EMS One-Stop

In this episode of EMS One-Stop, host Rob Lawrence sits down with Oscar Monterrosa, the 2026 NAEMT Paramedic of the Year, whose career has taken him from Army combat medic to street paramedic, medical student and now an emergency medicine-internal medicine resident at Hennepin County Medical Center. Yet despite the white coat and demands of residency, Monterrosa continues to work on the ambulance, including in rural Minnesota, and remains closely connected to the profession that shaped his approach to medicine. The conversation also returns to one of the defining moments of Monterrosa's career: the Oct. 1, 2017, mass shooting in Las Vegas. Working an overtime special-event shift, Monterrosa was already inside the medical tent when gunfire began and casualties started arriving. He describes slipping into “work mode,” drawing on his experience as an Army combat medic in Iraq as he and others triaged and treated patients while the shooting was still underway. Beyond that extraordinary night, the discussion explores rural EMS, critical care and ECMO, education, mentorship and the long road from paramedic to physician. Monterrosa's message to other EMS clinicians considering further education is straightforward: the road may be difficult and it may take longer than expected, but it is possible. Key quotes from Oscar Monterrosa “We have that critical call or whatever, somebody that's crashing right in front of you and you just kind of get into work mode.” “Even though there's still gunfire going on, you try to be as safe as you can and take cover, but ultimately all that is really out of your control.” “A lot of these experiences in the cornfields has been very rewarding, just seeing this different culture, like meeting a lot of different people.” “It just takes hard work and just not giving up.” “I was an undergrad for 9 years because I was working full time on the streets.” Additional resources National Association of Emergency Medical Technicians (NAEMT) NAEMT National EMS Awards of Excellence Hennepin Healthcare Las Vegas Metropolitan Police Department: October 1 / Las Vegas mass shooting – After-Action Report Episode timeline 00:52 – Rob introduces the 2026 NAEMT Paramedic of the Year 01:34 – Oscar 101: paramedic and emergency medicine-internal medicine resident 02:05 – Oscar hears what his colleagues wrote about him in his award nomination 04:04 – His reaction to being named National Paramedic of the Year 05:00 – The journey into EMS, military medicine and becoming a paramedic 07:20 – From the desert Southwest to rural Minnesota EMS 09:00 – The realities of rural 911 response and long interfacility transports 10:15 – Critical access hospitals and managing high-acuity patients 12:30 – The conversation turns to October 1, 2017, in Las Vegas 13:17 – What began as a routine special-event EMS shift 13:55 – Reports of gunfire and the first shooting victims reaching the medical tent 14:24 – What happens mentally when a mass-casualty incident suddenly unfolds 15:00 – Combat medic training, triage and functioning while gunfire continues 17:00 – Reflections on the Las Vegas response and its lasting impact 18:00 – From paramedic to physician: why Oscar continued his education 19:30 – Rural critical care, cardiac arrest and mobile ECMO 21:00 – Remaining connected to EMS while completing medical residency 23:00 – Advice for paramedics considering college or medical school 23:42 – Nine years as an undergraduate while working full time on the streets 24:00 – Perseverance, education and why the path is still achievable Closing – Looking ahead, mentorship and what being NAEMT Paramedic of the Year means to Oscar Enjoying the show? Email editor@ems1.com to share feedback. 

FDNY Chief of Department John Esposito recounts FDNY's devastating losses, the decisions that saved thousands of lives and why honoring 9/11 means preparing the next generation to meet the moment Twenty-five years after Sept. 11, 2001, FDNY Chief of Department John Esposito joins podcast hosts Jim Dudley, Rob Lawrence and Aaron Zamzow of Police1's Policing Matters, EMS1's EMS One-Stop and FireRescue1's Better Every Shift for a deeply personal conversation about 9/11, its enduring impact and the lessons that continue to shape fire, EMS and law enforcement. Esposito was a newly promoted FDNY lieutenant on Sept. 11, 2001. He recalls returning to the city after the towers fell, the collapse of command and communications, the desperate effort to account for missing members, and the realization that FDNY had suffered unimaginable losses. The discussion moves beyond remembrance to examine what emergency services learned: stronger accountability, controlling self-deployment, incident management teams, interoperable communications, interagency cooperation, intelligence sharing and peer support. Esposito also reflects on the continuing toll of World Trade Center-related illness and explains why “never forget” must mean more than remembering 343 names. For him, it means remembering the decisions responders made, the conditions they faced and the thousands of lives their actions helped save. His challenge to today's generation is simple: know your job, keep learning, take care of your people and ask whether you are prepared to “measure up” to those who came before. Key quotes from FDNY Chief of Department John Esposito “Never forget is not just their names and who they were, how they lived their lives, and most importantly, the decisions that they made that day and the actions that they took.” “They're like, ‘No, we think we lost everybody.' And that was when it started to sink in that no, this is gonna be as bad as it could be.” “If we never showed up and we had no losses that day, the loss of civilians is in the tens of thousands.” “This is your legacy. This is our legacy, this is what we do, and these are the people that did this before us.” “I believe that some of them knew that they were not going to make it home that night. And they still did their job.” “September twelfth came, the doors of the firehouse went up, people got on fire trucks, and they went out and did their job.” “It was like an all-star team that we lost. Some of the best people to ever do this job we lost that day.” “I see my job here and our job in this building and headquarters is to take care of the people that take care of the city.” “We have no idea. We're in a firehouse or an ambulance one second and in five minutes we could be in the worst situation we've ever been in.” “It's our job to make sure that the people in the field are prepared and when they need something, it's our job to get it for them.” Episode timeline 00:27 – Introduction: EMS1, FireRescue1 and Police1 come together to reflect on 25 years since September 11 02:28 – Introduction: FDNY Chief of Department John Esposito 03:23 – Chief Esposito recalls Sept. 11, 2001 as a newly promoted lieutenant with a day off and plans to study for the captain's exam 04:28 – Chief Esposito details arriving in lower Manhattan and finding command structures and communications devastated 05:04 – The desperate process of identifying who was alive, missing or lost 07:00 – Chief Esposito describes his initial response and why he never imagined the towers could collapse 09:00 – “We think we lost everybody.” When the magnitude of FDNY's losses began to become clear 09:30 – Accountability and self-deployment emerge as major lessons from 9/11 10:00 – How FDNY now wants off-duty members to report to firehouses and EMS stations rather than directly to an incident 10:30 – Modern digital accountability, riding lists and identifiable radio transmissions compared with 2001's paper systems 12:00 – The human factor: firefighters desperate to get aboard apparatus headed toward the World Trade Center 12:30 – Leadership decisions that removed extra firefighters from overloaded apparatus ultimately saved lives 14:00 – The continuing human toll: FDNY's memorial walls and deaths from World Trade Center-related illness 16:30 – How FDNY will commemorate the 25th anniversary 17:30 – Why September 11 remembrance is intensely personal for individual firefighters and families 21:00 – Chief Esposito discusses the emotional effect September 11 continues to have on him 22:00 – “Never forget” means remembering actions and decisions, not merely names 24:00 – The actions of responders helped prevent civilian deaths potentially reaching into the tens of thousands 25:00 – Managing the overwhelming desire of responders to help during catastrophic incidents 27:30 – How outside incident management teams helped FDNY solve problems after 9/11 28:30 – FDNY repaying the assistance it received through deployments around the United States 30:00 – How today's incident command and dispatch systems control resources and prevent uncontrolled response 31:42 – Sponsor message 32:30 – Improved interagency collaboration between FDNY, NYPD and other agencies 36:00 – Peer support, firehouse culture and challenging the stereotype that firefighters do not talk about emotional distress 38:30 – How FDNY's peer-support system works after difficult incidents 42:30 – September 11 demonstrated why the fire service needs to be part of the intelligence community 44:00 – FDNY members are trained to recognize suspicious activity during routine fire and EMS responses 46:00 – How information spotted by firefighters may become the missing piece in a larger investigation 48:30 – What Chief Esposito wants responders who were not alive on 9/11 to understand 49:00 – “This is our legacy.” Measuring today's performance against those who came before 52:00 – Know your job and do your job — while recognizing that not every emergency fits an SOP 52:30 – A recent Bronx explosion illustrates the need to adapt principles to situations for which no exact procedure exists 53:30 – Applying the overarching principles of life safety and rescue when the situation is unprecedented 54:30 – What does “never forget” mean 25 years later? 55:30 – September 12: despite catastrophic losses, FDNY opened its firehouses and continued protecting New York City 56:30 – Chief Esposito describes those killed as “an all-star team” and some of the best ever to do the job 58:00 – Aaron Zamzow reflects on the responsibility to “measure up” 59:30 – The nationwide impact of 9/11 and seeing FDNY remembered on apparatus thousands of miles from New York 1:01:30 – Jim Dudley reflects on intelligence, prevention and acting on warning signs 1:03:30 – Chief Esposito discusses the difficulty of measuring successful prevention 1:05:00 – Warning signs, intelligence and lessons shared with other historic disasters 1:06:00 – Rob Lawrence reflects on September 12 and the emergency services reality that tomorrow brings another shift 1:07:00 – “At the going down of the sun and in the morning, we will remember.” 1:08:00 – Esposito discusses how 9/11 affected his career and leadership journey 1:09:00 – Leadership, doing the right thing and measuring decisions against the memory of colleagues lost 1:10:00 – “Take care of the people that take care of the city.” 1:11:30 – Emergency responders never know when the next call will become the worst situation they have ever faced 1:12:00 – The responsibility to ensure frontline personnel are prepared and supported 1:12:30 – Closing message: “Keep learning and keep moving forward.” About our sponsor This crossover episode of the Policing Matters, Better Every Shift and EMS One-Stop podcasts is sponsored by FirstNet — the only wireless network built with and for first responders. Twenty-five years ago, first responders faced an emergency unlike any other. They stepped forward to protect and care for others, demonstrating extraordinary courage and resolve. This September 11th, we remember and honor those who answered the call. The example they set endures through the values that continue to inspire the profession today. Learn more about FirstNet, Built with AT&T, at www.firstnet.com. 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. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

AI may feel like the newest revolution in EMS, but the industry's relationship with data has been evolving for decades. In this episode of EMS One-Stop, Rob Lawrence sits down with FirstWatch founder Todd Stout, whose 28 years working with EMS data gives him a particularly long view of where the industry has been and where it is heading. Todd traces the journey from an era when monthly reports printed on green-bar paper were considered normal, to today's world of real-time dashboards, cloud-based systems and enormous volumes of operational and clinical information. The challenge has changed: EMS no longer suffers primarily from a lack of data; leaders now need technology that can identify what matters, separate signal from noise and turn information into decisions. That makes AI extraordinarily promising — and potentially dangerous. Todd explains why he is more excited about the next 3-5 years than at any point in his career, while simultaneously being more concerned about the next 8-10 months. Rob and Todd discuss unreliable AI outputs, data security, HIPAA and privacy, the risks associated with startups and what EMS leaders should ask before entrusting vendors with organizational or patient data. They also examine the urgent need for EMS agencies to establish AI policies and train their workforce on responsible use. Todd concludes with a preview of FirstWatch's next generation of AI-enabled tools and a broader message for EMS leaders: the organizations that thrive through this technology shift will not necessarily be those with the newest technology, but those capable of adapting, learning and using it responsibly. Additional resources: EMS1 Leadership Institute: 2026 Spotlight on AI in EMS: On-demand: Smart tools, strategic choices: EMS puts AI into action Why EMS must measure the human side of care: What patients remember No rulebook is coming: EMS must take control of AI now: Why EMS must govern AI locally as adoption accelerates Hyper-turbulent times: EMS economics and AI guardrails with Matt Zavadsky and Dr. Shannon Gollnick: Why EMS needs AI guardrails and Medicare reform today Memorable quotes "I'm more excited about the next 3-5 years than I've ever been, I am also more scared about the next 8-10 months for our industry than I've ever been because it's so messy." — Todd Stout "Nobody gets into EMS to be excellent data enterers." — Todd Stout "AI well formed — with the proper bumpers, guidelines, rules around it — is astonishingly good at processing through lots of data." — Todd Stout "If you're not paying for the thing that you're using, you are the product." — Todd Stout "AI to many people seems like magic. And it's the opposite of magic almost. It's a lot of work and plumbing to get it right." — Todd Stout Episode timeline 00:27 – Rob introduces the episode and the evolution of EMS data, information and AI 01:54 – Twenty-eight years of FirstWatch: from Stout Solutions to today's real-time data environment 03:57 – Looking back at EMS's early adoption of real-time operational data 05:18 – Why immediate data can improve individual performance and expose problems with systems and protocols 06:24 – The "ah, buts:" gut instinct versus what the data actually shows 07:19 – Dirty data, disconnected systems and why organizations sometimes don't believe their own numbers 09:45 – EMS has moved from too little information to information overload 10:31 – How AI can sift through enormous amounts of data and identify what leaders actually need to know 11:22 – The accuracy problem: AI can produce impressive outputs while struggling with surprisingly basic tasks 12:39 – Todd explains why he is simultaneously excited and concerned about the immediate future of AI in EMS 14:35 – How EMS leaders can become better, more discerning customers of AI technology 15:10 – Established technology partners versus innovative AI startups 17:00 – What happens to your organization's data if an AI vendor fails or goes out of business? 17:41 – HIPAA, privacy, cybersecurity and employee data obligations 18:11 – Sponsor break 19:26 – Part two: protecting patient and organizational information when using AI 20:18 – AI training models, data sharing and why leaders need to understand vendors' default settings 22:44 – The pace of change: today's AI expertise can become outdated within weeks 23:08 – Preparing for the wave of "AI everything" appearing in EMS exhibit halls 23:45 – Questions EMS leaders should ask prospective AI vendors 25:20 – Why AI isn't magic — and why implementation requires significant work behind the scenes 27:08 – The case for every EMS organization having an AI policy now 27:41 – Todd warns that employees are almost certainly already using AI, sometimes without understanding the privacy implications 28:21 – Why AI education should resemble cybersecurity education: policy, training, suspicion and continual reinforcement 30:13 – Preview of FirstWatch Collaborate and the company's next generation of technology 31:02 – FirstWatch 2.0, AI-enabled mobile tools and workload management 31:55 – Reflect: incorporating patient satisfaction alongside operational and clinical performance 33:34 – Why rapid patient feedback can be more meaningful to crews than retrospective monthly scores 35:19 – Todd's closing message: EMS is good at adapting and improvising, and technology can make the job easier 36:22 – Rob's takeaway: adapt, innovate, become a discerning AI customer and establish an organizational AI policy Enjoying the show? 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This week on EMS One-Stop, I sit down with Liz Harney, almost a year after I first walked into a classroom at EMS World Expo looking for another session to report on and found what I later described as “the keynote I didn't know I needed.” Liz's presentation was built around a part of EMS education we routinely acknowledge but rarely give equal billing: the affective domain — empathy, communication, professionalism, self-awareness and the ability to connect with another human being in what may be the worst moment of their life. But the real power came from Liz herself. Before she was a paramedic, educator and EMS leader, she was the patient. At the lowest point of a decade-long struggle with addiction, one paramedic looked beyond the overdose, the circumstances and the judgement, and treated her as a person who still mattered. Liz credits that interaction not simply with helping save her clinically, but with changing the trajectory of her life. She recovered, entered EMS and ultimately became the kind of paramedic she had encountered that day. It is a remarkable journey from patient to paramedic, and in this conversation, Liz explains why that experience now sits at the heart of everything she teaches about the human side of EMS. | MORE: Liz Harney — the affective domain is the heart of EMS, so why aren't we teaching it? Our discussion also catches up with where Liz's thinking has evolved since. In her recent EMS1 article, “Shiny Happy People,” she takes that same belief in people and applies it to EMS leadership, challenging professionals that is exceptionally good at identifying everything that might go wrong not to let that instinct extinguish every new idea before it gets moving. Together, we connect those themes: the provider who changed one patient's life, the importance of deliberately teaching the affective domain, turning cynics into champions, recognizing burnout through QA and QI, and creating leadership teams with enough optimism and emotional intelligence (EI) to make change happen. At a time when EMS is increasingly consumed by another form of intelligence (AI), the conversation comes back to a proposition I think matters more and more: if we are going to get good at AI, we first need to get much better at EI. Additional resources: Liz Harney: Shiny happy people. The leadership power of optimism Rob Lawrence: The affective domain is the heart of EMS — so why aren't we teaching it? Inside EMS: Tactical empathy: The leadership tool you're not using enough Colby Davis: Can emotional intelligence be taught? Shannon L. Gollnick: The paradox of progress — emotional intelligence as the differentiator in an AI-augmented workforce Key quotes “It truly was a paramedic that not only saved me in a clinical sense, but she saved me in a human sense.” — Liz Harney “Everybody has a story and they're all a little the same, but they're all very different at the same time.” — Liz Harney “It's our role as educators and program directors to be able to ensure that we are instilling, improving the affective domain, just as we are the cognitive and the psychomotor.” — Liz Harney “You created from the cynic, turned them into the champion, and then the champion then took that back to their own service.” — Rob Lawrence “I am the dreamer, probably because I have forged myself out of the depths of hell.” — Liz Harney “Look at me, anything is possible. Like there is never a ‘no' in my language.” — Liz Harney “In order to build, in order to make change, in order to move the needle, you have to have folks that are strong in EI to make that happen.” — Liz Harney “There's always room for improvement.” — Liz Harney “I may not be able to teach everyone to care, but I absolutely think you can teach people what caring looks like in practice.” — Liz Harney “No one's ever complained about the gauge of needle that we used, but they've certainly complained that the medic was mean.” — Rob Lawrence “People underestimate the power of storytelling, but I'm here to tell you that is what creates the change into someone, that changes their perspective.” — Liz Harney Episode timeline 00:00 — Harney on surviving addiction, being written off and the potential EMS providers have to influence another person's future 01:02 — Rob welcomes listeners to EMS One-Stop and introduces Liz Harney 02:14 — How Rob first encountered Harney at EMS World Expo and why he describes her presentation as “the keynote I didn't know I needed” 02:40 — Liz Harney 101: critical care paramedicine, organizational leadership, Baptist Health, Kentucky EMS workforce initiatives and Paramedic Pathways 04:10 — Harney reflects on the rapid growth of her speaking platform and why sharing her story remains difficult but necessary 05:32 — The human side of EMS: affect, emotional intelligence and why clinical competence alone is not enough 08:10 — AI versus EI: why Lawrence argues that increasingly intelligent technology makes human emotional intelligence even more important 09:00 — From patient to paramedic: Harney recounts the interaction with the paramedic who changed the direction of her life 18:33 — Revealing her past to colleagues and students, and how that story changes attitudes toward people experiencing addiction 22:08 — Why simply telling EMS students to care does not work — and how Harney began using clinical rotations and direct patient interaction to build the affective domain 23:18 — “Everybody has a story:” students hear directly from people in addiction recovery 25:23 — The cynic-to-champion story: a student's dismissive attitude toward patients with addiction is transformed through one clinical rotation 31:00 — Educating not simply for cognitive and psychomotor competence, but for the clinician the student is becoming 32:15 — Harney moves from education into leadership and begins seeing the same issues around decision-making tables 33:19 — The case for optimism: Harney describes herself as a dreamer and explains how persistent negativity can kill innovation 34:04 — Lawrence's rule: “If we do what we always did, we'll get what we always got” 36:27 — Why potential barriers matter — but introducing every possible objection too early can destroy an idea before it develops 38:02 — “Shiny, happy people:” the discussion turns to Harney's article on optimism, innovation and assembling teams capable of making change 39:02 — Harney describes Kentucky's EMS workforce committee and what happened when a group of optimistic problem-solvers started building ideas without immediately saying “no” 41:00 — Choosing the right people for decision-making groups: why names, titles and tenure should not outweigh emotional intelligence 41:59 — Harney defines EI: self-awareness, self-regulation, communication and empathy 45:00 — “You can teach people what caring looks like in practice.” 45:15 — Lawrence asks whether EMS can genuinely change the affect and attitudes of a generation of clinicians 46:39 — Protecting the workforce: recognizing behavioral changes, cumulative exposure and the early warning signs of burnout 47:41 — QA/QI as more than clinical oversight: documentation can expose frustration and changes in provider behavior 48:07 — The leadership question: “What can I do for you?” 49:27 — The power of storytelling to challenge judgment and change perspectives 49:49 — Harney returns to her own experience: addiction, being cast off and ultimately demonstrating that recovery and transformation are possible 51:10 — Harney's closing message: “You don't have to understand someone's life to understand your responsibility to them.” 52:41 — Turning QA/QI from a fault-finding function into a mechanism for recognizing providers, celebrating success and checking on people carrying heavy cognitive and emotional loads 54:10 — Lawrence recommends seeing Harney speak: “You will come away emotional but enlightened.” Enjoying the show? 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EMS research has grown rapidly, but finding the studies that truly matter to everyday clinical practice remains a challenge. In this edition of EMS One-Stop, Rob Lawrence is joined by Dr. Christopher Richards, EMS and emergency physician at the University of Cincinnati; and Dr. Christian Martin-Gill, chief of the Division of EMS at the University of Pittsburgh and former president of the Prehospital Guidelines Consortium, to discuss the recently published EMS research reading list and the effort to identify the most important evidence EMS clinicians and medical directors should know about. The discussion explores how the reading list was created; why a significant gap remains between publication and implementation; and how EMS can better translate research into education, protocols and patient care. Richards and Martin-Gill explain the mix of evidence-based guidelines, position statements, systematic reviews and original research included in the project, while highlighting major gaps in behavioral emergencies, pediatrics, obstetrics, workforce wellness and EMS operations. The message is clear: EMS practitioners should not wait for new research to appear in their protocols. They should read it, discuss it, question current practice and, where evidence is lacking, consider contributing to research that closes the gap. Additional resources: Richards CT, Cash RE, Crowe RP, et al. 2026. “Developing an emergency medical services research reading list for emergency medical services practitioners.” Prehospital Emergency Care, 1-6. https://doi.org/10.1080/10903127.2026.2693158 EMS1 Research Center. A central access point for critical research that can help drive operational and policy changes Understanding research and its impact on patient care. David Page, MS; Hezedean Smith, DM; and Ayanna Walker, MD, share best practices for evaluating and interpreting prehospital research  Key quotes “With EMS research, there's always something missing. There's always more that we can do.” — Dr. Christian Martin-Gill “What we're seeing here, particularly over the last decade, is these organizations working less as silos and moving more towards working together when it makes sense to do that.” — Dr. Christian Martin-Gill “We didn't go in actually feeling like we needed to identify 10 primary research or professional statements that complemented the guidelines that were already identified through the systematic review. But there was just a natural break point there.” — Dr. Christopher Richards “There are a number of position statements that are published by national and international organizations that are key scientific literature out there that people need to be paying attention to.” — Dr. Christian Martin-Gill “Still there is research lacking in what the EMS clinicians themselves experience as part of the workforce — safety on scene, wellness, these sort of questions.” — Dr. Christopher Richards “The behavioral emergency space I think is really important right now.” — Dr. Christian Martin-Gill Episode timeline 01:09 – Rob introduces the episode and welcomes Drs. Christopher Richards and Christian Martin-Gill 02:16 – Dr. Richards introduces his EMS, emergency medicine and research background 03:18 – Dr. Martin-Gill discusses his role at the University of Pittsburgh, UPMC and the Prehospital Guidelines Consortium 04:15 – Why does EMS need a dedicated research reading list? 07:11 – Where can EMS practitioners currently go to identify the research that really matters? 09:13 – Moving research into protocols, practice and clinical care 11:15 – Can the Prehospital Guidelines Consortium help align the many organizations producing EMS clinical guidance? 13:41 – Breaking down the different categories of publications on the reading list 14:47 – Evidence-based guidelines included in the broader reading list 15:49 – Position statements covering hemorrhage, restraint, air medical utilization and workforce issues 16:26 – Systematic reviews addressing airway management and prehospital evidence-based guidelines 16:51 – Four original research papers, including refractory VF, pain disparities, evidence integration and midazolam use 18:58 – How the research reading list was actually developed 19:32 – The open call for EMS research submissions 20:10 – The project is ongoing, with submissions continuing for the next iteration 20:42 – Expert panel review, scoring and the natural cutoff that produced the final 10 23:18 – What important EMS research is still missing? 24:37 – Gaps in airway, pediatric and behavioral emergency evidence 26:08 – Dr. Richards highlights workforce, safety, wellness and operational research gaps 28:18 – Which areas should future EMS researchers investigate? 28:31 – Martin-Gill highlights behavioral, obstetric and pediatric emergencies as priorities 30:12 – Richards explains how everyday frustrations in EMS can become important research questions 32:12 – Final thoughts on the paper and the breadth of the reading list 33:37 – Martin-Gill discusses access to research and why highlighting important publications matters 35:05 – Turning reading into discussion, protocol review and further research 35:58 – Rob closes with a challenge to read, question, discuss and contribute to EMS research Enjoying the show? 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In this episode of EMS One-Stop, Rob Lawrence speaks with Wesley Brookshear, critical care paramedic and FTO program supervisor with AMR in Knoxville, Tennessee, about a community-led effort that is changing how EMS responds to the city's Mission District. What began as an attempt to understand unusually high 911 utilization has evolved into a multidisciplinary outreach program bringing EMS, public health, addiction services, shelter providers, clinicians and other community organizations directly to Knoxville's unhoused population. By concentrating on relationships, consistency and basic human needs, the initiative has produced a reported 32% reduction in traditional EMS call volume while dramatically expanding access to wound care, food, addiction treatment, mental health support, nurse navigation and other services. Wesley explains why the program's success is less about creating another specialized EMS unit and more about connecting people to the resources that already exist. The team initially arrived without uniforms, handed out fruit, listened and built trust before attempting to provide care. Two years later, the program has recorded thousands of encounters, helped more than 140 people enter treatment or sober living and generated remarkably few ambulance transports from its outreach activity. The conversation explores how other EMS systems can identify high-utilization areas, develop community partnerships, protect the mental health of outreach staff and start small—even with a single motivated employee. Above all, Wesley argues that EMS has an opportunity to move beyond simply transporting patients and instead become the connector that gets people to the care and resources they actually need. Additional resources: Global Medical Response - AMR Mission District Medical Team Program Sees 32 Percent Decline in 911 Calls eBook: How to fund community paramedicine Very high EMS utilizers: 7 strategies for local action From sirens to solutions: Guiding paramedics to a patient-centered mindset Public health at the front door: An MIH model to emulate Key quotes “We did go down without our EMS uniforms on. We went in black t-shirts, blue jeans and started making connections.” — Wesley Brookshear “We have noticed a 32% reduction in our normal call volume down at the mission since we started this program 2 years ago.” — Wesley Brookshear “MIH, mobile integrated healthcare, isn't a title; it's actually a list. It's mobile, it's integrated and it's healthcare.” — Rob Lawrence “This is not Wesley Brookshear, this is not AMR, this is an entire community of Knox County citizens that are coming together to support.” — Wesley Brookshear “We talk about the homeless or the unhoused, and I do use both terms, but the unhoused, and we act like it's those individuals; it's never those individuals, those are humans within your community.” — Wesley Brookshear “My mission wasn't admission avoidance, it was arrival avoidance.” — Rob Lawrence “Our folks are wrapping their own wounds now. We are providing supplies. We are giving education.” — Wesley Brookshear “Do not go down with the idea that you're going to cure this idea that homelessness is going to go away.” — Wesley Brookshear Episode timeline 00:49 – Rob introduces the episode and the concept of specialist teams focused on populations at risk 01:52 – Wesley introduces himself, AMR Knoxville and the multidisciplinary Mission District outreach team 03:25 – Identifying concentrated 911 utilization around the North Broadway area 04:22 – The headline result: a 32% reduction in normal call volume after 2 years 05:08 – Building services around Maslow's hierarchy of needs: food, water, shelter and safety 06:10 – How the project began with surveys asking community members what they actually needed 06:50 – Wesley emphasizes that homelessness should be understood as a human and community issue 08:05 – Building partnerships and establishing a consistent Tuesday outreach presence 08:28 – Why the team initially attended in jeans and black t-shirts rather than EMS uniforms 10:10 – Rotating team members to manage emotional and mental-health pressures 11:27 – Training new outreach personnel and protecting the culture of the program 12:10 – The practical work: washing wounds, basic dressings and human contact 13:02 – Patients begin managing and dressing their own wounds with education and supplies 13:26 – Taking CPR and Stop the Bleed education directly into the Mission District 14:00 – Using GMR nurse navigation to expand access to alternative care and follow-up 16:09 – Nurse navigation, mental-health pathways and bypassing the emergency department when appropriate 18:28 – Discussion resumes: community paramedicine versus mobile integrated healthcare 19:23 – Rob defines MIH as “mobile, integrated and healthcare” 20:01 – Building relationships with partner organizations beyond the street-level outreach work 21:23 – Program numbers: approximately 4,800 encounters, 515-plus people served, 140-plus entering treatment or sober living, and only nine outreach encounters requiring ambulance transport 22:14 – A frostbite patient whose feet were saved through coordinated community intervention 24:23 – Wesley reflects on severe wounds, winter outreach and the impact of simple acts of care 25:18 – Where another EMS chief should start: find the hot spots and find someone who cares 26:39 – Starting small and expanding services gradually through community partnerships 27:08 – Why handing someone a resource list is not enough 27:36 – EMS as clinicians and navigators rather than simply a transport service 28:50 – Rob discusses “arrival avoidance” and directing patients into appropriate pathways of care 29:51 – The minimum viable program: one person who builds connections and physically links patients to resources 30:42 – Costs, donated supplies and the operational value of reducing unnecessary 911 demand 31:55 – The broader return: increased ambulance availability and potentially improved workforce engagement 33:14 – What not to do: don't approach outreach expecting to “solve homelessness” 33:43 – Managing compassion fatigue and rotating team members 34:58 – Food, coffee and small gestures as tools for relationship-building 35:26 – Challenging assumptions about who becomes unhoused 36:51 – Wesley's closing message: seek opportunities for EMS to grow and approach vulnerable populations with compassion 38:38 – Rob closes the episode with a challenge to EMS leaders: start something, even if it is small Enjoying the show? 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Finding grant funding can feel overwhelming, particularly for smaller EMS and fire agencies where one person often wears multiple hats. In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Lexipol Grant Writer and Colorado Firefighter-Paramedic Anya Otterson to demystify the grant-writing process. From identifying funding priorities and locating grant opportunities, to building a compelling case backed by data, Anya provides a practical roadmap for agencies looking to secure funding for equipment, staffing and operational improvements. She explains why success starts with clearly defining organizational needs, understanding grant priorities, and assembling evidence that demonstrates both community impact and operational necessity. The discussion explores the complete grant lifecycle, from preparing competitive applications, through to post-award reporting and compliance. Anya emphasizes that strong grant applications combine hard data with real patient stories, while Rob shares lessons learned from managing successful Assistance to Firefighters Grants (AFG) and transportation safety grants. They also discuss how AI tools such as ChatGPT can accelerate research when used appropriately — but caution against relying on AI to write narratives outright. The episode concludes with encouragement for agencies to not be discouraged by unsuccessful applications, reminding listeners that grant writing is an iterative process where persistence and continual improvement often lead to success. Additional resources EMS1 GrantFinder: Our suite of solutions gives agencies direct access to seasoned grant professionals—backed by over 500 years of combined experience—along with a comprehensive tailored grant database Assistance to Firefighters Grants: Meeting firefighting and emergency response needs On-demand webinar: Grants Day — Your funding playbook. Get the insights, expert advice and tools to help your agency score big on grants Key quotes "The data and statistics are incredibly important when writing grants, but to try to set yourself apart, I do like to have a little bit more of a personal touch." — Anya Otterson "Figure out what kinds of things you want funding for and prioritize it." — Anya Otterson "You've got to be in it to win it." — Rob Lawrence "Give yourself enough time. This is not a day-before kind of thing." — Anya Otterson "Making sure that everybody's on the same page is critical because this is not something you can really do in a silo." — Anya Otterson "Never be afraid to reach out to the funding agency with questions. Their job is to help you through the process." — Anya Otterson "ChatGPT should not be writing your narratives for you." — Anya Otterson "If you don't get funded the first time, keep trying." — Anya Otterson "The juice is worth the squeeze." — Rob Lawrence Episode timeline 00:00 – Introduction and why so many EMS leaders struggle to know where to begin with grants 01:30 – Meet Firefighter-Paramedic and Lexipol Grant Writer Anya Otterson 03:00 – The first step: identifying and prioritizing organizational funding needs 04:00 – Where to find grants, including GrantFinder, ChatGPT, state resources and direct outreach 05:45 – Overview of FEMA's Assistance to Firefighters Grant (AFG) program 07:00 – Understanding funding priorities and why high-priority requests have the greatest chance of success 09:00 – Building a compelling grant narrative using statistics, research and patient stories 12:30 – Grant writing best practices: answer the questions, proofread thoroughly and involve leadership early 15:50 – Importance of organizational buy-in and internal communication 17:20 – Understanding grant requirements, matching funds and funding conditions before applying 18:40 – Post-award responsibilities, reporting requirements and maintaining compliance 20:40 – Rob shares practical lessons from administering successful federal grants 23:20 – Lexipol's GrantFinder platform and professional grant writing services 25:45 – Using ChatGPT responsibly to support grant research while avoiding AI-generated narratives 29:35 – Final advice: persistence, continual improvement and learning from unsuccessful applications Enjoying the show? Email editor@ems1.com to share feedback. 

Matt Zavadsky explains how a commercial insurer's reimbursement proposal — and looming Medicaid changes — could reshape EMS funding In this week's episode of EMS One-Stop, we examine two major financial threats facing EMS reimbursement. Host Rob Lawrence is joined by Matt Zavadsky to analyze the recent Elevance (Anthem) Health Public Policy Institute paper, which argues that commercial insurers should reimburse ambulance services at approximately 160% of the Medicare fee schedule. Zavadsky, EMS/mobile healthcare consultant with PWW | Advisory Group, explains why this paper is significant, noting that Medicare already reimburses below the actual cost of providing ambulance services. If policymakers adopt or even believe Elevance's recommendations, commercial reimbursement could fall dramatically, removing one of the few revenue sources that currently offsets chronic underpayments from Medicare and Medicaid. The discussion highlights the growing influence of commercial insurers in state legislatures and stresses the need for EMS leaders to counter policy proposals with credible cost and operational data rather than anecdotal arguments. The conversation then shifts to CMS's proposed Medicaid supplemental payment rule (GEMT), where Matt predicts that most of the proposed changes are likely to survive into the final rule despite industry opposition. Both hosts discuss their review of the public comments, noting differing impressions of stakeholder sentiment but agreeing that agencies should begin financial planning now for a potential reduction in supplemental Medicaid revenue beginning in 2029. Throughout the episode, the recurring theme is that EMS must become far more effective at explaining both the cost of readiness and the consequences of underfunding. The episode concludes on a more positive note by highlighting the newly released What Paramedics Want in 2026 report as a practical roadmap for improving workforce satisfaction while the industry continues addressing long-term reimbursement challenges. Additional resources The 160% mirage: Why every EMS leader should read the Elevance Ambulance Report When the spreadsheet meets the siren: How CMS's Proposed GEMT Rule could reshape EMS funding What Paramedics Want in 2026 Key quotes "The commercial insurance industry is creating a story that elected officials may perceive as reasonable. We need to combat that story with facts." — Matt Zavadsky "Medicare reimbursement is already below cost, so using it as the benchmark automatically discounts ambulance services." — Matt Zavadsky "We do a great job telling stories about the lives we save. We do a poor job telling the story of what it costs to provide that service." — Matt Zavadsky "The balance billing issue is going to be the No. 1 issue in the next 12 months." — Matt Zavadsky "The first time local elected officials hear there's a problem is usually when the sky is already falling. We need to tell the story before the sky falls." — Matt Zavadsky "Know your costs; know your costs at different service levels, and begin educating your local community." — Matt Zavadsky "This isn't necessarily good news, but it's something we need to understand and all work together to deal with." — Rob Lawrence Episode timeline 00:00 – Introduction and the Elevance Health Public Policy Institute report 02:00 – Matt explains who Elevance Health is and why the report should be viewed as a commercial insurer's policy position 03:30 – Discussion of state balance billing legislation and how commercial insurers are successfully pushing lower reimbursement benchmarks 06:15 – Breakdown of what percentages of Medicare actually mean using national EMS financial data 08:30 – Why using Medicare as the reimbursement benchmark is fundamentally flawed because Medicare itself pays below cost 10:30 – Discussion on the political influence of insurers and why EMS must counter with data-driven messaging 12:30 – Why EMS has historically struggled to tell its financial story despite being effective at telling patient care stories 14:20 – Matt predicts balance billing legislation will become the industry's No. 1 policy issue over the next year 16:10 – Potential consequences if commercial reimbursement falls to 160% of Medicare 17:30 – Discussion on community funding, essential service models and matching service expectations with available revenue 22:20 – Transition to CMS's proposed Medicaid supplemental payment (GEMT) rule 22:45 – Review of public comments submitted on the CMS proposal and differing observations about stakeholder support 25:00 – Matt predicts the CMS rule will largely move forward and agencies should prepare accordingly 27:45 – California and other states discussed as examples of systems likely to experience significant reductions in supplemental Medicaid funding 30:45 – Closing on a positive note with discussion of the What Paramedics Want workforce survey

The 2026 AIMHI Excellence in Public Information or Education Award recognizes organizations that create innovative programs which improve health, educate communities and demonstrate measurable outcomes. This year's recipient, the Medic Keep the Beat Foundation, earned national recognition for a groundbreaking fall-prevention initiative that is helping older adults remain independent, reducing repeat 911 calls and preventing avoidable hospital admissions. The award celebrates programs that move EMS beyond emergency response into proactive, community-based healthcare. In this episode of EMS One-Stop, Rob Lawrence sits down with Jimmy Pierson, president and COO of Medic Ambulance; and Angeline Pierson, occupational therapist with the Medic Keep the Beat Foundation, to explore the award-winning program in depth. The discussion covers everything from home safety assessments and occupational therapy interventions, to public-private partnerships, sustainable funding, EMS workforce innovation and why prevention may be one of the greatest opportunities facing EMS today. Key quotes “You've taken the frequency out of a faller.” — Rob Lawrence “We don't want healthier transports; we want a healthier community.” — Jimmy Pierson “This isn't a business model; it's a community model.” — Jimmy Pierson “We want to keep people safe and independent in their own homes.” — Angeline Pierson “With this program they can stay at home instead of moving into a skilled nursing facility.” — Angeline Pierson “The key is finding partners who see you as a partner; not as a subcontractor.” — Jimmy Pierson “The Australian paramedics became part of our family; they weren't temporary staff.” — Jimmy Pierson Additional resources Awards – AIMHI Medic Keep the Beat Foundation Fall prevention: EMS patient education tips after the lift assist Fall hazard reduction and emergency alerting Geriatric slips, trips and falls: 3 assessment considerations 9 fall prevention tips for EMS providers to share Episode timeline 01:00 – Meet Jimmy and Angeline Pierson 02:00 – Inside the award-winning fall prevention program 06:45 – How patients enter the program 08:30 – Why preventing falls starts inside the home 12:30 – Measuring outcomes and demonstrating return on investment 15:00 – Funding, grants and building community partnerships 17:00 – Public-private partnerships with California fire departments 22:00 – Sonoma County Fire and collaborative EMS delivery 28:00 – Workforce rebuilding after COVID-19 31:30 – Recruiting Australian paramedics and creating a sustainable workforce 34:30 – Final reflections on prevention, partnerships and the future of EMS 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. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

This week on the EMS One-Stop podcast, Rob Lawrence sits down with emergency management and large-scale exercise expert Mike Marsh to explore what really goes into preparing agencies, communities and public safety partners for major events. With the FIFA World Cup underway, America 250 upon us, and countless local events happening every weekend, the conversation focuses on the practical realities of planning, exercising and pressure-testing emergency response systems before the big day arrives. | MORE: Training hard and fighting easy. Creating an effective tabletop training exercise for pre-planning MCI response Drawing on decades of EMS leadership experience and his current work through Marsh EMS Consulting, Mike shares how agencies can move beyond "grant compliance exercises" and build meaningful operational readiness. From tabletop exercises and ROC drills, to stakeholder coordination, communication failures and after-action reviews, Mike provides a masterclass in how to build resilient systems from the operator up. His central premise is simple: exercises should be designed to break the system in a safe environment so weaknesses can be identified and corrected before a real incident occurs. Whether you're preparing for a World Cup match, a county fair, or simply reviewing your MCI plans, this episode offers practical lessons for agencies of every size. Notable quotes "Our team is hired to break your system and rebuild it together." — Mike Marsh "The scene will be bigger than they are. And it is OK to ask for help." — Mike Marsh "We don't walk in and say, 'You don't understand ICS.' Actually, you do understand ICS, you just don't know that you're using it." — Mike Marsh "Identifying and learning are two different activities; and they have to be cemented in." — Rob Lawrence "Trust your people, know that you can't do it all, get a team together, train them, drill them, pressure them." — Mike Marsh "Prior preparation and planning prevents pathetic performance." — Rob Lawrence | MORE: 5 lessons for special events standby services and emergency response Episode timeline 00:00 – Introduction and why major events require planning, exercises and preparation 02:25 – Mike's journey from California EMS leadership to emergency management consulting in Texas 04:53 – The biggest misconceptions about exercises and tabletop planning 06:30 – What frontline EMTs and supervisors need to know when the incident is bigger than they are 08:07 – The first questions Mike asks when planning a major event 10:13 – Communication, stakeholder engagement and identifying operational gaps 12:16 – Translating ICS and NIMS concepts into practical operational language 17:08 – Planning a county fair exercise: where to start and why capability gaps matter 19:46 – Who should be at the planning table and why executive participation matters 21:23 – The role of public works, politicians, emergency managers and public information officers 22:29 – The best and worst exercises Mike has ever experienced 25:29 – How to challenge leaders who believe their plans don't need testing 28:01 – Exercise planning for small and rural systems with limited resources 30:22 – After-action reviews and turning lessons identified into lessons learned 32:11 – Advice for agencies that have never exercised their plans before 33:54 – Mike's biggest leadership lesson from a career in EMS and emergency management Rate and review the EMS One-Stop podcast Enjoying the show? Email editor@EMS1.com to share ideas, suggestions and feedback.

The countdown to Pinnacle is on. Returning this year to San Diego from July 13-16, Pinnacle remains one of the most influential leadership and management conferences in EMS. Now entering its 22nd year, the event continues to attract executives, clinical leaders, innovators, educators and industry partners who gather not simply to learn, but to debate, challenge assumptions and shape the future direction of EMS. EMS1 is proud to be the premier media partner of Pinnacle. | MORE: What Paramedics Want in 2026: Bookmark this page to get your copy Joining EMS One-Stop this week is Anthony Minge, senior partner at Fitch & Associates and one of the driving forces behind Pinnacle. Anthony previews the major themes emerging this year, including workforce retention, leadership development, burnout and wellness, preparedness, artificial intelligence, blood delivery, drone technology and the ever-popular What Paramedics Want report. Throughout the discussion, Anthony emphasizes that Pinnacle's value extends beyond the classroom. The real learning often happens in the conversations between sessions, over meals and among peers facing the same challenges across the country. The conversation explores why retention has overtaken recruitment as EMS's primary workforce concern, how leaders must take greater responsibility for organizational culture, and why emerging technologies such as AI and drone-delivered medical supplies are changing the profession faster than many realize. Anthony also offers a preview of keynote speakers, including preparedness expert and author William Forstchen, and highlights sessions covering leadership, resilience, operational excellence, workforce wellness and healthcare innovation. As always, Pinnacle promises to deliver practical takeaways, provocative discussions, and the opportunity to connect with some of the brightest minds in EMS. Key quotes "If we can keep our people, we don't need to spend as much time trying to replace them." "People don't leave organizations, they leave managers." "Burnout is still too high. One suicide is way too many." "We can't push it into the dark corners of our organizations and just hope it goes away." "AI is here to stay. It's going to help us. It's going to do some great things." "It is never meant to replace this computer right here." "We practice healthcare. We practice extremely innovative healthcare out there." "It's amazing the things that are happening out there." "Good leaders share." "Being responsible leaders is probably one of our largest challenges." Additional resources Pinnacle EMS 2026: Conference information, agenda details, speakers and registration Conference dates: July 13-16, 2026 Location: Sheraton San Diego Resort Pinnacle Early Bird Offer: provide the code “EMS26”. This gives early-bird offer provides $100 off the current/regular price What Paramedics Want: 2026 Report debuts July 13, 2026 William Forstchen's books Episode timeline 03:00 – The major themes of Pinnacle 2026. Discussion of retention, leadership, financial sustainability, workforce wellness, preparedness, AI and emerging technologies. 06:30 – Recruitment vs. retention. Why keeping employees has become more important than finding new ones and how organizations can build careers rather than simply fill vacancies. 08:15 – Leadership beyond operations. The role of leadership in employee engagement, succession planning, data-driven decision-making and lessons from Matthew McConaughey's book Greenlights. 11:00 – Burnout, wellness and resilience. Why burnout remains a major challenge for EMS and how leaders must confront it rather than ignore it. 13:00 – Preparedness for the next crisis. A preview of keynote speaker William Forstchen and discussions around resilience, disaster readiness and planning for both natural and man-made events. 19:00 – AI Comes to EMS. Anthony discusses the opportunities and risks associated with artificial intelligence, from documentation and CAD integration, to clinical decision support. 24:00 – Blood, drones and clinical innovation. A look at how blood products, AEDs, naloxone and other critical supplies are increasingly being delivered through innovative technologies, including drones. 29:00 – What Paramedics Want in 2026. A preview of the latest survey findings and the issues currently weighing most heavily on the minds of EMS professionals. 30:00 – Why Pinnacle matters. Anthony explains why networking, relationship building and peer-to-peer learning remain among the conference's greatest strengths. 32:00 – The conversation EMS needs to have. Anthony identifies leadership responsibility and accountability as one of the most important — and often avoided — topics facing EMS today. Enjoying the show? Email editor@ems1.com to share feedback. 

At a time when EMS reimbursement faces unprecedented scrutiny and pressure, Shawn Baird joins the EMS One-Stop podcast to explain what is happening in Washington, D.C., why it matters to every ambulance service in America and what EMS leaders can do about it. | MORE: When the spreadsheet meets the siren: How CMS's Proposed GEMT Rule could reshape EMS funding A former Paramedic, ambulance service owner, CEO, American Ambulance Association resident, and now Vice President of Government Affairs for the AAA, Baird brings a unique perspective that spans frontline care, operations and national advocacy. In this episode, Rob Lawrence and Baird unpack the growing threats to Medicare and Medicaid funding, discuss the proposed changes to Medicaid supplemental payment programs, and explore the work of the National EMS Payment Reform Committee. The conversation also previews the AAA Legislative Fly-In, and highlights efforts to secure EMS workforce funding, streamline military medic transitions into civilian EMS and advance federal fuel tax relief. Most importantly, Baird delivers a clear message: EMS professionals must tell their story, engage with elected officials and advocate for the future of mobile healthcare. This episode serves as both an explainer and a call to action. As federal policymakers debate Medicaid funding, EMS reimbursement, workforce development and healthcare spending, Baird makes the case that every EMS professional has a role to play. Whether through legislative fly-ins, ride-alongs, town halls or simply telling the EMS story, advocacy is no longer optional. It is essential to preserving access to emergency medical care in communities across America. Notable quotes "We're hoping to make some proposals for real long-term reform on Medicare that will shore up the EMS system, not just to survive day to day, but really to thrive." — Shawn Baird "We are more than just a ride. We are mobile healthcare." — Rob Lawrence "We really have not been able to find a lot of data to support a bunch of waste, fraud and abuse in the EMS system. What there is, is a lot of misunderstanding." — Shawn Baird "If we don't get paid ourselves, how can we pay other people? How can we then afford to deliver excellent healthcare to our patients?" — Rob Lawrence "First of all, talk about the patient because the patient is the most important part of this whole discussion; second of all, talk about the medical care you provide because that's what the patient needs." — Shawn Baird "We're the safety net. We're access to critical emergency care in many communities that don't have other healthcare." — Shawn Baird "Probably the most important thing that folks listening to your show can do is attend a town hall and raise your hand and say, 'I'm just worried about our ambulance service.'" — Shawn Baird "We have the greatest story of all to tell." — Shawn Baird Additional resources AAA Advocacy Call to Action – Contact your member of Congress here 2026 Ambulance Ride-Along Toolkit Episode timeline 01:00 – Rob introduces the episode and outlines the challenges facing EMS reimbursement and federal healthcare funding. 02:07 – Shawn Baird's EMS Journey — from paramedic intern at Grady Hospital to rural EMS operator, company owner, AAA president and government affairs leader. 03:00 – Why healthcare reimbursement decisions are increasingly shifting from Washington to state legislatures. 06:45 – The National EMS Payment Reform Committee and the search for long-term solutions to EMS financing. 09:13 – Medicaid, waste, fraud and abuse — understanding misconceptions about EMS reimbursement and why ambulance services are being caught in broader healthcare debates. 11:33 – EMS is more than transportation — reframing EMS as healthcare first, transportation second. 13:20 – The threat to Medicaid supplemental funding — provider taxes, GEMT programs and proposed federal changes that could impact ambulance services nationwide. 15:15 – Proposed CMS rule changes — why EMS leaders are concerned about being included in Medicaid funding reductions. 17:40 - How national EMS organizations are coordinating efforts to speak with one voice. 20:08 – The AAA Legislative Fly-In — what it is, how it works and why provider participation matters. 21:45 – Federal legislative priorities — EMS workforce development funding, military medic-to-civilian certification pathways and federal fuel tax relief for ambulance services. 26:50 – How EMS providers can engage when legislation is moving. 27:40 – The importance of local advocacy — town halls, community events and direct engagement with elected officials. 29:30 – Ride-alongs as an advocacy tool — why seeing EMS firsthand changes policymakers' perspectives. 32:00 – Final thoughts — politics is ultimately about relationships, storytelling and helping decision-makers understand EMS. Enjoying the show? Email editor@ems1.com to share feedback.

What happens when the stars of the television series that introduced America to paramedicine decide it's time to tell the real story? In this episode of EMS One-Stop, Rob Lawrence is joined by EMS pioneer Dr. Baxter Larmon and award-winning filmmaker Tom Putnam to discuss Into the Unknown: The Paramedics' Journey. | MORE: ‘Emergency!' stars launch Kickstarter campaign to expand reach of paramedic documentary, “Into the Unknown,” backed by Steve Buscemi, Randolph Mantooth and Kevin Tighe Born from the vision of Emergency! stars Randolph Mantooth and Kevin Tighe, and backed by Steve Buscemi, the documentary follows paramedics, dispatchers, volunteers, flight crews and their families across America, revealing the realities of modern EMS. From Baton Rouge to Sparks, from volunteer rescue squads in Virginia, to helicopter rescue teams in California, the film explores not only what paramedics do, but what the job does to them. The conversation examines workforce shortages, mental health, resilience, public misunderstanding of EMS, and the role the film could play in educating communities, policymakers and future generations. The episode also explores the documentary's Kickstarter campaign and plans for worldwide release. If Emergency! introduced America to paramedics 50 years ago, Into the Unknown seeks to explain the people behind the uniform. Notable quotes "One of the things that I'm probably most proud about in the movie is that these first responders are now allowing their family members and their friends to be able to see what they go through every single day." — Dr. Baxter Larmon "The call volume, I mean, they used to sit in the station, they'd joke in the station, they'd eat, they'd have dinner, they'd complete their whole dinner and they would never get a call. That just doesn't happen anymore." — Dr. Baxter Larmon "Our fourth goal is to get recognition by governmental agencies to understand what EMS is, to be able to recognize its importance in the community, but more importantly, to fund it appropriately as well." — Dr. Baxter Larmon "I honestly had no idea what I was getting into with this and how intense the personal interactions were gonna be." — Tom Putnam "By the time that particular run was over, I just think I was wide-eyed and said, wow, we're making a war movie." — Tom Putnam "For the right person, this is the best job in the world." — Tom Putnam Episode timeline 00:00 – Trailer and opening montage 01:41 – Rob introduces the episode and guests 03:18 – The origin story of Into the Unknown 05:13 – The lasting impact of Emergency! on EMS and what story the documentary is trying to tell 08:32 – Tom explains why he said “yes” immediately 10:52 – The first EMS call filmed and realizing the scale of the project 12:15 – Locations featured in the documentary 16:22 – How EMS has changed since Johnny Gage and Roy DeSoto 17:54 – Stories that surprised Tom most 20:15 – The emotional burden of the profession 22:40 – Calls Tom "can't unsee" 24:00 – EMS as the safety net for society 25:07 – Burnout, resilience and humanity 27:30 – Why families need to see this film 28:06 – Why the project launched a Kickstarter campaign, funding goals and distribution plans 33:30 – Using the film as an EMS advocacy tool 35:43 – Lightning round 38:03 – Why EMS might be the best job in the world 39:05 – Dr. Richard Carmona's role in the film 40:16 – Final thoughts and call to action Enjoying the show? Email editor@ems1.com to share feedback. 

In Episode 4 of the EMS One-Stop Blood on Board Series, host Rob Lawrence brings together two powerful perspectives on prehospital blood transfusion. First, retired Army trauma nurse and national blood advocate Randi Schaefer discusses the work of the Prehospital Blood Transfusion Initiative Coalition and the ongoing effort to remove barriers to blood product availability across the United States. Drawing on lessons learned from military deployments and civilian implementation efforts, Schaefer explains why successful blood programs require collaboration among EMS agencies, hospitals, blood banks, legislators and funding partners. She emphasizes that while every system is different, the goal remains the same: getting lifesaving blood to patients before they reach the hospital. The second half of the episode focuses on the story behind the statistics. Dr. Kate Krause, an emergency physician from Dallas, recounts her near-fatal postpartum hemorrhage just weeks after giving birth to her daughter. After she lost more than two liters of blood at home, Dallas Fire-Rescue paramedics recognized the severity of her condition and secured authorization to administer prehospital blood. That decision, combined with rapid transport and seamless hospital coordination, helped save her life. Today, fully recovered and back to practicing medicine, Dr. Krause has become a compelling advocate for prehospital blood programs, reminding policymakers and EMS leaders that behind every protocol, funding request and unit of blood is a patient whose future depends on receiving the right treatment at the right time. Previous Blood on Board episodes: Blood on Board: Everything is bigger in Texas Blood on board: Lessons from Sacramento and LA County Fire Blood on Board: Federal funding paves the way for EMS blood programs Impactful quotes "I had a severe postpartum hemorrhage and had my life saved by a prehospital blood transfusion." — Dr. Kate Krause "I'm here. I have no deficits. I'm healthy. I'm back to being a physician. I'm back to being a wife and being a mother to my beautiful little baby girl." — Dr. Kate Krause "The coalition wants to make blood products available to those EMS agencies that want to carry them."  — Randi Schaefer "This is a brand-new relationship. So there's a lot of learning how each other's worlds work." — Randi Schaefer "We were not going to let people die of preventable death." — Randi Schaefer "Keep pressing forward. We will find a way to yes." — Randi Schaefer "Blood is one of those things that really makes a difference when it's given early." — Dr. Kate Krause Additional resources Prehospital Blood Transfusion Coalition Episode timeline 00:00 – Introduction to Episode 4 and recap of the Blood on Board series and overview of previous episodes covering local, state and national blood initiatives. 02:18 – Introduction of Randi Schaefer and Dr. Kate Krause. Schaefer discusses military deployments and early blood program experiences, while Dr. Krause outlines her journey from lifeguard, to EMT, to emergency physician. 05:05 – Origins and mission of the Prehospital Blood Transfusion Initiative Coalition, military lessons learned, funding challenges, sustainability concerns, the importance of legislative support and reimbursement 13:57 – Dr. Krause recounts her postpartum hemorrhage. 19:03 – Discussion of non-trauma indications for prehospital blood and the importance of medic judgment and protocol flexibility 20:22 – Dr. Krause discusses recovery and advocacy efforts, and Dallas City Council appearance and public awareness activities. 24:24 – Dr. Krause delivers a concise advocacy message supporting blood programs nationwide. 25:01 – Schaefer reflects on meeting blood recipients and the impact of seeing survivorship firsthand. 27:47 – Closing remarks from Dr. Krause and Schaefer 29:03 – Lawrence wraps up the four-part Blood on Board series and reinforces the need for continued advocacy and funding. This episode is sponsored by Triad of Life. After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That's why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. Learn how your team can put the Triad of Life into practice. Enjoying the show? Email editor@ems1.com to share feedback. 

Texas is taking prehospital whole blood to scale. In this second installment of the Blood on Board series, the conversation moves from pioneering local programs to a statewide initiative backed by legislation, trauma system collaboration and a $10 million investment in EMS blood capability. Host Rob Lawrence welcomes Dr. Jeff Jarvis, chief medical officer and system medical director, Fort Worth Office of the Medical Director; Dr. C.J. Winckler, deputy medical director for the San Antonio Fire Department; and Jorie Klein, director of EMS-Trauma Systems Section, Texas Department of State Health Services. From San Antonio's early adoption to Fort Worth's operational maturity and the Texas Department of State Health Services' statewide rollout, this episode examines how Texas built one of the most ambitious prehospital blood programs in the country. The discussion goes beyond clinical theory. The guests tackle implementation, logistics, blood stewardship, wastage concerns, rural access, legislative strategy and the realities of getting physicians, transfusion medicine specialists, EMS leaders and lawmakers aligned around a shared mission. The episode also explores the expanding use of whole blood beyond trauma, including GI bleeds, obstetrics and surgical hemorrhage, while reinforcing the operational mantra repeated throughout the show: systems save lives. | MORE: Blood on board: Lessons from Sacramento and LA County Fire Impactful quotes “You can't quarterback it from your office. You have to be engaged and be out there with them.” — Jorie Klein “Little did I know that it would take almost every waking minute of my life to get blood on an ambulance.” — Dr. C.J. Winckler “We're not improving overall mortality yet, but we are improving mortality in the first six hours.” — Dr. C.J. Winckler “When you work together as a system, you can do amazing things.” — Dr. Jeff Jarvis “In the last 13 months, we've given 259 units to 211 patients.” — Dr. Jeff Jarvis “Our definition of wastage is anything that doesn't go into a patient.” — Dr. Jeff Jarvisv “It turns out this stuff works.” — Dr. Jeff Jarvis “It's all about communication and trust.” — Dr. C.J. Winckler “Five years ago, we knew those patients would not survive. Now we have new tools.” — Jorie Klein “My dad was saved by prehospital whole blood.” — Dr. C.J. Winckler “Talk to the clinicians who are giving this blood and ask them about the impact it's making.” — Dr. Jeff Jarvis Episode timeline 00:00 – Opening message. Jorie Klein outlines the central lesson for other states: engage frontline providers and avoid managing programs remotely. 00:40 – Introduction. Rob Lawrence introduces Episode 2 of the Blood on Board series, shifting focus from local systems to statewide implementation in Texas. 01:20 – Meet the guests. Jorie Klein, Dr. Jeff Jarvis and Dr. C.J. Winckler introduce themselves and their roles in Texas EMS and trauma care. 03:22 – The San Antonio origin story Dr. Winckler explains how military medicine, trauma surgeons and Texas delegated medical practice helped launch San Antonio's whole blood program. 06:04 – Building the first protocols. Dr. Winckler discusses creating guidelines from scratch, operationalizing blood administration and securing funding support from city leadership. 08:52 – Going system-wide. San Antonio launches whole blood citywide in October 2018 without a pilot project. 10:13 – Ethics and evidence. Discussion shifts to mortality data, prehospital physiology and whether balanced blood resuscitation should already be considered standard of care. 12:14 – Fort Worth follows. Dr. Jarvis explains how San Antonio's system inspired adoption in Fort Worth and highlights the importance of regional collaboration. 14:03 – Texas goes statewide. Klein explains the legislative process that resulted in a $10 million statewide prehospital whole blood initiative. 17:24 – Rural Texas and blood access. The conversation focuses on plasma options, rural hospital shortages and improving access for remote communities. 23:45 – The data discussion. Dr. Jarvis shares Fort Worth operational metrics, transfusion volumes and remarkably low wastage rates. 28:49 – Whole Blood Academy. Drs. Jarvis and Winckler discuss the National Whole Blood Academy and how Texas is teaching other EMS systems to replicate their success. 32:00 – Trust, logistics and blood stewardship. Dr. Winckler explains the importance of relationships between EMS and transfusion medicine physicians, emphasizing operational discipline and trust. 36:20 – What comes next? Dr. Klein discusses statewide reporting, future funding requests and sustaining the Texas model long term. 40:15 – Final lessons for other states. The guests close with advice on advocacy, clinician engagement and building support from the ground up. Email editor@ems1.com to share feedback. 

The EMS One-Stop Blood on Board series moves to the federal level in Episode 3, exploring how the National Highway Traffic Safety Administration Safe Streets and Roads for All (SS4A) grant program is opening new funding pathways for prehospital blood programs. Host Rob Lawrence is joined by three leaders directly involved in building regional blood capability through federal funding. Julie Stilley, PhD, is an EMS researcher at the University of Missouri, whose team secured a $4.6 million SS4A demonstration grant focused on advanced post-crash care, including prehospital blood administration. Jason White represents the Mid-America Regional Council in Kansas City, a multi-jurisdictional regional planning organization coordinating EMS, trauma systems, hospitals and transportation partners around a regional whole blood strategy. Mark Heath is chief of EMS for the Kansas City Kansas Fire Department and one of the operational leaders preparing to launch whole blood in the field as part of the Kansas City regional effort. Rather than focusing solely on clinical practice, this episode examines the realities of applying for, winning and administering federal grant funding. The guests discuss building regional coalitions, engaging blood banks, developing standardized protocols, navigating compliance requirements and preparing operational rollouts. From Missouri's $4.6 million demonstration grant, to Kansas City's regional planning initiative, this episode provides a practical roadmap for EMS leaders looking to transform roadway safety funding into lifesaving trauma care capability. Watch episode 1: Blood on Board: Lessons from Sacramento and LA County Fire Watch episode 2: Blood on Board: Everything is bigger in Texas Impactful quotes “Don't be afraid of applying for a big, scary federal grant.” — Mark Heath “EMS is the perfect partner to try to understand how to address the post-crash care component of a safety action plan.” — Julie Stilley “If you're going to do it as a region, you've got to hang together.” — Jason White “The data points on the backside will set you free.” — Mark Heath “If my blood is closer to the next address over, just because there's a river in the way doesn't mean we can't get across the bridge.” — Mark Heath “What started initially as an absolute ‘no' became, ‘Wait, let me listen to you some more.'” — Julie Stilley “The juice is worth the squeeze.” — Rob Lawrence “Firefighters and EMS are cowboys, and blood banks are accountants.” — Mark Heath “Cowboys do marry accountants.” — Jason White “Run, don't walk, to your local blood bank.” — Mark Heath “It's your blood in your community and going into you on your ambulances.” — Mark Heath “We're moving toward reducing mortality and reducing long-term injury.” — Julie Stilley Additional resources Safe Streets and Roads for All (SS4A) Grant Program | US Department of Transportation NHTSA's Office of Emergency Medical Services | EMS.gov Accessing the Safe Streets and Roads for All EMS grant program Researchers receive $4.6 million to pilot advanced EMS response program Episode timeline 00:00 – “Free money is free money”. Chief Mark Heath opens with encouragement for agencies considering federal grant applications and urges smaller communities not to be intimidated by the process. 00:44 – Introduction to Episode 3. Rob Lawrence recaps Episodes 1 and 2 of the Blood on Board series before introducing the SS4A grant focus and the featured guests. 02:07 – Meet the guests. Julie Stilley introduces her role at the University of Missouri and reveals her project's $4.6 million award. Jason White and Mark Heath outline the Kansas City regional collaboration. 04:19 – Why apply for SS4A? Julie Stilley explains how frustration around operational barriers to blood implementation motivated her grant application. 05:38 – Understanding demonstration grants. Discussion on the difference between planning and demonstration grants, and how post-crash care fits into regional traffic safety action plans. 06:51 – Building regional coalitions. Jason White discusses Kansas City's existing regional EMS partnerships and how those relationships became the foundation for the grant application. 10:30 – Regional protocols and data. Mark Heath explains how Kansas City agencies standardized protocols, agreed on shared data points and committed to a coordinated regional approach. 13:04 – Pulling together the application. Julie Stilley outlines the process of bringing together planners, EMS leaders, trauma centers and blood banks to support the grant proposal. 15:02 – Equipment, compliance and logistics. Discussion shifts to blood warmers, storage systems, chain-of-custody monitoring and the operational realities of safely carrying blood products in the field. 18:25 – Planning grants and future implementation. Jason White explains how the Kansas City effort uses a planning grant to build toward larger implementation funding opportunities. 23:22 – Busting myths about blood. Mark Heath describes how data and national experience changed his thinking about whether whole blood matters in urban EMS systems with short transport times. 27:19 – The reality of grant administration. Julie Stilley and Jason White explain federal reimbursement structures, compliance requirements and why strong administrative partners are essential. 31:37 – Sustainability and reimbursement. Discussion on long-term funding, legislative advocacy and the need for reimbursement models for prehospital blood administration. 33:43 – Final lessons learned. The guests share advice on partnerships, blood bank relationships, data collection and not being afraid of “big scary federal grants.” 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. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed. About the sponsor After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That's why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. To learn how your team can put the Triad of Life into practice visit the link to get started.

EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving Whole blood in the field is no longer theoretical; it is operational, measurable and increasingly expected. In this EMS One-Stop episode, host Rob Lawrence brings together two of California's leading medical directors — Drs. Clayton Kazan and Kevin Mackey — to compare and contrast their prehospital blood programs. From concept to deployment, both systems demonstrate how data, relationships and persistence can translate innovation into lives saved. This discussion goes beyond theory. It addresses real-world barriers — regulation, blood bank skepticism, funding gaps — and pairs them with practical solutions. The result is a clear message: EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving. For agencies considering similar programs, this episode provides a roadmap grounded in experience, outcomes and operational reality. Notable quotes “When there's someone who wants to see your program, talk about your program.” — Kevin Mackey “I kind of never believed it really possible to put it on a paramedic truck until I saw what the military was able to do.” — Clayton Kazan “If the five minutes matter, why wouldn't we want to do it 5, 10, 15, 20 minutes sooner?” — Clayton Kazan “Never say ‘no,' never say ‘die.'” — Kevin Mackey “They're never tired of trying to find new ways to save people's lives.” — Clayton Kazan Episode timeline 00:00 – Opening message. “Never say ‘no,' never say ‘die'” sets the tone for program development and persistence 01:00 – Series introduction. Rob frames the episode as part of a broader national discussion on blood in EMS 02:00 – Guest introductions. Dr. Kazan and Dr. Mackey outline their EMS and medical backgrounds 03:20 – Program overviews. LA County: April 2025 launch, 11 squads, 58 transfusions; Sacramento: December 2025 launch after 15-month build 05:20 – Origins and catalysts. Influence from San Antonio and New Orleans programs; leadership support as a trigger 07:00 – Military influence. Translation of battlefield success into civilian EMS feasibility 08:50 – Building the business case. Data-driven forecasting using ePCR systems 11:00 – Overcoming resistance. Regulatory hurdles, skepticism and blood bank concerns 15:00 – Survivor stories. Real-world saves that validate the programs and influence policymakers 18:00 – Funding realities. Grant-based models, no current reimbursement, cost-benefit framed in life-years saved 21:45 – Equipment and logistics. Cold chain, monitoring systems, delivery devices and operational considerations 24:40 – Training and deployment. Targeted rollout using heat maps and trauma incidence data 27:45 – Early challenges. Blood recirculation, cold chain validation and system integration issues 31:50 – QA/QI and research. 100% case review and participation in multi-county data collaboratives 34:10 – Patient populations. Primarily trauma, with emerging medical indications 36:00 – Sustainability and scaling. Political engagement and expansion planning 38:15 – Rapid fire lessons learned. Transparency, persistence, relationships 42:50 – Myths and realities. Frontline providers embrace innovation; capability concerns disproven 44:00 – Final takeaways. Appreciation, relationships and system-wide collaboration as keys to success Enjoying the show? Email editor@ems1.com to share feedback. 

In this special EMS One-Stop update, Rob Lawrence is joined by returning guest Dr. Alex Isakov to break down the rapidly developing Andes Hantavirus outbreak linked to the expedition cruise ship MV Hondius. What began as a handful of unexplained respiratory illnesses aboard a South Atlantic voyage has evolved into an internationally monitored infectious disease event involving multiple countries, quarantine operations, public health investigations and the repatriation of exposed passengers to specialized containment facilities in the United States. | MORE: Hantavirus outbreak aboard cruise ship sends Americans to biocontainment quarantine units Dr. Isakov is professor of emergency medicine at Emory University School of Medicine and executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR). He also serves as EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC), where he helps lead national preparedness efforts for high-consequence infectious diseases. In the episode, he explains how Andes Hantavirus differs from other hantaviruses already present in North America because it is capable of person-to-person transmission in limited circumstances. The discussion covers transmission dynamics, incubation periods, PPE recommendations, public health monitoring and why experts continue to assess the overall public risk as low. Listeners are also directed toward the excellent educational resource hub on preparedness and response available through NETEC Hantavirus Resources. Episode timeline 00:00 – Introduction to the Special Edition. Rob Lawrence introduces the emergency update format and welcomes Dr. Alex Isakov to discuss the emerging Andes Hantavirus outbreak. 00:50 – Understanding hantaviruses. Dr. Isakov explains the difference between common North American hantaviruses and Andes Virus, emphasizing the rare person-to-person transmission capability. 03:13 – The cruise ship incident. Discussion of the outbreak aboard the MV Hondius, including onboard transmission concerns, severe illness development and international evacuation efforts. 05:16 – U.S. monitoring and quarantine. Review of quarantine operations in Nebraska and ongoing public health monitoring of exposed American passengers. 07:21 – Incubation and EMS risk assessment. Dr. Isakov outlines the prolonged incubation period and explains why frontline EMS encounters remain unlikely. 11:17 – PPE guidance for EMS personnel. Specific PPE recommendations are reviewed, including standard, contact and airborne precautions with eye protection. 13:17 – Looking ahead to World Cup 2026. The discussion turns to international travel, mass gatherings and why clinicians must maintain awareness of rare infectious diseases tied to travel history. 14:32 – EMS and public health resources. Dr. Isakov directs listeners to CDC, WHO and NETEC resources for ongoing guidance and EMS-specific updates.

In this episode of EMS One-Stop, Rob Lawrence sits down with Tanir Ami of the CARESTAR Foundation to explore a subject that is increasingly central to the future of EMS: equity, data and system design. Born from the legacy of CalSTAR, CARESTAR has evolved into a philanthropic engine focused on improving EMS through research, convening and targeted investment. Ami brings a 25-year background in community health, grounded in service to underserved populations, and applies that experience to a sector that is only now beginning to fully interrogate disparities in care and outcomes. The conversation moves beyond theory into practical reality. From disparities in pain management and pediatric restraint use, to the challenges of fragmented EMS systems and the slow pace of statewide change, Ami outlines both what is known and what remains uncertain. The throughline is clear: data must be collected, interrogated and acted upon. CARESTAR's work sits at the intersection of research and action, funding studies, building infrastructure, and creating space for difficult but necessary conversations. For EMS leaders, the message is direct and national in scope: examine your data, stay curious and be prepared to confront what it reveals. Key quotes “The data show that there are differences not only in how people are treated, but on the back end and the outcomes that they experience.” — Tanir Ami “Particularly Black girls were four times as likely to be physically restrained as any of their counterparts.” — Tanir Ami “Stay open-minded and open-hearted about what it is, the type of conversation that we're trying to have.” — Tanir Ami “We really come at it holding the clinicians who are out working at the front lines of EMS in incredibly high regard, and also simultaneously wanting to talk about how and where and what the challenges are.” — Tanir Ami “Just collecting those numbers and sending them off … is not the end of the game.” — Rob Lawrence “We had a section of the city … almost a desert of non-911 calls and we realized that was our Latino community. We worked with them to promote the fact that we're not ICE … we want to assist you in your emergency. Through that process, we closed off that desert.” — Rob Lawrence Additional resources CARESTAR Seeding innovation and racial equity in EMS. Tanir Ami, CEO of California's CARESTAR Foundation on diversifying the prehospital care workforce and improving health outcomes Beyond policy: EMS's moral duty to deliver equitable care. “Our commitment to take care of others is not a political undertaking; it represents the greatest of social contracts in helping our fellow humans in their time of need.” Improving equity in prehospital care. Despite the best efforts of EMS providers, gaps persist – learn what goes into them and what you can do about them Rainn Wilson on ‘Code 3' and the brutal beauty of EMS life. From emotional trauma to gallows humor, Wilson reflects on his new role as a burned-out medic — and why “Code 3” is a tribute to the heart of paramedicine 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. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed. About the sponsor This episode of the EMS One-Stop Podcast is sponsored by the 7th Annual EMS Leadership Summit. Learn from over 25 prehospital leaders from around the world sharing real-world strategies to reduce burnout, improve retention and build stronger organizations. Get your free pass at EMSLeadershipSummit.com/EMS1. Episode timeline 01:00 – Tanir Ami outlines her 25-year healthcare career and explains the transition from CARESTAR to the CARESTAR Foundation. 04:30 – Discussion of disparities in care and outcomes, and the complexity of addressing systemic inequities. 08:00 – Insights into disparities in pain management and pediatric restraint use, with examples from UC Berkeley and UCSF studies. 11:30 – Focus on building momentum, creating safe spaces for discussion and balancing research with implementation. 15:45 – Overview of CARESTAR funding priorities, including community conversations, behavioral health integration and pilot programs. 20:30 – Exploration of regulatory fragmentation and the challenges of statewide EMS coordination. 25:00 – Call for EMS leaders nationwide to interrogate their own data and remain open to findings. 30:00 – Emphasis on localized interventions and the absence of one-size-fits-all solutions. 35:00 – Tanir reinforces optimism and momentum, leaving listeners with a clear challenge: examine, understand and act on their data. About CARESTAR The CARESTAR Foundation is a California-based philanthropic organization dedicated to improving emergency medical services through research, innovation, and system-wide collaboration. Established in 2018 following the sale of the CalSTAR air ambulance program, the foundation was created to honor that legacy by advancing quality, integrity and equitable care across the EMS spectrum. Under the leadership of Tanir Ami, CARESTAR focuses on identifying and addressing disparities in prehospital care, funding research into EMS practices and outcomes, and convening stakeholders to drive meaningful change. Its work emphasizes the use of data to uncover gaps in treatment, supports community-driven solutions, and invests in initiatives that strengthen both the workforce and the systems that serve diverse populations.

In this episode of the Inside EMS podcast, host Chris Cebollero shares why he left the consulting and community paramedicine world to become chief of EMS and COO for EMS Team in Dayton, Ohio — a growing multi-state agency with “visions of world dominance.” The conversation digs deep into servant leadership, workforce buy-in and the balance between supporting crews while still holding the line on professionalism and performance. Chris also lays out his vision for creating a sustainable culture built on accountability, engagement and shared ownership. It's equal parts leadership seminar, war story and reality check for anyone who's ever tried to fix a fractured EMS system. Additional resources: How to lead without being that boss Leadership lessons: How to turn failure into growth Enjoying Inside EMS? Email theshow@ems1.com to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence sits down with Kevin Hazzard to explore No One's Coming, a gripping account of the 2014 Ebola outbreak and the extraordinary effort to rescue infected American aid workers from West Africa. |WATCH NOW: FDNY's future: AI, BWCs and pay parity with Commissioner Lillian Bonsignore  What begins as a seemingly impossible mission evolved into a high-stakes, time-critical operation led by Phoenix Air — a team known for taking on the missions no one else will. Hazzard traces the origins of this unconventional organization, from transporting explosives and nuclear materials, to pioneering aeromedical evacuation of the world's most dangerous infectious patients. The conversation moves beyond storytelling into operational reality. With no established protocols, limited knowledge of Ebola and widespread public fear, crews were forced to improvise, adapt and execute under intense pressure. The episode examines the intersection of EMS readiness, public health hesitation and leadership under uncertainty. At its core, this is a study in preparation, risk tolerance and professional duty — illustrating how a small group of individuals stepped forward when systems hesitated, reinforcing the enduring EMS principle: when the call comes, you answer. Key quotes from Kevin Hazzard “This is as scary as it gets.” “It is the largest and deadliest Ebola outbreak in human history.” “We've got to figure out how to transport highly contagious patients — nobody does that.” “They risked their lives. They risked their families' lives for strangers.” “Preparation is the most important thing.” “We are notoriously short-minded … we're not long-range thinkers.” “There are people out there who are willing to step into the breach when needed.” Episode timeline 00:00 – Opening context: Ebola outbreak severity and mission stakes 01:00 – Introducing Kevin Hazzard, author background 03:30 – Origins and evolution of Phoenix Air 08:00 – High-risk missions (including Libya nuclear extraction) 14:30 – Transition to EMS and infectious disease transport 16:00 – Development of the biocontainment system 20:00 – Ebola mission planning and execution challenges 27:00 – U.S. reception, EMS transport and public reaction 31:00 – Leadership lessons and EMS preparedness gaps 35:00 – Reflections on readiness, resilience and future threats Enjoying the show? Email editor@ems1.com to share feedback. 

This week on Inside EMS, it's a no-holds-barred breakdown of HBO's The Pitt — and surprisingly, it earns a solid thumbs up from the field. The show nails the feel of emergency medicine: nonstop chaos, overlapping patients and that mental grind that never lets up. The set, the medicine and the team dynamics all hit close enough to make even seasoned providers nod along. But let's not pretend it's perfect. The guys call out the usual TV sins — compressed timelines, back-to-back disasters and docs who never miss on the first try. But, there is a botched 12-lead that sparks a real-world debate about electrode placement, patient modesty and doing the job right when it matters most. Where The Pitt really shines? The emotional weight. Burnout, breaking points and the slow unraveling that comes with the job — it's all there, and it hits hard. Have you watched the show? What are your thoughts? Let us know in the comment field below. Quotable takeaways “At some point you're so saturated by fear and emotion and being strong through somebody else's grief and trying to be on 24/7, you can't afford a bad moment.” “I think they do a great job of displaying the emotional toll that a career in medicine takes on the people who practice it.” Enjoying Inside EMS? Email theshow@ems1.com to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers. | MORE: First responders and alcohol – how much is too much? Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture. What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty. The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians. At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures. Key quotes from Maria Koeppel “Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.” “EMS providers tend to drink a little bit more frequently than the general population — and that's tied directly to stress.” “It's not just the big trauma calls — it's the micro-stressors that add up over time.” “A third of clinicians in our sample engaged in high-risk drinking behaviors.” “Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.” “Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.” “Some described going out after shift as ‘hydraulic debriefing' — using alcohol to process the day.” “Gen Z is driving a more sober culture — they're choosing connection without alcohol.” “Leadership isn't just policy — it's culture, awareness and how you care for your people.” “Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.” Episode timeline 01:06 – Maria's background: firefighter and researcher 02:24 – Overview of NIH/FEMA research and EMS focus 04:14 – Key findings: stress, frequency of drinking and EMS culture 05:08 – Micro-stressors vs. major trauma calls 06:54 – Risk factors: age, role, education, multiple jobs 10:11 – Culture and “hydraulic debriefing” 11:46 – Fire vs. private EMS cultural differences 14:38 – Generational shift: Gen Z and sober culture 19:24 – Alternative substances and coping trends 21:20 – Leadership roles: policy vs. culture 24:11 – Peer support gaps in EMS 26:41 – Workforce impact: sleep, stress, retention 27:14 – Education gap and need for EMS-specific training 29:11 – Conferences and future research dissemination 30:13 – Episode wrap-up Enjoying the show? Email editor@ems1.com to share feedback. 

Editor's Note: Suicide is always preventable. If you are having thoughts of suicide or feeling suicidal, please call the National Suicide Prevention Hotline immediately at 988. Remember: You deserve to be supported, and it is never too late to seek help. Speak with someone today. ----more---- This week on Inside EMS, host Kelly Grayson is joined by Texas educator John Puryear as they process the loss of a colleague to suicide — and to confront the uncomfortable truth: the mental health crisis in EMS is years in the making, and awareness alone isn't cutting it. From peer support to fatigue policies, Chris and Jon lay out what actually helps: real conversations in the rig, leadership that prioritizes mental health and seeking professional help. The message is clear: taking care of your mind is operational readiness. And if you're not checking on your partner, you're missing the fight that matters most. Quotable takeaways “I don't think the public understands how much this profession can break you.” “It's not about what's wrong with you, it's what's happened to you.” “Help is a professional strength, not a weakness.” Additional resources: What's your department's suicide prevention plan? How to recognize, help a struggling team member Mental wellness check-ins: What they are and how they help Enjoying Inside EMS? Email theshow@ems1.com to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence travels to New York City to sit down with Lillian Bonsignore, the 37th Commissioner of the Fire Department of the City of New York (FDNY). A 30-plus year veteran who rose through the ranks of EMS — from EMT in the South Bronx to Chief of EMS and now Commissioner — Bonsignore brings a ground-up understanding of the largest fire-EMS system in the United States. 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. Key quotes from Commissioner Bonsignore “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.” Episode timeline 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 Enjoying the show? Email editor@ems1.com to share feedback. 

This week on the Inside EMS podcast, host Kelly Grayson tags in Texas educator John Puryear for a deep dive into the ever-evolving world of EMS education. What starts with a little sweet tea and Southern storytelling quickly turns into a masterclass on how to actually make distance learning work. Puryear breaks down the difference between synchronous and asynchronous learning, and why simply dumping recorded lectures on students isn't enough. The real magic? Engagement. Whether it's live interaction, strategic questioning or just being a “bit of an entertainer,” effective online education demands more than a webcam and a PowerPoint. Bottom line: online education isn't going anywhere. But if you're going to do it, you better do it right. The future isn't just virtual — it's hybrid, interactive and built by educators who actually care. Enjoying Inside EMS? Email theshow@ems1.com to share feedback. 

This week on EMS One-Stop, Rob Lawrence sits down with Sarah McEntee, executive director of the Commission on Accreditation of Ambulance Services (CAAS), to unpack what accreditation really means for modern EMS systems. 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 Enjoying the show? Email editor@ems1.com to share feedback. 

This edition of EMS One-Stop, recorded at the inaugural National EMS Management Association conference in Arlington, Virginia, pairs two complementary conversations about leadership and the future of EMS.   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. Enjoying the show? Email editor@ems1.com to share feedback. 

Things get intense on this episode of Inside EMS as hosts Chris Cebollero and Kelly Grayson tackle an age-old industry debate: should EMTs spend time on a truck before going to paramedic school or is that “experience” overrated? Kelly kicks things off with a spicy take, arguing that poor field training and inconsistent preceptorship often do more harm than good. From his perspective, bad habits, weak mentorship and burnout culture are the norm, not the exception. But Chris isn't buying it. He counters that experience builds what classrooms can't: clinical judgment, scene management and the ability to function in chaos. For him, skipping that step means stacking advanced skills on a shaky foundation. What follows is a back-and-forth that hits on everything from “microwave medics” and outdated curricula to high-fidelity simulation and whether modern education can truly replicate the street. Both sides agree the system is flawed — but disagree on where to fix it. Enjoying the show? Email editor@ems1.com to share feedback. 

In this episode of Inside EMS, cohosts Chris Cebollero and Kelly Grayson are once again joined by paramedic student April McKenzie, a.k.a., “April Anonymous,” for a deep dive on measuring arterial blood gas. Chris and Kelly walk April (and anyone else grinding through class) through the core idea that everything hinges on knowing “normal.” Once you lock in pH, CO₂ and bicarb ranges, the rest becomes pattern recognition, not panic. The big takeaway? Master normal, stay curious and treat every patient like a learning opportunity. Because the more normals you encounter, the faster you'll catch what's not. Quotable takeaways “Our whole job in a nutshell is maintaining homeostasis and knowing when the body is going to restore homeostasis.” “Voltaire said that the art of medicine is entertaining the patient until nature cures the disease. But, we know that nature doesn't always cure the disease. We have to know when to step in, when nature's not gonna do it.” Email theshow@ems1.com to share feedback. 

This week on Inside EMS, hosts Chris Cebollero and Kelly Grayson take a practical look at how leadership — both formal and informal — shapes the culture of an EMS organization. The hosts break down three things crews notice immediately: consistency, presence and composure. They emphasize that good leadership isn't about controlling people or enforcing policies — it's about developing crews, communicating clearly and earning trust over time. This episode breaks down how leadership credibility is built slowly through consistent behavior — and it only takes one misstep to damage it. Quotable takeaways “The culture of an EMS organization is shaped far more by leadership behavior than by policy manuals.” “You don't build strong organizations by controlling people. You build them by developing people.” “Leadership starts the moment people are watching.” Email theshow@ems1.com to share feedback. 

In this edition of EMS One-Stop, Rob Lawrence is joined by Bob Davies and Hilary Gates to explore the mission behind Six Minutes to Live, a growing movement focused on improving survival from sudden cardiac arrest. | 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. Email editor@ems1.com to share feedback. 

“The greatest victory is that which requires no battle.” ― Sun Tzu, The Art of War This week on Inside EMS, host Chris Cebollero brings a fresh interpretation to Sun Tzu's ancient text with his latest book, “The Art of War for Business Leaders: Winning Without Fighting in Leadership, Strategy, and Life.” Chris makes the case that EMS leadership is more about clarity and discipline than chest-thumping command presence, tying Tzu's principles back to everyday EMS realities. The discussion digs into why leaders so often fight the wrong battles, from staffing drama and culture clashes, to policy headaches and ego wars, and how better planning can keep those problems from blowing up in the first place The conversation dissects what accountability without chaos means in practice: building culture, reducing friction and leading in a way that gives crews the tools, support and ownership they need to succeed. Quotable takeaways “Most leaders don't fail because they're bad people. They fail because they fight battles that they never really need to fight.” “Never allow your emotions to dictate your actions. I was a powder keg that would explode when things didn't go right. [“The Art of War”] taught me to be less reactive.” “Discipline creates freedom.” Email theshow@ems1.com to share feedback. 

EMS on the Hill isn't just a date on the calendar — it's the profession's annual moment to stand in front of Congress and tell the EMS story with clarity, confidence and unity. 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 Episode timeline 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) Email editor@ems1.com to share feedback. 

This episode of Inside EMS is brought to you by ZOLL software and data solutions. Optimize EMS performance and outcomes at every stage of operations with interoperable solutions from dispatch, to patient care, QA/QI, billing and beyond. Visit zolldata.com to learn about the complete solution suite. This week on the Inside EMS podcast, Jon Puryear, NREMT-P, is back and if you've ever sweated a National Registry deadline, this one hits home. Amid the ever-looming March 31 cutoff, Puryear breaks down what's changed in continuing education — and what hasn't. Known for his ability to simplify complex topics, Puryear has built National Registry refresher courses, explainers and CE programs designed not just to check a box, but to truly reinforce clinical understanding. His teaching style leans heavily on storytelling and practical analogies — think pulmonary edema explained through a waterlogged sponge — so providers walk away actually understanding the information, not just memorizing it. If you need hours, motivation — or just someone to explain it like a human — this episode is your reset. Top quotes “I don't believe that we chose this profession. I believe that the profession chose us. We have a special calling inside of us to be able to take care of our fellow mankind.” “We don't get rich. We don't make a lot of money doing this. We're truly public servants.” “Continuing education is still important to be able to keep our mind, our clinical care, our judgment, everything on top.” Email editor@ems1.com to share feedback.

Recorded on location at the EMS Association Summit in sunny Kansas City, this edition of EMS One-Stop captures something that's been building for a while across the profession: real momentum. 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. Episode timeline 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. 

Editor's Note: This episode of Inside EMS is brought to you by ZOLL software and data solutions. Optimize EMS performance and outcomes at every stage of operations with interoperable solutions from dispatch, to patient care, QA/QI, billing and beyond. Visit zolldata.com to learn about the complete solution suite. This episode of Inside EMS tackles a difficult question: When is it time to step away from the job? Hosts Chris Cebollero and Kelly Grayson trade hard-earned wisdom — from Kelly's knee-rehab comic relief to serious talk about emotional burnout, wellness needs and timing. The hosts also explore the psychology of identity — how being a paramedic or EMT isn't just a job, it's who you are. They unpack how to carry forward the best parts of that identity — calm under pressure, decisive action, compassion — into new roles if needed. This isn't about quitting — it's about owning your career before it owns you. Whether it's fewer shifts, a new role, a new service or a new direction altogether, the message is clear: protect your identity, protect your professionalism and make moves that keep you sharp for the long haul. Quotable takeaways “Burnout is gradual. It's not explosive, but you've got to be able to realize the emotional flattening that is happening.” — Chris Cebollero “Our identity often becomes EMS. I tell people, to this day, ‘I'm a paramedic,' and there's a lot that goes into that — and not just when you put the boots or the polo shirt on. It really becomes the core of who you are.” — Chris Cebollero “The vast majority of us don't leave after one bad call. We wake up one day and realize we've been surviving instead of serving, and that's when the burnout epiphany really hits us hard.” — Kelly Grayson Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for a future episode.

This episode of Inside EMS is brought to you by ZOLL software and data solutions. Optimize EMS performance and outcomes at every stage of operations with interoperable solutions from dispatch, to patient care, QA/QI, billing and beyond. Visit zolldata.com to learn about the complete solution suite. NAEMSP is officially a “big little conference” — and it's only getting bigger. In this crossover episode, Rob Lawrence and Chris Cebollero unpack the momentum: tighter collaboration, a unified push toward EMS on the Hill Day, and the growing realization that if we want change, we need boots (and uniforms) on Capitol Hill. But the real buzz? AI. From autonomous ambulances to narrative-writing software, the conversation gets real about the promise — and the potholes — of artificial intelligence in EMS. Charting shortcuts? Maybe. Courtroom landmines? Definitely possible. Add in body-worn camera debates, budget crises and a push for legislative support at the federal level, and it's clear the profession is standing at a pivot point. Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for future episodes. 

In this episode of EMS One-Stop, Dr. Linda Dykes joins Rob Lawrence from the UK for a wide-ranging, transatlantic conversation that starts with workplace culture and ends with a practical look at how health systems can keep patients safely at home. 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. Timeline 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. 

This episode of Inside EMS is brought to you by ZOLL software and data solutions. Optimize EMS performance and outcomes at every stage of operations with interoperable solutions from dispatch, to patient care, QA/QI, billing and beyond. Visit zolldata.com to learn about the complete solution suite. This week on Inside EMS, Chris Cebollero takes on one of the most anxiety-inducing topics in paramedic education: alpha and beta receptors. Sparked by a question from paramedic student April McKenzie, a.k.a., “April Anonymous,” this episode strips away rote memorization and replaces it with something far more useful in the field — understanding the why behind the medicine. There's no fluff here; no cheesy memory tricks that fall apart under stress. Just physiology, practical mental models and a challenge to start practicing medicine with intention. If pharmacology has ever felt random, this episode connects the dots in a way that finally clicks. Quotable takeaways “Every medication you give in EMS is doing one of two things: It's either pushing the gas pedal or it's releasing the brake — that's it. If you don't understand which one you're doing, you're guessing, even if the protocol says you're right.” “We really have to become the ultimate detective of the body.” “Every patient is somewhere between gas and brake at all times. Those systems are constantly working, they're not off. It's just a dimmer switch. Every medication pushes one system or pulls the other system back into play.” Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for a future episode. 

Dr. Peter Antevy returns to the Inside EMS co-host seat this week, filling in for Kelly Grayson and bringing some serious pediatric firepower to the conversation. Host Chris Cebollero dives right into the latest buzz around the Broselow tape recall — yes, again — as Dr. Antevy unpacks what went wrong, why it matters and what EMS agencies should be doing about it now. He also shares exciting details on his brand-new, field-focused Newborn Resuscitation & Obstetrics course (NROC), built by EMS for EMS. Designed with two hours of online content (zero PowerPoints!) and a short, in-house skills lab, this course aims to tackle one of the most nerve-wracking call types. No more dragging medics to the hospital for NRP classes that don't translate to street-level care. Also on deck: OB deserts, delayed cord clamping, why you might need to Saran-wrap a newborn (seriously), and what AI can — and can't — do for EMS. This one's packed with practical pearls, myth-busting insights and a whole lot of passion for pediatric education. Quotable takeaways from Dr. Peter Antevy “EMS is one specialty that AI will never take away, as far as like the human-to-human contact. We resuscitate people, we treat people who are seizing. AI will never do that. That's a good thing.” “Academics and the hospital folks don't recognize the value that EMS brings to the table. They think we're ambulance drivers. It's time for them to wake up and recognize that we are the people who deliver babies. We are the people who resuscitate grandma, grandpa and the little kid.” Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for future episodes. 

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. 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. Memorable quotes from John Sammons “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.” Episode timeline 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. 

In this episode of Inside EMS, host Chris Cebollero sits down with Mic Gunderson, CEO of the Center for Systems Improvement and EMS Quality Academy; and editor‑in‑chief of the new peer-reviewed International Journal of Paramedicine, which launched in January 2023. Gunderson explains how the publication provides a forum for thoughtful debate around complex topics to be examined and analyzed. A recent issue, for example, touched on degree requirements for entry-level medics using the Socratic method to frame and manage the debate — a far cry from the horrors of a social post's comment section. Sprinkled with wit, respect and real curiosity, this episode is a masterclass in how EMS can grow — not just louder, but smarter. Whether you drive an ambulance, manage a system, or just care about the future of prehospital care, this conversation is worth your seat time. Additional resources: The International Journal of Paramedicine Degrees, debate and direction: Why this debate deserves our attention Top quotes from Mic Gunderson “Allow us to have enough maturity in our dialogue to say, ‘what's your logic or reasoning behind your opinion?' instead of just saying, ‘I think the sky is blue.' Tell me why you think the sky is blue and why it isn't red.” “With the Socratic debate format, because we're not trying to pick a loser or a winner, it allows us to really focus on the issues and the merits of the different perspectives.” Enjoying the show? Email theshow@ems1.com to share feedback or suggest guests for future episodes. 

In this episode of EMS One-Stop, Sophie Fuller — better known across social media as Paramedic Sophie — joins host Rob Lawrence for a candid, energizing conversation about what it really feels like to work in EMS right now: pride, the pressure, the burnout, and the culture issues that too many providers have been taught to silently absorb. 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 Memorable quotes “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 Episode timeline 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. 

In this episode of the Inside EMS podcast, Chris and Kelly are joined by paramedic student April McKenzie — aka “April Anonymous” — for a deep dive into the buffer system and CO2 mapping. April's in the thick of paramedic school and like every good learner, she's asking “why?” — so the guys break down the physiology behind capnography, acid-base balance and the lungs-vs.-kidneys showdown that keeps our patients alive. Plus, they throw in old-school war stories, rant about naloxone misuse and admit that bicarb is no longer the go-to cardiac arrest drug. If you've ever tried to explain respiratory vs. metabolic acidosis in under 10 minutes, this episode is your cheat sheet. April will be back throughout the year with more student questions, so buckle up for the ongoing EMS education you didn't know you needed. Quotable takeaways “Just because you see somebody with signs and symptoms and the protocol says, do this; that's OK, but that just makes you a protocol paramedic.” “My friend Romy Duckworth calls [capnography] the MVP of vital signs, and that's a good way to remember it — MVP: Metabolism, Ventilation and Profusion. And it will tell you derangement about all three of those things very well once you're proficient at interpreting the waveforms.” “Basically, the buffer system is the body's way of keeping the pH stable. So, if we're blowing out, if we're having problems with respiratory acidosis — and let's talk about CDKA, where they're trying to blow off — it's the respiratory systems' way of making sure that we have homeostasis.” Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for an upcoming episode. 

In this episode of EMS One-Stop, Rob Lawrence is joined by his own Medical Director, Dr. Maia Dorsett, to unpack the 2025 NEMSQA Measures Report — a deep dive into trauma-focused quality measures built largely from NEMSIS data. 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. 

This week on Inside EMS, Chris Cebollero kicks off 2026 with a heartfelt conversation featuring Eric Morrison, vice president of the National EMS Memorial Bike Ride and EMS director for Iredell County, North Carolina. The ride, founded 26 years ago, exists to honor the memory of EMS providers who died in the line of duty, from illness or mental health struggles. Each rider wears a dog tag bearing the name of a fallen provider, often connecting with their families along the journey. Eric shares his personal journey from lifeguard to leader and how his rekindled love for cycling — along with the loss of friend and EMS wellness advocate Brian Fass — led him to the ride. He breaks down what it takes to join (hint: it's more doable than you think), the logistics of the ride, and how EMS agencies and individuals can support the cause, even off the bike. Quotable takeaways from Eric Morrison “All of us are focused on the idea that our providers matter. They matter to their families, they matter to their communities, and they should matter to all of us.” “People that didn't even know that person are recognizing their service. They're recognizing their commitment to the community, and they're honoring them and remembering them.” “Once you come out and see what the ride is really about, you understand the mission and you see the impact it has on these families that we're able to meet with.” Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest a guest for a future episode. 

Dr. Douglas Kupas joins Rob Lawrence to kick off EMS One-Stop in 2026, reflecting on his first year as President of NAEMSP — a year he describes as fast-moving, complex and occasionally “whack-a-mole,” with emerging issues demanding real-time leadership while long-term priorities still had to move forward. 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. Episode timeline 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. 

As the year wraps, Rob Lawrence welcomes back the “EMS Avenger” Jimmy Apple for a fast-moving, end-of-year pulse check on the EMS universe — through the lens of social media, research and what frontline clinicians are actually saying when the mic is on and the comments are open. 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. Memorable quotes “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 Episode timeline 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. Additional resources 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.

As EMS closes out 2025, host Rob Lawrence is joined by Matt Zavadsky (PWWAG) and Rodney Dyche (Patient Care EMS Solutions) for their second annual EMSIntel.org “year in review” conversation — a fast-moving tour through the biggest stories shaping the EMS profession. 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 Memorable quotes “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 Episode timeline 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. 

In this end-of-year special, Chris Cebollero and Kelly Grayson wrap 2025 with their trademark mix of humor, insight and zero sugarcoating. From venomous bites to venomous behavior, the Inside EMS duo continue counting down the top EMS stories that had the industry buzzing this year — and occasionally cringing. As always, the guys don't shy away from the tough stuff, but they make sure to end on a note of gratitude for the everyday EMS pros out there doing the job with compassion, competence and quiet heroism. Quotable takeaways “Every day, EMS providers go out there, do their jobs and bring some kindness and some comfort to a really bad day for their patients. And I think we need to look forward to more of that in 2026.” “Sometimes we've done things that maybe we shouldn't have, because it isn't in our scope of protocols, but I think we make a difference. Where's the line?” “Most of the advantages of mechanical CPR are not advantages at all.” The top EMS1 stories of 2025 Representatives Glenn Thompson and John Mannion introduced the EMS Counts Act Social Security Fairness Act signed into law, boosting retirement benefits for first responders Kentucky EMTs face KBEMS hearing for administering antivenom after mamba bite Elkhart firefighter appeals loss of paramedic duties after nurse's harassment complaint American Heart Association's 2025 CPR guidelines: Choking, opioids & survival chain Ill. city council makes $500 lift assist fee permanent Warren-Wentworth Ambulance shuts down after entire staff quits 'Shut the f**k up!': North Babylon Fire Chief Peter Alt on leave after video shows him cursing at patient Orange County fire chiefs demand removal of EMS director for halting blood transfusions, ketamine use Colo. paramedic charged with manslaughter after sedating, restraining man National EMS Advisory Council board members terminated Enjoying Inside EMS? Email theshow@ems1.com to share feedback or suggest guests for an upcoming episode.