randy Strozyk brings to his leadership of the American Ambulance Association more than 34 years of experience in EMS operations and management. He has been part of the American Medical Response leadership team for 16 years, and currently serves as the company’s executive vice president of operations.

Strozyk earned his EMT/paramedic certification and worked on an ambulance while studying microbiology at Washington State University. He later earned an MBA from California State University. He has been heavily involved in the American Ambulance Association for nearly two decades and is the current president of the organization.

Gerad Troutman, MD, MBA, FACEP, FAEMS, is the national medical director for innovative practices at Global Medical Response. He is an assistant professor of Emergency Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas, and serves as a mentor to the Texas Tech Innovations Hub. He is a past president of the Texas College of Emergency Physicians and currently serves on the Governor’s EMS & Trauma Advisory Council of Texas.

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

On October 7, 2023, the Palestinian group Hamas launched a surprise attack on Israel at dawn during the Jewish holiday of Simchat Torah – with armed assailants breaching security barriers and a barrage of rockets fired from Gaza. The attack came 50 years and a day after Egyptian and Syrian forces launched an assault during the Jewish holiday of Yom Kippur in an effort to retrieve territory Israel had taken during a brief conflict in 1967.

As the world has seen, terrorists entered Israel. Militants burst into houses, shooting residents begging for their lives and taking others – including women, children and the elderly – hostage, driving the terrified captives back into Gaza.

Operating as part of the initial and ongoing response to the events unfolding in Israel is United Hatzalah, a network of more than 6,500 EMS volunteers, with a fleet of emergency medical vehicles, who in peacetime, are able to respond to more than 2,000 medical emergencies per day in an average response time of less than 3 minutes (and in major cities, often less than 90 seconds). Since October 7, United Hatzalah has been pushed to its absolute limits and has expended the majority of its disposable medical equipment.

In this special edition of EMS One-Stop, Rob Lawrence speaks with Dov Maisel, United Hatzalah’s Vice President of Operations.

Donate to support United Hatzalah’s EMS response: United Hatzalah – Israel is at War | The Chesed Fund

TOP QUOTES FROM THIS EPISODE

“We are a multi-faith organization, but we are an organization of human beings. What we've underwent here in the past week has nothing to do with human beings. This is barbaric. This is something that I've never witnessed. And I've been through terror waves here in my 30 years of EMS. I've seen buses blown up. I've seen suicide bombers in dozens. Nothing on this scale. This is something that Isis did, we all remember watching the videos of what ISIS did, years ago. This overcomes all of that.” — Dov Maisel

“I would say that the amount of tourniquets that we put out in the first 36 hours was in the thousands ... thousands of tourniquets. We treated over 3,000 victims on the ground. The amount of tourniquets, bandages, chest seals, trachs, chest drains, needle applications, tubes that were put out in this first 36, 48 hours of operation is more than what we use, I would say in half a year.” — Dov Maisel

“Our ground rule is in EMS, you don't enter a danger zone, but the volunteers getting on the radios with me, I was in HQ when it started, before I headed actually down to the field – they’re calling and screaming for help … the IDF soldiers that started the defense process were understaffed and they had no capabilities to rescue the victims out from the scene. And our volunteers simply, I told them, ‘it's up to you. Literally, it's up to you;’ and they all went in.” — Dov Maisel

“There were so many, just try to wrap your thoughts around having 3, 4, 5, 10 gunshot wound patients thrown at you – at one or two medics with one ambulance. You can't pile them up one on top of another. You had volunteers going with their private cars, throw them in the backseats, literally with tourniquets on them. Imagine – tourniquets on all extremities, all extremities, needle in their chest, chest seals – thrown in the back seats of cars driven out two, three kilometers out to the ambulance crews that were waiting there that can treat them.” — Dov Maisel

ABOUT OUR GUEST

With 30 years of experience, Dov Maisel has dedicated his life to saving the lives of others. When Dov was just 9 years old, he was walking home from school when he witnessed a horrific accident in which a 6-year-old girl was hit by a bus. He decided he never wanted to be helpless when someone in his vicinity so desperately needed lifesaving treatment. By the age of 14, he began volunteering on an ambulance. Maisel has served as a combat paramedic in the Israeli Defense Forces (IDF) in four different wars. After his army service, he began working as an EMT, dispatcher and driver for Israel’s national ambulance service. During the 2000-2003 terror wave in Israel, Maisel personally responded to and managed EMS teams at thousands of terror attacks.

Maisel is the inventor and developer of numerous medical devices, including a pocket BVM airway management device, which is used internationally in many armies, including the U.S. Military. In 2006, he was one of the founders of United Hatzalah, Israel’s first all-volunteer EMS organization. He serves as the director of operations, managing national and international operations along with the Israeli police, IDF and Ministry of Health as well as other government bodies. He invented what is now United Hatzalah’s Uber-like GPS-based dispatch system which locates and sends the EMT closest to the medical emergency. Maisel graduated from several NATO- and Red Cross-led international workshops on disaster management and led international relief missions in Haiti, Nepal, Mumbai and, most recently, in both Houston and Florida, after the devasting hurricanes, as the head of international operations of United Hatzalah.

He continues to serve as a volunteer, instructor and mass casualty incident manager. He has received the Israel President’s Award for volunteerism and sits on the International Editorial Board of JEMS Magazine.

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Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

This edition of EMS One-Stop was recorded in New Orleans at the 2023 EMS World Expo.  Host Rob Lawrence is joined by a range of guests who discuss the sessions they presented and the latest developments in clinical medicine.

Alexia Jobson, director of public relations at REMSA, discusses top tips for dealing with the media, and she then interviews media pre-con student Katherine Robillard. 

Peter Antevy, MD, describes his conference session, titled “Five protocol changes you're too afraid to make.”

Brian Maloney of Plum EMS, in Pennsylvania, talks culture of safety, and lights and sirens reduction (and their results within the NEMSQA L&S reduction program).

Doug Wolfberg, Esq., of Page, Wolfberg & Wirth, steps in to discuss leadership lessons from the Beatles and his new book – "Beatles FAB but True."

The episode concludes with veteran EMS podcasters Chris and Anne Monterra, who offer tips on the art of podcasting.

TOP QUOTES FROM THIS EPISODE

“‘No comment is a comment!’ So you really want to avoid that as part of your media strategy and work to develop some transparent and honest information when those tough questions come.” — Alexia Jobson

“Anything that you say to a reporter is considered on the record and can be used in a news story.” — Alexia Jobson

“Top tips for going on camera: You want to make sure that they are knowledgeable about what they are going to be talking about, you want them to be a willing participant and able to re-frame and be positive about the content they are going to cover.” — Alexia Jobson

“It's important for you to just spend a little time looking inside your organization, recognize those important stories that you want to share, and then make sure that you commit some time and resources to building those relationships with your audiences ... having that positive relationship in place will go a long way. And it's also important as a profession that we work together to kind of raise the profile of out of hospital healthcare and EMS.” — Alexia Jobson

“Getting out the door, our shoot time is the No. 1 thing that can decrease our response times. It's not driving lights and sirens; it's not driving recklessly or speeding or not obeying the laws ... it's getting out that door quick from the time of dispatch to the time our truck's pulling out of the garage.” — Brian Maloney

“When we first started looking at the use of lights and sirens during transport to the hospital, which is right there, that increases our chance of getting in a wreck threefold and so it's very dangerous. When we first started it, we were at 26% of the time using lights and sirens during transport; we're down to almost 2%, for transport to the hospital. For response to calls, we were about 46-48% of the time using lights and sirens; we’re down to 7% of the time now.” — Brian Maloney

“Antibiotics for sepsis, so a lot of people are fearful of giving antibiotics, and why? Because the hospital says we need to have a culture, a blood culture. Turns out that's not true. If the patient's hypotensive, they're fixing to die, as they say. And we in Palm Beach County can give the antibiotics within 12 minutes of the 911 call. And our own data shows that the hospital is giving antibiotics at 120 minutes. That's a 10-fold difference in that. So, antibiotics for sepsis are, I think, a major item.” — Dr. Peter Antevy

“There's a story about how the Beatles had a drummer for a couple of years before Ringo. He wasn't quite the right fit for that band. He's a good drummer. But when they got Ringo in, they took off, right? So, in EMS, we tend to think if somebody has a pulse and a patch, let's hire them or let's bring them in. But we need the right people.” — Doug Wolfberg

“Recognize your own limitations, I tell a story about how the Beatles sort of came on hard times when their manager died, but weren't quite wise enough to know what they didn't know. They thought ‘we can manage ourselves,’ and so it’s to also recognize your limitations and get the skills that you need, if you don't possess them yourself, with your team.” — Doug Wolfberg

EPISODE CONTENTS

01:15 – Media management with Alexia Jobson (REMSA)

09:22 – Alexia Jobson interviews Katherine Robillard (LA Office of EMS)

11:37 – Brian Maloney (Plum EMS) talks culture of safety and lights and sirens reduction

20:15 – Dr. Peter Antevy on the five protocol changes you're too afraid to make

23:54 – Doug Wolfberg Esq. (Page, Wolfberg & Wirth) on leadership lessons from the Beatles

28:13 – Chris and Anne Monterra on the art of podcasting

ABOUT OUR GUESTS

Alexia Jobson REMSA

Alexia Bratiotis Jobson is the director of public relations and serves the organization by expanding opportunities for engagement, promotion, communication and relationship-building. She has more than two decades of business and communications experience. Prior to joining REMSA Health, Alexia worked as a senior account director with KPS3, where she managed REMSA’s client account, as well as accounts related to industrial real estate and higher education. She held communications-related positions with Renown Health and the Nevada Museum of Art. She holds an Accreditation in Public Relations (APR). This certification asserts professional competence, high ethical standards and mastery of progressive public relations industry practices. She is a Nationally Registered Emergency Medical Technician and is a graduate of the University of Nevada, Reno’s Reynold’s School of Journalism. She serves as the immediate past president of the board of directors for Western Industrial Nevada (WIN), Chair of the Public Relations Committee of AIMHI and chair of the American Ambulance Association Communications Committee.

Dr. Peter Antevy

Peter M. Antevy, MD. is a pediatric emergency medicine (EM) physician practicing in-hospital emergency medical care at Joe DiMaggio Children’s Hospital, a level I trauma and tertiary care center in South Florida. Board-certified in pediatrics, emergency medicine and the complex subspecialty of EMS, he is also the founder and chief medical officer of Handtevy – Pediatric Emergency Standards, Inc.; and he serves as the medical director for Davie Fire-Rescue, Coral Springs-Parkland Fire Rescue, Southwest Ranches Fire Rescue and United Medical Transport, all in South Florida. Dr. Antevy also serves as associate medical director for several other agencies, including Palm Beach County, Florida, and he is also the longstanding medical director for two highly regarded paramedic training programs as well as several mobile integrated healthcare (MIHC) programs in greater Broward County, Florida.

Brian Maloney

Brian Maloney has been working in EMS for over 24 years as a practitioner, educator and leader. His EMS career began while attending the University of Pittsburgh, where he obtained his paramedic certification and bachelor’s degree in emergency medicine. Later, he continued his education and achieved his Master of Science degree from Carlow University. He has spent most of his career working in the field and had the opportunity to teach with the Center for Emergency Medicine and the University of Pittsburgh. Currently, he is the director of operations of Plum EMS, where he has been for the past 5 years. His love and appreciation for the EMS profession run deep, and he continuously strives to help make it that much better.

Doug Wolfberg, Esq.

Doug Wolfberg has been a well-known national EMS leader for decades. He is an EMS attorney and consultant, and a founding partner of Page, Wolfberg & Wirth. He has served as an EMS practitioner and has held positions at the county, regional, statewide and federal levels in his EMS career prior to becoming an attorney. He has written hundreds of articles and has been one of the most highly rated presenters at EMS conferences throughout the U.S. He earned his law degree magna cum laude from Widener University School of Law and holds an undergraduate degree from Penn State University. Doug also serves as an adjunct professor of law at Commonwealth Law School and as an adjunct professor at the University of Pittsburgh.

Chris Montera

Christopher Montera has more than 34 years of experience in paramedic services, public health, and the fire service. He is the director of State and Federal Programs for ESO and the former chief executive officer at Eagle County Health Service District and holds a master’s degree in health leadership. Chris is serving as the National EMS Museum Treasurer for 2023.

Anne Montera

Anne Montera received a master’s degree in health leadership from Western Governors University and a BSN from Bethel College. She has over 20 years of nursing experience in public health, labor and delivery, patient safety/quality improvement, and EMS coordination in urban and rural hospitals and community settings, including the use of telemedicine. In her previous role as the senior VP of quality for Ready Responders, she worked to research, develop and implement quality matrix to demonstrate program cost savings and health impact. She was also the executive director for the Central Mountains RETAC, supporting a 6-county EMS and trauma region in Colorado. She is the co-creator and public health partner for the first National Community Paramedic Pilot Program in rural Eagle, Colorado. She received the State of Colorado EMS Region of the year in 2019 and Colorado Nightingale Luminary Award for Innovation work on the Colorado community paramedic program in 2011.

ADDITIONAL RESOURCES

Team-driven improvement in the use of lights and sirens – Plum EMS use cases demonstrate when the risk of using L&S is lower than the risk of delaying a lifesaving intervention

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Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

In August 2020, Shawky S. Amine Eddine, MD, became the EMS commander for the Beirut Port Explosion – the largest non-nuclear explosion in history. The blast killed 200, injured 6,500, and resulted in excess of 300,000 people suffering home damages and losses.

In terms of medical facilities in the blast area, four hospitals we rendered totally out of action, with eight further healthcare centers damaged.

The explosion added to an already pressurized healthcare system, as the country was at the height of the pandemic, as well as hosting over 900,000 refugees from war-torn Syria.

In this episode of EMS One-Stop, Dr. Eddine joins host Rob Lawrence to discuss the backstory and devastation of the explosion, as well as the challenges to access, hospital capacity, communication, record keeping and the management of the dead.

Tune in as Dr. Eddine shares 10 takeaways and lessons for responding to a large-scale MCI both identified from that eventful day (discussed in full in the broadcast):

1. Don’t fish in the same lake
2. Factor emotions
3. Leadership tokens are earned in management and spent in command
4. Even in crisis … plan
5. The importance of data
6. Decision making
7. You are not alone – coordinate and communicate
8. Rescuers’ wellbeing is a priority
9. Don’t forget yourself and don’t lose yourself amidst the crisis
10. We make mistakes

About our guest

Dr. Shawky Amine Eddine, MD, is a medical doctor with special interest in prehospital care, healthcare quality management and disaster management. He has served as an EMT in the Lebanese Red Cross (LRC) since 2007 and as head of station for Damour EMS Station, and is currently acting as LRC director for learning and development, assistant EMS director for training and quality, and COVID-19 response coordinator.

Dr. Amine Eddine has commanded multiple crises including Lebanon fires in 2019, Lebanon floods in 2019, protests in 2019-2020, COVID-19 outbreak in 2020 and the Beirut port explosion in 2020. He has led the real-time evaluations of COIVD-19 response. Dr. Amine Eddine is also a disaster management instructor in the Humanitarian Leadership Diploma, offered by Global Health Institute at AUB, an assistant professor at the Faculty of Nursing of the Lebanese Red Cross and a consultant for multiple local, regional and global NGOs.

Connect with Dr. Amine Eddine:

• Twitter: @SAmineeddine
• LinkedIn

EPISODE CONTENTS

1:00 – Introduction Shawky S. Amine Eddine, MD

1:30 – Description of EMS in Lebanon

04:43 – The role of Jerry Overton in the development of EMS in Lebanon

06:18 – Setting the 2020 scene in Lebanon.

09:00 – Ammonium Nitrate – a bomb in the warehouse

12:00 – Gathering the situation: The fog of war!

14:00 – Loss of medical infrastructure due to the blast

17:00 – EMS resources deployed

18:00 – Command and control: The UK GOLD, SILVER and BRONZE system

23:00 – Lessons identified versus lessons learned

23:50 – Don’t fish in the same lake

28:00 – Factor emotions

30:00 – Leadership tokens are earned in management and spent in command

33:00 – Even in crisis … plan

37:00 – The importance of data

40:00 – Decision making

41:40 – You are not alone: Coordinate and communicate

43:00 – Rescuers’ wellbeing is a priority

45:30 – Don’t forget yourself and don’t lose yourself amidst the crisis

48:00 – I make mistakes

Additional resources

• Rapid Response: Beirut blast serves as stark reminder of the power of energetic materials
• Beirut and beyond: Planning for explosives in your community
• Forensic review: The Beirut port explosion
• UN Report: Beirut blast

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

It’s very clear that Ryan Reynolds and Rob McElhenney have raised the profile of the country of Wales with their “Welcome to Wrexham” football (soccer) team and series, but one Welsh organization – the Welsh Ambulance Service NHS trust – has a vision and world class level of service delivery that should receive equal attention. In this audio and video edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Professor Jason Killens, Chief Executive of the Welsh Ambulance Service. 

As the 999 emergency system that serves over 3 million Welsh citizens emerges into a post-pandemic world, Jason describes service delivery, the training and education of its medics and the fact that it is a about to operate without a medical director – in itself a move that identifies that clinical and academic paramedicine has come of age.  As Jason tells Rob, “We are transforming the way we deliver our service here in Wales, looking to tip the service model on its head essentially. Instead of responding to the majority of 999 calls we receive every day, we want to flip that so we only go to those patients who really, really need a double staffed paramedic emergency ambulance quickly … car crashes, broken legs, falls from height, cardiac arrest; and the rest we would service by the means of telephone or video advice, upstream with clinicians in our contact center or with advanced practice clinicians in the community.”

TOP QUOTES FROM THIS EPISODE

When a patient calls 999, “you could see a traditional road ambulance, but increasingly here in Wales and in other services across the UK, you could see a disposal which includes telephone or video triage and advice from our clinicians in our contact centers – they could be either nurses or paramedics … and we are closing now here in Wales about 15% of all of our emergency calls every day by way of telephone or video consultation without turning a wheel or sending an ambulance” — Jason Killens

“If we do respond to the scene, it could be a traditional ambulance or increasingly it could be what we call an advanced paramedic practitioner, so that is an experienced paramedic, who has a degree, who has gone on to masters/education – those advanced paramedic practitioners with a master’s degree, increasingly we are seeing a non-conveyance rate some 35-40% higher than a regular paramedic crew, so what that means is we are able to safely close episodes of care in the community and not respond with a double staffed ambulance/not convey the patient to the emergency department.” — Jason Killens

“Fire Brigades and Departments in the UK aren’t associated with medical response – It is the exception in the UK rather than the rule.” — Rob Lawrence

“We are not transport organizations anymore, we do transport, but increasingly, we are providers of great clinical care in our communities … but we are looking to stretch and grow so we provide better outcomes for all patients here in Wales, and only convey them to the emergency department when we really need to and we think the solution to that is advance practice in communities with our own people.” — Jason Killens

“We have just agreed with our board that when our medical director retires at the end of this year, we will not replace him. We will be the first ambulance service in the UK not to have a medical director on the governance board. Instead, here, we will have our senior clinician leadership provided by our executive director of paramedicine and we are the first ambulance service in the UK to have that role on the board. And we have taken that point of view simply because the paramedic profession has developed over the last two decades, to the point now where we believe we have sufficiently experienced senior clinicians in the paramedic workforce that are able to provide that senior level governance leadership, and direction for our clinical strategy. It is an important signal and message to our paramedic workforce that the glass ceiling is broken and paramedics to join us at 21/22 years old from university can absolutely see a pathway through to senior leadership, to a director on the board, and ultimately to jobs like mine as a paramedic if that’s what they aspire to.” — Jason Killens

EPISODE CONTENTS

1:10 –  Introduction of Professor Jason Killens

3:30 – Recruiting Australian paramedics to work in London

4:30 – Explaining EMS organization and control in England, Scotland, Northern Ireland and Wales

8:30 – In the UK, healthcare is free at the point of delivery

11:30 – Geographical distribution of ambulance services in Wales

12:38 – The provision of helicopter emergency medical services (which are mostly charity based, relying on donations to operate)

14:30 – What happens when a citizen calls 999 – how call taking and response is organized

15:30 – Hear and treat and advanced paramedic practitioners

21:10 – The journey of continuous service improvement

23:00 – Paramedic degree and advanced degree education, and career pathways

27:49 – Co-responding agencies including police, fire, the military and citizen responders

29:59 – Future plans for the Welsh Ambulance Service

31:00 – Senior clinical leadership provided by paramedics and not a medical director

34:00 – Fantastic people doing fantastic stuff

ABOUT OUR GUEST

Professor Jason Killens has spent his career working in Ambulance Services in the UK and Australia. He progressed through the ranks in London Ambulance Service from an EMT to executive director of operations. He was appointed as the chief executive of the South Australia Ambulance Service in 2015 before joining the Welsh Ambulance Service as chief executive in September, 2018.

He is an honorary professor at Swansea University’s College of Human and Health Sciences, and the chief executive lead for operations at the Association of Ambulance Chief Executives.

About Welsh Ambulance Services NHS Trust

Welsh Ambulance Services NHS Trust (WAST) provides healthcare services for people across Wales, delivering high quality and patient-led clinical care, wherever and whenever needed

Services include:

• The blue light emergency ambulance services: including call taking, remote clinical consultation, see-and-treat, and, if necessary, conveyance to an appropriate hospital or alternative treating facility.
• Non-emergency patient transport service: taking patients to and from hospital appointments, and transferring them between hospitals and treatment facilities.
• The 111 service: a free-to-call service which incorporates the NHSDW service and the call taking and first stage clinical triage for the out-of-hours GP service. The number was live throughout 2021/22 and the full service was rolled out in Betsi Cadwaladr, Cardiff and Vale University Health Boards in 2021/22, making the complete service universally available across Wales.
• WAST also supports community first responders, co-responders and uniformed responders to provide additional resources to respond to those most in need of help.
• During the pandemic, WAST provided the mobile PCR testing service for the whole of Wales.

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In this EMS One-Stop international edition, Host Rob Lawrence welcomes Dr. Linda Dykes, an emergency medicine physician from the UK, and Rom Duckworth, fire captain and paramedic EMS coordinator for Ridgefield (CT) Fire Department.

The discussion begins with the demise of the U.S. ET3 program, and then the group examine how community paramedicine is thriving in the UK and the lessons to be taken away.

Rob and Linda also discuss the EMS World Expo “International Roundup” session they have jointly delivered together for the last 7 years and how they extract best practices from all international attendees. Rob, Rom and Linda then discuss the similarities and differences in emergency management tactics, techniques and procedures, and identify trans-Atlantic lessons already being exchanged.

About our guests

Dr. Linda Dykes

Dr. Linda Dykes qualified from Newcastle (UK) Medical School in 1996, trained in the northeast and Mersey regions, and is one of only a handful of doctors in the UK who are dual-qualified in both Emergency Medicine & Primary Care/General Practice. Even fewer remain active in both specialties, and she is believed to be the only dual-qualified EM/GP in the UK who has also gained experience working in acute community geriatrics, in a "Hospital at Home" service. Linda also spent 2 years working regular shifts in Ambulance Control, and has dabbled in the development of telephone algorithms via a short secondment to NHS111 Cymru/Wales.

Equipped with this unique skillset – plus a track record of successfully building up services – Linda sees the NHS through a unique lens, and loves to work at bridging the gap between hospital and community services.

Rom Duckworth

Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private emergency medical services. Rom is currently a career fire captain and paramedic EMS coordinator for Ridgefield (CT) Fire Department, the founder and director of the New England Center for Rescue and Emergency Medicine; and is the recipient of the American Red Cross Hero award, Sepsis Alliance Sepsis Hero award, and the JEMS EMS 10 Innovators award.

As the author of chapters in more than a dozen EMS, fire, rescue and medical textbooks, as well as over 100 published articles in firefighting and EMS magazines and websites, Rom is working to advance leadership in modern emergency services education.

Learn more

Rob, Linda and Rom will also be delivering an international seminar: “Major Incidents & Disasters – an International Masterclass” on Saturday August 5.  

For most emergency services personnel, major incidents are a rare event – maybe a handful at most in a career; maybe none. Few will become experts from personal experience alone, so learning from events that have gone before is crucial to preparedness at national, organizational and individual levels.

This unique webinar brings you five world-class speakers, each of whom has operational, tactical and/or strategic experience (and some of them all of the above!) of major incidents from the UK, U.S., and Lebanon. Between them, they have responded to incidents ranging from boots on the ground at 9/11, to coordinating the pandemic response for an entire country, and everything in between … bus crashes, train derailments, gas explosions, bioterrorism, forest fires, floods, and hurricanes.

This is an event where theory, research and first-hand experiences come together. Our speakers will share not only what they’ve learned from their personal experiences, but what they wish they’d known beforehand and what crucial points they now find themselves passing to others.

This webinar is aimed at those who may have to plan for, and/or respond to, major incidents. As well as the obvious emergency service personnel, think also of hospital staff outside ED, council workers, undertakers, utility companies, coroners’ teams and many more. The event is also open to the general public, and promises to be a fascinating and absorbing morning.

Ambulances for Ukraine lead Chris Manson returns to provide an update on the program that is now not only sending ambulances, but also fire trucks and SUVs to Ukraine. To date. U.S. Ambulances for Ukraine has delivered 38 ambulances and 6 fire trucks to Ukraine. A further 12 ambulances, 2 fire engines and several SUVs are to be shipped in July.

Host Rob Lawrence and Chris recap the program so far and the tasks that the donated vehicles are be put to in country. Sadly, some of the ambulances donated earlier in the year have been destroyed due to hostile action. Chris issues a further call to action for donating ambulances, fire trucks and SUVs. Ukraine has now moved from defensive to offensive operations, and every vehicle is needed. As Chris describes, “If anyone gives me an ambulance, a fire engine or an SUV, I will get that vehicle into the fight.”

In the video edition of this episode of EMS One-Stop, Chris has provided photos of the vehicles on their way to Ukraine as well as images and video of the vehicles in action and the brave crews on the front lines that operate them.

 TOP QUOTES FROM THIS EPISODE

“The reality is the Russians in this conflict are targeting first responders, and it is one of the things they like to do. They will shell an area, cause havoc in an area with some sort of military strike, and then they will wait until the first responders respond, and when they do, they will target them.”

“Like any firefighter in any city department, what’s the first thing you want to do when a kid wanders around the fire truck? You want to sit them in the seat or put the helmet on right? So we put the first kid in, got them out, put the second kid in, I turned around and 20 kids are lined up. I went through those 20 kids and the 20 turned into 100, it felt like the entire town came out.”

“I feel fairly confident now, that several of those vehicles have been destroyed.”

“If anyone gives me an ambulance, a fire engine or an SUV, I will get that vehicle into the fight.”

EPISODE CONTENTS

0:30 – Rob intro

01:17 – Introduction Chris Manson

01:38 – U.S. Ambulances for Ukraine backstory

04:53 – Why would we give serviceable ambulances to Ukraine if we still have a shortage in the U.S.?

06:38 – Current stats of vehicles donated

07:30 – The logistics of shipping a vehicle to Ukraine

10:34 – The road drive from Germany and through Poland

11:21 – Tracking ambulances – a big no-no!

12:40 – Distribution of vehicles in Ukraine

14:36 – The moment Chris arrives to hand over a vehicle down range

16:50 – Vehicles in military units liveried into camouflage paint

19:00 – The need for fire trucks and SUV/patrol vehicles

22:01 – Call to action – we need ambulances, fire trucks and SUVs – now!

24:00 – Where the fire trucks are deployed

25:15 – The Ukrainians can fix anything (so it doesn’t matter if the donated vehicle has a few faults)

27:55 – Final thoughts

ADDITIONAL RESOURCES ON THIS TOPIC

ABOUT OUR GUEST

Chris Manson is the vice president of government relations for OSF HealthCare, a 15-hospital health system operating out of Peoria, Ill. He is a former firefighter from California and he served in the U.S. Marine Corps Reserves.

CONNECT WITH OUR GUEST

U.S. Ambulances for Ukraine @ambulancesU 

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this EMS One-Stop/Inside EMS crossover podcast, Chris Cebollero teams up with Rob Lawrence to report on the 2023 American Ambulance Association Annual Conference from the MGM Grand, in Las Vegas. Rob and Chris discuss their own personal highlights and Rob’s leadership session, delivered with Acadian Ambulance President, Justin Back.

Rob and Chris are joined by Page, Wolfberg & Wirth Founding Partner, Steve Wirth, Esq., and discuss bias, the topic of Steve’s conference session.  Rob then interviews AAA keynote speaker, Anna Liotta, together with Royal Ambulance President Steve Grau, as they discuss:

• Generational codes in the workforce
• The revolving door of employment
• Creating the milestones of forward progression
• Understanding that your people are you primary customer

TOP QUOTES FROM THIS EPISODE

“In dealing with bias, self-awareness is absolutely critical – you have to do an inventory of your life and say ‘where are these things that I’ve experienced and how do they affect my decision making today and my interaction with other people,’ so self-awareness is really the first step.” — Steve Wirth

“When you go to a conference, go up to somebody. The reason that you have a nametag, with your first name in very large font is so that I can say, ‘Hello Chris, I’m Rob, pleased to meet you. What do you do?’ and that’s how a network occurs.” — Rob Lawrence

“Having this culture of a high-level of engagement is really focusing on our employees as our primary customer and making sure that we understand what their goals, ideals, passions are, and how to meet them.” — Steve Grau

“Just by the way they answered a simple question ‘so, what do you do?’ I could tell if they had been working there 2-3 weeks if they answer with a bright sparkle, ‘I work at Amazon.’ But if they had been there 2-3 months, they would pause, ‘well … I work at Amazon,’ And 6 months, they would drop a codeword, ‘I currently work at Amazon.’” — Anna Liotta

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Watch for more

https://www.ems1.com/leadership/articles/the-10-commandments-of-servant-leadership-OkBq610vz8C12Gb1/

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EPISODE CONTENTS

Part 1: Rob Lawrence and Chris Cebollero – Serving to lead

00:30 – Rob and Chris introduction

1:30 – Car seat safety (not rated for ambulances)

3:30 – Rob’s leadership session with Acadian President Justin Back on the principles of leadership, serving to lead

05:30 – Chris discusses leadership as a science

06:30 – What we want from our leaders

Part 2: Steve Wirth – Overcoming bias

07:30 – Welcome Steve Wirth

08:00 – Steve discusses his conference session, “We are all prejudiced” delivered in partnership with Macara Trusty (GMR)

11:30 – The importance of networking and meeting professional friends

14:56 – Chris talks about his leadership series on EMS1

Part 3: Anna Liotta and Steve Grau – Retaining your primary customer

16:00 – Introduction: Anna and Steve

17:00 – Generational difference - Have you seen a “Star Wars” movie?

17:30 – Anna: Common sense is not that common

18:30 – The Royal Ambulance (award winning) Career Bridge Program

20:00 – Generational codes in the workforce

22:50 – The revolving door of employment

24:00 – Creating the milestones of forward progression

25:00 – Anna’s Experience with Fortune 500 companies

25:30 – Understanding that your talent and people are your primary customer

26:00 – Creating an arc of experience

28:00 – Not allowing yourself to say “that’s how I did it”

29:00 – Fostering the whole human

30:00 – Pulling talent forward

31:00 – Rob and Chris close

ABOUT OUR GUESTS

Anna Liotta

Anna Liotta, creator of Generationally Savvy Communication Solutions, is an award-winning speaker, business consultant and author. She engages audiences with her practical strategies for attracting, growing and retaining top talent and loyal clients from every generation.

Anna integrates communications, sociology, business psychology and demography to unify workplaces and dramatically improve company performance. Her expertise and insight have helped such companies as Pike Place Market, Intel, Wells Fargo, Microsoft, Amazon, the PGA, NBA and United Way.

Steve Grau

Steve Grau and his family emigrated from Ukraine in 1989, arriving in San Francisco with $80 to their name. He became interested in healthcare 15 years later, when he took a hands-on role caring for his grandfather after a series of debilitating strokes. Witnessing how emotional support impacted physical healing, Steve was inspired to leave the tech industry to start an ambulance service that focused on patient experience.

Steve Wirth

Steve Wirth is a founding partner of Page, Wolfberg & Wirth. In a distinguished four-decade public safety career, Steve has worked in virtually every facet of EMS – as first responder, firefighter, EMT, paramedic, flight paramedic, EMS instructor, fire officer and EMS executive. He was one of central Pennsylvania’s first paramedics. Steve brings a pragmatic and business-oriented perspective to his diverse legal practice, having served for almost a decade as senior executive of a mid-sized air and ground ambulance service, helping to build the company from the ground up.

Our EMS One-Stop Host Rob Lawrence was recently invited attend the keynote session at the North Carolina EMS Expo, and to deliver an after-dinner speech at the banquet. The title of Rob’s session was “Elephants in the EMS room,” in which he addressed 10 things we must acknowledge and fix in order to improve the health of our profession.

As soon as he left the keynote stage, Rob joined Bradley Dean and David Blevans from the EMS Handoff Podcast to discuss the key issues raised in Rob’s presentation.

The biggest elephant in the room currently is recruiting and retention, and in addition to discussing inside industry suggestions, Rob looked to the outside world and got his inspiration from Glass Door, and identified what stands EMS apart from the nation's top 50 companies to work in.

The discussion also covers data and politics, cost collection and surprise billing, amongst the other elephants in the EMS room.

TOP QUOTES FROM THIS EPISODE

“I don’t talk about surprise billing, I talk about surprise payment, the surprise is what the insurance company actually gives you.” — Rob Lawrence

“A lot of local authorities will describe what they want to see in their EMS system when they bid them out and these are wholly unaffordable, in fact, they describe the cruise liner, when they can only afford a rowboat.” — Rob Lawrence

“We have to stop thinking that we are the UN and start to thinking like NATO, because NATO is an attack on one is an attack on all so, we have to start changing our mindset.” — Rob Lawrence

EPISODE CONTENTS

00:53 – Introduction

01:15 – Bradley Dean and David Blevins

2:10 – Elephants in the room

2:58 – Recruiting and retention

4:00 – Looking for clues via Glassdoor

5:05 – Is EMS in a pickle?

6:00 – Surprise billing

6:22 – EMS costs

7:00 – The cost of readiness

7:30 – Ground Ambulance and Patient Billing Committee

9:46 – Four little words – all those in favor!

10:20 – We are all politicians

11:30 – Degree or no degree – that is the question

15:40 – If you are going to get a degree anyway, why not a paramedicine degree!

17:00 – Data and making use of it

20:00 – Wall time

24:00 – The importance of advocacy

28:00 – National organizations working together

37:00 – The Peter Principle and training our people for the next position

39:00 – Close

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

EMS One-Stop Host Rob Lawrence recently travelled to Florida to attend the Metropolitan Medical Directors Gathering of Eagles Conference. In this week’s episode, he shares video from key sessions and interviews with a number of leading EMS medical directors, including Dr. Jim Augustine, medical director of Lee County, Florida.

The Eagles also gave the floor to the U.S. Fire Administrator Dr. Lori Moore-Merrell, who identified how the Metropolitan Medical Directors will work closely in the future with the U.S. Metropolitan Fire Chiefs – and identified that a name change to USFA may soon follow.

TOP QUOTES FROM THIS EPISODE

“Seventy-five percent of what we do in the fire response space is in fact EMS, and something that I shared with these guys yesterday is an action, I won't say a movement yet, but an action under way, we may in fact in the near term actually rename the U.S. Fire Administration the U.S. Fire and EMS Administration.” — Dr. Lori Moore Merrell

“We have just stood up in January an EMS branch within our National Fire and EMS Programs Division. That is a huge move for USFA, so we are going to be moving toward even bigger announcements in the near future ... but we need to embrace what we do in the fire service, that is greater than 70%, most departments 75% and up of EMS.”  — Dr. Lori Moore Merrell

EPISODE CONTENTS

01:00 - Takeaways from Brandon Morshedi, MD; Peter Antevy, MD; Joseph Zalkin; Petar and Amber Hossick

02:00 - Introducing the comments from Dr. Moore-Merrell

04:00 - Recorded comments from Dr. Moore Merrell

09:00 - Discussion with Dr. James Augustine

24:00 - Closing commentary

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

After realizing she was suffering from burnout, Paramedic Amanda King decided to leave her service and take on one of the most physically challenging trails in the United States. Amanda made a decision that changed how she saw people, how she viewed the world and how she understood herself.

Three months after resigning, selling her house and storing her furniture, Amanda was dropped off in Georgia, alone, with one goal: to hike the entire Appalachian Trail. With her hiker home packed into a rucksack on her back, she embarked on a seven-and-a-half month epic adventure which saw her hike nearly 2,200 miles. She endured harsh weather, a regional drought, rugged terrain and so much more on a journey that evolved her in ways she could not have ever imagined.

After deciding to return to EMS, Amanda chats with Rob Lawrence about her experience, the individuals she met along the way and how her experiences can be translated back into life as a medic. Amanda also reflects on her life before the trail and offers inspiration and takeaways for all.

TOP QUOTES FROM THIS EPISODE

“I think my biggest regret is, it's a very simple word. It's two letters long and it's the word ‘no!’ Don't be afraid to say no. Take time for yourself, because you are the most important person. You know, if you're not happy and if you're not safe, how can you expect to keep other people happy and safe? I think that's the biggest thing, don't work so much overtime, don't inconvenience yourself to do all of these things that's asked of you, in return you're not taking care of yourself. So, one thing that I decided if I got back into EMS, is I would use my vacation time. So I'll put it to you this way. When I was at the former employer, I took a vacation maybe twice in 6 years or something like that, like an actual vacation. I've already taken two vacations since I started here at Novant, since November – so that's a huge difference.”

“I don't want to say yes, a 7-month hike in the woods cured all my problems, because that's not at all the case. I think that it's an ongoing process that, once you reach that point of burnout, it's number one up to you. It's not up to anybody else to help you. It's up to you to help you. And you have to want that change. I think that it's an everyday thing. Every day I need to do things that keep me on that path of not going back down that road again.”

“I think that was a symptom of the burnout where I was at, I had no patience whatsoever and it showed. It showed to my partner, it showed to family members that I would encounter on a call. And I hate to admit all that; it's embarrassing, but that's where I was, that was the point where I was at. I think now, after all that time off, and all that time to self-reflect, I think I'm more patient because I believe that I'm more empathetic, which is also something that I can't say that I possessed before I left.”

EPISODE CONTENTS

02:29 – Introducing Amanda King

05:06 – Symptoms of burnout

07:16 – The moment you realize you are done

10:57 – Selling and putting everything in storage

13:23 – Hiking with friends

15:53 – Packing for a 2,000 mile walk

18:48 – Mental fortitude

22:47 – Trail angels

24:40 – Trail magic

26:32 – Becoming ‘moss’

29:49 – Hindsight is 20/20

31:16 – Keeping a journal

33:30 – Taking a zero: how to use down time

41:14 – 2,000 miles later …

48:05 – Developing patience

51:02 – Message to those heading into crisis or breakdown

54:13 – Contact details

ADDITIONAL RESOURCES ON THIS TOPIC

• Reignite EMS passion by banishing burnout (eBook)
• On-demand webinar: Navigating a path to career satisfaction
• 5 EMS tips for a work-life balance
• EMS Burnout Repair Kit: Reigniting your EMS passion

ABOUT OUR GUEST

Amanda King is a paramedic from the coast of North Carolina. Prior to joining EMS, she obtained a Bachelor of Arts degree from the University of North Carolina at Wilmington. During her first 10 years in EMS, she was promoted to field training officer, became an EMS instructor, developed a field training and evaluation program for her former agency, taught EMS classes for the local community college and earned a real estate license. She left EMS and thought she’d never return. Now, after becoming one of just over 1,000 people to thru-hike the Appalachian Trail in 2022, she has returned to EMS and now works for Novant Health Mobile Integrated Health. She is currently in graduate school to obtain a master’s degree in public administration.

CONNECT WITH OUR GUEST

• Instagram
• LinkedIn

RATE AND REVIEW THE EMS ONE-STOP PODCAST

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

Page, Wolfberg & Wirth was asked by the National EMS Information System (NEMSIS) Technical Assistance Center (TAC) to research frequently asked questions related to data in EMS patient care reports. PW&W analyzed these questions under applicable laws and guidance, and developed general answers and best practices contained in the new publication, “Patient Care Report Data QuickGuide - FAQs on owning, amending, retaining and sharing patient care report data.”

In this week’s EMS One-Stop, available in both video and audio versions, Host Rob Lawrence speaks with the PW&W authors of the project, Ryan Stark, managing partner, and Steve Johnson, director of reimbursement consulting. They discuss the guide, why it’s needed, and the major FAQs and misconceptions about PCRs.

The guide is broken down into four key areas of FAQs:

1. PCRs’ legal status
2. Amending PCRs
3. PCR retention
4. Transferring PCR data

Top quotes from this episode

“I would much rather defend an organization who regularly goes through a quality assurance process, whereby they make the provider and hold them responsible for the accuracy and completeness of the record.” — Ryan Stark

“Others may say, we see a lot of amendments to your records. The answer is ‘yes, that’s because we care about getting it right’ – that’s the mantra of our organization.” — Ryan Stark

“One of the things behind the importance of documentation is that it doesn’t live in a vacuum. We are in a day and age where it’s going to follow the patient for their lifetime, so you may have a rehab facility that wants to consult the medical record to determine the mechanism of injury or how the injury occurred and the only person [that knows that] is the EMS practitioner.” — Ryan Stark

“Long gone are the days where we can give you a quick ticket, passing along the information to the receiving facility. Now we are marrying up records, electronic health exchanges and other mechanisms and the genesis of all this starts with the original call.” — Steve Johnson

“Everyone should sign the patient care report. Why? Because everyone was a function of providing that particular service and we get a lot of pushback and they say ‘well now I’m legally responsible for everything that happened,’ and that’s not what the law says. The law says, for what you did, you are responsible for what you did and what you didn’t do when you had a legal duty to do something or withhold doing something because it was contraindicated. All that indicates is that yes, I reviewed it and to the best of my knowledge it’s true and accurate.” — Ryan Stark

“The law will impose liability where it lands. Just because you’ve signed that particular patient care report, doesn’t mean you’re responsible for all the interventions and everything that I outlined in there, it would be whoever performed or withheld those interventions that would be responsible within the scope of practice.” — Ryan Stark

Episode contents

1:09 – Introductions

1:30 – PWW history

3:30 – Introducing the PCR Data QuickGuide

4:20 – The circle of life of a PCR 

11:00 – NEMSIS data/research license and EMS by the numbers

13:20 – Who owns PCR data

15:50 – Signatures! And legal responsibility

17:40 – Accuracy of documentation to defend your actions

18:30 – Why does the driver have to sign?

20:00 – Amending PCRs: When and why

22:33 – Who do you tell if a record is amended?

24:30 – Can your state request you to amend your PCR?

27:30 – How long should we keep documents?

30:50 – When an agency closes down or merges

33:30 – Body-worn camera content

35:30 – Transferring paper records to digital

37:15 – Bi-directional data and HIE – responsibilities

40:00 – Final thoughts

Additional resources

• The PCR Data QuickGuide is available now, and we encourage all EMS professionals to download their copies and gain a deeper understanding of PCR data best practices. To download the guide, please follow the link:
• About NEMSIS
• About Page, Wolfberg & Wirth

About our guests

Ryan Stark

Ryan Stark is a managing partner with Page, Wolfberg & Wirth, and is the firm’s resident “HIPAA guru.”  He counsels clients on labor relations, privacy, security, reimbursement and other compliance matters affecting the ambulance industry. 

Ryan started in the healthcare field as a freshman in college, where he worked for a local hospital and a retail pharmacy.  After college, he decided to become a lawyer, hoping to guide healthcare providers through the demanding legal issues they face.  He has been with PW&W since 2007, fulfilling that ambition.  

Ryan is passionate about educating EMS professionals and loves collaborating with providers and CEOs alike. He is a featured speaker in PW&W seminars and webinars, including the firm’s signature abc360 Conference, where he hosts the abc360 Game Show. Always enthusiastic, Ryan has been invited to speak at many state and regional EMS conferences, as well as national industry events. He is also an adjunct professor at Creighton University in the school’s Master of Science in Emergency Medical Services Program. 

Ryan developed, and is the primary instructor for, the nation’s first and only HIPAA certification for the ambulance industry – the Certified Ambulance Privacy Officer.  He also co-authored PWW’s widely used Ambulance Service Guide to HIPAA Compliance.  

Ryan volunteers with local community nonprofit organizations. He was also a big brother with the Big Brothers Big Sisters program for over a decade and keeps in touch with his “little.” Ryan also enjoys hiking, running, kayaking and traveling, and spending time with son Oliver.   

Steve Johnson

Steve began his career in the EMS industry in 1985, gaining valuable experience while serving as an EMT and later as director of a municipal ambulance service in Minnesota. As an ambulance service manager, Steve established his expertise in areas of operations, billing and administration.  

Steve also has significant EMS educational experience. He established and served as training coordinator and lead instructor for a State Certified EMS Training Institution for EMTs and First Responders.  

Steve served on both the Rules Work Group and the EMS Advisory Council to the Minnesota State Department of Health.

He joined the staff of a large, national billing and software company, where he was a frequent lecturer at national events and software user group programs. For over 7 years, Steve served as director of a national ambulance billing service and was responsible for all aspects of managing this company, including reimbursement, compliance and other activities for ambulance services throughout the nation.

Steve served as founding executive director of the National Academy of Ambulance Coding (NAAC), overseeing all activities of the Academy, including the Certified Ambulance Coder program, the nation’s only coding certification program specifically for ambulance billers and coders.  

As the director of reimbursement consulting with Page, Wolfberg & Wirth, Steve is involved in all facets of the firm’s consulting practice. Steve works extensively on billing and reimbursement-related activities, performing billing audits and reviews, improving billing and collections processes, providing billing and coding training, conducting documentation training programs, and performing many other services for the firm’s clients across the United States.  

Steve is also a licensed private pilot, and enjoys an active role in his church.

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

This edition of the EMS One-Stop podcast spotlights the popular online education series Reel Emergency, which uses real bodycam footage to illustrate various types of medical emergencies. The footage is then discussed in a live broadcast by very well-known emergency medicine physicians, Drs. Peter Antevy, Mark Piehl and David Spiro.

Reel Emergency offers free continuing education credit on the day of the Prodigy EMS based broadcast (you must be in the live audience to receive CE) and is then made available via YouTube for all to view and use as part of their clinical education. 

Reel Emergency has now produced 15 episodes and has been viewed tens of thousands of times as both individuals and departments benefit from the content, the expert analysis and commentary, as well as subject matter expert guests.

In this podcast, Rob Lawrence chats with Reel Emergency’s regular host Hilary Gates, director of educational strategy for Prodigy EMS; and Zach Dunlap, clinical education specialist from 410 Medical.

Zach also previously worked for an agency that pioneered the use of body-worn cameras in EMS and offers insight into their adoption and use. 

TOP QUOTES FROM THIS EPISODE

“These real patient videos actually show what’s happening on a call. Where else do you get that? You can’t get that anywhere else and there’s something to be said for doing scenarios and having standardized patients or mannikins, but nothing beats watching the actual call itself because you also have all of the other elements of the call that are really hard to recreate in the classroom. You have all of the emotions all of the bystanders, all of the equipment, the communication aspects you have to worry about, and you have real human reactions” — Hilary Gates

“If you are an educator, and you are teaching a certain topic – anatomy, physiology, scene management, all operations, whatever it is – and there is a way to illustrate that, you should be required to illustrate it with a video – there’s just no better way to do it.” — Hilary Gates

“It should almost be a requirement at this point, the main reason people don’t want body cameras in EMS is because it’s grossly misunderstood.” — Zach Dunlap

EPISODE CONTENTS

1:00 – Introductions

01:35 – REEL Emergency

02:20 – Everyone knows Drs. Spiro, Antevy and Piehl

4:00 – Using video for education

6:10 – Gaining free CE and watching on-demand

07:20 – Using body-worn cameras on the street

08:23 – Using BWCs for performance improvement

11:25 – Suggesting that BWC eventually become the standard of care

12:50 – Where does Reel emergency get its videos from?

14:00 – Filming the Falmouth Road Race and heat emergencies

15:20 – How to view Reel Emergency?

ADDITIONAL RESOURCES ON THIS TOPIC

Current Reel Emergency topics include sessions on HP CPR, heat emergencies, peds emergencies, junctional hemorrhage, ped airways, anaphylaxis, intracranial emergencies, delirium, end of life care, GSWs and altered mental status.

Following are additional resources on incorporating body-worn cameras:

• Promoting transparency and accountability with BWCs
• Three outdated paradigms holding EMS back
• Leadership’s role in keeping our workforce safe
• How to buy body-worn cameras (eBook)

ABOUT OUR GUESTS

Zach Dunlap began his EMS career as a paramedic in Amarillo, Texas. After working in Oklahoma City, he returned to the Texas panhandle, where he worked as a flight paramedic for several years. Zach now resides in Houston, and has served as a flight paramedic and clinical director for a progressive 911 system. Currently, he is a clinical education specialist for a national medical company educating and training clinicians across the country on volume resuscitation. Zach obtained his bachelor’s in emergency health sciences and has always focused on providing excellent patient care through innovative approaches. Zach enjoys sports and spending time with his two children, Brogan and Brynlee, and their Goldendoodle, Claire. Zach is also the assistant treasurer of the Board of Commissioners of Harris County ESD11 in northern Houston.

Hilary Gates, MAEd, NRP, is the director of educational strategy for Prodigy EMS and a volunteer paramedic in the Alexandria (Virginia) Fire Department. She is also a faculty member of the School of Education at American University in Washington, D.C., and teaches Introduction to Community Health in the EM Program at University of Pittsburgh. Beginning her career as a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, Maryland, Hilary became a full-time paramedic, EMT instructor and FTO at AFD, and then served as senior editorial and program director for EMS World. She implemented AFD’s MIH/CP program in 2017 and has extensive experience as an EMS educator, symposium presenter and quality improvement trainer.

ABOUT THE REEL EMERGENCY PANEL

Dr. David Spiro is a pediatric emergency physician and professor at University of Arkansas Medical System, and he is chief medical officer of Reel Dx. Dr. Peter Antevy is a nationally recognized lecturer and expert in the field of prehospital pediatrics and cofounder of Handtevy Pediatric Emergency Standards. He currently serves as the EMS medical director for multiple fire and rescue departments in Florida. Dr. Mark Piehl is a board-certified pediatrician and pediatric intensivist at WakeMed Hospital in Raleigh, North Carolina, and co-founder of 410 Medical.

CONNECT WITH OUR GUESTS

Hilary Gates:

• Linkedin
• Twitter

Zach Dunlap:

• Linkedin
• Twitter

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Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

In this edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Dr. Maia Dorsett and Paramedic Nikki Little to discuss the NAEMSP Quality Improvement and Safety Course, an exciting year-long course that provides EMS physicians and quality improvement leaders with the knowledge and skills necessary to lead QI and patient safety initiatives in their region, system or agency. Participants will develop an in-depth understanding of how to apply QI tools and strategies to their local needs to affect the care of patients.

Dr. Dorsett and Little identify that the program will take participants on a journey to improve the quality of care and safety in their system through a multi-modal approach in sessions led by expert faculty, who will discuss key aspects of quality improvement.

TOP QUOTES FROM THIS EPISODE

“I think one of the things I love about this course is half the faculty are not physicians. There is a fair percentage of NAEMSP membership that are not physicians and the quality course especially is very deliberate. It has faculty from different backgrounds.” — Dr. Dorsett

“Your system is complex; all of the policies and procedures and processes that you have set up for the folks to work in them, they don’t always work as designed.” — Nikki Little

“Once a month, and even more often than that, because you meet with your mentees, you get to really collaborate idea-wise and work together with a group of people who are all there committed to making improvements in their system.” — Dr. Dorsett

“So many quality leaders are still stuck in this in this moment, where they’re looking at 50% in May and 52% in June, and we’re just comparing these two numbers and making massive strategic decisions about things that might be seasonal or have abnormal variation and we could be really making some really dumb mistakes if we’re not looking at our data over time.” — Nikki Little

EPISODE CONTENTS

02:00 – Introduction – Nikki Little

2:25 – Introduction – Dr. Maia Dorsett

02:40 – Description of the course

03:30 – Quality Course origin story

05:30 – Little’s experience as an inaugural participant

0745 – Month-by-month syllabus

10:00 – PDSAs and brevity in QI

13:00 – Capstone and results presentation

15:20 – Little’s course highlights

17:29 – Dorsett’s course highlights

21:25 – This course is not just for physicians

23:10 – Course overall timeline

24:30 – Cohort presentations at the annual meeting and poster presentations

26:20 – Class sign-up details

ADDITIONAL RESOURCES ON THIS TOPIC 

NAEMSP Year-Long Quality Improvement and Safety Course

ABOUT OUR GUESTS

Maia Dorsett, MD, PhD, is an emergency medicine and EMS physician and educator. She completed her EMS fellowship at Washington University before moving to Rochester, New York, where she now serves as the medical director for EMS education at Monroe Community College and is the associate regional medical director for education and quality for the Monroe-Livingston Region. She is also the medical director for Gates Volunteer Ambulance as well as Prodigy EMS. Nationally, she serves on the board of the National Association of EMS Physicians and the National Registry of EMTs. She is involved in quality improvement implementation and education, serving as the co-course director for the NAEMSP Quality and Safety course.

Nikki Little, FAEMS, has fulfilled many roles as a paramedic, including advanced care paramedic, district chief of paramedic operations, 911 communication supervisor, and quality and patient safety officer in almost 30 years in EMS. She has a passion for patient-centered quality improvement of systems and has advocated for policy advances in the areas of patient safety, team communication and opioid overdose. She has dedicated countless hours to improve the quality and safety of patients with non-transport dispositions, (especially elderly and at-risk persons) and to improve the care for patients experiencing acute coronary syndromes (with particular focus on gender disparities in care). She has also contributed through committee work by way of the Paramedic Chiefs of Canada and the Manitoba Chapter of the Canadian Women’s Heart Health Alliance. In the area of quality improvement and paramedic education, she is in her sixth year as faculty of the National Association of EMS Physicians (NAEMSP) Quality and Safety Year-Long capstone course and preconference workshop. Her dedication to furthering the educational mission of the organization, and skill in teaching patient safety and improvement science to paramedic professionals and EMS physicians was duly recognized when she was named co-director.

CONNECT WITH OUR GUESTS

• Maia Dorsett
• Nikki Little

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

Recorded with less than 24 hours to go before the coronation of King Charles III, of England, host Rob Lawrence sits down with Simon Harding, deputy director of the London Ambulance Service to discuss planning for the coronation. Harding also serves as deputy director of the London's 999 control centers.

Harding begins by highlighting the construct of ambulance services in the United Kingdom, as well as the scope and operation of the London Ambulance Service, which serves 9 million citizens of the national capitol, plus visitors. LAS takes over 2 million 999 (the UK equivalent of 911) calls a year in addition to 2 million 111 calls (for non-emergency responses).

Harding and Rob discuss how incident management operates in the UK, using the GOLD, SILVER and BRONZE levels of command, and the roles and responsibilities at each level.

They talk about the plans for the coronation and how LAS – in partnership with public safety and military planners – are preparing to support the historic event.

Resources mentioned in this episode

• London Ambulance Service
• John’s Ambulance Service

Additional resources for mass gathering planning

• Boston EMS' Joe O'Hare: All hazards incident management
• EMS coverage for mass gatherings and public events
• How EMS can prepare for a mass gathering to become an MCI
• 7 ways to be prepared before the mass gathering turns into an MCI

Ginny Renkiewicz, PhD, is an assistant professor of healthcare administration in the College of Health Sciences and Human Services at Methodist University, Fayetteville North Carolina. Dr. Renkiewicz has been involved in EMS for 21 years as a credentialed paramedic, administrator and leader. Her specific research interests include defining predictors and profiling traumatic stress syndromes in EMS personnel and she recently had two papers published in the U.K. and U.S. on subjects related to her research interests.

In this edition of EMS One-Stop, Rob Lawrence and Dr. Renkiewicz discuss her publications, “Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel,” which discusses the emotional countertransference that occurs between the clinician and patient, and “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic,” which analyses how the coronavirus disease pandemic has profoundly affected EMS professionals.

TOP QUOTES FROM THIS EPISODE

“I don’t think we will ever go back to normal; this is kind of like 911. There was before 9/11, and there was after 9/11, and this is going to be before COVID, and after COVID.”

“Vicarious trauma is emotional counter, transference; essentially, you are feeling what the patient feels when they’re experiencing a traumatic event. Example being, if you had a call, for example, a stillbirth, you may for the following weeks or months have this weird aversion to children or things in which infants are involved and you may have a stress response to those situations in the same way that the patient would have.”

“Post traumatic stress injury is not the only stress disorder that exists out there. It is the one that I think most frequently cited by educators and administrators, because we don’t know all of the other more insidious stress disorders, of which vicarious trauma is one.”

“A predictor of having vicarious trauma as an EMS professional; my hypothesis is that if your parents or whomever your caregivers are do not teach you how to appropriately and emotionally cope with anything in any situation, it becomes very difficult for you to know how to do it properly in your adult life and so you overcompensate, and so vicarious trauma occurs in that population.”

EPISODE CONTENTS

1:12 – Introduction: Dr. Ginny Renkiewicz

1:55 – Ginny’s academic career

3:00 – The development of research on EMS

4:50 – Paper discussion – secondary trauma response

09:00 – Education on stress disorders

11:24 – Therapy dog program

12:30 – Next steps/further work on resilience training

1530 – Maladaptive cognitions

17:20 – Getting published in the SOM Journal

19:00 – Learning, conclusions and takeaways

23:00 – The new normal

24:18 – Call to action for leaders

26:13 – NHTSA Listening Group on wellness, resilience and peer support programs

27:30 – Getting involved in research

31:00 – NAEMT Lighthouse leadership program

ADDITIONAL RESOURCES ON THIS TOPIC

• Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel
• “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic”

ABOUT OUR GUEST

Dr. Ginny Renkiewicz is an assistant professor of healthcare administration in the College of Health Sciences and Human Services Methodist University, Fayetteville, North Carolina. She has been involved in EMS for 21 years as a credentialed paramedic and Level II paramedic instructor. She has spent 17 years as a program director, division chair or department head and has been recognized for her contribution to the EMS profession as a Fellow of the Academy of Emergency Medical Services (FAEMS) through the National Association of EMS Physicians. She has won several national and international awards, including National EMS Educator of the Year and the global EMS10 Award for innovation in the field of EMS.

She holds an Associate of Applied Science in Sign Language Interpreting degree from Wilson Community College, a Bachelor of Science in Emergency Medical Care with a concentration in EMS management and a Master of Health Science in EMS education (both from Western Carolina University), and a Ph.D. in Health Science with a concentration in Respiratory Care from Rush University. Dr. Renkiewicz is a reviewer for several peer-reviewed journals; serves as executive director of the Foundation for Prehospital Medicine Research; and is enthusiastic about research, innovation and student mentoring. She is also the vice chair of the North Carolina Association of EMS Educators. Her specific research interests include defining predictors and profiling traumatic stress syndromes in EMS personnel.

CONNECT WITH OUR GUEST

Email: drginnyrenkiewicz@outlook.com

Twitter: @DrKrankyPants

LinkedIn: www.linkedin.com/in/ginnyrenkiewicz

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COVID-19 was declared a Public Health Emergency (PHE) on Jan. 31, 2020, and was extended a number of times, but it is now set to expire on May 11, 2023. In this episode of EMS One-Stop, Rob Lawrence is joined by Doug Wolfberg, Esq., of Page, Wolfberg & Wirth to discuss the immediate actions organizations should take (or should have already taken) to preserve documentation relating to the PHE, as well as adjust operational and documentation practices and procedures as we “return to normal.”

Rob and Doug discuss issues such as rule changes that have become normal operating procedures over the last 2 years and the need to build a time capsule to preserve evidence. They also cover patient signatures, telehealth changes, transport to alternate destinations, agency licensing and Physician Certification Statements.

Doug, a lifelong Beatles music fan, also shares that he has just published a book: “The Beatles: Fab but True: Remarkable Stories Revealed” and will be undertaking a book signing tour in the UK later in the year.

TOP QUOTES FROM THIS EPISODE

At the end of the PHE, “We revert back to the standard inflexible Medicare signature rules which means that the patient needs to be the signer, and the only time that you can get a signature from anyone else is if that patient is physically or mentally incapable of signing that statement.”

EPISODE CONTENTS

1:12 – End of the PHE announced

2:00 – Rule changes have become normal operating procedures

2:20 – The need to build a time capsule to preserve evidence

4:30 – Big change ticket item number one – patient signatures

6:40 – A reminder to establish the reason the patient is unable to sign a PCR

7:20 – Telehealth changes                                                

10:00 – Transport to alternative destination coverage ends (but place your pandemic local clinical guidance in your time capsule now!)

13:07 – ET3 – not affected and is separate

15:24 – Doug and the Beatles

17:52 – Ambulance staffing waver also going away

18:55 – Agency licensing back into full force – no more grace periods

21:12 – Physician Certification Statements (PCS) – do not cut corners on your PCS signatures

22:15 – Leaders pay attention to this podcast

ADDITIONAL RESOURCES ON THIS TOPIC

• CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency
• Doug’s new book: “The Beatles: Fab but True: Remarkable Stories Revealed”

ABOUT OUR GUEST

Doug Wolfberg is a founding partner of Page, Wolfberg & Wirth, and one of the best-known EMS attorneys and consultants in the United States. Widely regarded as the nation’s leading EMS law firm, PWW represents private, public and non-profit EMS organizations, as well as billing companies, software manufacturers and others that serve the nation’s ambulance industry. Doug answered his first ambulance call in 1978 and has been involved in EMS ever since. Doug became an EMT at age 16, and worked as an EMS provider in numerous volunteer and paid systems over the decades. Doug also served as an EMS educator and instructor for many years.

After earning his undergraduate degree in Health Planning and Administration from Pennsylvania State University in 1987, Doug went to work as a county EMS director. He then became the director of a three-county regional EMS agency based in Williamsport, Pennsylvania. He then moved on to work for several years on the staff of the state EMS council. In 1993, Doug went to the nation’s capital to work at the United States Department of Health and Human Services, where he worked on federal EMS and trauma care issues. Doug left HHS to attend law school, and in 1996 graduated magna cum laude from Widener University School of Law. After practicing for several years as a litigator and healthcare attorney in a large Philadelphia-based law firm, Doug co-founded PWW in 2000 along with Steve Wirth and the late James O. Page. As an attorney, Doug is a member of the Pennsylvania and New York Bar Associations, and is admitted to practice before the United States Supreme Court as well as numerous Federal and state courts. He also teaches EMS law at the University of Pittsburgh, and teaches health law at the Widener University School of Law, where he is also a member of the school’s Board of Overseers.

Doug is a known as an engaging and humorous public speaker at EMS conferences throughout the United States. He is also a prolific author, having written books, articles and columns in many of the industry’s leading publications, and has been interviewed by national media outlets including National Public Radio and the Wall Street Journal on EMS issues. Doug is a Certified Ambulance Coder (CAC) and a founder of the National Academy of Ambulance Coding (NAAC). Doug also served as a commissioner of the Commission on Accreditation of Ambulance Services (CAAS).

In his free time, Doug is an avid bicyclist and musician.

CONNECT WITH OUR GUEST

Website: www.pwwemslaw.com

Email: www.pwwemslaw.com/contact#

Linkedin: www.linkedin.com/in/douglas-wolfberg-099ab236

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This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.

In this episode of EMS One-Stop, Host Rob Lawrence discusses the National EMS Museum (NEMSM) with President Dave Zaiman; Museum Director, Kristy Van Hoven; and Jon Krohmer, MD, immediate past-secretary and "We are EMS" coordinator. The National EMS Museum is a volunteer-led organization that collects, preserves and shares the history of emergency medical response in the United States in hopes of inspiring future professionals to take up the call.

The National EMS Museum organization operates a virtual museum and produces traveling exhibitions that tour the country every year. The Collections at the National EMS Museum house over 300 years of history that cover the development of prehospital care in the United States, North America and around the world.

TOP QUOTES FROM THIS EPISODE

“We are here to educate the future. We are here not only to document the legacy, but here to provide a foundation and an education that EMS as a profession, as we move forward is respected, is understood, and maybe in a small part this museum can play a part in improving EMS altogether.”

EPISODE CONTENTS

03:05 – Origins of the NEMSM

05:04 – The style and model of the NEMSM

07:00 – Changes underway – recruiting individuals with experience in museum activities

11:50 – President Dave Zaiman

13:20 – Getting EMS into the community

15:00 – Favorite artifacts

16:30 – From MAST pants to blood transfusion

17:20 – Fundraising effort in order to take the museum on the road

20:30 – Developing a traveling mobile “We are EMS” museum project

23:40 – How to book a traveling exhibit

ADDITIONAL RESOURCES ON THIS TOPIC

• The National EMS Museum
• California Ambulance Association Siren special edition: Fifty Years of Wedworth-Townsend

ABOUT OUR GUESTS

Dave Zaiman

Dave is currently Sales VP - Midwest at Pulsara.  For over 30 years, Dave has been working in healthcare – both as an EMS professional as well as holding several leadership roles in the healthcare technology industry. Based in Minnesota, Dave spent his first 15 years working in the field as an EMT and paramedic in the Twin Cities metro area for both Allina and Hennepin County Medical Center.

Kristy Van Hoven

Kristy is the museum director for the National EMS Museum and PhD candidate at the University of Leicester. Over the last 3 years, Kristy has worked with the National EMS Museum’s Board of Trustees to develop and implement engaging e-volunteer opportunities and community programs that reach their digital audience. In addition to her work with the EMS Museum, Kristy volunteers at several local museums in Toronto, Ontario.

Jon Krohmer, MD

Dr. Krohmer served as the director of the NHTSA Office of EMS before his retirement in November 2021.  During his tenure as director, Dr. Krohmer oversaw several milestones for the profession, including the creation of EMS Agenda 2050; major revisions to the National EMS Scope of Practice Model and the National EMS Education Standards; and improvements in the collection and use of EMS data through the expansion of the National EMS Information System. Soon after the onset of the COVID-19 pandemic, Dr. Krohmer was tapped to lead the prehospital/911 team as part of the Federal Healthcare Resilience Task Force.

Prior to joining NHTSA, Dr. Krohmer had decades of experience as a local EMS medical director, initially in his home state of Michigan. His EMS career began as an EMT with a volunteer rescue squad. Like many EMS professionals, he was inspired by the television show “Emergency!” and by the emergence of the relatively new field of emergency medicine. He entered medical school at the University of Michigan knowing he wanted to make EMS his career. After becoming involved in EMS at the state and national level, he also served as president of the National Association of EMS Physicians from 1998 to 2000. In 2006, he came to Washington to serve as the first deputy chief medical officer for the Department of Homeland Security Office of Health Affairs and served in several other DHS roles before joining NHTSA in 2016.

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This week, Host Rob Lawrence welcomes back, Alexander Isakov, MD, MPH, professor of emergency medicine at Emory University School of Medicine, executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), and EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC).

Returning guest, Dr. Isakov provides an update on the current emerging pathogens, diseases, outbreaks and fevers that have featured recently in the news. Candida auris, Marburg virus disease, avian influenza, Nipah virus are discussed as well as recaps on Ebola, COVID-19, polio and seasonal influenza.

TOP QUOTES FROM THIS EPISODE

“What’s concerning CDC officials and experts is there is a multi-drug resistant strain of Candida auris that is really picking up in their surveillance programs.”

“While no one wants to be exposed to a multi-drug-resistant Candida auris, it’s really the ominous compromised patient that’s going to be likely most affected by it, so that means elderly patients or patients that are getting chemotherapy and have some immunosuppression consequence of that or people that are taking immunosuppressant drugs, they are the ones really at greatest risk.”

“The likelihood that EMS personnel are going to encounter somebody with Marburg virus disease in the U.S. during routine operations is extremely low, but good to be vigilant about it and identifying that someone might have been exposed, and understanding their travel history, if someone is ill, has a fever or myalgia, GI complaints and has travelled within the last 21 days to equatorial Guinea or Tanzania, then it would raise suspicion.”

ADDITIONAL RESOURCES ON THIS TOPIC

• CDC: Infection prevention and control for Candida auris
• CDC: Information for infection preventionists
• NETEC: Situation report: Marburg cases rise in equatorial Guinea and Tanzania
• NETEC: EMS guidelines for Marburg virus disease

ABOUT OUR GUEST

Alexander Isakov, MD, MPH, is a professor of emergency medicine at Emory University School of Medicine. He is certified by the American Board of Emergency Medicine in both emergency medicine and emergency medical services (EMS).

Dr. Isakov is the director of the Section of Prehospital and Disaster Medicine whose faculty provides medical oversight for 911 communications centers, and ground and air EMS responders in metropolitan Atlanta. He is also the executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), which serves as the center for Emory enterprise-wide planning for and coordinated response to catastrophic events.

Dr. Isakov has provided leadership in emergency medical services and disaster preparedness locally and nationally. He serves as the medical director for the Sandy Springs Fire Department and Air Life Georgia. He is the founding medical director for the Emory-Grady EMS Biosafety Transport Program. He is the EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC) and is a designated Subject Matter Expert for the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE). Dr. Isakov is also on the American College of Emergency Physicians Epidemic Expert Panel and is a member of the EMS sub-board for the American Board of Emergency Medicine. He previously served on the National Association of EMS Physicians board of directors and the Technical Expert Panel for NHTSA’s EMS Agenda 2050.

Dr. Isakov has an MD from the University of Pittsburgh and an MPH from Boston University. He completed his emergency medicine residency training at the University of Massachusetts Medical Center and his EMS fellowship with Boston EMS. Dr. Isakov has lived and worked in Atlanta for 20 years. He practices clinically in the emergency department of Emory University Hospital.

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Russ Myers, Nikki Holm and Gwen Powell are chaplains at Allina Health Emergency Medical Services and in this episode, they join Rob Lawrence to discuss the role of chaplaincy in EMS. The guests discuss their role and responsibilities as well as the book, “Because We Care: A Handbook for Chaplaincy in Emergency Medical Services,” written by Russ Myers.

Over the past half century, the field of chaplaincy has come to a fork in the road. Many will recognize the well-traveled path of traditional chaplaincy. Others will follow the newer but clearly marked way to professional chaplaincy: a clinically trained, evidence-based discipline, reflecting and serving the diverse expressions of spirituality in modern society. Until now, chaplaincy in EMS has been the terra incognita, the unknown land on the map. Drawing on three decades of clinical chaplaincy practice, scholarship and original research, Russell Myers charts the map, making the case for ambulance service chaplaincy: how to think about it and how to do it.

TOP QUOTES FROM THIS EPISODE

“For me it’s all about love, how can I bring some light, some life, some love into the world, and I am able to do that in these situations by just showing up as we call in chaplaincy – the ministry of presence.” —Gwen Powell

“I do this work is to come alongside people and remind them of their humanity to help them break down their defenses and their shields to get back to the truth of who they are, to help them be seen and heard and taken care of.” —Nikki Holm

EPISODE CONTENTS

1:23 – Introduction Russ Myers

2:43 – Introduction Nikki Holm

4:00 – Introduction Gwen

7:35 – Book discussion: Because We Care – The Role of the Chaplaincy in Emergency Services

11:20 – Terra Incognita

12:30 – What motivates a chaplain?

15:30 – A chaplaincy intervention story

20:15 – A chaplain’s workload

23:00 – Being Proactive: Establishing a trusting relationship with the workforce

23:30 – Being Reactive: when an incident or issue occurs

30:15 – Education and being a presence during training

34:58 – If you are thinking about introducing g a chaplain

36:30 – Moral Injury and the social contract

40:40 – Overcoming the staff stigma about coming forward

42:00 – Close

ADDITIONAL RESOURCES ON THIS TOPIC

• “Because We Care: A Handbook for Chaplaincy in Emergency Medical Services”
• When EMS meets hospice. End-of-life care takes a heavy emotional toll: Seek support when needed

ABOUT OUR GUESTS

Russell Myers serves as a chaplain for Allina Health Emergency Medical Services, based in Minneapolis. He holds a BA from Ohio State University and a Doctor of Ministry degree from Luther Seminary, St. Paul, Minnesota. Russ is ordained by the Evangelical Lutheran Church in America and is board certified with the Association of Professional Chaplains. He lives in Saint Paul, Minnesota.

Gwen Powell is an ordained episcopal priest and board-certified professional chaplain who has been working with Allina EMS since 2020. Prior to working for Allina, she provided spiritual care to patients and staff on the adolescent behavioral health units at the M Health Fairview University of Minnesota Medical Center. Gwen graduated from Valparaiso University with a degree in psychology in 2008 and earned her Master of Science in Psychology from Kansas State University in 2010. She earned her Master of Divinity from Luther Seminary in St. Paul, MN in 2014 and has been passionate about mental health chaplaincy since beginning her ministry work in 2015. In her free time, she likes to beat her husband and kids at Mario Kart, exercise, walk/hike with her family, watch baseball, and sing with the Northern Lights Chorale.

Nikki Holm has been engaged in the meaningful work of EMS Chaplaincy through Allina Health since the Spring of 2020. Prior to making the transition to EMS, Nikki provided spiritual care and health education in an outpatient mental health setting for several years. Nikki was board certified with the Board of Chaplaincy Certification Inc. in 2017, graduated with a Master’s degree in Spirituality from St. John’s School of Theology in 2007 and with a Bachelor’s degree in Theology from The College of St. Benedict in 2005. Nikki lives in an earth home with her husband, their three beloved children, and three furry companions. Outside of soaking up life with her littles, Nikki enjoys rock climbing, writing, reading, yoga, gardening, and otherwise spending time with her tribe. Contact Nikki at Nicole.Holm@allina.com.

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In this special First Responder Wellness Week episode of  EMS One-Stop, Host Rob Lawrence welcomes Mike Taigman and Kevin Pannell to discuss the many facets of wellness, why wellness is essential for first responders, and easy tips for getting started to improve fitness, nutrition, stress management and more.

Memorable quotes

“The work we do involves your cognitive abilities to think well and sort out challenging situations for patients and calls and circumstances. You’ve got to lift people and move them and those kinds of things, so there’s a whole physical component, and the stress management is absolutely part of the wellness, and if you don’t kind of have a handle on that, there’s a lot of stresses this world presents to you – and poorly managed stress, we know, tears down your physical, psychological and emotional wellness.” —Mike Taigman

“If you’re in EMS or fire and you can’t carry the med box in one hand and the defibrillator in another up two flights of steps and you’re gassed and you can’t work when you get there, then you’re useless. And, for police, if you can’t wrestle with somebody because you’re exhausted in 30 seconds, it’s a problem.” —Kevin Pannell  

Together, they offer tips like:

• Pay attention to your plant-to-processed food ratio
• Start with pushups. You don’t need all the equipment they have at the CrossFit Games, Pannell notes. “You can get a smokin’ workout from just you and the ground.” Or take a walk.
• Take a holistic approach to fitness (weightlifting, something that makes you breathe hard and stretching); it’s about balance

About our guests

Mike Taigman uses more than four decades of experience to help EMS leaders and field personnel improve the care/service they provide to patients and their communities. Mike is the Improvement Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data along with performance improvement coaching for EMS agencies. 

He teaches Improvement Science in the Master’s in Healthcare Administration and Interprofessional Leadership at the University of California San Francisco and the Emergency Health Services Management Graduate Program at the University of Maryland Baltimore County.

Kevin Pannell works in program and project management in the healthcare IT space. He has previous experience as a public safety and military veteran, and produces wellness content.

Resources mentioned in this episode

• Pannell5 Fitness Club
• KEV Talks Podcast
• Kevin Pannell on Twitter @pannellkg
• “Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases” by Dean Ornish, MD; and Anne Ornish
• “How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease” by Michael Greger, MD, FACLM; and Gene Stone

In this EMS One-Stop international edition, this month, Rob Lawrence talks with Professor Tony Walker, immediate past chief executive officer of Ambulance Victoria, a professor with the Faculty of Medicine, Nursing and Health Sciences and Bachelor Paramedic Studies at Monash University. While in charge of Ambulance Victoria, Tony led significant transformation to improve the health and well-being of their workforce and the response they provide to the community.

In this broad-reaching discussion, Tony explains the structure, organization and funding models of EMS down under and then Rob and Tony identify current challenges, issues and solutions common to both the U.S. and Australia, including the dreaded hospital handover challenges as well as reduction in lights and siren responses.

TOP QUOTES FROM THIS EPISODE

“We know at least one in five people who call triple zero, our 911 equivalent, don’t require an emergency ambulance and so new models of care are being developed.”

“When people call triple zero, they no longer expect that they will automatically get an ambulance, as often described to people, you don’t walk into a hospital triage and say I’d like you to admit me to the coronary care unit,, you get triaged, you work out what is wrong by a health professional and you get the care you need; that’s exactly the same being applied in the paradigm of ambulance service delivery here in Victoria and the rest of Australia.”

“In the next decade or so, I wouldn’t be surprised if we see predominantly women making up the majority of staff working on frontline ambulances.”

“New models of care have been developed. We have looked at the MPDS grid and where the disposition of those patients go to so we have reduced significantly the number of lights and sirens responses which has enabled us.”

“Issues of transfer of care in hospital are a real challenge for ambulance services in the time it takes to transfer patients and there is no easy fix for that.”

“If you are a paramedic who has gone to university, done your training, wants to deliver care and you are spending a significant proportion of your shift in an emergency department caring for your patient before he can offload it, that can be demoralizing and that probably goes against why you joined in the first place.”

EPISODE CONTENTS

1:16 Introducing Tony Walker

2:00 The scale and scope of Australian Services

05:45 Healthcare funding – how does the patient get their healthcare

7:45 EMS system organization and deployment

09:15 Degrees and paramedic education

11:50 Student debt … or not!

14:10 Is Australia over-producing graduate medics?

16:40 Alternative treatment models

19:00 Reducing lights and siren responses

21:08 Public expectation education

23:02 Looking after your people

25:50 Handover delay at the ED – a global issue

27:00 Gender and diversity

27:34 Scheduling and rostering – creating a flexible roster that meets the needs of the individual and service

28:40 Hospital capacity and flow issues

31:08 How can you work in Australia?

ADDITIONAL RESOURCES

• Additional EMS One-Stop podcast solutions to EMS staffing woes from down under: Australia EMS medics join the podcast to discuss their efforts to fill U.S. positions with their paramedic surplus
• On-Demand webinar: Ambulances held hostage: Strategies to unilaterally reduce ED wait times and get back into service
• Ambulances held hostage: EMS strategies for reducing ambulance offload times

ABOUT OUR GUEST

Professor Tony Walker, ASM, is a registered paramedic with over 36 years’ experience working across senior clinical, operational and leadership roles within the ambulance sector. He was previously chief executive officer of Ambulance Victoria, where he led significant transformation to improve the health and well-being of their workforce and the response they provide to the community.

Tony is a Fellow of the Australasian College of Paramedicine and holds a Bachelor of Paramedic Studies, Graduate Certificate of Applied Management, Graduate Diploma of Emergency Health (MICA) and Master of Education.  He is a non-executive director of the Prostate Cancer Foundation of Australia, the Emergency Services Foundation and TLC for Kids, a Director of Fairhaven Consulting Pty. Ltd., and an executive member of the Global Resuscitation Alliance and an Associate Investigator with the Australian Resuscitation Outcomes Consortium.

He is a past non-executive director and chair of the Council of Ambulance Authorities (CAA), the peak body representing the eleven statutory ambulance services across Australia, New Zealand and Papua New Guinea, past chair of the Australian Resuscitation Council (Victorian branch) and past deputy convenor of the Australian Resuscitation Council ALS sub-committee.

Tony is published in an extensive range of literature relating to advancements in paramedic practice and prehospital systems of care, including prehospital thrombolysis, cardiac arrest, pain relief and prehospital rapid sequence intubation for traumatic brain injury.

Tony is a recipient of the Ambulance Service Medal (ASM) for his contribution to the development of ambulance services at a state and national level and awarded the National Heart Foundation President’s Award and Australian Resuscitation Council Medal (ARC) and included in the ARC Honor Roll, for his significant contributions to improving cardiovascular health and resuscitation practice and outcomes. He was a finalist for the Australian Mental Health Prize in 2019 in recognition of his work in improving paramedic mental health and wellbeing.

CONNECT WITH TONY WALKER

• Linkedin
• Twitter

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Like many other states across the U.S., California’s ambulance services are both understaffed and underfunded.  In what has turned into a vicious circle, poor reimbursement levels hamper the employer’s ability to increase pay and compete with other sectors that offer better hourly rates for less risky or skilled employment. In fact, California has not had an increase in its Medi-cal (Medicaid) rate in 20 years.

In this podcast, Host Rob Lawrence doesn’t talk about the EMTs on the truck – he talks to the EMTs on the truck.  He gets their views on what keeps them on the job and what is driving them away.  As Rob notes, “In talking to this amazing cohort of EMTs, it is clear that the passion to serve and care for those they treat is there, but the living wage they receive is not!”

Recurring themes emerge from the discussions (which are reflected in various EMS industry surveys):

• Having a good and receptive boss/leader
• Camaraderie – good coworkers make the day fly by
• Training – keeping skills up to date.
• The ability to do the job; respond; if necessary, transport; hand over and repeat! … not delay

About the guests

Alyssa Catalan – EMT with Shoreline Ambulance based in Orange County California

Doricela Mozo – EMT with. Medic 1 Ambulance based in Irwindale CA

Tyler Coombes – EMT with PRN Ambulance based on North Hills California

Ryan Walters – EMT with Falck Ambulance based in Orange County

Lasalle Jones – EMT with AmbuServe Ambulance based on Gardena California

Damian Henriquez - EMT with AmbuServe based in Gardena California

Top quotes from this episode

“We do have patients’ lives in our hands, and unfortunately, the pay does not reflect that whatsoever, so a lot of us are working two other jobs, like myself, I work here and I have another job and I have the most overtime than anyone else in the company and I still don’t have enough to pay my bills.” —  Damien Henriquez

“I have to work twice as much as a normal worker would have to to afford to live, and that’s one of the reasons why I’ve amassed about 40,000 work hours, I have a 20-year career but I’ve only been here 14 years.” — Ryan Walters

“One of the great things about EMS – coming to work and not knowing what type of call you are going to get, whether it’s interfacility transport, 911, just never knowing what kind of call am I going to get, sometimes you get really cool calls, sometimes you get calls that are very difficult, but after the call, just knowing that you accomplished it and what it took to accomplish is really rewarding.” — Lasalle Jones 

“Do you realize EMS as a whole is a bubble that’s about ready to pop? Do you want to be proactive or reactive? Do you want to get ahead of it before it bursts or do you want to figure it out after? Right here, right now, we are trying to be proactive so everyone can get a living wage.” — Damien Henriquez

Episode contents

01:25 – Meet the panel

02:56 – The view of the new EMTs

04:55 – Time served EMTs

07:17 – How can we help you make a living?

10:22 – What’s keeps you motivated and on the truck

13:56 – What is the FTO seeing as people come in?

21:40 – If you had a rider down the escalator with an elected official, what would you say to them?

25:54 – Get involved

26:24 – Final thoughts

Additional resources on this topic

California’s Fund First Responders Website

California Ambulance Association

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Like many other states across the U.S., California’s ambulance services are both understaffed and underfunded.  In what has turned into a vicious circle, poor reimbursement levels hamper the employers’ ability to increase pay and compete with other sectors that offer better hourly rates for less risky or skilled employment. In fact, California has not had an increase in its Medi-Cal (Medicaid) rate in 20 years.

As part of the ongoing legislative campaign, California’s ambulance service owners and operators have created a coalition with all the labor unions that represent EMS in the state to campaign for increases.

In this episode of EMS One-Stop, both labor and leadership sit down with Rob Lawrence to discuss politics, funding and working as a team.

About our guests

Melissa Harris - president and CEO of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; and board member and treasurer of the California Ambulance Association

Shelly Huddleson - national labor representative for the International Association of EMTs and Paramedics

Chad Druten - COO Emergency Ambulance Service based in Brea, California; president of the Los Angeles County Ambulance Association, president of the Ambulance Association of Orange County

Ryan Walters - president of IAEP Local 370 representing EMTs and paramedics working at Falck in Orange County and Los Angeles

Jim Karras - vice president and chief operating officer of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; vice president, Los Angeles County Ambulance Association; and secretary of the Ambulance Association of Orange County

Top quotes from this episode

“EMTs are one missed shift away from poverty. This is the industry I love. I’ve seen people leave, people that I wish we could hold on to, but they have to provide for their families.” — Ryan Walters

“Unlike the In and Outs, the Jack in the Boxes, the Del Tacos who can raise their prices to meet the escalating minimum wage and escalating inflationary pressures that they are feeling, we don’t have the ability to do that. Our rates are set for us by the government and by government payers and they are capped and in some cases, they are fixed, so we are beholden to the State of California to help us and give us some relief.” — Jim Karras

“If we don’t do something soon with our Medi-Cal rates, then our EMS system is going to implode, it’s going to implode because our ambulance companies are either going to stop taking these Medi-Cal patients because they can’t afford them and so who is going to take care of them or they are going to start shutting their doors. When they shut their doors, our members lose jobs.” — Shelly Huddleson

“The patient is the one that’s most important here, the medical recipient, they are the ones that stand to lose the most and they are the only reason we exist, they are the only reason any of us have jobs and we can’t lose sight of that, so we are not just advocating for our industry, we are advocating for the citizens of California.” — Chad Druten

Episode contents

0:30 Rob sets the scene

1:00 Meet the guests

2:05 The campaign to increase reimbursement

3:08 EMTs are one missed shift away from poverty

3:45 Management and labor alliance

6:30 How labor and management can work together on political campaigns

9:00 We share a common humanity

11:00 We as an industry are not good at going hat in hand

13:00 The politicians are astonished at what we pay and that we are losing people to fast-food chains

14:00 Medi-Cal is for the patient to have equal access to healthcare

17:00 This is an economic nightmare

18:30 If you were in an elevator with a politician, what would your pitch be?

21:45 Find your champions – those elected officials that will fight for you

23:00 Acting as a coalition

24:40 Ambulance companies with staffing issues

26:10 Workers deserve a long and dignified career

28:30 The patient is at the center

30:00 A call to action

Additional resources on this topic

• California’s Fund First Responders
• California Ambulance Association
• International Association of EMTs and Paramedics

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In the second EMS One-Stop international edition, Host Rob Lawrence welcomes Steinar Olsen, director for emergency medical services and national preparedness in the Norwegian Directorate of Health. Steiner describes the composition and deployment of EMS services across Norway – a country with the second largest coastline in the world and 1,100 miles from North to South (the distance from Seattle to San Diego or Chicago to Miami). Norway has one government/healthcare run system consisting of 400 stations, 520 ambulances, 4,500 EMTs and paramedics, aided by 14 helicopters and 12 fixed wing aircraft.

Educational requirements, current initiatives and future plans are discussed. Lawrence and Steiner also identify that EMS systems around the world encounter similar challenges, and international best practice exchange is always welcomed and encouraged. 

TOP QUOTES FROM THIS EPISODE

“Looking at just response times – you can waste a lot of money that could be used wisely in other parts of the service to create more health.”

“Between 25-30% of calls are handled with just a phone call or a combination of phone and video conference with the patient.”

“EMS in the next 20 years will develop from just lights and sirens to being an advanced platform for performing healthcare in the patients’ home instead of moving them to the hospital.”

EPISODE CONTENTS

1:13: Introduction – Steinar Olsen

2:08: Description of EMS in Norway

4:05: Ambulance stations, helicopters and fixed wing aircraft

6:07: Paramedic training and education

7:17: EMS as a gateway to healthcare

9:38: Norwegian support to international disasters and events (Turkey and Ukraine)

14:00: The next big things for EMS in Norway

16:00: Response times can waste a lot of money

17:35: Hear and treat – Nurse triage

20:00: The need for EMS nations to learn from each other

21:00: The challenge for treating patients in the future

23:34: The relationship between fire and EMS in Norway

24:50 : Vehicle extrication – Norwegian style!

26:15: Steiner Olsen’s final thoughts

27:10: Contact details

ABOUT OUR GUEST

Steinar Olsen is a RN and paramedic with 38 years of clinical and high-level management background from EMS and specialized healthcare services. He now serves as the director for emergency medical services and national preparedness in the Norwegian Directorate of Health. Steinar is also the regional chair of the European Regional Group for EMTs and national focal point to NATO joint Civil Military Health group. His previous experiences include serving in various positions in national healthcare, ranging from field disaster management to hospital management, project management through various national and international projects, including heading Norway’s contribution to Sierra Leone during the Ebola outbreak in 2014/15 and followed by various deployments to international humanitarian and consular crises.

ADDITIONAL RESOURCES ON THIS TOPIC

Patient Quick Release Extrication Paper

Norwegian Telemedicine and Nurse Triage Video (in Norwegian)

CONNECT WITH STEINAR OLSEN

Linkedin  

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In this episode of EMS One-Stop, host Rob Lawrence welcomes Matt Zavadsky back to the podcast to catch up on three key ongoing issues and developments: MedStar’s EMS-on-demand model via their MedStarSaver+PLUS program, the recent article by Zavadsky and Dr. Doug Kupas on the reduction of red lights and sirens with the additional news that MedStar ceased all RLS use during the recent ice-related weather event.  Finally, Zavadsky discusses the recent National Association of Emergency Medical Technicians’ 2022 EMS Worker Engagement Survey and the top five takeaways.

Top quotes from this episode

“One of the mantras we have always said is if someone is going to get paid to reduce our call volume, it should be us.”

“We take an oath to do no further harm, if we know that we are doing something that causes further harm while we are getting to a call that probably doesn’t need an immediate response, then we are not fulfilling our oath.”

“Our medical director has implemented a directive in the same theme of bad weather, bad driving that no patient will be transported with CPR in progress, meaning that you are just not going to transport patients in cardiac arrest … there is no reason for us to relocate corpses from the field to the emergency room.”

“Community expectation ... is it really what the community expects or is it something we have taught them to expect because we are competing for contracts?”

Episode contents

1:52       MedStar Saver Plus Model

11:37    NAEMSP2023 discussion

13:15    Red lights and sirens reduction

15:11    MedStar suspends RLS

19:07    Political navigation to reduce use of RLS with local officials

23:06    We stink at communicating effectively with our workforce

23:45    We stink at providing feedback to our employees about their performance (and their patients)

24:59    We don’t pay our people enough

26:21    California’s Medi-Cal Campaign

29:10    Work-life balance is a real thing

32:13    This is a long-term challenge that needs long-term solutions

34:33    Zavadsky’s final thoughts

34:44    Drs. Larmon, Kazan and Mackey

Additional resources

EMS-on-demand the next big transformation for the profession?

Culture shift: Reducing lights and siren vehicle operation

The EMS workforce: Critical condition!

About our guest

Matt Zavadsky is the chief transformation officer for MedStar Mobile Healthcare, the Public Utility Model EMS system serving Fort Worth, and 14 other cities in Texas. He has 43 years of experience in EMS. He is an at-large director for NAEMT and chairs its EMS Economics Committee.

Connect with Matt Zavadsky

Online

Linkedin

Twitter: @MattZavadsky

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In a recent blog post, Dave Williams, PhD, noted that half to two-thirds of Dallas city general funds are dedicated to police, fire and EMS. With significant tax dollar investments, elected officials, community leaders, and the media want to be good stewards. Still, they are frequently not equipped with the knowledge or data to determine if their services are built to get results and where there are opportunities for improvement.

In this week’s podcast, host Rob Lawrence sat down with EMS thought leader, Dr. Dave Williams, to discuss and identify the 12 questions local leaders can use to learn about their communities. Each point discussed should generate ideas for more learning and improvement both inside an organization and for those citizens and elected officials that surround it.

Top quotes from this episode

“I have been to dozens of ambulance systems around the world and met with leaderships teams and I can count on one hand the number of times they started by talking to me about their clinical outcomes.”

“Almost all of your staff are not your generation … which means they have a totally different value system and a totally different prioritization of things.”

“One of your real powers is to be able to help your community and its leaders understand what’s happening in it. The data that you have is a huge enabler for others to be able to change policy.”

Additional resources on this topic

• Williams’ Blog
• To Err is Human: Building a Safer Health System
• The EMS workforce: Critical condition! Why right-sizing EMS response is crucial to increasing pay and improving work-life balance
• Crossing the Quality Chasm: A New Health System for the 21st Century

About our guest

Dave Williams, PHD, designs and improves ambulance systems. He is known for leading objective, ethical and collegial approaches focused on patient and community needs, and incorporating evidence-based and best practice methods. He is one of a few researchers to study EMS system design. His published doctoral research focused on patient-centric EMS system design.

Dr. Williams is a former paramedic, EMS commander and researcher. Previous leadership positions include the Institute for Healthcare Improvement, Fitch & Associates, and Austin-Travis County EMS.

Dr. Williams is faculty at the Institute for Healthcare Improvement and serves as a senior improvement advisor. He served as faculty in emergency health services at The George Washington University School of Medicine and public safety management at St. Edward’s University. He supported professional development programs, including the National Association of EMS Physicians Quality and Safety program, the American Ambulance Association Ambulance Service Manager Program, and the National Academies of Emergency Dispatch Communication Center Manager Program.

Dr. Williams served as the vice chairman of the Board of CommUnityCare, the Federally Qualified Health Center system serving the City of Austin, Texas, and was appointed by the Travis County Commissioners Court to serve as a member of the Advisory Board of Austin/Travis County EMS. He is an alumni of Leadership Austin (Essential 2013).

He has contributed to several EMS leadership and research textbooks and published dozens of peer-reviewed papers and industry articles. He is a frequent keynote speaker.

Dr. Williams earned a B.S. in EMS Management and an M.S. in Emergency Health Services Management. He also earned a Ph.D. in Organizational Systems, where his research focused on the obstacles to patient-centric EMS system design.

Connect with Dave Williams

Online

Twitter @davewilliamsATX

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Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

In this episode of EMS One-Stop, our host, Rob Lawrence, kicks off a series on international EMS, interviewing EMS leaders across the globe on how their systems are operated, the challenges they face and the successes they have had.