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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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In this edition of the EMS One-Stop podcast, host Rob lawrence welcomes Todd Stout and Mike Taigman of FirstWatch as they introduce the 2024 Jack Stout Fellow, Mary Meeks, district chief of night shift at Chatham Emergency Services.
The Jack Stout EMS Fellowship, endowed by FirstWatch, aims to empower emerging EMS leaders by equipping them with the knowledge and skills necessary to guide EMS systems effectively in the future. Developed by FirstWatch in cooperation with the Fitch EMS Foundation, the Fellowship underscores the commitment to leadership development and community service. Named in honor of Jack Stout, a pioneer in high-performance EMS systems, the Fellowship teaches principles such as people-centered leadership, data-driven decision-making, improvement science and systems thinking.
As the chosen Fellow, Meeks will attend the 2024 Pinnacle EMS Leadership Forum, participate in either the Fitch Ambulance Service Manager or Communication Center Manager program, and benefit from a customized mentorship led by Mike Taigman, renowned for his contributions to EMS quality improvement. This comprehensive program not only honors Jack Stout’s legacy but also ensures that his visionary principles continue to shape the future of EMS.
Additional resources
IHI Framework for Improving Joy in Work | Institute for Healthcare Improvement
The Jack Stout EMS Fellowship, endowed by FirstWatch
Pinnacle EMS leadership conference
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In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Fayetteville, North Carolina’s Cumberland County EMS Chief David Grovdahl and Behavioral Health Community Paramedic Tara Tucker to discuss the Cape Fear Valley Mobile Integrated Health Behavioral Health Community Paramedicine programs.
The Cape Fear MIH Team is composed of four community paramedics, one social worker and a peer support specialist. The team focusses in particular on overdoses/request for substance use treatment, suicide related calls – ideation/attempts as well as youth calls related to mental health and substance use, and also EMS referrals and associated case management.
Fayetteville is home to Fort Liberty and Pope Army Air Base, and is the sixth most populous city in North Carolina with a high number of uninsured and underinsured patients. Fifteen percent of Cumberland County’s population is military-affiliated and it is the third busiest EMS system in North Carolina. Cumberland’s affiliated ED, CFVMC Emergency Department, had 90,595 visits in 2021 for adults, and 30% of those (27,300) were for behavioral-health related issues, creating the need for a Behavioral Health service line employing community paramedics.
In addition to discussing their mobile integrated healthcare system, Grovdahl also shares about the North Carlina whole blood programs and their progress.
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In this special, on-site episode of EMS One-Stop, host Rob Lawrence takes us to the 2024 North Carolina EMS Expo in Greensboro, North Carolina, a well-attended conference with over 1,200 attendees.
Rob spent time with several conference faculty.
EMS lawyer Matt Streger joins Rob to discuss just culture, HR issue spotting, leadership communication and employee engagement.
Kevin Collopy joins Rob to discuss the outstanding prehospital training being delivered to medics in Ukraine and also discusses this years “Stand and Deliver” new speaker event (a now annual event held as EMS World Expo).
Rob discusses whole blood and its national rollout with Dr. Randall Schaeffer and David Grovdahl.
To close, Peter Dworsky of the National EMS Safety Conference provides an overview of the current top EMS industry safety themes.
Enjoying the show? Email [email protected] to send in guest suggestions, episode feedback or questions for our host.
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Editor’s note: This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.
In this episode of the EMS One-Stop podcast, host Rob Lawrence welcomes back Matt Zavadsky to discuss the latest development in the move to fund treatment in place and the recent disclosure from CMS about the potential savings to Medicare identified in the analysis of the limited ET3 program.
Matt discusses the potential legislative moves regarding EMS funding, highlighting bipartisan support and urging listeners to engage with elected officials to support bills benefiting EMS.
The conversation underscores the need for sustained advocacy efforts and highlights the level of interest shown by key policymakers.
Rob and Matt also discuss the recent developments in the City of Fort Worth and the decision to absorb MedStar into the Fort Worth Fire Department, emphasizing the need to ensure equitable treatment for EMS personnel transitioning to new roles.
Top quotes from this episode“We can officially say that the net savings to Medicare after they pay EMS and after they pay the tertiary provider telemedicine, whatever it is, is still $550 to $570 per enrolled ET3 participant. And when you do the math, that's a billion dollars or more of savings to the Medicare program, which now CBO can use to evaluate the benefit, economically of doing a treat, no transport, treatment-in-place model. So it's big news.” — Matt Zavadsky
“Nobody benefits from a knock-down, drag-out fight. But as you indicated, there are now people in the community and people across the country that are saying why and what does this mean? We don't have all those answers, but again, it's the decision from the folks who are elected to represent the community and if that's what they want to do, that's great. Our role is to try and do as much as we can to maintain a transition into a new provider system that keeps those core tenants – the high performance, high value mobile, integrated healthcare, flexible deployment. All those things that have really made the system a world class EMS system, even though it might say something different on the side of the ambulance and the employees might be wearing a different uniform.” — Matt Zavadsky
“It's going to be a long transition – 12 to 18 months, and it's not just branding and rebranding, it's really infusing the culture of a group of people who are used to doing 7-10 calls in 12 hours and used to having things operate with a certain cadence that's going to be totally different when they start a different type of organization.” — Matt Zavadsky
Episode contents00:00 – Introduction
02:15 – ET3/TIP: Challenging CMS outcome data
03:15 – Cost savings per intervention
04:00 – CMS data showing net savings to Medicare
04:30 – Congressional Budget Office score based on savings
06:00 – Net savings of a billion dollars or more
07:00 – Applying this new information for the good and benefit of the industry
09:00 – Congress is, is what Congress does
10:40 – Meeting with Congress to push TIP
14:30 – Fort Worth and the PWW Advisory Group
14:50 – Fort Worth economies and level of service
17:30 – Matt Zavadsky to join the PWW Advisory Group
19:15 – The staffing issues as Med star staff transit to the FD fire department
21:00 – Ensuring the staff is protected
25:00 – Call to action-how we communicate all value to elected officials
26:00 – Final Thoughts
About our guest
Matt Zavadsky is the former chief transformation Officer at MedStar Mobile Healthcare, formerly the exclusive emergency and non-emergency public utility model EMS system for Fort Worth and 14 other cities in North Texas.
Coming to MedStar in 2008 as the operations director, Matt made significant changes to the EMS delivery model, and in 2010, successfully eliminated the need for the tax subsidy that MedStar had been operating on since its inception in 1986. He has helped guide the development and implementation of numerous innovative programs with healthcare partners that have transformed MedStar fully as a Mobile Integrated Healthcare (MIH) provider, including high utilizer, CHF readmission reduction, observational admission reduction, hospice revocation avoidance, 911 nurse triage programs and partnerships with home health agencies. He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation,” published by Jones and Bartlett Publishing.
He has 42 years’ experience in EMS and holds a master’s degree in Health Service Administration with a graduate certificate in Healthcare Data Management. Matt is a frequent speaker at national conferences and has consulted on numerous EMS issues, specializing in high-performance EMS operations, finance, mobile integrated healthcare, public/media relations, public policy, transformative economic strategies and EMS research.
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In this episode of the EMS One-Stop podcast, Dr. Edward Racht and Matt Zavadsky join Rob Lawrence to discuss their recent attendance at the U.S. House Committee on Ways & Means hearing on “Access to Health Care in America: Ensuring Resilient Emergency Medical Care,” which took place in an off-site hearing in Denton, Texas, on March 18, 2024.
Dr. Racht, chief medical officer of Global Medical Response; and Zavadsky, chief transformation officer for the Metropolitan Area EMS Authority (MedStar Mobile Healthcare) discuss the evidence and the key issues they conveyed to the committee.
Dr. Racht's testimony included:
The significant advancements made in emergency medicine over the past decades, leading to reduced mortality and disability rates for patients.
The importance of updating Medicare reimbursement rates for ambulance services, which have not been revised for over 20 years.
Advocating for wholesale reform of Medicare's coverage of emergency medical services to align with contemporary practices, such as covering treatment in place and transportation to alternative healthcare sites.
Matt Zavadsky's testimony included:
The impact of CMS payment policies on EMS, which incentivize unnecessary transportation of patients to the emergency room.
Innovative programs initiated by EMS agencies to prevent unnecessary 911 calls and navigate patients to appropriate care settings.
Legislative changes required to provide EMS with flexibility in patient navigation, including treatment in place and transport to alternate destinations.
The challenges faced by ambulance services nationwide, especially in rural areas, exacerbated by the COVID-19 pandemic.
Top quotes from this episode“We are the front of the frontline in medicine.” — Dr. Ed Racht
"Our coordinated and integrated EMS and healthcare system now gives gravely injured patients ... the opportunity for rapid surgical intervention and a chance at full recovery." — Dr. Ed Racht
"Emergency healthcare professionals pride ourselves on our ability to dramatically decrease morbidity and mortality from unexpected and sudden illness and injury." — Dr. Ed Racht
"CMS payment policy is such that we are incentivized to transport every 911 patient to the ER because that is the only time we get paid." — Matt Zavadsky
"Ambulance services are a vital component of our local and national healthcare and emergency response systems." — Matt Zavadsky
"Innovative EMS agencies ... have initiated patient-centric programs designed to prevent 911 calls and navigate patients to the most appropriate care setting." — Matt Zavadsky
"Ambulance services across the nation, especially in rural areas, are facing unprecedented challenges." — Matt Zavadsky
Episode contents0:05 – Introduction
0:55 – Guest introduction
1:40 – Explaining the Ways and Means Committee
2:30 – We are being noticed!
3:40 – Preparing for a congressional hearing
5:40 – The impact of having a congressional hearing in an EMS location
5:58 – The genuine interest of the committee members
9:00 – Dr. Ed Racht testimony to the Congressional Ways and Means Committee
14:24 – Matt Zavadsky testimony to the Congressional Ways and Means Committee
20:52 – Dr. Racht and Zavadsky’s reactions to the evidence they gave and the feedback
29:00 – Zavadsky’s key points he wished to reinforce during his evidence session
31:45 – Balanced billing, patient protections and removing the patient from the middle of the process
32:50 – Independent Dispute Resolution (IDR) and its challenges.
38:29 – Questions for Secretary Becerra on Capitol Hill
44:00 – Final thoughts
45:00 – A call to action to become one and present a united front “When we unify, we are unstoppable.”
48:00 – You the listener are the great politician
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Editor’s note: This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.
“Honorable but Broken: EMS in Crisis” is a documentary film exploring the world of EMTs and paramedics, the collapse of the EMS system, and what needs to be done to save it. Narrated by six-time Golden Globe and two-time Primetime Emmy award winning actress, Sarah Jessica Parker, “Honorable but Broken” raises awareness of the systemic collapse of EMS and advocates for change.
In this episode of the EMS One-Stop podcast, host Rob Lawrence chats with producer Bryony Gilbey about the documentary that is now completed and available for streaming. Gilbey hopes the impactful, hard-hitting documentary will serve as a briefing and education tool for our elected officials and members of the general public.
As Gilbey notes, “It’s no good any longer just throwing up your hands and saying that’s just the way EMS is; it’s no good saying it’s someone else’s problem; it’s something we all need to work on, as a civilized society we need to address this issue and we need to do it quickly.”
The 60-minute documentary is now available on demand, streamed by Prodigy EMS and it is hoped that it will be used at local, state and national levels to bring attention to the issues we are facing.
Top quotes from this episode
“I expected to tell a story; I did not think that it would have quite this reaction” — Bryony Gilbey“We now all have not many degrees of separation to somebody who has had some sort of PTSD, who has had to leave the job because of the pressures of work and dare I say ultimately taken their lives and that is incredibly sad.” — Rob Lawrence“It all comes down to three words – all in favor – if we don’t get the vote, we don’t get the money, we don’t get the change.” — Rob LawrenceEpisode contents
00:48 – Documentary teaser
01:18 – Introduction/Bryony Gilbey
02:16 – The “Honorable but Broken” back story
05:46 – How did Gilbey view EMS and its issues
08:15 – The finished product and how can we view it
10:24 – A federal screening on Capitol Hill
11:30 – Reaction from elected officials
13:16 – John Mondello/emotional trauma
14:00 – Eileen Mondello – John’s mother
15:25 – Reaction to Eileen Mondello – “It never gets easier’
17:00 – He wasn’t the first, he isn’t the only and sadly he won’t be the last
22:00 – Other featured speakers in the documentary and their powerful messages
22:30 – Recruitment, retention and retirement
24:35 – What is the cost of a human life to a politician?
26:25 – Educating the legislators and the public
28:00 – The cost of readiness
29:05 – Reimbursement doesn’t add up
31:00 – The hospital side of things – Beckers Review on Hospital closures and adding to ambulance and hospital deserts
31:30 – Call to action and the legislative agenda
35:30 – Sarah Jessica Parker
39:00 – How and where to view via Prodigy EMS
39:50 – Final thoughts
About our guest
With a prolific career spanning several decades, Bryony Gilbey is a seasoned director, producer and freelance writer/editor, distinguished for crafting compelling narratives across various media platforms. As the director/producer for the impactful EMS documentary, “Honorable but Broken: EMS in Crisis,” Gilbey has showcased an unparalleled ability to guide projects from inception to completion.
Gilbey previously worked with the Nexstar Media Group, Inc. as a freelance writer/editor. Here, she demonstrated versatility by producing feature pieces on health and lifestyle topics for Tribune Publishing and contributing to BestReviews.com.
Gilbey also served as an associate producer at Mary Murphy & Co. from 2005 to 2012. During this period, she played a pivotal role in the production of the PBS American Masters documentary "Hey Boo," centered around Harper Lee. In the early 2000s, Bryony worked as a Producer/AP at ABC News Productions, where she produced documentaries on medical breakthroughs in neonatal care for Discovery Health.
The foundation of Bryony’s career was laid during her time as an associate producer at “60 Minutes,” CBS News, from 1995 to 2000. Working closely with producers and correspondents, she contributed to the creation of original news stories.
Throughout her extensive and diverse career, Bryony Gilbey has consistently demonstrated a passion for storytelling, a keen journalistic instinct, and an unwavering commitment to delivering content that informs and resonates with audiences worldwide.
Resources
“Honorable but Broken: EMS in Crisis”NAEMT's Advocacy programAAA’s Advocacy programRATE AND REVIEW THE EMS ONE-STOP PODCAST
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Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.
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Collecting and communicating the big EMS news of 2023
The American Ambulance Association and the Academy of Mobile Healthcare Integration (AIMHI) collect, collate, categorize and share weekly EMS-based news stories widely with many national organizations and associations, including NHTSA, USFA and NAEMT.
The information contained in the news tracker allows officials and EMS leaders to brief and educate journalists and elected officials, as well as the public as to the current plight of EMS. EMS is delivered on a local level and those experiencing issues with their service can believe it is just them suffering funding shortages, staffing challenges, hospital delays or general poor performance. The tracker can be used to demonstrate that the issues are occurring on a wider regional, state, national and, in some cases, international level.
In this episode of the EMS One-Stop podcast, host Rob Lawrence, who also heads up the AAA-AIMHI news collation effort, welcomes fellow news collator, Rodney Dyche of Patient Care EMS; and AIMHI Education Committee Chair, Matt Zavadsky, chief transformation officer at MedStar Mobile Healthcare. Rob, Rodney and Matt examine EMS news and current trends, and discuss how these themes can be used to inform, influence and educate.
Top quotes from this episode
“There's a perverse ‘incentive’ about response time … if you have the target of 8:59, you arrive on time and the patient dies; that's a success. If you arrive in 9:01 and the patient lives; that's a failure. That's absolute garbage” — Rob Lawrence“There was a quote from Dr. Clawson in a news story that was done in Minneapolis, and I love his quote. He says, ‘there is no evidence that using red lights and sirens have saved more lives than they've taken.’” — Matt Zavadsky“Every week in this great country, an ambulance is stolen either from hospital or from scene – that's avoidable.” — Rob Lawrence“Stop being timid. Stop licking your wounds. Get out in your community, talk to your elected officials. Talk to your city managers or county administrators – very factually, not emotionally. There will be time for emotions, but give them the facts and let them know what it's gonna take to resuscitate their EMS delivery system.” — Matt ZavadskyEpisode contents
00:23 – Guest introduction
02:06 – AAA/AIMHI News Tracker and story categories
04:22 – A resource to brief the press and elected officials
04:30 – Operational challenges across many states
05:50 – Massive sign-on bonuses – robbing Peter to pay Paul
06:30 – Staffing and funding issues
08:40 – Communities/local governing bodies facing the fact that they are running out of money, and their EMS isn’t free
09:40 – Transitioning from a volunteer to a paid system
11:00 – Explaining EMS economics to your elected officials
11:50 – Has anyone died? Bring data
13:30 – EMS systems closing
15:30 – “Elected officials get nervous deciding to allocate funding to a service that they haven't had to fund or haven't, haven't had to fund to this certain level in the past.”
18:40 – Response time
19:25 – Increase in low acuity calls
20:30 – Service design
22:50 – Single- versus double-paramedic crewed trucks
25:04 – MEDIC Charlotte – Taking bold steps within categories of response
27:00 – The rate of ambulance crashes across the county at intersections
27:47 – If you are not the ambulance driver … who is?
29:49 – There is no evidence that using red lights and siren have saved more lives than they've taken!
30:30 – Stolen ambulances
32:59 – Supply chain and vehicle availability
34:00 – Rurality and ambulance deserts
35:00 – Violence against providers
37:00 – Responding to patients in crisis/agitated patients
38:00 – How to use the media log in your locality to good effect
40:00 – Final thoughts
About our guests
Matt Zavadsky is the chief transformation officer at MedStar Mobile Healthcare, the exclusive emergency and non-emergency public utility model EMS system for Fort Worth and 14 other cities in North Texas that provides service to 436 square miles and more than 1 million residents and responds to over 170,000 calls a year with a fleet of 65 ambulances. MedStar is a high performance, high value EMS system, providing advanced clinical care with high economic efficiency.
Zavadsky is also immediate past president of the National Association of EMTs, and chairs their EMS Economics Committee. He is an appointed committee member to the Joint Commission’s Home Care Professional and Technical Advisory Committee (PTAC), and the Lewin Group’s Hospital Outpatient Quality Reporting (HOQR) Program Stroke and AMI Expert Work Group developing metrics for use in value-based purchasing measures for emergency departments. He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation.”
Rodney Dyche is director of compliance and responsible for risk management with PatentCare EMS Solutions. PatientCare EMS Solutions is a multistate EMS solution, and additionally provides a hybrid online training program and owns a remount facility. As a teenager, Dyche began his EMS career in rural Missouri. He has had multiple system experiences in addition to rural EMS, including MAST (Kansas City, Missouri), REMSA (Reno, Nevada) and Mercy (Las Vegas). In 2010, he became an internal consultant to Paramedics Plus until its sale in 2018. During that time, he led several high-level projects, to include the timely transition of the purchase of Paramedics Plus. Rodney resides in East Texas and in his spare time is a licensed HAM radio operator, and enjoys fishing, off-roading and reading.
Resources
AAA-AIMHI news collation trackerAnalysis of Ground Ambulance Crash Data from 2012 to 2018 -
This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com.
The American Ambulance Association recently held its annual AAA Stars of Life event in Washington, D.C. The American Ambulance Association’s Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession.
While in Washington, EMS One-Stop Host Rob Lawrence interviewed AAA President Randy Strozyk, on the aims and objectives of the stars program and the 2023 Legislator of the Year. Rob also spoke with AAA Medical Director Dr. Gerad Troutman, who is AAA’s first medical director. Finally, Rob chats with AAA Immediate Past President, Shawn Baird, on the Federal Balanced Billing legislation and the role that AAA and others are playing in protecting both the patient and EMS agencies.
Top quotes from this episode
“Every provider is out to make a difference, but to actually be recognized for it, which you don’t often get the opportunity to have, makes it that much more of an honor to be selected for something like this” — Paramedic Erica Brockman
“AAA stars and hundreds of thousands of people like you are the beginning of the healing process. When somebody is hurt, somebody is wounded, somebody is scared, it is the EMT that first touches that patient and then begins to transport into the healthcare system when the rest of the healthcare system can then kick in to what it does, but it would not start unless it begins with you.” — Senator Bill Cassidy
“Think about when Covid hit, at 0200 in the morning, we were the ones that came, we were the ones that had to deal with a whole new level of challenges, not only Covid, but we had to deal with the fact that people didn’t want to go to the hospital, so we were providing levels of care, interfacing, making sure that people had connections. I see that as a bright future to how EMS will progress in the next decade” — AAA President Rany Strozyk
“I’m really passionate about patients called 911 looking for solutions to a problem and that solution is not always an ambulance to take them to an emergency department, so we try to impact their care differently, especially lower acuity patients, because we now have all the technology and tools to treat them in place with our paramedics or EMTs on site of even treating them utilizing a navigation program from the 911 system, the PSAP and maybe get them to an urgent care or virtual care doctor, where they can be cared for right in their home. Patients love it and the best thing is it really puts the ‘E’ back in EMS and allows us to save those emergent resources that need those most.” — Dr. Gerad Troutman, AAA medical director
“We will be coming back to Congress with a recommendation that ground ambulance not be rolled into the No Surprises Act. That (if we were included) would be devastating to access for care.” — Shawn Baird, immediate past president, AAA
Episode contents
00:21 – Opening: Erica Brockman
01:02 – Introduction: Rob Lawrence
01:36 – Randy Strozyk, president, American Ambulance Association
05:12 – Key areas of legislation for 2023/24
08:07 – Presentation of Legislator of the Year: Senator Bill Cassidy
11:00 – Dr. Gerad Troutman, AAA medical director
17:00 – Federal Balanced Billing Committee: Shawn Baird
18:35 – Summary and close
Additional resources
The full bios for all of the AAA Class of 2023 Stars of Life can be found here.
Listen to next: Alexia Jobson, Dr. Peter Antevy, Brian Maloney, Doug Wolfberg and more join the EMS One-Stop podcast to discuss takeaways from the show
About our guests
Randy Strozyk brings to his leadership of the American Ambulance Association more than 34 years of experience in EMS operations and management. He has been part of the American Medical Response leadership team for 16 years, and currently serves as the company’s executive vice president of operations.
Strozyk earned his EMT/paramedic certification and worked on an ambulance while studying microbiology at Washington State University. He later earned an MBA from California State University. He has been heavily involved in the American Ambulance Association for nearly two decades and is the current president of the organization.
Gerad Troutman, MD, MBA, FACEP, FAEMS, is the national medical director for innovative practices at Global Medical Response. He is an assistant professor of Emergency Medicine at Texas Tech University Health Sciences Center in Lubbock, Texas, and serves as a mentor to the Texas Tech Innovations Hub. He is a past president of the Texas College of Emergency Physicians and currently serves on the Governor’s EMS & Trauma Advisory Council of Texas.
Rate and review the EMS One-Stop podcastEnjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.
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