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Explore the forefront of EMS leadership with Rob Lawrence on the ”EMS One-Stop” Podcast. Tackling critical issues like staffing, service delivery and operational challenges, each episode delves into the latest in patient care enhancement, EMS technology advancements; and emerging trends like AI, telehealth, quality improvement and alternate destinations with industry experts.

Rob Lawrence brings to the table his extensive expertise from decades of service spanning the American Ambulance Association, AIMHI, Richmond Ambulance Authority, Pro EMS, Prodigy EMS Education and the East Anglian Ambulance NHS Trust.

Stay informed with the latest EMS industry news, organizational updates and inspiring agency success stories. Tune in to the ”EMS One-Stop” Podcast for a deep dive into the challenges and triumphs of EMS leadership in today’s dynamic prehospital care landscape.
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  • 21 episodes
  • Avg 38 min
  • English

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  • #119
    Friday · 37 min

    Data versus Darwin with Todd Stout

    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? Email editor@ems1.com to share feedback.

  • #117
    September 1 · 55 min

    Liz Harney on the human side of EMS

    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? Email editor@ems1.com to share feedback.

  • #116
    August 21 · 36 min

    EMS One-Stop: The EMS research every clinician should be reading

    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? Email editor@ems1.com to share feedback.

  • #115
    August 16 · 39 min

    Knoxville’s Mission District model takes EMS beyond the 911 call

    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? Email editor@ems1.com to share feedback.

  • #114
    August 7 · 31 min

    Grant funding demystified with Anya Otterson

    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.

  • #112
    July 24 · 32 min

    Why EMS can’t sing along with this Anthem

    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

  • #111
    July 23 · 37 min

    Preventing falls, preserving independence: An EMS success story

    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.

  • #110
    July 3 · 35 min

    Breaking the system to make it stronger

    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.

  • #109
    June 26 · 35 min

    Pinnacle 2026 preview: Leadership, retention, AI and the future of EMS

    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.

  • #108
    June 18 · 34 min

    Policy, payment reform and why EMS must engage

    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.

  • #107
    June 12 · 41 min

    Johnny and Roy inspired a generation. Now they're telling EMS's toughest truths

    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.

  • #106
    June 4 · 30 min

    Blood on Board: The second chance that changed everything

    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.

  • #105
    May 28 · 46 min

    Blood on Board: Everything is bigger in Texas

    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.

  • #104
    May 28 · 42 min

    Blood on Board: Federal funding paves the way for EMS blood programs

    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.

  • #103
    May 14 · 45 min

    Blood on board: Lessons from Sacramento and LA County Fire

    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.

  • #102
    May 13 · 16 min

    Special report: Andes Hantavirus risk assessment

    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.

  • #113
    May 8 · 40 min

    Mind the gap: Data, disparities and the future of EMS

    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.

  • #101
    April 30 · 39 min

    When systems hesitate, they deploy: The rogue air crews who faced Ebola head-on

    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.

  • #100
    April 23 · 30 min

    ‘Hydraulic debriefing:’ Alcohol, stress, and the hidden culture of EMS

    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.

  • #99
    April 16 · 57 min

    FDNY’s future: AI, BWCs and pay parity

    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.

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