EMS One-Stop

In this episode of EMS One-Stop, host Rob Lawrence welcomes back FDNY Chief of Department John Esposito for a candid conversation about the challenges and opportunities facing emergency medical services in New York City.

Following a recent city council hearing examining ambulance response times, staffing shortages and EMS compensation, Esposito discusses the realities of operating one of the world's busiest emergency response systems.

With approximately 4,500 EMS calls each weekday, a nearly 10% staffing vacancy rate and mounting pressure to improve response times, he explains why the challenge is not a shortage of ambulances, but a shortage of people to staff them. Central to his vision is making FDNY EMS a career destination, rather than a steppingstone to other public safety professions.

The conversation also highlights Esposito's commitment to strengthening the relationship between fire and EMS within one unified department. From assigning rescue paramedics to FDNY rescue companies and deploying non-transport paramedic response units, to improving hospital turnaround times, Esposito outlines practical initiatives to increase operational efficiency and patient care.

He also discusses the importance of public education, alternative care pathways and FDNY's planned next-generation EMS computer-aided dispatch system, expected in November 2027. The episode concludes with a reflection on leadership, the professionalism of FDNY personnel, and the lasting impact EMTs and paramedics make on the patients and families they serve.

Key quotes

• "We have a budgeted headcount in FDNY EMS of 4,500 people, and we have slightly over 4,000 — almost a 10% vacancy." — Chief John Esposito
• "And that results in in less ambulances. We have plenty of physical ambulances in service ... we just don't have the people to put in them." — Chief John Esposito
• "One of our goals — one of my goals — is to make EMS here a career, make EMS the destination that you get people that come here for that." — Chief John Esposito
• "But the people that they had those interactions with — those people's houses and apartments and homes that they went into to save somebody's life to make a difference — they will remember them probably forever." — Chief John Esposito

Episode timeline

• 00:49 – Welcome and reflections on the 9/11 remembrance
• 03:47 – Building a unified fire and EMS department
• 05:34 – Rescue paramedics embedded with rescue companies
• 07:35 – Making EMS a career destination
• 12:10 – Compensation, resources and response times
• 13:39 – Non-transport paramedic response units
• 15:41 – The unique challenges of responding in New York City
• 17:42 – Bystander CPR and the role of hospital ambulance partners
• 20:42 – City Council oversight and public accountability
• 23:24 – Staffing vacancies and rising ambulance response times
• 27:07 – Improving field staffing and response classification
• 30:00 – Daily call volume and alternative care pathways
• 33:52 – Hospital turnaround times and ambulance availability
• 36:38 – FDNY's operational priorities
• 38:11 – New EMS CAD, predictive technology and AI
• 39:30 – Leadership, professionalism and the lasting impact of EMS
• 41:31 – Closing reflections

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In the first part of the Hyde County story, EMS One-Stop explored how a small rural North Carolina EMS system became the first in the nation to deploy an eVTOL aircraft as part of a 911 response. In this episode, host Rob Lawrence talks to the people who actually took the concept into the air.

Quinn Reece, a North Carolina paramedic with a background in emergency management, austere medicine and technical rescue, became the first pilot-paramedic to fly the Pivotal BlackFly on a 911 response in Hyde County. On both of the operational calls she flew, Reese arrived and began providing ALS care approximately 20 minutes before the responding ground ambulance.

Joining Quinn is James Robinson, an experienced North Carolina paramedic who served as ground support and supporting pilot for the project. Together, they take Rob behind the scenes of the proof of concept: intensive simulator training, emergency procedures, actually flying a single-seat eVTOL, operational control, weather and range calculations, landing close to patients, carrying a 38-pound ALS package, and using a Cybertruck as a mobile charging platform.

They also tackle the inevitable criticism around new technology and explain why the project was never about replacing the ambulance. It was about finding another way to put a skilled clinician beside a patient sooner when geography, water, distance and limited resources make conventional response difficult.

Memorable quotes

• “The pilot is 100% flying the aircraft.” — James Robinson
• “I did run the first two calls to provide ALS care on scene 20 minutes before an ambulance on both times.” — Quinn Reece
• “For you to first time sit back in it, you feel like almost an astronaut being projected up.” — Quinn Reece
• “That patient had no idea how I got there. They weren’t looking outside to see what I arrived in. They were just happy that care was there in an appropriate amount of time to help them for what they needed.” — Quinn Reece
• “To have them [my sons] actually see the aircraft for the first time and watch their mom fly was actually really inspirational for me.” — Quinn Reece
• “You don’t have a copilot sitting there that can bail you out.” — James Robinson
• “This is just another tool in the toolbox that allows you to pop straight up in the air, fly over the top of all that water that would otherwise be an obstacle.” — James Robinson

Episode timeline

• 00:26 ­– Rob introduces the second chapter of the Hyde County story and reflects on the leadership, determination and regulatory work required to move the concept from idea to actual flight.
• 02:04 – Meet Quinn Reese and James Robinson.
• 02:32 – Quinn explains her background in paramedicine, emergency management, technical rescue and austere environments, and why that experience helped prepare her to operate as a sole provider ahead of the ambulance.
• 03:27 – James introduces himself and describes almost 30 years in emergency services and his role providing ground support for the Hyde County project.
• 04:41 – Quinn recalls receiving the initial phone call in December 2025 asking whether she would consider joining the project.
• 06:13 – Quinn admits to some nerves as a North Carolina paramedic suddenly surrounded by engineers and PhD students — before telling them she was there to fly the aircraft operationally.
• 07:22 – Inside the simulator: VR goggles, moving seat, sound, wind and realistic flight environments.
• 08:30 – Two days of intensive simulator work including check rides, GPS and radar failures, parachute deployment, wind management, and transitioning between hover and cruise modes.
• 09:16 – James explains why simulator training and muscle memory are so critical in a single-seat aircraft where there is no copilot sitting beside you.
• 10:53 – Who is actually flying? James makes it clear: the pilot is controlling the aircraft, while built-in systems help prevent unsafe maneuvers.
• 12:43 – Quinn explains what happens when the controls are released in cruise and hover modes.
• 13:09 – The ballistic parachute: how an emergency parachute can lower the entire aircraft.
• 14:31 – Quinn remembers her first real flight over Monterey Bay.
• 15:06 – “You feel like almost an astronaut being projected up.” Quinn describes the sensation and power of the aircraft on initial vertical takeoff.
• 17:02 – Navigating the operational missions using both the aircraft display and SARTopo/CalTopo to plot call locations.
• 18:00 – James emphasizes that this was a prototype and a proof of concept designed in part to identify exactly these operational issues.
• 19:34 – Moving the aircraft: the BlackFly breaks into three major sections and fits into a 16-foot trailer.
• 20:08 – Range and weather: Quinn explains the roughly 20-nautical-mile operating capability and how wind changed the practical mission radius.
• 21:29 – The unusual support vehicle: a Cybertruck capable of charging the BlackFly repeatedly in the field.
• 25:34 – The first 911 call arrives while Quinn is already conducting a proficiency flight. She hears the dispatch over the radio, lands, plots the call, checks the weather and operational parameters, and launches toward the patient.
• 27:42 – Quinn arrives at the patient — and nobody initially understands how the paramedic got there.
• 28:43 – One of the less glamorous first-flight lessons: getting the medical bag out of the aircraft proves harder than expected, leading to changes before the second mission.
• 29:12 – Quinn begins patient care and explains that, from the patient’s perspective, the method of arrival was irrelevant: they were simply pleased that help had arrived.
• 29:40 – Meanwhile James and the ground team arrive, recharge the aircraft and prepare it for departure while neighbors slowly realize there is an aircraft sitting in the yard.
• 31:07 – From pilot Quinn to paramedic Quinn: what medical equipment did she carry?
• 32:48 – Public reaction evolves from skepticism and raised eyebrows to families bringing their children to see the aircraft and learn about the program.
• 33:23 – Rob addresses the skeptics: Is this just an expensive gimmick with limited range?
• 33:53 – James makes the clinical case: in rural areas where conventional 10-minute response simply is not realistic, an eVTOL is another way to overcome geography and put ALS care beside the patient sooner.
• 36:34 – What happens next? Quinn and James describe taking the aircraft to emergency management and aviation events to demonstrate the concept and educate other agencies.
• 38:15 – Other possible missions: moving critical medications across flooded areas, search and rescue, disaster assessment and other emergency-management applications.
• 39:07 – Quinn discusses the evolution from the BlackFly toward Pivotal’s newer Helix platform, with greater range, payload and capability.
• 40:13 – Will Quinn fly operational EMS missions again? She hopes so, with growing interest from other agencies exploring the concept.
• 44:35 – A personal moment: Quinn describes bringing her two young sons to Hyde County and watching them see their mother fly the aircraft.
• 44:53 – Rob closes the two-part Hyde County story, reflecting on the enthusiasm, belief and determination of everyone involved.

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Weather is no longer simply something EMS and public safety agencies can react to when it arrives. In this episode of EMS One-Stop, Rob Lawrence is joined by meteorologist and emergency management specialist Sunny Wescott to examine what she describes as “weather whiplash” — rapidly changing conditions, stronger storms, heavier rainfall, coastal erosion, flooding, drought and infrastructure failures occurring with increasing intensity and sometimes in places where responders have not traditionally expected them.

| WEBINAR: Ready before the call — Building a stronger fire and EMS preparedness strategy

Sunny explains why understanding global weather patterns matters locally, and why storms developing thousands of miles away can provide valuable early warning for emergency managers in the United States.

The discussion moves from the global weather picture to the West Coast, El Niño, coastal erosion, Lake Mead and the Colorado River, before looking east toward the remainder of hurricane season. More importantly, Sunny translates the science into practical advice for first responders:

• Study international disasters
• Anticipate public behavior
• Identify critical infrastructure before it fails
• Use recent after-action reviews to improve the next response
• Plan not only for the emergency itself, but for the much longer recovery period that follows

Along the way, there is also the extraordinary example of a flooded snake farm in China that released 900 king cobras into floodwaters — a reminder that disasters frequently create secondary hazards no emergency plan anticipated.

Key quotes

• “None of these weather events are new, but they’re entering into areas where they don’t typically go or haven’t gone before.” — Sunny Wescott
• “If you look out of your windows, you can see there’s this thing called weather going on.” — Rob Lawrence
• “If we’re not paying attention to Russia, Asia, India, then we’re going to be surprised when these weather events get into the Pacific and approach our coastline.” — Sunny Wescott
• “I’m a Brit. I’m professionally trained to talk and moan about the weather, so I might as well do it on One-Stop.” — Rob Lawrence
• “The problem is we weren’t prepared for the intensity of the last decade, and that’s led us into a place of complacency, kicking the can down the road.” — Sunny Wescott
• “If you just did your after-action review from the last weather system, you have a real opportunity to make those corrections and to get it right even as soon as next week.” — Rob Lawrence

About our guest

Sunny Wescott is a federal emergency response official chief meteorologist with the Department of Homeland Security (DHS) specializing in national extreme weather hazards and climatological studies for impacts to public and private sector key resources; and deputy project manager for the National Hurricane Program (FEMA).

Episode timeline

• 00:31 — Rob introduces the episode and welcomes Sunny Wescott back to EMS One-Stop.
• 01:42 — Sunny’s background: from U.S. Air Force meteorology to critical infrastructure, homeland security, FEMA’s National Hurricane Program and geospatial intelligence.
• 03:26 — The global weather picture and why traditional weather patterns are becoming less reliable.
• 05:53 — Why U.S. emergency managers should pay attention to weather in Russia, Asia and Europe.
• 06:10 — The jet stream, wildfire smoke and the “carousel of weather” moving systems around the globe.
• 07:24 — How overseas weather events can offer advance warning of the intensity of systems later approaching North America.
• 09:29 — Sunny explains Kelvin waves, warmer coastal water, king tides and why California’s coastal flooding risk continues to increase.
• 11:25 — Emergency managers are being forced into a cycle of continually trying to catch up with increasingly damaging events.
• 13:03 — Sunny predicts continued worsening of coastal erosion and discusses wider infrastructure impacts — sinkholes, water mains and groundwater depletion: how underground infrastructure may become another increasingly important response issue.
• 15:00 — Why heavy rain does not necessarily solve the water crisis affecting Lake Mead and the Colorado River.
• 15:09 — Intense rainfall can fall too rapidly for soil, vegetation and drainage systems to absorb it effectively.
• 16:20 — Evaporation, human water use and warming water further complicate reservoir forecasts.
• 17:07 — The coming political and resource challenge: deciding who gets scarce Colorado River water.
• 18:41 — Rob and Sunny return and shift attention to the Atlantic and the remainder of hurricane season.
• 19:28 — Sunny explains Saharan dust, wildfire smoke and the environmental factors that influence tropical cyclone development.
• 20:22 — Late-season concern turns toward the Caribbean and Gulf.
• 21:44 — Sunny’s first recommendation: follow international disasters and learn how both responders and the public behaved.
• 22:12 — Preparing for public distrust, misinformation and hostility during emergencies.
• 22:45 — Using overseas infrastructure failures as scenario planning: bridges, roads, supply routes and rescue access.
• 23:07 — The 900 king cobras example and the importance of anticipating unexpected secondary hazards.
• 24:36 — A near-real-time look at the forecast for the following week. Sunny warns that a significant West Coast system may catch people off guard
because it lacks a dramatic label such as “hurricane” or “atmospheric river.”
• 25:14 — A developing system is expected to track down the West Coast, bringing waves of wind and precipitation.
• 26:03 — “Now’s your time to shine.” Agencies that have just completed after-action reviews have an immediate opportunity to make improvements.
• 26:20 — Rob reinforces the value of turning recent lessons learned into operational changes before the next event.
• 27:35 — Rob’s closing takeaway: first responders should think beyond immediate response and plan equally seriously for recovery.

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North Carolina has always been proud of being first in flight. More than 120 years after the Wright brothers took to the air at Kitty Hawk, a small rural EMS system in the eastern part of the state is once again asking what flight might mean for the future. In this episode of EMS One-Stop, Rob Lawrence heads to Hyde County, North Carolina, where EMS leaders have become the first in the nation to operationally deploy an electric vertical takeoff and landing — eVTOL — aircraft to get a paramedic rapidly to a 911 call.

Rob is joined by Hyde County EMS Chief Brooke Cox; Todd Baker, director of education and clinical services with Code Blue Resources and a captain with Hyde County EMS; and Carla Baker, owner of Code Blue Resources. They explain how a geographically challenging rural county moved from an ambitious idea to an operational proof of concept; working through state EMS regulation, the FAA, aviation safety, clinical requirements, pilot training and more than 1,000 training missions.

They also describe the moment a paramedic reached a remote patient about 20 minutes ahead of the responding ambulance, what the project has taught them, and why this is not about replacing ambulances or helicopters. It is about finding another tool to overcome the challenge of time and distance — and proving that even a small rural EMS system can do very big things.

| MORE: N.C. county EMS is first in nation to deploy eVTOL aircraft on 911 calls

Key quotes

• “We’re here for the patient. We’re here for the community. We’re here to make a difference nationally; not just in our little pond.” — Brooke Cox
• “Let’s look at what we can do to make it work and overcome challenges.” — Todd Baker
• “Why has somebody not done this before?” — Carla Baker
• “Come visit Hyde County. We are a small, small county, but we’re doing big things and we have a heart for community.” — Brooke Cox
• “Let’s utilize the technology, the innovation that’s out there and see if it works, and if it doesn’t, it doesn’t.” — Todd Baker
• “This was never meant to replace an ambulance. It’s not meant to replace a helicopter, a medical air helicopter.” — Carla Baker
• “It is to figure out if this particular asset will help you overcome obstacles in various response areas. And that’s what it’s about.” — Carla Baker

Additional resources

• Code Blue Resources
• Akute OS
• Pivotal

Episode timeline

• 00:36 – Rob introduces EMS One-Stop and the extraordinary concept of flying a paramedic to a 911 call aboard an eVTOL aircraft — meet the guests: Hyde County EMS Chief Brooke Cox, Captain Todd Baker and Carla Baker of Code Blue Resources
• 02:38 – Understanding Hyde County: rural geography, marshland, water, Ocracoke Island and the challenge of accessing timely EMS and air-medical resources
• 04:31 – Brooke describes moving from a resource-rich EMS environment to one where a critically ill patient could wait almost 3 hours for a helicopter
• 06:01 – The eVTOL concept: essentially a large electric vertical takeoff and landing aircraft capable of carrying a paramedic
• 07:14 – Carla explains Code Blue Resources and how conversations about bringing the technology into EMS began
• 09:34 – Todd traces the project back to December 2024 and the effort to turn the concept into an operational reality
• 09:59 – The first regulatory hurdle: determining how North Carolina’s Office of EMS would classify the aircraft and what equipment it would need to carry
• 11:22 – Brooke describes being a dreamer, becoming a trailblazer and the unforgettable moment the aircraft first launched
• 13:37 – Inside the aircraft: battery power, operational range, controls, safety systems and even an emergency parachute
• 16:29 – Working with the North Carolina Office of EMS and finding a regulatory pathway for something nobody had previously attempted
• 18:34 – Building the clinical package around providing what a paramedic might need during the first 15 minutes of an EMS call
• 20:26 – Taking the project to the FAA and learning how EMS and aviation had to develop a common language around risk and life safety
• 22:34 – Selecting the paramedics: why clinical judgment, aviation awareness and experience mattered more than simply putting out a job advertisement
• 23:43 – Meet Quinn Reese, the paramedic who flew the first operational mission
• 24:16 – Preparing clinicians for the aircraft and ensuring they were fully credentialed within Hyde County’s EMS system
• 26:33 – Brooke goes to California to train: VR simulation, repetitive skills development, fatigue management and progressing to proficiency
• 29:14 – Who actually flies it? Brooke explains the dual joystick controls and the authority of the paramedic operating the aircraft
• 30:03 – How Hyde County positioned the aircraft and used call location, range, weather and operational parameters to determine whether a mission was viable
• 31:51 – Todd tackles some of the misinformation surrounding the program and explains the multiple layers of operational and pilot decision-making
• 33:31 – More than 1,000 training missions during the proof-of-concept period
• 33:53 – The operational call that demonstrated the potential: a paramedic finds a remote patient and arrives approximately 20 minutes ahead of the ambulance
• 36:17 – The reaction after a successful mission and the satisfaction of seeing months of planning and training translate into patient care
• 37:33 – Lessons learned: leadership support, educating decision-makers, having a clear mission and understanding the strengths of the team
• 39:34 – Todd explains the culture of asking, “How can we make this happen?” rather than immediately looking for reasons why it cannot
• 41:51 – The wider Hyde County team: how law enforcement and EMS routinely work together in a resource-limited rural environment
• 43:16 – The proof of concept has ended — for now — as Hyde County looks toward the next generation of longer-range eVTOL technology
• 44:49 – “This is just the tip of the iceberg:” Brooke explains why Hyde County is not finished with the concept
• 45:21 – Carla discusses interest from other organizations and manufacturers and what has been learned about building a comprehensive eVTOL EMS program
• 47:09 – Brooke’s message from Hyde County: a small county doing big things and trying to put community back at the center of EMS innovation
• 47:36 – Todd on the need to think beyond the traditional model of simply placing two people in an ambulance and sending them toward every call
• 49:54 – Rob closes: North Carolina is first in flight once again — and the team in Hyde County has shown it has the right stuff

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In this episode of EMS One-Stop, host Rob Lawrence sits down with Oscar Monterrosa, the 2026 NAEMT Paramedic of the Year, whose career has taken him from Army combat medic to street paramedic, medical student and now an emergency medicine-internal medicine resident at Hennepin County Medical Center. Yet despite the white coat and demands of residency, Monterrosa continues to work on the ambulance, including in rural Minnesota, and remains closely connected to the profession that shaped his approach to medicine.

The conversation also returns to one of the defining moments of Monterrosa’s career: the Oct. 1, 2017, mass shooting in Las Vegas. Working an overtime special-event shift, Monterrosa was already inside the medical tent when gunfire began and casualties started arriving. He describes slipping into “work mode,” drawing on his experience as an Army combat medic in Iraq as he and others triaged and treated patients while the shooting was still underway.

Beyond that extraordinary night, the discussion explores rural EMS, critical care and ECMO, education, mentorship and the long road from paramedic to physician. Monterrosa’s message to other EMS clinicians considering further education is straightforward: the road may be difficult and it may take longer than expected, but it is possible.

Key quotes from Oscar Monterrosa

•

“We have that critical call or whatever, somebody that's crashing right in front of you and you just kind of get into work mode.”

•

“Even though there's still gunfire going on, you try to be as safe as you can and take cover, but ultimately all that is really out of your control.”

•

“A lot of these experiences in the cornfields has been very rewarding, just seeing this different culture, like meeting a lot of different people.”

•

“It just takes hard work and just not giving up.” “I was an undergrad for 9 years because I was working full time on the streets.”

Additional resources

•

National Association of Emergency Medical Technicians (NAEMT)

•

NAEMT National EMS Awards of Excellence

•

Hennepin Healthcare

•

Las Vegas Metropolitan Police Department: October 1 / Las Vegas mass shooting – After-Action Report

Episode timeline

• 00:52 – Rob introduces the 2026 NAEMT Paramedic of the Year
• 01:34 – Oscar 101: paramedic and emergency medicine-internal medicine resident
• 02:05 – Oscar hears what his colleagues wrote about him in his award nomination
• 04:04 – His reaction to being named National Paramedic of the Year
• 05:00 – The journey into EMS, military medicine and becoming a paramedic
• 07:20 – From the desert Southwest to rural Minnesota EMS
• 09:00 – The realities of rural 911 response and long interfacility transports
• 10:15 – Critical access hospitals and managing high-acuity patients
• 12:30 – The conversation turns to October 1, 2017, in Las Vegas
• 13:17 – What began as a routine special-event EMS shift
• 13:55 – Reports of gunfire and the first shooting victims reaching the medical tent
• 14:24 – What happens mentally when a mass-casualty incident suddenly unfolds
• 15:00 – Combat medic training, triage and functioning while gunfire continues
• 17:00 – Reflections on the Las Vegas response and its lasting impact
• 18:00 – From paramedic to physician: why Oscar continued his education
• 19:30 – Rural critical care, cardiac arrest and mobile ECMO
• 21:00 – Remaining connected to EMS while completing medical residency
• 23:00 – Advice for paramedics considering college or medical school
• 23:42 – Nine years as an undergraduate while working full time on the streets
• 24:00 – Perseverance, education and why the path is still achievable
• Closing – Looking ahead, mentorship and what being NAEMT Paramedic of the Year means to Oscar

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FDNY Chief of Department John Esposito recounts FDNY’s devastating losses, the decisions that saved thousands of lives and why honoring 9/11 means preparing the next generation to meet the moment

Twenty-five years after Sept. 11, 2001, FDNY Chief of Department John Esposito joins podcast hosts Jim Dudley, Rob Lawrence and Aaron Zamzow of Police1’s Policing Matters, EMS1's EMS One-Stop and FireRescue1’s Better Every Shift for a deeply personal conversation about 9/11, its enduring impact and the lessons that continue to shape fire, EMS and law enforcement. Esposito was a newly promoted FDNY lieutenant on Sept. 11, 2001. He recalls returning to the city after the towers fell, the collapse of command and communications, the desperate effort to account for missing members, and the realization that FDNY had suffered unimaginable losses.

The discussion moves beyond remembrance to examine what emergency services learned: stronger accountability, controlling self-deployment, incident management teams, interoperable communications, interagency cooperation, intelligence sharing and peer support. Esposito also reflects on the continuing toll of World Trade Center-related illness and explains why “never forget” must mean more than remembering 343 names. For him, it means remembering the decisions responders made, the conditions they faced and the thousands of lives their actions helped save. His challenge to today’s generation is simple: know your job, keep learning, take care of your people and ask whether you are prepared to “measure up” to those who came before.

Key quotes from FDNY Chief of Department John Esposito

“Never forget is not just their names and who they were, how they lived their lives, and most importantly, the decisions that they made that day and the actions that they took.”

“They're like, ‘No, we think we lost everybody.’ And that was when it started to sink in that no, this is gonna be as bad as it could be.”

“If we never showed up and we had no losses that day, the loss of civilians is in the tens of thousands.”

“This is your legacy. This is our legacy, this is what we do, and these are the people that did this before us.”

“I believe that some of them knew that they were not going to make it home that night. And they still did their job.”

“September twelfth came, the doors of the firehouse went up, people got on fire trucks, and they went out and did their job.”

“It was like an all-star team that we lost. Some of the best people to ever do this job we lost that day.”

“I see my job here and our job in this building and headquarters is to take care of the people that take care of the city.”

“We have no idea. We're in a firehouse or an ambulance one second and in five minutes we could be in the worst situation we've ever been in.”

“It's our job to make sure that the people in the field are prepared and when they need something, it's our job to get it for them.”

Episode timeline

00:27 – Introduction: EMS1, FireRescue1 and Police1 come together to reflect on 25 years since September 11

02:28 – Introduction: FDNY Chief of Department John Esposito

03:23 – Chief Esposito recalls Sept. 11, 2001 as a newly promoted lieutenant with a day off and plans to study for the captain’s exam

04:28 – Chief Esposito details arriving in lower Manhattan and finding command structures and communications devastated

05:04 – The desperate process of identifying who was alive, missing or lost

07:00 – Chief Esposito describes his initial response and why he never imagined the towers could collapse

09:00 – “We think we lost everybody.” When the magnitude of FDNY's losses began to become clear

09:30 – Accountability and self-deployment emerge as major lessons from 9/11

10:00 – How FDNY now wants off-duty members to report to firehouses and EMS stations rather than directly to an incident

10:30 – Modern digital accountability, riding lists and identifiable radio transmissions compared with 2001's paper systems

12:00 – The human factor: firefighters desperate to get aboard apparatus headed toward the World Trade Center

12:30 – Leadership decisions that removed extra firefighters from overloaded apparatus ultimately saved lives

14:00 – The continuing human toll: FDNY's memorial walls and deaths from World Trade Center-related illness

16:30 – How FDNY will commemorate the 25th anniversary

17:30 – Why September 11 remembrance is intensely personal for individual firefighters and families

21:00 – Chief Esposito discusses the emotional effect September 11 continues to have on him

22:00 – “Never forget” means remembering actions and decisions, not merely names

24:00 – The actions of responders helped prevent civilian deaths potentially reaching into the tens of thousands

25:00 – Managing the overwhelming desire of responders to help during catastrophic incidents

27:30 – How outside incident management teams helped FDNY solve problems after 9/11

28:30 – FDNY repaying the assistance it received through deployments around the United States

30:00 – How today's incident command and dispatch systems control resources and prevent uncontrolled response

31:42 – Sponsor message

32:30 – Improved interagency collaboration between FDNY, NYPD and other agencies

36:00 – Peer support, firehouse culture and challenging the stereotype that firefighters do not talk about emotional distress

38:30 – How FDNY's peer-support system works after difficult incidents

42:30 – September 11 demonstrated why the fire service needs to be part of the intelligence community

44:00 – FDNY members are trained to recognize suspicious activity during routine fire and EMS responses

46:00 – How information spotted by firefighters may become the missing piece in a larger investigation

48:30 – What Chief Esposito wants responders who were not alive on 9/11 to understand

49:00 – “This is our legacy.” Measuring today's performance against those who came before

52:00 – Know your job and do your job — while recognizing that not every emergency fits an SOP

52:30 – A recent Bronx explosion illustrates the need to adapt principles to situations for which no exact procedure exists

53:30 – Applying the overarching principles of life safety and rescue when the situation is unprecedented

54:30 – What does “never forget” mean 25 years later?

55:30 – September 12: despite catastrophic losses, FDNY opened its firehouses and continued protecting New York City

56:30 – Chief Esposito describes those killed as “an all-star team” and some of the best ever to do the job

58:00 – Aaron Zamzow reflects on the responsibility to “measure up”

59:30 – The nationwide impact of 9/11 and seeing FDNY remembered on apparatus thousands of miles from New York

1:01:30 – Jim Dudley reflects on intelligence, prevention and acting on warning signs

1:03:30 – Chief Esposito discusses the difficulty of measuring successful prevention

1:05:00 – Warning signs, intelligence and lessons shared with other historic disasters

1:06:00 – Rob Lawrence reflects on September 12 and the emergency services reality that tomorrow brings another shift

1:07:00 – “At the going down of the sun and in the morning, we will remember.”

1:08:00 – Esposito discusses how 9/11 affected his career and leadership journey

1:09:00 – Leadership, doing the right thing and measuring decisions against the memory of colleagues lost

1:10:00 – “Take care of the people that take care of the city.”

1:11:30 – Emergency responders never know when the next call will become the worst situation they have ever faced

1:12:00 – The responsibility to ensure frontline personnel are prepared and supported

1:12:30 – Closing message: “Keep learning and keep moving forward.”

About our sponsor

This crossover episode of the Policing Matters, Better Every Shift and EMS One-Stop podcasts is sponsored by FirstNet — the only wireless network built with and for first responders.

Twenty-five years ago, first responders faced an emergency unlike any other. They stepped forward to protect and care for others, demonstrating extraordinary courage and resolve. This September 11th, we remember and honor those who answered the call. The example they set endures through the values that continue to inspire the profession today.

Learn more about FirstNet, Built with AT&T, at http://www.firstnet.com.

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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:

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EMS1 Leadership Institute: 2026 Spotlight on AI in EMS: On-demand: Smart tools, strategic choices: EMS puts AI into action

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Why EMS must measure the human side of care: What patients remember

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No rulebook is coming: EMS must take control of AI now: Why EMS must govern AI locally as adoption accelerates

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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

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"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

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"Nobody gets into EMS to be excellent data enterers." — Todd Stout

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"AI well formed — with the proper bumpers, guidelines, rules around it — is astonishingly good at processing through lots of data." — Todd Stout

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"If you're not paying for the thing that you're using, you are the product." — Todd Stout

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"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

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00:27 – Rob introduces the episode and the evolution of EMS data, information and AI

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01:54 – Twenty-eight years of FirstWatch: from Stout Solutions to today's real-time data environment

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03:57 – Looking back at EMS's early adoption of real-time operational data

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05:18 – Why immediate data can improve individual performance and expose problems with systems and protocols

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06:24 – The "ah, buts:" gut instinct versus what the data actually shows

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07:19 – Dirty data, disconnected systems and why organizations sometimes don't believe their own numbers

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09:45 – EMS has moved from too little information to information overload

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10:31 – How AI can sift through enormous amounts of data and identify what leaders actually need to know

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11:22 – The accuracy problem: AI can produce impressive outputs while struggling with surprisingly basic tasks

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12:39 – Todd explains why he is simultaneously excited and concerned about the immediate future of AI in EMS

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14:35 – How EMS leaders can become better, more discerning customers of AI technology

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15:10 – Established technology partners versus innovative AI startups

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17:00 – What happens to your organization's data if an AI vendor fails or goes out of business?

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17:41 – HIPAA, privacy, cybersecurity and employee data obligations

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18:11 – Sponsor break

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19:26 – Part two: protecting patient and organizational information when using AI

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20:18 – AI training models, data sharing and why leaders need to understand vendors' default settings

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22:44 – The pace of change: today's AI expertise can become outdated within weeks

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23:08 – Preparing for the wave of "AI everything" appearing in EMS exhibit halls

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23:45 – Questions EMS leaders should ask prospective AI vendors

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25:20 – Why AI isn't magic — and why implementation requires significant work behind the scenes

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27:08 – The case for every EMS organization having an AI policy now

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27:41 – Todd warns that employees are almost certainly already using AI, sometimes without understanding the privacy implications

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28:21 – Why AI education should resemble cybersecurity education: policy, training, suspicion and continual reinforcement

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30:13 – Preview of FirstWatch Collaborate and the company's next generation of technology

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31:02 – FirstWatch 2.0, AI-enabled mobile tools and workload management

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31:55 – Reflect: incorporating patient satisfaction alongside operational and clinical performance

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33:34 – Why rapid patient feedback can be more meaningful to crews than retrospective monthly scores

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35:19 – Todd's closing message: EMS is good at adapting and improvising, and technology can make the job easier

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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.

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.

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:

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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

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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

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“With EMS research, there's always something missing. There's always more that we can do.” — Dr. Christian Martin-Gill

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“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

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“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

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“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

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“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

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“The behavioral emergency space I think is really important right now.” — Dr. Christian Martin-Gill

Episode timeline

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01:09 – Rob introduces the episode and welcomes Drs. Christopher Richards and Christian Martin-Gill

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02:16 – Dr. Richards introduces his EMS, emergency medicine and research background

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03:18 – Dr. Martin-Gill discusses his role at the University of Pittsburgh, UPMC and the Prehospital Guidelines Consortium

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04:15 – Why does EMS need a dedicated research reading list?

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07:11 – Where can EMS practitioners currently go to identify the research that really matters?

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09:13 – Moving research into protocols, practice and clinical care

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11:15 – Can the Prehospital Guidelines Consortium help align the many organizations producing EMS clinical guidance?

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13:41 – Breaking down the different categories of publications on the reading list

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14:47 – Evidence-based guidelines included in the broader reading list

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15:49 – Position statements covering hemorrhage, restraint, air medical utilization and workforce issues

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16:26 – Systematic reviews addressing airway management and prehospital evidence-based guidelines

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16:51 – Four original research papers, including refractory VF, pain disparities, evidence integration and midazolam use

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18:58 – How the research reading list was actually developed

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19:32 – The open call for EMS research submissions

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20:10 – The project is ongoing, with submissions continuing for the next iteration

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20:42 – Expert panel review, scoring and the natural cutoff that produced the final 10

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23:18 – What important EMS research is still missing?

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24:37 – Gaps in airway, pediatric and behavioral emergency evidence

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26:08 – Dr. Richards highlights workforce, safety, wellness and operational research gaps

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28:18 – Which areas should future EMS researchers investigate?

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28:31 – Martin-Gill highlights behavioral, obstetric and pediatric emergencies as priorities

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30:12 – Richards explains how everyday frustrations in EMS can become important research questions

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32:12 – Final thoughts on the paper and the breadth of the reading list

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33:37 – Martin-Gill discusses access to research and why highlighting important publications matters

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35:05 – Turning reading into discussion, protocol review and further research

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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.

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

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eBook: How to fund community paramedicine

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Very high EMS utilizers: 7 strategies for local action

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From sirens to solutions: Guiding paramedics to a patient-centered mindset

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Public health at the front door: An MIH model to emulate

Key quotes

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“We did go down without our EMS uniforms on. We went in black t-shirts, blue jeans and started making connections.” — Wesley Brookshear

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“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

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“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

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“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

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“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

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“My mission wasn't admission avoidance, it was arrival avoidance.” — Rob Lawrence

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“Our folks are wrapping their own wounds now. We are providing supplies. We are giving education.” — Wesley Brookshear

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“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.

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

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Assistance to Firefighters Grants: Meeting firefighting and emergency response needs

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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

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"Figure out what kinds of things you want funding for and prioritize it." — Anya Otterson

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"You've got to be in it to win it." — Rob Lawrence

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"Give yourself enough time. This is not a day-before kind of thing." — Anya Otterson

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"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

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"Never be afraid to reach out to the funding agency with questions. Their job is to help you through the process." — Anya Otterson

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"ChatGPT should not be writing your narratives for you." — Anya Otterson

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"If you don't get funded the first time, keep trying." — Anya Otterson

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"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

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01:30 – Meet Firefighter-Paramedic and Lexipol Grant Writer Anya Otterson

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03:00 – The first step: identifying and prioritizing organizational funding needs

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04:00 – Where to find grants, including GrantFinder, ChatGPT, state resources and direct outreach

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05:45 – Overview of FEMA's Assistance to Firefighters Grant (AFG) program

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07:00 – Understanding funding priorities and why high-priority requests have the greatest chance of success

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09:00 – Building a compelling grant narrative using statistics, research and patient stories

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12:30 – Grant writing best practices: answer the questions, proofread thoroughly and involve leadership early

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15:50 – Importance of organizational buy-in and internal communication

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17:20 – Understanding grant requirements, matching funds and funding conditions before applying

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18:40 – Post-award responsibilities, reporting requirements and maintaining compliance

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20:40 – Rob shares practical lessons from administering successful federal grants

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23:20 – Lexipol's GrantFinder platform and professional grant writing services

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25:45 – Using ChatGPT responsibly to support grant research while avoiding AI-generated narratives

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29:35 – Final advice: persistence, continual improvement and learning from unsuccessful applications

Enjoying the show? Email editor@ems1.com to share feedback.

Matt Zavadsky explains how a commercial insurer’s reimbursement proposal — and looming Medicaid changes — could reshape EMS funding

In this week’s episode of EMS One-Stop, we examine two major financial threats facing EMS reimbursement.

Host Rob Lawrence is joined by Matt Zavadsky to analyze the recent Elevance (Anthem) Health Public Policy Institute paper, which argues that commercial insurers should reimburse ambulance services at approximately 160% of the Medicare fee schedule.

Zavadsky, EMS/mobile healthcare consultant with PWW | Advisory Group, explains why this paper is significant, noting that Medicare already reimburses below the actual cost of providing ambulance services. If policymakers adopt or even believe Elevance's recommendations, commercial reimbursement could fall dramatically, removing one of the few revenue sources that currently offsets chronic underpayments from Medicare and Medicaid. The discussion highlights the growing influence of commercial insurers in state legislatures and stresses the need for EMS leaders to counter policy proposals with credible cost and operational data rather than anecdotal arguments.

The conversation then shifts to CMS's proposed Medicaid supplemental payment rule (GEMT), where Matt predicts that most of the proposed changes are likely to survive into the final rule despite industry opposition. Both hosts discuss their review of the public comments, noting differing impressions of stakeholder sentiment but agreeing that agencies should begin financial planning now for a potential reduction in supplemental Medicaid revenue beginning in 2029.

Throughout the episode, the recurring theme is that EMS must become far more effective at explaining both the cost of readiness and the consequences of underfunding. The episode concludes on a more positive note by highlighting the newly released What Paramedics Want in 2026 report as a practical roadmap for improving workforce satisfaction while the industry continues addressing long-term reimbursement challenges.

Additional resources

• The 160% mirage: Why every EMS leader should read the Elevance Ambulance Report
• When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding
• What Paramedics Want in 2026

Key quotes

"The commercial insurance industry is creating a story that elected officials may perceive as reasonable. We need to combat that story with facts." — Matt Zavadsky

"Medicare reimbursement is already below cost, so using it as the benchmark automatically discounts ambulance services." — Matt Zavadsky

"We do a great job telling stories about the lives we save. We do a poor job telling the story of what it costs to provide that service." — Matt Zavadsky

"The balance billing issue is going to be the No. 1 issue in the next 12 months." — Matt Zavadsky

"The first time local elected officials hear there's a problem is usually when the sky is already falling. We need to tell the story before the sky falls." — Matt Zavadsky

"Know your costs; know your costs at different service levels, and begin educating your local community." — Matt Zavadsky

"This isn't necessarily good news, but it's something we need to understand and all work together to deal with." — Rob Lawrence

Episode timeline

00:00 – Introduction and the Elevance Health Public Policy Institute report

02:00 – Matt explains who Elevance Health is and why the report should be viewed as a commercial insurer's policy position

03:30 – Discussion of state balance billing legislation and how commercial insurers are successfully pushing lower reimbursement benchmarks

06:15 – Breakdown of what percentages of Medicare actually mean using national EMS financial data

08:30 – Why using Medicare as the reimbursement benchmark is fundamentally flawed because Medicare itself pays below cost

10:30 – Discussion on the political influence of insurers and why EMS must counter with data-driven messaging

12:30 – Why EMS has historically struggled to tell its financial story despite being effective at telling patient care stories

14:20 – Matt predicts balance billing legislation will become the industry's No. 1 policy issue over the next year

16:10 – Potential consequences if commercial reimbursement falls to 160% of Medicare

17:30 – Discussion on community funding, essential service models and matching service expectations with available revenue

22:20 – Transition to CMS's proposed Medicaid supplemental payment (GEMT) rule

22:45 – Review of public comments submitted on the CMS proposal and differing observations about stakeholder support

25:00 – Matt predicts the CMS rule will largely move forward and agencies should prepare accordingly

27:45 – California and other states discussed as examples of systems likely to experience significant reductions in supplemental Medicaid funding

30:45 – Closing on a positive note with discussion of the What Paramedics Want workforce survey

The 2026 AIMHI Excellence in Public Information or Education Award recognizes organizations that create innovative programs which improve health, educate communities and demonstrate measurable outcomes. This year’s recipient, the Medic Keep the Beat Foundation, earned national recognition for a groundbreaking fall-prevention initiative that is helping older adults remain independent, reducing repeat 911 calls and preventing avoidable hospital admissions. The award celebrates programs that move EMS beyond emergency response into proactive, community-based healthcare.

In this episode of EMS One-Stop, Rob Lawrence sits down with Jimmy Pierson, president and COO of Medic Ambulance; and Angeline Pierson, occupational therapist with the Medic Keep the Beat Foundation, to explore the award-winning program in depth. The discussion covers everything from home safety assessments and occupational therapy interventions, to public-private partnerships, sustainable funding, EMS workforce innovation and why prevention may be one of the greatest opportunities facing EMS today.

Key quotes

“You’ve taken the frequency out of a faller.” — Rob Lawrence

“We don’t want healthier transports; we want a healthier community.” — Jimmy Pierson

“This isn’t a business model; it’s a community model.” — Jimmy Pierson

“We want to keep people safe and independent in their own homes.” — Angeline Pierson

“With this program they can stay at home instead of moving into a skilled nursing facility.” — Angeline Pierson

“The key is finding partners who see you as a partner; not as a subcontractor.” — Jimmy Pierson

“The Australian paramedics became part of our family; they weren’t temporary staff.” — Jimmy Pierson

Additional resources

• Awards – AIMHI
• Medic Keep the Beat Foundation
• Fall prevention: EMS patient education tips after the lift assist
• Fall hazard reduction and emergency alerting
• Geriatric slips, trips and falls: 3 assessment considerations
• 9 fall prevention tips for EMS providers to share

Episode timeline

01:00 – Meet Jimmy and Angeline Pierson

02:00 – Inside the award-winning fall prevention program

06:45 – How patients enter the program

08:30 – Why preventing falls starts inside the home

12:30 – Measuring outcomes and demonstrating return on investment

15:00 – Funding, grants and building community partnerships

17:00 – Public-private partnerships with California fire departments

22:00 – Sonoma County Fire and collaborative EMS delivery

28:00 – Workforce rebuilding after COVID-19

31:30 – Recruiting Australian paramedics and creating a sustainable workforce

34:30 – Final reflections on prevention, partnerships and the future of EMS

Rate and review the EMS One-Stop podcast

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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

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Enjoying the show? Email editor@EMS1.com to share ideas, suggestions and feedback.

The countdown to Pinnacle is on. Returning this year to San Diego from July 13-16, Pinnacle remains one of the most influential leadership and management conferences in EMS. Now entering its 22nd year, the event continues to attract executives, clinical leaders, innovators, educators and industry partners who gather not simply to learn, but to debate, challenge assumptions and shape the future direction of EMS. EMS1 is proud to be the premier media partner of Pinnacle.

| MORE: What Paramedics Want in 2026: Bookmark this page to get your copy

Joining EMS One-Stop this week is Anthony Minge, senior partner at Fitch & Associates and one of the driving forces behind Pinnacle. Anthony previews the major themes emerging this year, including workforce retention, leadership development, burnout and wellness, preparedness, artificial intelligence, blood delivery, drone technology and the ever-popular What Paramedics Want report.

Throughout the discussion, Anthony emphasizes that Pinnacle's value extends beyond the classroom. The real learning often happens in the conversations between sessions, over meals and among peers facing the same challenges across the country.

The conversation explores why retention has overtaken recruitment as EMS's primary workforce concern, how leaders must take greater responsibility for organizational culture, and why emerging technologies such as AI and drone-delivered medical supplies are changing the profession faster than many realize.

Anthony also offers a preview of keynote speakers, including preparedness expert and author William Forstchen, and highlights sessions covering leadership, resilience, operational excellence, workforce wellness and healthcare innovation.

As always, Pinnacle promises to deliver practical takeaways, provocative discussions, and the opportunity to connect with some of the brightest minds in EMS.

Key quotes

• "If we can keep our people, we don't need to spend as much time trying to replace them."
• "People don't leave organizations, they leave managers."
• "Burnout is still too high. One suicide is way too many."
• "We can't push it into the dark corners of our organizations and just hope it goes away."
• "AI is here to stay. It's going to help us. It's going to do some great things."
• "It is never meant to replace this computer right here."
• "We practice healthcare. We practice extremely innovative healthcare out there."
• "It's amazing the things that are happening out there."
• "Good leaders share."
• "Being responsible leaders is probably one of our largest challenges."

Additional resources

• Pinnacle EMS 2026: Conference information, agenda details, speakers and registration

• Conference dates: July 13-16, 2026
• Location: Sheraton San Diego Resort
• Pinnacle Early Bird Offer: provide the code “EMS26”. This gives early-bird offer provides $100 off the current/regular price

• What Paramedics Want: 2026 Report debuts July 13, 2026
• William Forstchen’s books

Episode timeline

03:00 – The major themes of Pinnacle 2026. Discussion of retention, leadership, financial sustainability, workforce wellness, preparedness, AI and emerging technologies.

06:30 – Recruitment vs. retention. Why keeping employees has become more important than finding new ones and how organizations can build careers rather than simply fill vacancies.

08:15 – Leadership beyond operations. The role of leadership in employee engagement, succession planning, data-driven decision-making and lessons from Matthew McConaughey's book Greenlights.

11:00 – Burnout, wellness and resilience. Why burnout remains a major challenge for EMS and how leaders must confront it rather than ignore it.

13:00 – Preparedness for the next crisis. A preview of keynote speaker William Forstchen and discussions around resilience, disaster readiness and planning for both natural and man-made events.

19:00 – AI Comes to EMS. Anthony discusses the opportunities and risks associated with artificial intelligence, from documentation and CAD integration, to clinical decision support.

24:00 – Blood, drones and clinical innovation. A look at how blood products, AEDs, naloxone and other critical supplies are increasingly being delivered through innovative technologies, including drones.

29:00 – What Paramedics Want in 2026. A preview of the latest survey findings and the issues currently weighing most heavily on the minds of EMS professionals.

30:00 – Why Pinnacle matters. Anthony explains why networking, relationship building and peer-to-peer learning remain among the conference's greatest strengths.

32:00 – The conversation EMS needs to have. Anthony identifies leadership responsibility and accountability as one of the most important — and often avoided — topics facing EMS today.

Enjoying the show? Email editor@ems1.com to share feedback.

At a time when EMS reimbursement faces unprecedented scrutiny and pressure, Shawn Baird joins the EMS One-Stop podcast to explain what is happening in Washington, D.C., why it matters to every ambulance service in America and what EMS leaders can do about it.

| MORE: When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding

A former Paramedic, ambulance service owner, CEO, American Ambulance Association resident, and now Vice President of Government Affairs for the AAA, Baird brings a unique perspective that spans frontline care, operations and national advocacy.

In this episode, Rob Lawrence and Baird unpack the growing threats to Medicare and Medicaid funding, discuss the proposed changes to Medicaid supplemental payment programs, and explore the work of the National EMS Payment Reform Committee.

The conversation also previews the AAA Legislative Fly-In, and highlights efforts to secure EMS workforce funding, streamline military medic transitions into civilian EMS and advance federal fuel tax relief. Most importantly, Baird delivers a clear message: EMS professionals must tell their story, engage with elected officials and advocate for the future of mobile healthcare.

This episode serves as both an explainer and a call to action. As federal policymakers debate Medicaid funding, EMS reimbursement, workforce development and healthcare spending, Baird makes the case that every EMS professional has a role to play. Whether through legislative fly-ins, ride-alongs, town halls or simply telling the EMS story, advocacy is no longer optional. It is essential to preserving access to emergency medical care in communities across America.

Notable quotes

"We're hoping to make some proposals for real long-term reform on Medicare that will shore up the EMS system, not just to survive day to day, but really to thrive." — Shawn Baird

"We are more than just a ride. We are mobile healthcare." — Rob Lawrence

"We really have not been able to find a lot of data to support a bunch of waste, fraud and abuse in the EMS system. What there is, is a lot of misunderstanding." — Shawn Baird

"If we don't get paid ourselves, how can we pay other people? How can we then afford to deliver excellent healthcare to our patients?" — Rob Lawrence

"First of all, talk about the patient because the patient is the most important part of this whole discussion; second of all, talk about the medical care you provide because that's what the patient needs." — Shawn Baird

"We're the safety net. We're access to critical emergency care in many communities that don't have other healthcare." — Shawn Baird

"Probably the most important thing that folks listening to your show can do is attend a town hall and raise your hand and say, 'I'm just worried about our ambulance service.'" — Shawn Baird

"We have the greatest story of all to tell." — Shawn Baird

Additional resources

• AAA Advocacy Call to Action – Contact your member of Congress here
• 2026 Ambulance Ride-Along Toolkit

Episode timeline

01:00 – Rob introduces the episode and outlines the challenges facing EMS reimbursement and federal healthcare funding.

02:07 – Shawn Baird's EMS Journey — from paramedic intern at Grady Hospital to rural EMS operator, company owner, AAA president and government affairs leader.

03:00 – Why healthcare reimbursement decisions are increasingly shifting from Washington to state legislatures.

06:45 – The National EMS Payment Reform Committee and the search for long-term solutions to EMS financing.

09:13 – Medicaid, waste, fraud and abuse — understanding misconceptions about EMS reimbursement and why ambulance services are being caught in broader healthcare debates.

11:33 – EMS is more than transportation — reframing EMS as healthcare first, transportation second.

13:20 – The threat to Medicaid supplemental funding — provider taxes, GEMT programs and proposed federal changes that could impact ambulance services nationwide.

15:15 – Proposed CMS rule changes — why EMS leaders are concerned about being included in Medicaid funding reductions.

17:40 - How national EMS organizations are coordinating efforts to speak with one voice.

20:08 – The AAA Legislative Fly-In — what it is, how it works and why provider participation matters.

21:45 – Federal legislative priorities — EMS workforce development funding, military medic-to-civilian certification pathways and federal fuel tax relief for ambulance services.

26:50 – How EMS providers can engage when legislation is moving.

27:40 – The importance of local advocacy — town halls, community events and direct engagement with elected officials.

29:30 – Ride-alongs as an advocacy tool — why seeing EMS firsthand changes policymakers' perspectives.

32:00 – Final thoughts — politics is ultimately about relationships, storytelling and helping decision-makers understand EMS.

Enjoying the show? Email editor@ems1.com to share feedback.

What happens when the stars of the television series that introduced America to paramedicine decide it's time to tell the real story?

In this episode of EMS One-Stop, Rob Lawrence is joined by EMS pioneer Dr. Baxter Larmon and award-winning filmmaker Tom Putnam to discuss Into the Unknown: The Paramedics' Journey.

| MORE: ‘Emergency!’ stars launch Kickstarter campaign to expand reach of paramedic documentary, “Into the Unknown,” backed by Steve Buscemi, Randolph Mantooth and Kevin Tighe

Born from the vision of Emergency! stars Randolph Mantooth and Kevin Tighe, and backed by Steve Buscemi, the documentary follows paramedics, dispatchers, volunteers, flight crews and their families across America, revealing the realities of modern EMS. From Baton Rouge to Sparks, from volunteer rescue squads in Virginia, to helicopter rescue teams in California, the film explores not only what paramedics do, but what the job does to them.

The conversation examines workforce shortages, mental health, resilience, public misunderstanding of EMS, and the role the film could play in educating communities, policymakers and future generations.

The episode also explores the documentary's Kickstarter campaign and plans for worldwide release. If Emergency! introduced America to paramedics 50 years ago, Into the Unknown seeks to explain the people behind the uniform.

Notable quotes

•

"One of the things that I'm probably most proud about in the movie is that these first responders are now allowing their family members and their friends to be able to see what they go through every single day." — Dr. Baxter Larmon

•

"The call volume, I mean, they used to sit in the station, they'd joke in the station, they'd eat, they'd have dinner, they'd complete their whole dinner and they would never get a call. That just doesn't happen anymore." — Dr. Baxter Larmon

•

"Our fourth goal is to get recognition by governmental agencies to understand what EMS is, to be able to recognize its importance in the community, but more importantly, to fund it appropriately as well." — Dr. Baxter Larmon

•

"I honestly had no idea what I was getting into with this and how intense the personal interactions were gonna be." — Tom Putnam

•

"By the time that particular run was over, I just think I was wide-eyed and said, wow, we're making a war movie." — Tom Putnam

•

"For the right person, this is the best job in the world." — Tom Putnam

Episode timeline

•

00:00 – Trailer and opening montage

•

01:41 – Rob introduces the episode and guests

•

03:18 – The origin story of Into the Unknown

•

05:13 – The lasting impact of Emergency! on EMS and what story the documentary is trying to tell

•

08:32 – Tom explains why he said “yes” immediately

•

10:52 – The first EMS call filmed and realizing the scale of the project

•

12:15 – Locations featured in the documentary

•

16:22 – How EMS has changed since Johnny Gage and Roy DeSoto

•

17:54 – Stories that surprised Tom most

•

20:15 – The emotional burden of the profession

•

22:40 – Calls Tom "can't unsee"

•

24:00 – EMS as the safety net for society

•

25:07 – Burnout, resilience and humanity

•

27:30 – Why families need to see this film

•

28:06 – Why the project launched a Kickstarter campaign, funding goals and distribution plans

•

33:30 – Using the film as an EMS advocacy tool

•

35:43 – Lightning round

•

38:03 – Why EMS might be the best job in the world

•

39:05 – Dr. Richard Carmona's role in the film

•

40:16 – Final thoughts and call to action

Enjoying the show? Email editor@ems1.com to share feedback.

In Episode 4 of the EMS One-Stop Blood on Board Series, host Rob Lawrence brings together two powerful perspectives on prehospital blood transfusion.

First, retired Army trauma nurse and national blood advocate Randi Schaefer discusses the work of the Prehospital Blood Transfusion Initiative Coalition and the ongoing effort to remove barriers to blood product availability across the United States.

Drawing on lessons learned from military deployments and civilian implementation efforts, Schaefer explains why successful blood programs require collaboration among EMS agencies, hospitals, blood banks, legislators and funding partners. She emphasizes that while every system is different, the goal remains the same: getting lifesaving blood to patients before they reach the hospital.

The second half of the episode focuses on the story behind the statistics. Dr. Kate Krause, an emergency physician from Dallas, recounts her near-fatal postpartum hemorrhage just weeks after giving birth to her daughter. After she lost more than two liters of blood at home, Dallas Fire-Rescue paramedics recognized the severity of her condition and secured authorization to administer prehospital blood. That decision, combined with rapid transport and seamless hospital coordination, helped save her life.

Today, fully recovered and back to practicing medicine, Dr. Krause has become a compelling advocate for prehospital blood programs, reminding policymakers and EMS leaders that behind every protocol, funding request and unit of blood is a patient whose future depends on receiving the right treatment at the right time.

Previous Blood on Board episodes:

• Blood on Board: Everything is bigger in Texas
• Blood on board: Lessons from Sacramento and LA County Fire
• Blood on Board: Federal funding paves the way for EMS blood programs

Impactful quotes

"I had a severe postpartum hemorrhage and had my life saved by a prehospital blood transfusion." — Dr. Kate Krause

"I'm here. I have no deficits. I'm healthy. I'm back to being a physician. I'm back to being a wife and being a mother to my beautiful little baby girl." — Dr. Kate Krause

"The coalition wants to make blood products available to those EMS agencies that want to carry them." — Randi Schaefer

"This is a brand-new relationship. So there's a lot of learning how each other's worlds work." — Randi Schaefer

"We were not going to let people die of preventable death." — Randi Schaefer

"Keep pressing forward. We will find a way to yes." — Randi Schaefer

"Blood is one of those things that really makes a difference when it's given early." — Dr. Kate Krause

Additional resources

• Prehospital Blood Transfusion Coalition

Episode timeline

00:00 – Introduction to Episode 4 and recap of the Blood on Board series and overview of previous episodes covering local, state and national blood initiatives.

02:18 – Introduction of Randi Schaefer and Dr. Kate Krause. Schaefer discusses military deployments and early blood program experiences, while Dr. Krause outlines her journey from lifeguard, to EMT, to emergency physician.

05:05 – Origins and mission of the Prehospital Blood Transfusion Initiative Coalition, military lessons learned, funding challenges, sustainability concerns, the importance of legislative support and reimbursement

13:57 – Dr. Krause recounts her postpartum hemorrhage.

19:03 – Discussion of non-trauma indications for prehospital blood and the importance of medic judgment and protocol flexibility

20:22 – Dr. Krause discusses recovery and advocacy efforts, and Dallas City Council appearance and public awareness activities.

24:24 – Dr. Krause delivers a concise advocacy message supporting blood programs nationwide.

25:01 – Schaefer reflects on meeting blood recipients and the impact of seeing survivorship firsthand.

27:47 – Closing remarks from Dr. Krause and Schaefer

29:03 – Lawrence wraps up the four-part Blood on Board series and reinforces the need for continued advocacy and funding.

This episode is sponsored by Triad of Life. After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That’s why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. Learn how your team can put the Triad of Life into practice.

Enjoying the show? Email editor@ems1.com to share feedback.

Texas is taking prehospital whole blood to scale. In this second installment of the Blood on Board series, the conversation moves from pioneering local programs to a statewide initiative backed by legislation, trauma system collaboration and a $10 million investment in EMS blood capability.

Host Rob Lawrence welcomes Dr. Jeff Jarvis, chief medical officer and system medical director, Fort Worth Office of the Medical Director; Dr. C.J. Winckler, deputy medical director for the San Antonio Fire Department; and Jorie Klein, director of EMS-Trauma Systems Section, Texas Department of State Health Services.

From San Antonio’s early adoption to Fort Worth’s operational maturity and the Texas Department of State Health Services’ statewide rollout, this episode examines how Texas built one of the most ambitious prehospital blood programs in the country.

The discussion goes beyond clinical theory. The guests tackle implementation, logistics, blood stewardship, wastage concerns, rural access, legislative strategy and the realities of getting physicians, transfusion medicine specialists, EMS leaders and lawmakers aligned around a shared mission.

The episode also explores the expanding use of whole blood beyond trauma, including GI bleeds, obstetrics and surgical hemorrhage, while reinforcing the operational mantra repeated throughout the show: systems save lives.

| MORE: Blood on board: Lessons from Sacramento and LA County Fire

Impactful quotes

•

“You can’t quarterback it from your office. You have to be engaged and be out there with them.” — Jorie Klein

•

“Little did I know that it would take almost every waking minute of my life to get blood on an ambulance.” — Dr. C.J. Winckler

•

“We’re not improving overall mortality yet, but we are improving mortality in the first six hours.” — Dr. C.J. Winckler

•

“When you work together as a system, you can do amazing things.” — Dr. Jeff Jarvis

•

“In the last 13 months, we’ve given 259 units to 211 patients.” — Dr. Jeff Jarvis

•

“Our definition of wastage is anything that doesn’t go into a patient.” — Dr. Jeff Jarvisv

•

“It turns out this stuff works.” — Dr. Jeff Jarvis

•

“It’s all about communication and trust.” — Dr. C.J. Winckler

•

“Five years ago, we knew those patients would not survive. Now we have new tools.” — Jorie Klein

•

“My dad was saved by prehospital whole blood.” — Dr. C.J. Winckler

•

“Talk to the clinicians who are giving this blood and ask them about the impact it’s making.” — Dr. Jeff Jarvis

Episode timeline

00:00 – Opening message. Jorie Klein outlines the central lesson for other states: engage frontline providers and avoid managing programs remotely.

00:40 – Introduction. Rob Lawrence introduces Episode 2 of the Blood on Board series, shifting focus from local systems to statewide implementation in Texas.

01:20 – Meet the guests. Jorie Klein, Dr. Jeff Jarvis and Dr. C.J. Winckler introduce themselves and their roles in Texas EMS and trauma care.

03:22 – The San Antonio origin story Dr. Winckler explains how military medicine, trauma surgeons and Texas delegated medical practice helped launch San Antonio’s whole blood program.

06:04 – Building the first protocols. Dr. Winckler discusses creating guidelines from scratch, operationalizing blood administration and securing funding support from city leadership.

08:52 – Going system-wide. San Antonio launches whole blood citywide in October 2018 without a pilot project.

10:13 – Ethics and evidence. Discussion shifts to mortality data, prehospital physiology and whether balanced blood resuscitation should already be considered standard of care.

12:14 – Fort Worth follows. Dr. Jarvis explains how San Antonio’s system inspired adoption in Fort Worth and highlights the importance of regional collaboration.

14:03 – Texas goes statewide. Klein explains the legislative process that resulted in a $10 million statewide prehospital whole blood initiative.

17:24 – Rural Texas and blood access. The conversation focuses on plasma options, rural hospital shortages and improving access for remote communities.

23:45 – The data discussion. Dr. Jarvis shares Fort Worth operational metrics, transfusion volumes and remarkably low wastage rates.

28:49 – Whole Blood Academy. Drs. Jarvis and Winckler discuss the National Whole Blood Academy and how Texas is teaching other EMS systems to replicate their success.

32:00 – Trust, logistics and blood stewardship. Dr. Winckler explains the importance of relationships between EMS and transfusion medicine physicians, emphasizing operational discipline and trust.

36:20 – What comes next? Dr. Klein discusses statewide reporting, future funding requests and sustaining the Texas model long term.

40:15 – Final lessons for other states. The guests close with advice on advocacy, clinician engagement and building support from the ground up.

Email editor@ems1.com to share feedback.

The EMS One-Stop Blood on Board series moves to the federal level in Episode 3, exploring how the National Highway Traffic Safety Administration Safe Streets and Roads for All (SS4A) grant program is opening new funding pathways for prehospital blood programs.

Host Rob Lawrence is joined by three leaders directly involved in building regional blood capability through federal funding.

• Julie Stilley, PhD, is an EMS researcher at the University of Missouri, whose team secured a $4.6 million SS4A demonstration grant focused on advanced post-crash care, including prehospital blood administration.
• Jason White represents the Mid-America Regional Council in Kansas City, a multi-jurisdictional regional planning organization coordinating EMS, trauma systems, hospitals and transportation partners around a regional whole blood strategy.
• Mark Heath is chief of EMS for the Kansas City Kansas Fire Department and one of the operational leaders preparing to launch whole blood in the field as part of the Kansas City regional effort.

Rather than focusing solely on clinical practice, this episode examines the realities of applying for, winning and administering federal grant funding. The guests discuss building regional coalitions, engaging blood banks, developing standardized protocols, navigating compliance requirements and preparing operational rollouts.

From Missouri’s $4.6 million demonstration grant, to Kansas City’s regional planning initiative, this episode provides a practical roadmap for EMS leaders looking to transform roadway safety funding into lifesaving trauma care capability.

• Watch episode 1: Blood on Board: Lessons from Sacramento and LA County Fire
• Watch episode 2: Blood on Board: Everything is bigger in Texas

Impactful quotes

“Don’t be afraid of applying for a big, scary federal grant.” — Mark Heath

“EMS is the perfect partner to try to understand how to address the post-crash care component of a safety action plan.” — Julie Stilley

“If you’re going to do it as a region, you’ve got to hang together.” — Jason White

“The data points on the backside will set you free.” — Mark Heath

“If my blood is closer to the next address over, just because there’s a river in the way doesn’t mean we can’t get across the bridge.” — Mark Heath

“What started initially as an absolute ‘no’ became, ‘Wait, let me listen to you some more.’” — Julie Stilley

“The juice is worth the squeeze.” — Rob Lawrence

“Firefighters and EMS are cowboys, and blood banks are accountants.” — Mark Heath

“Cowboys do marry accountants.” — Jason White

“Run, don’t walk, to your local blood bank.” — Mark Heath

“It’s your blood in your community and going into you on your ambulances.” — Mark Heath

“We’re moving toward reducing mortality and reducing long-term injury.” — Julie Stilley

Additional resources

• Safe Streets and Roads for All (SS4A) Grant Program | US Department of Transportation
• NHTSA's Office of Emergency Medical Services | EMS.gov
• Accessing the Safe Streets and Roads for All EMS grant program
• Researchers receive $4.6 million to pilot advanced EMS response program

Episode timeline

00:00 – “Free money is free money”. Chief Mark Heath opens with encouragement for agencies considering federal grant applications and urges smaller communities not to be intimidated by the process.

00:44 – Introduction to Episode 3. Rob Lawrence recaps Episodes 1 and 2 of the Blood on Board series before introducing the SS4A grant focus and the featured guests.

02:07 – Meet the guests. Julie Stilley introduces her role at the University of Missouri and reveals her project’s $4.6 million award. Jason White and Mark Heath outline the Kansas City regional collaboration.

04:19 – Why apply for SS4A? Julie Stilley explains how frustration around operational barriers to blood implementation motivated her grant application.

05:38 – Understanding demonstration grants. Discussion on the difference between planning and demonstration grants, and how post-crash care fits into regional traffic safety action plans.

06:51 – Building regional coalitions. Jason White discusses Kansas City’s existing regional EMS partnerships and how those relationships became the foundation for the grant application.

10:30 – Regional protocols and data. Mark Heath explains how Kansas City agencies standardized protocols, agreed on shared data points and committed to a coordinated regional approach.

13:04 – Pulling together the application. Julie Stilley outlines the process of bringing together planners, EMS leaders, trauma centers and blood banks to support the grant proposal.

15:02 – Equipment, compliance and logistics. Discussion shifts to blood warmers, storage systems, chain-of-custody monitoring and the operational realities of safely carrying blood products in the field.

18:25 – Planning grants and future implementation. Jason White explains how the Kansas City effort uses a planning grant to build toward larger implementation funding opportunities.

23:22 – Busting myths about blood. Mark Heath describes how data and national experience changed his thinking about whether whole blood matters in urban EMS systems with short transport times.

27:19 – The reality of grant administration. Julie Stilley and Jason White explain federal reimbursement structures, compliance requirements and why strong administrative partners are essential.

31:37 – Sustainability and reimbursement. Discussion on long-term funding, legislative advocacy and the need for reimbursement models for prehospital blood administration.

33:43 – Final lessons learned. The guests share advice on partnerships, blood bank relationships, data collection and not being afraid of “big scary federal grants.”

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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.