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In this episode of the EMS One-Stop podcast, host Rob Lawrence kicks off a special series spotlighting national EMS associations, beginning with a deep dive into the EMS Personnel Licensure Interstate CompAct (REPLICA). His guest, Donnie Woodyard Jr., executive director, Interstate Commission for EMS Personnel Practice, brings decades of EMS experience and leadership to the table to demystify what the EMS Compact is, how it operates, and why it matters to the profession today. From improving workforce mobility to protecting public safety during disasters, Woodyard Jr. provides clarity on this critical multi-state agreement.
The conversation covers everything from how EMS Compact came to be, to the significance of national registry standards, disaster response logistics, interstate licensure, and even leadership lessons from Woodyard Jr.’s latest book project, “Leadership in action: The Wisdom and stories of EMS innovators”. Whether you're a field provider or policymaker, this episode is a must-listen for understanding how collaborative legislation can shape the future of EMS.
In the episode, Woodyard Jr. candidly addresses the ongoing debate in North Carolina over transitioning from a state-only EMS certification exam to exclusive use of the National Registry. Woodyard Jr., while respectful of North Carolina’s long-standing EMS tradition, emphasizes the importance of national consistency. He acknowledged that the proposed legislation needed amendments, particularly around grandfathering existing providers, but stood firm in his belief that a single, legally defensible national standard is essential for provider mobility and professional integrity. Drawing on real-world examples, Woodyard Jr. described how providers are often caught off guard when relocating — only to discover their credentials aren't accepted elsewhere. “Maintaining a state-only exam is harmful to individuals,” he said, calling for unified testing standards that support workforce movement and strengthens the profession nationwide.
Memorable quotes from Donnie Woodyard Jr
“Every EMT and paramedic in the United States should go through a fingerprint background check. You know, babysitters have to do it. Teachers have to do it. EMS personnel absolutely should do it.”“Maintaining a state-only exam is harmful to individuals. It limits their mobility.” “When you waive that requirement for licensure, you actually are removing essential elements of public protection and accountability.”Timeline
00:21 – Rob introduces the series on national EMS associations and welcomes Donnie Woodyard, Jr.
01:55 – Woodyard, Jr.shares his EMS journey from volunteer in Virginia to international disaster medicine and state leadership
03:41 – What is the EMS Compact and how does it work?
06:38 – Challenges of multistate EMS licensing pre-Compact
08:00 – Explaining the driver’s license analogy and compact accountability
11:17 – EMAC vs. EMS Compact for disaster response and liability concerns
15:31 – National Registry and grandfathering provisions
17:30 – Arkansas joins as the 25th compact state
18:56 – Model legislation and how states join the compact
21:22 – What REPLICA stands for and its legislative origin
22:20 – What California (and other non-compact states) should consider
24:33 – National Registry debate: North Carolina’s challenges and Woodyard, Jr.’s response
27:52 – Mobility, workforce attrition and job-sharing innovation
30:11 – The Commission and national EMS-coordinated database
35:17 – Final thoughts on fragmentation, collaboration and EMS unity
36:41 – Woodyard, Jr.’s leadership book, EMS charity support and Secretary Panetta’s forward
41:08 – Closing remarks and contact information
Additional resources
Learn more about the EMS Compact“Leadership in action: The Wisdom and stories of EMS innovators”, by Donnie Woodyard Jr.“The future of emergency medical services: Artificial intelligence, technology & innovation”, by Donnie Woodyard Jr. -
In this special data-driven edition of the EMS One-Stop podcast, host Rob Lawrence is joined by Dr. Brent Myers, chief medical officer, ESO, and Dr. Remle Crowe, ESO’s director of clinical and operational research, to unpack the newly released 2025 ESO EMS Index.
This annual report provides a powerful, real-world snapshot of national EMS trends — drawing on more than 14 million anonymized records to surface opportunities for clinical and operational improvement.
The conversation dives into key metrics that move beyond response times and into areas like pain management, opioid overdoses, airway confirmation, obstetric emergencies, whole blood use, pediatric behavioral health and high-utilization patient populations.
Throughout the episode, Drs. Myers and Crowe share the motivation behind each metric, explain how the data was gathered and analyzed, and reflect on how EMS agencies can use these insights to guide better care delivery and system design. From confronting equity in pain management, to pushing forward innovations like buprenorphine administration and whole blood programs, this is a compelling call to turn data into meaningful change.
Timeline
01:08 – Overview of the ESO EMS Index and its intent
02:59 – Origins of the report and data methodology
05:46 – Database scale: 14M+ records, 3,000+ agencies
07:14 – Metric 1: Pain management for long bone fractures
10:53 – Documentation, AI in EMS, and future documentation tools
14:30 – Metric 2: Suspected opioid overdose and buprenorphine use
18:51 – Best practices, COWS scoring, and naloxone delivery strategy
21:31 – Metric 3: Invasive airway confirmation using waveform capnography
28:06 – Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)
34:34 – Metric 5: Prehospital whole blood surveillance
40:22 – Metric 6: Pediatric behavioral health and substance use disorder cases
44:54 – Metric 7: High utilization patient group (HUG)
52:48 – Final thoughts, calls to action, and Rob’s reflections
55:47 – Episode wrap-up and subscription reminder
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In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Christine Carico and Dr. Matt Levy to discuss the peer-reviewed paper, “Nationwide Trends in Prehospital Blood Product Use After Injury.” The paper, published in “Transfusion” in April 2025, explores the use of blood products in prehospital trauma care.
Despite the proven benefits of blood transfusion in the field, their research uncovers the alarming reality that less than 1% of eligible patients receive prehospital blood products. This conversation dives into the study’s methodology, key findings and the significant barriers EMS systems face in implementing blood transfusion protocols. The discussion also touches on the evolving role of EMS in trauma care, regional variations in blood product access, and the future of prehospital blood transfusion programs.
Dr. Carico and Dr. Levy break down their work and reflect on the data, explaining how the study used National Emergency Medical Services Information System (NEMSIS) data to identify trauma patients who would have benefited from blood transfusions.
The episode delves into the operational challenges EMS systems face in obtaining and administering blood products in the field, the financial and logistical obstacles, and the potential life-saving impact of more widespread adoption of these protocols.
Timeline
00:00 – Intro and welcome: Rob Lawrence introduces Dr. Matt Levy and Dr. Christine Carico, setting up the discussion on prehospital blood product use
03:00 – Study overview: Dr. Carico explains the methodology of the study, focusing on the use of NEMSIS data and the inclusion criteria for the patient population
07:00 – Key findings: Dr. Carico reveals the key findings of the paper, including the low percentage of eligible patients receiving prehospital blood products
11:00 – Barriers to implementation: Dr. Levy discusses the main barriers to the widespread implementation of blood transfusion protocols in the field, including access to blood, logistics and training
17:00 – Regional variations: The speakers touch on the regional disparities in blood product availability and the differences in protocols across the country
23:00 – Data challenges: Dr. Levy and Dr. Carico discuss the challenges related to data accuracy, particularly in terms of blood product documentation
27:00 – Cost and reimbursement: Dr. Levy addresses the financial aspects of blood product programs, including cost, reimbursement challenges and funding opportunities
32:00 – The future of blood transfusion in EMS: Dr. Levy envisions the future of prehospital blood transfusion programs, including the potential for shelf-stable blood products and regional blood supply systems
37:00 – Closing thoughts: Both guests offer their final thoughts on the importance of continued research and data collection, and the need for EMS to embrace a more integrated role in acute care
Additional whole blood resources
Carico C, Annesi C, Clay Mann N, Levy MJ, et al. “Nationwide trends in prehospital blood product use after injury,” 2025. Transfusion – Wiley Online LibraryTracking the whole blood landscape as updated guidelines allow EMS to carry and administer whole bloodEMS One-Stop: Stop the bleed, fill the tank – The New Orleans EMS blood programInsider analysis: Delaware’s statewide whole blood rollout sets a new EMS standardWhole blood in EMS promises a revolution in resuscitation: How one county agency is saving lives with prehospital transfusionsMatthew Levy | LinkedInChristine Carico | LinkedIn -
In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Deputy Director Tracey Loscar from Mat-Su Borough EMS in Alaska. Together, they discuss the looming threat of Mount Spurr, a volcano located 75 miles west of Anchorage, which is currently showing signs of potential eruption.
Loscar provides insights into disaster management and preparedness in a region where EMS operations are stretched across vast, remote territories. The conversation also touches on how to plan for the unexpected, especially in an environment with limited resources and harsh geographical challenges. This episode delves into the logistical challenges faced by EMS in the face of volcanic activity and offers critical lessons in disaster management.
TIMELINE
00:22 – Rob Lawrence welcomes Deputy Director Tracey Loscar and sets the stage for a discussion on disaster management in Alaska
02:10 – Loscar gives a brief overview of Mat-Su Borough and its proximity to Mount Spurr
04:01 –Loscar discusses her transition from Newark, New Jersey, to Mat-Su Borough and the challenges of EMS in rural Alaska
06:00 – Lawrence and Loscar discuss the vast distances and limited resources available in the region
08:01 – Loscar explains the preparations for the potential ash fallout from Mount Spur, including messaging to the community and respiratory protection
10:04 – The conversation shifts to the nature of volcanic ash and the practical challenges it presents to infrastructure, vehicles and personal health
14:36 – Loscar shares lessons learned from previous seismic events, such as the 2018 earthquake, and emphasizes the importance of clear communication during disasters
17:06 – Lawrence and Loscar discuss EMS liaison roles and the need for better coordination between dispatch, EDs and field teams
18:01 – Loscar talks about the current status of the Mount Spur eruption, with no immediate risk but preparations ongoing, and discusses how Alaskans stay calm and prepared in the face of frequent natural events, from earthquakes to volcanic eruptions
20:03 – Loscar highlights the importance of including pets in emergency plans, emphasizing the need for respiratory protection for animals
21:00 – The role of pantyhose in volcano preparedness
RATE AND REVIEW
Enjoying the show? Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.
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In this episode of EMS One-Stop, recorded live from the ABC 360 and XI Conference, host Rob Lawrence chats with keynote speaker Catherine Kuhlmann, a firefighter-paramedic with over 26 years of experience.
Kuhlmann discusses the importance of understanding both internal and external customer service in EMS, emphasizing the need for a healthy organizational culture to ensure the best patient care. She reflects on the profound impact that first responders can have on individuals, drawing from her own experiences and personal tragedies to highlight the emotional resilience required in the profession.
Rob also speaks with Page Wolfberg & Wirth’s PWW/AG Principal Doug Wolfberg, long-time EMS lawyer and educator, about lessons learned from working in and around law enforcement during patient care. Wolfberg provides actionable insights into how EMS professionals can better collaborate with police officers, ensuring that patient care remains a priority while navigating complex, high-stress situations.
Together, Kuhlmann and Wolfberg offer invaluable perspectives on fostering better patient advocacy, maintaining professional integrity and refining EMS protocols to adapt to new challenges.
MEMORABLE QUOTES
“How many careers, professions are there that, more often than not, you can make somebody's worst day their best?" — Catherine Kuhlmann
"If you want to know what's going on in your hospital, ask housekeeping. Patients will not remember that you worked your butt off for 45 minutes to restart their heart … but they will remember that you tucked their feet in with a blanket underneath it." — Catherine Kuhlmann
"You have to have a healthy department in order to continue to be healthy. And a lot of times when people think that they have problems with an individual and their agency, sometimes it’s not actually a problem with the individual, it’s with the agency." — Catherine Kuhlmann
"We have a duty to the patient. We're not there to help the police. We're there to advocate and treat the patient." — Doug Wolfberg
"EMS cannot subordinate judgement to law enforcement. If a police officer says give this guy some juice and put him to sleep, we first have to do an assessment and figure out if clinically that's the right thing." — Doug Wolfberg
ADDITIONAL RESOURCES
ABC 360 and XI Conference is Page Wolfberg & Wirth Advisory Group’s all-day workshop for EMS leaders, chiefs, HR managers and compliance professionals.
Vodcast: Lessons from the McClain case: Protecting first responders and improving EMS practices
Balancing care and collaboration: Key lessons from EMS and law enforcement interactions
TIMELINE
00:37 – Catherine Kuhlmann introduces herself, detailing her extensive background in EMS, law enforcement, and as a justice of the peace. Rob then highlights the key themes of Kuhlmann’s keynote speech, which revolves around the importance of understanding the "why" in EMS.
02:16 – Kuhlmann discusses the importance of organizational culture in retaining quality personnel and how many individuals leave — not due to the work itself — but because of the agency's culture. Kuhlmann talks about the personal fulfillment that comes from EMS work, sharing a story about a young girl she saved who later became a doctor.
06:13 – Kuhlmann introduces the concept of "Murphy," a problematic employee in the agency, and suggests that sometimes these individuals may reflect a deeper organizational issue.
08:12 – Kuhlmann emphasizes the importance of communication, advising that EMS leaders should hold honest, one-on-one conversations with problematic staff before resorting to exit interviews.
12:04 – Kuhlmann reflects on the small gestures that have a lasting impact on patients, highlighting how seemingly minor acts of compassion can leave a lasting impression.
14:03 – Rob and Kuhlmann discuss the concept of bedside manner in EMS, stressing the importance of treating patients with dignity and respect. Kuhlmann closes with a powerful message about EMS professionals’ responsibility to treat others’ families with the same care and respect as they would their own.
21:06 – Rob Lawrence introduces Doug Wolfberg, who returns to discuss lessons on collaborating with law enforcement in EMS.
22:05 – Wolfberg explains the need for scenario-based training in chaotic environments to build muscle memory and advocate for patients.
23:11 – Wolfberg discusses the importance of EMS maintaining independent clinical judgment, even when law enforcement may request specific actions.
24:03 – Wolfberg stresses the need for clarity in determining whether a patient is in custody and how this affects EMS protocols.
25:06 – Wolfberg explains the importance of advocacy in EMS, particularly in law enforcement scenarios, and the significance of body camera footage for ensuring accountability.
27:13 – Wolfberg shares the potential consequences for EMS professionals who fail to act empathetically or professionally, especially when caught on body camera.
29:15 – Wolfberg speaks about the future of ABC 360, including their upcoming conferences and certifications.
Previously on EMS One-Stop
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NOTE: Be sure to check out the Inside EMS podcast this month where Rob Lawrence will be joining Kelly Grayson as a guest cohost for Chris Cebollero.
In this episode of the EMS One-Stop podcast, Dr. Dave Williams discusses an exciting new master's-level course designed for EMS and fire leaders, focused on advanced improvement science.
Along with Mike Taigman, Dr. Williams is leading this program, which aims to equip leaders with the tools and methods necessary to achieve results-driven improvement in their EMS systems. Over the course of 12 months, attendees will work on real-world projects, gaining the skills needed to make data-driven decisions and improve patient care outcomes within their organizations.
Dr. Williams also dives into the core concepts of improvement science, including understanding of variation and the importance of creating organizational systems that support sustainable improvements. He shares insights into the curriculum, the significance of benchmarking and how the course will help EMS leaders tackle systemic challenges by applying proven improvement methodologies. This conversation also touches on the future of EMS leadership and how innovation in data management, process design and leadership will shape the profession moving forward.
Timeline02:22 – Dr. Williams explains the background of the course, highlighting how it builds on improvement science to drive better results in EMS systems. He and Mike Taigman aim to teach EMS leaders to use data and evidence to improve patient care outcomes.
06:16 – Quality improvement: Dr. Williams discusses the gap in EMS leadership regarding quality improvement, emphasizing that quality needs to be integrated into the leadership team’s responsibilities, not treated as a separate function.
11:01 – Why data matters: The conversation shifts to the importance of data in EMS improvement efforts. Dr. Williams highlights how collecting and analyzing data helps organizations understand system performance and drive change.
15:43 – The fleet management example: Rob shares a fleet management story where data was used to improve vehicle downtime, highlighting the real-world impact of using improvement science to solve practical challenges.
19:29 – Project-based learning in the course: Dr. Williams elaborates on the project-based nature of the course, explaining how each participant will bring a real-world project that directly impacts their organization and use improvement science to solve it.
23:09 – Practical applications: Dr. Williams talks about how the course will blend online learning with in-person workshops, providing practical tools and methods that participants can apply to their projects throughout the year.
31:08 – Course logistics: Dr. Williams discusses course deadlines and important dates, including the application deadline of April 18, 2025; and the course's first workshop in September 2025.
54:05 – ROI and the course's value: Dr. Williams emphasizes the return on investment for attending the course, explaining that solving organizational problems through improvement science will ultimately save money and improve results for EMS services.
1:00 – Final thoughts: Rob and Dr. Williams close the conversation by reiterating the uniqueness of the course and its potential to reshape EMS leadership through the application of improvement science.
ADDITIONAL RESOURCES
Next-level improvement science: New master-level course equips EMS and fire leaders with advanced improvement science skills
Course application deadline: April 18, 2025
Course start date: July 22, 2025
Workshop dates: September 2025; February 2026
Mastering data and EMS performance metrics with Mike Taigman: Exploring how data informs change, improves clinical outcomes and drives leadership decisions
Improve EMS quality with a model that works: The simple yet powerful Model for Improvement holds the key to making real changes to an EMS organization
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In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Dan Patterson, a clinician-scientist specializing in safety in emergency care settings. Dr. Patterson’s work centers around critical factors in EMS safety, such as sleep health, shift work, fatigue and their combined effects on clinician well-being.
Timeline of key discussion points00:00 – Introduction to Dr. Dan Patterson
Dr. Patterson’s background and how his clinical experience as a paramedic informs his research on EMS safety and sleep health
04:30 – The Impact of Shift Work and Fatigue on EMS Providers
Discussing the direct effects of fatigue on EMS professionals, including medical errors, cognitive performance and decision-making
10:00 – The Science of Sleep in EMS
Why sleep is critical for EMS personnel and the unique challenges they face in getting adequate rest during shift work
15:00 – Development of Safety Measurement Tools
Dr. Patterson explains the creation of safety tools to track fatigue, sleep health and workplace injury rates in EMS settings
20:30 – Experimental Studies and Interventions
Overview of studies testing novel approaches to mitigating fatigue, including practical solutions and interventions in EMS environments
25:00 – Creating a Safety Culture in EMS
The role of leadership and teamwork in reducing fatigue-related errors and fostering a culture of safety in EMS organizations
30:00 – Key Takeaways and How Agencies Can Implement Changes
Final thoughts on how EMS agencies can integrate Dr. Patterson's findings and create healthier, safer work environments for their teams
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In this episode of EMS One-Stop, host Rob Lawrence welcomes back Dr. Alex Isakov, a leading expert in infectious diseases from NETEC and Emory University in Atlanta. Dr. Isakov provides valuable updates on current and emerging infectious diseases; their global impact; and the critical role EMS professionals play in identifying, isolating and protecting themselves and their patients.
This discussion highlights key infectious diseases, including H5N1 (avian flu/bird flu), Mpox (previously known as monkeypox), Ebola, Marburg, Lassa fever and seasonal flu, providing EMS personnel with essential knowledge and safety protocols in light of ongoing global health concerns.
Throughout the episode, Dr. Isakov offers insights into the latest outbreaks, the importance of vaccinations, and strategies for responding to potential infectious disease threats. He stresses the necessity of remaining vigilant and prepared for high-consequence diseases while maintaining optimal patient care.
From the evolving threat of H5N1 to the resurgence of seasonal influenza, Dr. Isakov ensures that EMS professionals are equipped with the most relevant and up-to-date information needed to protect both themselves and their communities.
Summary of key infectious diseases covered by Dr. Isakov
H5N1 (avian influenza/bird flu): Dr. Isakov provides an update on the H5N1 outbreak in poultry and dairy herds, stressing the importance of limiting human exposure and watching for potential mutations that could lead to human-to-human transmission.
Mpox (Clade 1B): Dr. Isakov discusses the risk of Mpox, particularly Clade 1B, which remains prevalent in Central Africa but has now spread to other countries, including the United States. He highlights the importance of identifying travel history and unusual rashes, along with strict protective measures for EMS clinicians.
Ebola and Marburg: These diseases continue to present a risk, with smaller outbreaks currently ongoing in Uganda (Ebola) and Tanzania (Marburg). Dr. Isakov notes the importance of being prepared to identify and isolate individuals who may have been exposed during travel to these regions.
Lassa fever: Dr. Isakov points out the ongoing concern of Lassa fever in West Africa and emphasizes that EMS professionals should be on alert for symptoms in travelers who have visited affected regions.
Seasonal influenza: The seasonal flu outbreak is particularly severe this year, and Dr. Isakov underscores the importance of vaccination, especially for vulnerable populations, to reduce serious illness and hospital strain.
Timeline
00:00 – Introduction to the episode and guest, Dr. Alex Isakov
01:33 – Uupdate on Mpox (Clade 1B) and its global spread
05:24 – Ebola and Marburg outbreaks: ongoing concerns in Uganda and Tanzania
08:01 – Lassa Fever in West Africa and its impact on EMS professionals
13:05 – The importance of travel vaccinations for high-risk areas like malaria zones
15:13 – Mystery illness in the Democratic Republic of Congo and the investigation into its cause
17:01 – H5N1 and avian influenza concerns, including potential human transmission risks
22:02 – Severity of the current seasonal flu outbreak and vaccination recommendations
25:24 – EMS community's role in flu and measles vaccination advocacy
29:05 – Discussing surge conditions and excess mortality during pandemics
32:01 – Closing remarks, including updates on new NITEC EMS resources
Additional infectious disease resources
National Emerging Special Pathogens Training & Education CenterEmergency Medical Services (EMS) Featured Resources | NETECSymptoms of Malaria | Malaria | CDCLassa Fever Suspected in Death of U.S. Traveler Returning from West Africa | CDC NewsroomCDC A(H5N1) Bird Flu Response Update February 26, 2025 | Bird Flu | CDCMpox | Mpox | CDCHealthcare Workers: Could it be Ebola? -
Recruiting and retaining EMS professionals has been an ongoing challenge across the U.S., made worse by the COVID-19 pandemic. In this episode of the EMS One–Stop podcast, host Rob Lawrence sits down with Joe Schmider, Texas State EMS director, to discuss the $21M Texas EMS Workforce Initiative — a data-driven approach to recruiting and retaining EMS providers statewide.
Schmider details how Texas identified a 40% non-utilization rate among certified EMS professionals, successfully secured state funding, and launched an innovative recruitment and retention campaign. With over 10,915 new personnel added since 2019, this program serves as a model for other states struggling with EMS workforce shortages. This episode is full of actionable insights for EMS leaders, policymakers and recruiters alike.
Key quotes from Joe Schmider"We were seeing about 40% of our certified people — licensed paramedics, EMTs, advanced EMTs — were not using their skills on an ambulance.""We worked with our associations here in Texas, the Texas EMS Alliance and the Texas Ambulance Association. They went and met with some legislators, worked the room a bit, and we got $21 million of federal dollars through the state to us for 2 years to put in place a recruitment and retention program.""We pushed out 3,152 scholarships. An EMT scholarship was worth $2,000, an advanced EMT scholarship was $3,200 and a paramedic scholarship was $8,000. The money went directly to the education program, not to the student. They had 1 year to complete their training and then had to serve 96 hours a month on an ambulance — either as a paid or volunteer position — for 1 year at the EMT level and 2 years at the paramedic level.""We spent $1.5 million on an advertising campaign throughout the state of Texas. We hired a media company to develop commercials, billboards and social media campaigns. The use of social media was incredible — 50 million views over 2 years, which was an incredible number. We never expected that.""The second thing people do [when considering EMS careers] is they watch us as EMS professionals. Do I want to work with these people? Do I want to be a part of this? I once saw two EMTs standing on the back of an ambulance smoking a cigarette at an event. I went up to them and said, ‘Are you kidding? What message are we putting out when we do stuff like that?’ We have to think about our image.""People leave the EMS profession for two reasons: money or the way they’re treated. Depending on which survey you look at, it could be money first or treatment first, but it’s always those two reasons."Episode timeline00:08 – Rob Lawrence introduces guest Joe Schmider, Texas EMS director
00:26 – The EMS staffing crisis and how COVID-19 accelerated workforce shortages
01:36 – How Texas used data to identify a 40% EMS non-utilization rate
02:51 – How Texas EMS leaders secured $21 million in funding
04:31 – Structuring EMS scholarships and training requirements
06:41 – The success of the recruitment campaign: 3,152 scholarships awarded
08:46 – How Texas reached 50 million views in its EMS recruitment campaign
11:16 – EMS workforce retention: The challenges of pay and treatment
13:46 – Addressing rural EMS shortages and workforce gaps
16:01 – How Texas EMS associations helped advocate for change
18:21 – The future of EMS funding and advocacy efforts
21:01 – Lessons from corporate retention strategies: What EMS can learn from HEB grocery stores
24:01 – The importance of EMS provider wellness: Texas’ Wellness Wednesday initiative
26:01 – Final takeaways: Lessons for other states and EMS leaders
28:01 – Closing thoughts and how to access Texas EMS resources
Additional resourcesConnect with Joe Schmider: [email protected]/512-484-5470
Texas EMS Careers and Education
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In this special episode of EMS One-Stop, host Rob Lawrence welcomes General Robert B. Neller, the 37th commandant of the United States Marine Corps, to discuss leadership, decision-making, team building and the evolving challenges facing public safety professionals.
General Neller shares his perspective on leading under pressure, making critical decisions, and fostering an ethical and resilient organizational culture. With decades of military leadership experience, he provides actionable insights that apply not only to the armed forces but also to EMS, law enforcement, and fire and rescue personnel.
Throughout the episode, General Neller emphasizes the importance of training, adaptability and the role of leadership in guiding organizations through times of uncertainty. He highlights the significance of ethical leadership, followership and how leaders must take responsibility for failures while empowering their teams.
The discussion also explores the impact of emerging technologies, such as AI and body-worn cameras on public safety, and the crucial need for ongoing training despite staffing and funding challenges. This thought-provoking conversation delivers key takeaways for current and aspiring leaders across all branches of public safety.
15 leadership quotes from General Robert B. Neller“Making decisions is part of your training — you’re expected to make them, and you have to do it in critical moments.”
“If I could wave a magic wand, I’d put everyone at 110% staffing so they had the time to train properly.”
“The leader’s job is to set the example — how you carry yourself, how you treat others, and how you communicate matters.”
“Good leaders anticipate. They don’t just react — they look ahead and keep their teams informed.”
“Followership isn’t blind obedience; it’s about understanding the mission, contributing ideas, and executing effectively.”
“Accepting responsibility is a core tenet of leadership — when things go wrong, the leader must own it.”
“Change is inevitable, and good leaders learn to embrace it while preparing their people for what’s ahead.”
“Take care of yourself — physically, mentally and morally — because leadership starts with personal discipline.”
“As a leader, you have to accept that sometimes you’ll make the right call, and things still won’t go your way — that’s part of the job.”
“You have to train and rehearse because time spent on reconnaissance is seldom wasted.”
“The worst thing you can hear as a leader is that ‘you don’t care’ — your people need to know that you do.”
“To build culture and cohesion, you set the example — you take the physical fitness test, you wear the uniform properly, and you carry yourself the right way.”
“Good leadership is not about the complete suppression of ideas — if you have time, get input, because someone might have a better idea than you.”
“If you have good followers, being a leader is significantly easier — if you don’t, it’s a challenge every day.”
“Change is inevitable — if you’re not evolving, you’re not making progress, and that’s a problem.”
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In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Shana Beggan, Esq.; and Mike Pellow, Esq., defense attorneys representing one of the firefighters involved in the tragic Elijah McClain case.
Beggan and Pellow discuss the complex legal and systemic issues surrounding the incident, including communication breakdowns, inadequate training, and the challenges faced by EMS and fire personnel when operating in chaotic environments. They also address the broader implications for EMS professionals, highlighting the importance of proper documentation, the use of body-worn cameras, and the need for stronger inter-agency collaboration between police and EMS teams.
This interview provides invaluable insights into the case and the steps necessary to improve EMS practices moving forward.
Beggan and Pellow share their experiences navigating the criminal and civil aspects of the case, emphasizing the importance of understanding the limitations and constraints that EMS providers face in high-pressure situations. They also advocate policy changes, such as enhanced training, better resource allocation and the introduction of body-worn cameras to protect both first responders and the patients they serve.
Their passionate discussion sheds light on the need for reform within EMS, encouraging listeners to reflect on their own practices and consider how they can contribute to a safer and more effective emergency response system.
Key quotes"First responders are people who run towards difficulties and trauma when many run away, and to see somebody be charged in this situation and the fallout from it ... has become a very strong passion for myself and for Mike." — Shana Beggan
"You take somebody – basically the bottom of an entire healthcare system – and say, let's blame this person, let's criminalize this. That is the wrong thing to do." — Mike Pellow
"I think that we need to allow for honest conversations in a safe way, not a blame-the-finger approach." — Shana Beggan
"We need to be better at helping first responders, not making them look over their shoulders and thinking, ‘Where am I going to get whacked in the back of the head if something goes wrong?’" — Mike Pellow
"We perform the way we train, and here the training was poor. We condone or even promote what we fail to address." — Shana Beggan
Takeaways and actionable itemsImprove documentation practices. Ensure that EMS providers document not only their actions, but also their thought processes. This can help prevent misinterpretation of their actions in high-stress situations and provide valuable context in legal proceedings.
Advocate for body-worn cameras. Implement body-worn cameras for EMS teams to improve transparency, protect first responders, and provide better evidence for both patient care and legal purposes. However, ensure that funding for such programs comes from appropriate sources, rather than placing additional strain on already underfunded EMS budgets.
Enhance training and protocols. EMS and police departments should collaborate on joint training sessions, focusing on clear communication, proper patient handoffs, and how to handle complex situations, like excited delirium. Ensure that protocols are updated regularly and that training is implemented in real-world scenarios.
Timeline01:48 – Introduction: Rob Lawrence introduces the episode and guests Shana Beggan, Esq.; and Mike Pellow, Esq.
04:21 – Case background: Pellow provides a brief overview of the Elijah McClain case, the charges against the paramedics, and the current status of the case.
07:10 – Communication breakdowns: Beggan discusses the major issues surrounding communication between police and EMS, particularly the lack of information shared between the different teams at the scene.
10:35 – Documentation and reporting: Beggan and Pellow emphasize the importance of documentation in EMS, especially in legal situations, and discuss how inadequate reporting and the failure to document actions and decisions contributed to the case.
12:01 – Body-worn cameras: Pellow advocates for the use of body-worn cameras in EMS to provide better documentation and protect both patients and responders.
19:25 – Police and EMS collaboration: Beggan and Pellow discuss the importance of training police and EMS teams together to improve coordination and response.
28:00 – Legal implications and criminalization of EMS: Beggan and Pellow discuss the growing trend of criminalizing medical practice in EMS and the need to protect providers from unjust legal consequences.
46:11 – Support from fire leadership: Beggan shares the support from the Aurora fire chief, who highlighted systemic failures and underscored the importance of better training and protocols.
50:57 – Closing remarks: Rob thanks Beggan and Pellow for sharing their insights and the discussion closes with a focus on the need for systemic change within EMS and emergency response.
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In this sobering episode of EMS One-Stop, host Rob Lawrence sits down with Chief Bill Salmeron of New Orleans EMS to discuss the tragic events that unfolded on New Year’s Day 2025, when a vehicle plowed through crowds in the French Quarter, resulting in 15 fatalities and 57 injuries, including two police officers.
Chief Salmeron provides a detailed account of the incident, the immediate EMS response, and the coordinated efforts with law enforcement and hospitals to manage the mass casualty incident.
The conversation also delves into the psychological impact on EMS personnel, the value of training and preparedness, and lessons learned from handling such a large-scale event.
Chief Salmeron emphasizes the importance of communication, mutual aid and the mental wellbeing of first responders, offering insights into how New Orleans EMS plans to support its teams in the long recovery process ahead.
Key quotes from the episode“You don’t teach that level of decision-making in EMT class. Telling a family member or police officer that you can’t help their loved one is one of the hardest things you’ll ever do.” — Chief Bill Salmeron“The recovery from an incident like this doesn’t take days or weeks – it takes years.” —Rob Lawrence“I told my team to go back to headquarters. I needed to put eyes on every single one of them and make sure they were OK.” — Chief Bill Salmeron“Situational awareness and incident command are critical. It’s about restoring order from chaos.” —Rob Lawrence“What we do is a unique calling. It’s critical to appreciate and take care of each other and ourselves.” — Chief Bill Salmeron“This episode is a masterclass for anyone planning for mass casualty incidents. Listen, learn and prepare.” —Rob LawrenceTimeline00:21 – Introduction to the episode and overview of 2025’s challenging start, including the New Year’s Day tragedy in New Orleans01:22 – Chief Salmeron describes the initial setup and EMS operations in the French Quarter03:26 – Incident details: the truck’s path, immediate EMS response, and the scale of injuries06:01 – Incident command and mutual aid coordination, including the deployment of 13 ambulances09:43 – Managing hospital capacities and patient transport logistics during the MCI15:11 – The discovery of explosive devices and the role of EMS in securing and retreating from the scene23:01 – Post-incident response: staff debriefings, mental health support and lessons learned33:31 – Preparing for future events like the Super Bowl and Mardi Gras under heightened security41:06 – Five key takeaways for leading and managing mass casualty incidents50:28 – Closing thoughts and appreciation for first responders’ dedication and resilience
Additional resources
New Orleans EMS -
Join Rob Lawrence on EMS One-Stop as he welcomes Sunny Wescott, chief meteorologist at the Department of Homeland Security, for an eye-opening discussion about the impact of extreme weather on emergency services and critical infrastructure.
Sunny shares her expertise on meteorological trends, the challenges of preparing for severe weather events, and the evolving role of EMS in managing climate-induced emergencies. From hurricanes and polar vortices, to the implications of electric vehicle adoption during extreme weather, this episode is packed with actionable insights for public safety leaders and EMS professionals.
Rob and Sunny explore the complex interplay between extreme weather and emergency response, emphasizing the importance of proactive planning and reliable information sources. Sunny delves into the science behind weather phenomena like atmospheric rivers, Rex blocks and heatwaves, connecting them to real-world challenges faced by first responders.
During this edition of EMS One-Stop discover the tools, resources and strategies Sunny recommends for staying ahead of severe weather impacts on both infrastructure and personnel, and gain practical advice for improving communication with the public during weather crises, ensuring safety and minimizing risk.
Key quotes from this episode
“The uneven heating of our planet is amplifying weather events, making them stronger and more unpredictable.” — Sunny Wescott
“The weather affects everything – and for EMS leaders, preparation isn't optional, it's essential.” — Rob Lawrence
“We’re seeing infrastructure pushed to its breaking point by weather extremes – things we couldn’t anticipate when they were built.” — Sunny Wescott
“Sometimes, the hardest command decision is telling your crews, ‘We’re hunkering down now.’ It’s the right call, but it’s never an easy one.” — Rob Lawrence
“Your life means so much more than the possessions inside your home. Evacuate early – it’s always the safest choice.” — Sunny Wescott
“Let’s face it: weather is as much a part of public safety planning as personnel and resources.” — Rob Lawrence
“Weather preparedness isn’t just about forecasts; it’s about collaboration, data sharing and breaking down silos across sectors.” — Sunny Wescott
Timeline
00:24 – Rob’s introduction and reflections on weather in the UK and US
01:22 – Sunny explains global weather patterns and their cascading impacts
03:32 – Sunny describes her role at DHS and how critical infrastructure is assessed against weather risks
11:13 – Hurricane trends, preparedness and landfall impacts for 2025
20:00 – EMS-specific challenges during extreme heat and cold, including effects on equipment and personnel
24:04 – How to interpret long-term weather forecasts and model reliability
30:06 – Operational decisions during extreme weather events, like grounding helicopters and using resources wisely
36:06 – Final thoughts on misinformation, insurance concerns, and public safety resilience
Additional resources
EMS in a changing climate: Understanding the impact of extreme weatherSnowfall Reports from past eventsAnnual Lightning Report 2024 – XweatherNWS Probabilistic Precipitation PortalNational Fire News | National Interagency Fire CenterAirNow Fire and Smoke MapIncidents | CAL FIREEvaporative Demand Drought Index (EDDI): NOAA Physical Sciences LaboratoryZoom Earth | Live Weather Map & Hurricane TrackerNullschool Earth :: a global map of wind, weather, and ocean conditionsNational Weather Service -
In this insightful episode of EMS One-Stop, host Rob Lawrence revisits New Orleans EMS to explore their pioneering use of body-worn cameras, joined by Chris Keller, chief of operations at New Orleans EMS.
The discussion dives into the motivations, challenges and successes of implementing this technology. From its initial deployment on tactical medic teams in 2018, to its current broader rollout, Chris shares the journey of navigating legal frameworks, staff buy-in and operational logistics. The conversation also highlights how body-worn cameras enhance patient care documentation, bolster staff safety and provide an unbiased account of events, positioning them as an emerging industry standard.
This episode offers practical advice on policy development, procurement processes and operational use cases, including their application during Mardi Gras and high-acuity events. With the aim to demystify the implementation process, Chris emphasizes the importance of collaboration, adaptability and using technology to improve EMS practices. Rob and Chris also discuss future goals for the program, funding challenges, and the potential for body-worn cameras to become a cornerstone of EMS operations nationwide.
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Dr Jeff Jarvis joins Rob Lawrence to discuss the recently released National EMS Quality Alliance (NEMSQA) Measures Report – “Enhancing airway management one measure at a time.”
The report begins with the following robust Foreword: “NEMSQA is not satisfied with the state of airway management safety in EMS. As you will see, the data clearly shows that we can do much better across our industry! Partnering with experts and EMS agencies around the country, NEMSQA is leading the second national EMS Quality Improvement Partnership (EQuIP), the Airway Management Collaborative to put the new NEMSQA airway measures to work.”
“Enhancing airway management one measure at a time” is the sequel to the Lights and Siren Collaborative and will utilize the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The goal of the project is to support national improvement in the safety and effectiveness of invasive airway management by focusing on two goals:
Reducing the adverse events, such as peri-intubation hypoxia and hypotensionImproving the use of waveform capnography to confirm and monitor all invasive airwaysRob and Dr. Jarvis discuss the report and actions individuals and their agencies should take to improve their personal and organizational airway management and patient outcome results.
Find more EMS One-Stop episodes here!
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In this episode of EMS One-Stop, host Rob Lawrence dives into the trending topic of pre-hospital blood administration with guests from New Orleans EMS: Tom Dransfield, the quality assurance and safety officer, and Dr. David Rayburn, deputy medical director.
This in-depth discussion explores the development and execution of the New Orleans EMS blood program, focusing on packed red blood cells (PRBC) and the challenges, successes and ongoing research surrounding cold blood administration in trauma and medical emergencies. New Orleans EMS is leading the charge in pushing the boundaries of pre-hospital blood, providing innovative solutions for penetrating trauma, GI bleeds and other critical cases.
Dransfield and Dr. Rayburn share the journey of New Orleans EMS in implementing the program, including their logistics, lessons learned and the vital impact of their interventions on patient outcomes.
The episode emphasizes the collaboration between EMS and trauma centers as well as blood suppliers to reduce mortality rates, while also tackling key questions, such as the supply chain, funding and future research.
Memorable quotes
"For every minute we delay blood administration, there's an 11% increase in mortality – this isn't just a theory; it's life and death." — Dr. David Rayburn
"We were topping the charts in the wrong categories – violence and stuff like that. So, our medics were frustrated with the old scoop and run. We're not just scooping and running anymore. We're providing definitive care." — Tom Dransfield
"We’re seeing no change in temperature for patients receiving two units of cold PRBCs in the pre-hospital environment, and that’s groundbreaking." — Dr. David Rayburn
"If we’re doing blood, we’re literally saving lives. But without reimbursement, it’s an uphill battle." — Rob Lawrence
"Our paramedics are pushing the envelope – it's no longer just about trauma; we’re now treating GI bleeds, OB cases and renal patients with blood administration." — Dr. David Rayburn
Find more episodes: https://www.ems1.com/ems-one-stop
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In this episode of EMS One-Stop, host Rob Lawrence is joined by quality improvement expert, Dr. Dave Williams, recent co-author of the book, “Quality as an Organizational Strategy,” and Dr. Jonathan Studnek, executive director of Wake County EMS.
Together they discuss the five activities for organization’s leaders to provide the structure to begin working on making quality their strategy.
These activities are centered on:
Purpose
Viewing the organization as a system
Obtaining information
Planning to improve
Managing improvement efforts
These five activities form a system for the leaders of an organization to focus their learning, planning and actions.
Memorable quotes"Leadership's job is to build systems where staff can be rock stars and bring their best selves every day." — Dr. Dave Williams
"Understanding your purpose as an EMS agency, like being responsible for cardiac arrest survival, is essential in improving performance." — Dr. Jon Studnek
"Our secret weapon in improvement is the Plan-Do-Study-Act (PDSA) cycle, where we learn fast by making low-risk, small-scale changes." — Dr. Dave Williams
"These five activities are the key elements that leaders should be engaging with to drive their organizations forward." — Dr. Jon Studnek
Highlights01:14 – Dr. Dave Williams shares his background in quality improvement and EMS
02:12 – Dr. Jon Studnek introduces himself and talks about his journey in EMS leadership
03:56 – Dr. Williams discusses his book, “Quality as an Organizational Strategy” and its origins, and outlines the five core activities of quality as an organizational strategy
15:02 – Dr. Studnek describes implementing the quality framework in EMS, using cardiac arrest survival as a real-world example
23:36 – Rob and Dr. Studnek discuss interconnectedness in EMS systems and fleet maintenance
30:00 – Dr. Williams explains how small-scale changes using the PDSA cycle help improve EMS operations
35:00 – Final thoughts from Dr. Studnek on leadership and quality as a guide for day-to-day work
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In this episode of the EMS One-Stop podcast, host Rob Lawrence welcomes back data and EMS expert Mike Taigman for a deep dive into the evolving role of performance metrics in EMS systems.
Together, they discuss two key publications – “Joint Position Statement on EMS Performance Measures Beyond Response Times” by Kupas and Zavadsky, et al., and the White Paper from the National EMS Quality Alliance in Collaboration with FirstWatch, titled, “Taking the Pulse of your System – Performance Measurement for Improvement.”
Lawrence and Taigman explore how data informs change, improves clinical outcomes and drives leadership decisions. Whether you’re a seasoned leader or new to the field, this conversation provides essential insights into how EMS organizations can better utilize data to elevate their services.
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In this special edition of EMS One-Stop, host Rob Lawrence discusses the Joint Position Statement on EMS Performance Measures – Beyond Response Times published yesterday by the leading EMS and public policy associations with Matt Zavadsky, MS-HSA, EMT, vice president of PWW|AG, and one of the primary authors of the position statement.
Rob and Matt discuss the statement in detail, examining all of the recommended metrics, the reasons for placing them in the paper and why response times are not recommended as a primary measure of system performance.
Rob and Matt begin by discussing the signatories of the statement – in particular, the sign off from the International City/County Managers Association (ICMA) and the pivotal role they play in ensuring EMS delivery in their communities.
The many associations that joined the statement recommend that communities and governments modernize EMS performance assessments by evaluating various domains with key performance indicators (KPIs). These KPIs should be measured, tracked over time, benchmarked against similar EMS systems or national data and regularly published for local community stakeholders.
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In this episode of EMS One-Stop, host Rob Lawrence welcomes back infectious disease expert Dr. Alexander P. Isakov, MD, MPH, founding executive director of the Office of Critical Event Preparedness and Response (CEPAR), and professor of emergency medicine at Emory University.
Rob begins by discussing his real-life experience with an H5N1 outbreak in the UK as an ambulance service leader, and Dr. Isakov discusses the current H5N1 emergence in the U.S.
The discussion covers the current U.S. H5N1 outbreak, bird and swine flus, and the spillover from bird to mammal populations. They also address three recent U.S. cases of H5N1 among agricultural workers. They go on to discuss signs and symptoms of H5N1, index of suspicion, the Hierarchy of Controls in infectious diseases, universal and standard precautions, and fit testing respirators. They also cover resources available at NETEC.
Dr. Isakov concludes with a roundup of other global issues, including viral hemorrhagic fever (VHF), Ebola, Marburg and smallpox.
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