EMS One-Stop

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

In this episode of EMS One-Stop, Rob Lawrence travels to New York City to sit down with Lillian Bonsignore, the 37th Commissioner of the Fire Department of the City of New York (FDNY). A 30-plus year veteran who rose through the ranks of EMS — from EMT in the South Bronx to Chief of EMS and now Commissioner — Bonsignore brings a ground-up understanding of the largest fire-EMS system in the United States. She reflects on stepping into the role as “walking onto a fast-moving train,” immediately confronted with major incidents, severe weather and system pressures, while simultaneously building her leadership team and setting direction for the future. | MORE: ‘We have to right the ship’: FDNY commissioner doubles down on EMS pay parity The conversation explores the unique structure of FDNY, where the Commissioner operates as the executive leader “almost like CEO of the company,” while operational command sits with the Chief of Department. Bonsignore is clear-eyed about the scale and demands of the system: over 2.2 million runs annually, with 1.6 million EMS-related, reinforcing her long-held position that EMS must be treated as an essential service with appropriate funding and career pathways. Drawing on her experience leading through the COVID-19 pandemic and responding on Sept. 11, 2001, she emphasizes resilience, communication and presence — being visible in stations, honest with staff and committed to supporting those who “leave their own families behind to go serve a stranger.” Bonsignore also addresses criticism of her appointment directly and without hesitation, framing it as a misunderstanding of the Commissioner’s role and the realities of modern emergency response. She underscores that FDNY is both fire and EMS, and that her career — spanning 9/11 response, pandemic leadership and decades of frontline service — positions her to lead the entire enterprise. Looking ahead, she speaks to the need for infrastructure investment, workforce stabilization, mental health support, and the thoughtful adoption of technologies such as AI and body-worn cameras. As FDNY approaches the 25th anniversary of 9/11 and the nation’s 250th year, her focus remains clear: support the workforce, strengthen the system, and prepare the department for the next generation of service. Key quotes from Commissioner Bonsignore “Walking into a position like this is like walking onto a fast-moving train.” “I understand the ground level challenges that go on because I lived them.” “The commissioner is the administrative level, almost like CEO of the company.” “We’re responding to over 2.2 million runs a year … 1.6 million of those runs are EMS-related runs.” “We have to stabilize our system … it’s time that EMS is finally treated as an essential service.” “I will always tell you the truth. You may not like my truth, but I will give it to you.” “The decision of a first responder is to leave their own families behind … to go serve a stranger.” “They are literally your heroes … they will put their lives on the line for you.” Episode timeline 01:10 – First 100 days as Commissioner — “fast-moving train” 02:30 – Career journey and EMS roots shaping leadership 04:30 – Workforce trust, credibility and lived experience 06:30 – Pay parity and EMS as an essential service 09:00 – Structure of FDNY — Commissioner vs. operational command 11:30 – Setting direction and stabilizing the organization 13:30 – Relationship with the Mayor and political leadership 17:30 – Addressing criticism and misconceptions 19:30 – Leading through COVID — scale, innovation, mutual aid 23:30 – Morale, resilience and leadership presence 26:30 – Recruitment and retention challenges 30:30 – AI and future innovation in EMS 32:30 – Behavioral health response and BeHeard program 36:30 – First responder mental health and support systems 38:30 – Violence against EMS and workforce protection 41:00 – Body-worn cameras and transparency 43:30 – 9/11 reflections and legacy 50:

This edition of EMS One-Stop, recorded at the inaugural National EMS Management Association conference in Arlington, Virginia, pairs two complementary conversations about leadership and the future of EMS. In the first half, General Robert Neller brings a military leader’s lens to universal leadership truths: lead yourself first, remember that everyone is watching, stay humble, listen better and understand that decisiveness matters. His message is simple and sharp. People want leaders who will set the example, make the call when it matters, and balance standards with empathy. | MORE: EMS Leadership Institute — AI and the future of EMS In the second half, NEMSMA President Dr. Hezedean Smith reflects on a successful launch for the conference and looks ahead to where EMS leadership must go next. He frames this association as a growing home for mentorship, shared learning and strategic thinking, while also pointing to the disruptive forces already reshaping the profession: Artificial intelligence Redesigned systems Recruitment and retention pressures The possibility of autonomous ambulance operations Taken together, the episode is both a leadership masterclass and a forward look at an EMS profession that cannot afford to stand still. Episode timeline 00:39 – Rob sets the scene from the inaugural NEMSMA conference in Northern Virginia. 00:51 – Rob introduces General Neller as the opening keynote speaker. 01:38 – General Neller explains his leadership “roadmap,” beginning with leading yourself first. 03:38 – Rob and General Neller discuss how leaders are always being watched. 06:04 – Advice for the newly promoted EMS lieutenant: growth takes time, ask for advice, study and learn. 08:11 – General Neller reflects on what he wishes he had known earlier in his career: be a better listener. 09:41 – The “don’t eat the cake” story becomes a lesson in humility and example-setting. 11:42 – General Neller discusses when leaders must consult and when they must simply decide. 13:22 – Final leadership theme from General Neller: empathy strengthens standards rather than weakening them. 17:04 – Rob returns with Dr. Hezedean Smith, President of NEMSMA. 17:18 – Dr. Smith describes the early success of the inaugural conference and strong turnout. 18:12 – Dr. Smith confirms planning is already underway for next year because the event has outgrown the venue. 19:25 – Discussion shifts to the future direction of EMS leadership and system design. 19:49 – Dr. Smith highlights AI, system redesign, and recruitment and retention as major themes. 20:47 – Dr. Smith talks about self-driving ambulances, solar-powered systems and rapid technological change. 21:38 – Dr. Smith emphasizes that technology must make providers’ work easier, not harder. 22:22 – Rob asks why people should join NEMSMA. 22:28 – Dr. Smith outlines mentorship, information sharing and rapid organizational growth. 23:13 – Dr. Smith closes by reaffirming NEMSMA’s role in the EMS leadership space. 23:46 – Rob signs off from what he calls an “amazing time” at the conference. Enjoying the show? Email editor@ems1.com to share feedback.

EMS on the Hill isn’t just a date on the calendar — it’s the profession’s annual moment to stand in front of Congress and tell the EMS story with clarity, confidence and unity. In this edition of EMS One-Stop, Rob Lawrence is joined by NAEMT President, Chris Way, to preview EMS on the Hill (March 25–26, 2026) and explain why this event matters now more than ever: EMS is where most Americans first enter the healthcare system, and the care delivered in the field is no longer “drive-you-to-the-hospital medicine.” Chris and Rob also unpack what’s changed — the scale of collaboration across national organizations and the discipline of going to Capitol Hill with aligned priorities and a shared message. They walk listeners through the event flow (Education Day, briefings, Hill visits, awards and reception), the importance of working relationships with staffers, and the advocacy “ask” that could reshape the future: reimbursement for treatment in place, mobile integrated healthcare/community paramedicine, and sustainable support for initiatives like prehospital blood. The throughline is simple: show up, speak with one voice, and translate momentum into legislative wins. Additional resources: EMS on the Hill Day One voice, one profession — EMS leaders open summit with call for unity and coordinated action Episode timeline 00:00 – Chris Way frames the goal: becoming a trusted, go-to EMS resource for lawmakers 00:52 – Why EMS on the Hill matters; EMS as the front door of healthcare; call to action 02:16 – Advocacy theme and EMS on the Hill as the seminal D.C. event 03:27 – Kansas City summit recap; commitment to making it annual; “stronger together” 05:39 – Evolution of EMS on the Hill into a multi-organization partnership; one message 08:24 – Logistics overview begins: dates, hotel, education day, briefings, awards 10:16 – How to succeed in legislative meetings: reading the room, time limits, staffer relationships 17:14 – Priority bills: treatment in place, MIH/CP, whole blood, NAMSP priorities 21:02 – “This is ongoing” collaboration: monthly cross-organization calls, broader coordination 24:05 – Chris shares his recommended approach: prep, priorities, cards/coins, questions, follow-up 27:34 – Rob’s add-ons: photos after meetings, tagging lawmakers, comms/PR value 28:59 – Final logistics recap; what to expect as a first-timer at state tables 30:37 – Chris closes: unprecedented partnership, focus to “get this done” 31:14 – Rob plugs state-level advocacy (CAA Stars/Capitol Day) Email editor@ems1.com to share feedback.

In this episode of EMS One-Stop, Dr. Linda Dykes joins Rob Lawrence from the UK for a wide-ranging, transatlantic conversation that starts with workplace culture and ends with a practical look at how health systems can keep patients safely at home. In the first half, Linda breaks down her newly published (open-access) qualitative paper, provocatively titled “It’s not bullying if I do it to everyone,” drawn from UK NHS “Med Twitter” responses: a raw, heartbreaking window into the red flags of toxic workplace culture, how bullying is experienced in the eye of the beholder, and why incivility and silence are not just HR problems — they’re patient safety threats. In the second half, Linda brings listeners into the UK’s evolving admission alternative world: frailty care at home, urgent community response models, and the increasingly important interface between EMS and community-based teams. She explains the UK’s SPOA (single point of access) concept, why she dislikes the term “admission avoidance,” and how ED crowding and access change the risk-benefit equation for hospital vs. home. Rob connects the dots back to the U.S. reality — reimbursement, APOT/wall time, treatment-in-place policy — and why this work is becoming a shared challenge on both sides of the Atlantic. Timeline 00:51 – Rob opens, recaps NAEMSP in Tampa and recent content. 02:25 – Rob introduces Linda as the “triple threat” (emergency medicine, primary care/GP, geriatrics) and tees up two-part discussion. 05:39 – Rob introduces Linda’s paper: “It’s not bullying if I do it to everyone.” 06:13 – Linda explains why toxic culture is increasingly visible and how the tweet prompt became a dataset. 07:33 – “Flash mob research group” forms; Linda explains social-media-to-qualitative methodology and limitations. 10:03 – Rob asks about bias; Linda clarifies purpose: insight, not representativeness. 16:39 – Linda defines gaslighting and why it’s so destabilizing. 18:21 – Reactions to publication; resonance, sharing and uncomfortable self-reflection on learned behaviors. 20:18 – The “16:55 Friday email” as a weapon — and as an accidental harm. 23:29 – Leadership as “the sponge” — absorbing pressure rather than passing it down. 25:27 – “One thing right now”: know the impact your words can have, especially on vulnerable staff. 26:41 – Rob on “pressure bubbles,” micro-movements and atmospherics: how leaders shift climate without realizing it. 30:53 – SPOA explained: single point of access and urgent community response behind it. 33:03 – EMS interface: calling before conveyance to find safe pathways to keep patients at home. 35:47 – Linda on mortality risk of access block/long waits and how that reframes risk decisions. 37:19 – Evolving models: primary care-led response vs. hospital at home approaches. 39:34 – Clinical myths challenged: oral antibiotics sometimes non-inferior to IV in conditions we assumed needed admission. 40:34 – Outcomes: hospital at home trial signals safety and fewer patients in institutional care by 6 months. 42:00 – Telemedicine/telehealth: underutilized but useful; when you still need a senior clinician in person. 44:50 – Closing takeaways: read the paper (with trigger warning); admission alternative work is deeply satisfying. Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode.

In this episode of EMS One-Stop, Sophie Fuller — better known across social media as Paramedic Sophie — joins host Rob Lawrence for a candid, energizing conversation about what it really feels like to work in EMS right now: pride, the pressure, the burnout, and the culture issues that too many providers have been taught to silently absorb. Sophie is a critical care ground paramedic, flight paramedic, educator and president of the Tennessee Association of EMS Providers (TAEMSP), and she brings a provider-first lens to everything from leadership visibility, to mental health and pay equity. Together, Rob and Sophie dig into why Sophie started creating content in the first place (hint: burnout and the need to connect), how social media can be used as a force for good, and what “healthy” EMS culture should look like in practice. Sophie shares practical advice for crews and leaders alike: Be human Say the uncomfortable thing Stop normalizing harm Build systems that “care back” for the people doing the work Memorable quotes “We're just working in systems that haven't yet learned how to care back for the provider.” — Sophie Fuller “Management by walking about. Don't be stuck in the office. Don't say my door is always open because that relies on people coming in to see you. Get out and go and see them.” — Rob Lawrence “We love this job and that distracts us from the fact that it's also hurting us.” — Sophie Fuller “Just because it's normal doesn't mean it's healthy.” — Sophie Fuller “We confuse trauma with tradition.” — Sophie Fuller Additional resources: Follow Paramedic Sophie on: YouTube Tik Tok “The Next Shift : A mentorship workbook for EMTs and Paramedics” | E-Book, by Sophie Fuller “To Err is Human: Building a Safer Health System” - PubMed Episode timeline 01:00 – Rob introduces Sophie Fuller (“Paramedic Sophie”) and frames the influencer vs. “effluencer” concept 02:14 – Sophie’s origin story: graphic design → hospital tech → EMT → volunteer fire → paramedic → critical care → flight 06:16 – TAEMSP: why Tennessee needed a provider-level association and the shift toward legislative advocacy 08:05 – Why she started with social media: two full-time 911 jobs, low pay, burnout and the need for an outlet/connection 09:32 – Defining EMS burnout: the “jar on the shelf” and cumulative strain that becomes chronic fatigue 13:26 – Sophie’s guidance to providers: vulnerability, telling the truth and not letting naysayers silence needed conversations 16:00 – Sophie’s message to leadership: don’t be the “Wizard of Oz” — show up, communicate and stay connected to crews 20:26 – EMS culture: self-sacrifice, silence, “earning your place through suffering,” and confusing trauma with tradition 23:10 – Sophie’s book “The Next Shift”: a field guide to “learn, lead and last” in EMS 26:03 – Mistakes and “just culture”: reporting, mentoring, anonymous reporting systems, and learning vs. blame 32:08 – Closing challenge: stop normalizing harm; speak up for culture and patient care 33:14 – Where to find Sophie online and how large her platform has become Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode.

Dr. Douglas Kupas joins Rob Lawrence to kick off EMS One-Stop in 2026, reflecting on his first year as President of NAEMSP — a year he describes as fast-moving, complex and occasionally “whack-a-mole,” with emerging issues demanding real-time leadership while long-term priorities still had to move forward. He shares what he’s learned about the presidency, the value of NAEMSP’s leadership “bench strength,” and why advocacy and coalition-building across national EMS organizations has become more coordinated, more strategic and more essential. The conversation then turns to what’s immediately ahead: the NAEMSP Annual Meeting in Tampa (late January), including pre-conference courses, the flagship Medical Director’s Course, and a packed scientific program. Kupas highlights a keynote focused on transforming battlefield trauma care; major research programming through oral abstracts and hundreds of posters; and high-impact sessions spanning clinical care, operations, legal issues, and international perspectives — reinforcing why the Tampa meeting remains a must-attend event for anyone serious about the science and future of EMS. Episode timeline 00:00 – Rob tees up NAEMSP Annual Meeting growth as a “good problem to have”00:50 – Welcome/Happy New Year 2026; Dr. Kupas introduced as first guest of the year01:45 – Year one as NAEMSP president: what’s surprised Dr. Kupas, pace of work, governance “bench strength”04:26 – NEMSAC termination: what happened, what NAEMSP hopes comes next07:02 – Building the pipeline: medical student/resident interest group, travel support ideas08:47 – “Hot off the press:” NAEMSP accepted into WHO Acute Care Action Network10:08 – Advocacy “hunting as a pack:” overlapping national orgs, EMS on the Hill coordination12:40 – Why Hill visits work: stories, staffers and why first-timers matter16:48 – “White hat” advocacy and patient-centered priorities; ED wall time as a key issue20:07 – Tampa preview: “It’s not just for docs,” NAEMSP membership structure22:11 – Pre-cons overview: Medical Director’s Course, QI workshop, MIH, ventilation, blood, TECC23:55 – Keynote: Dr. Frank Butler and special intro by Dr. Bob Mabry; Grand Rounds obstetric focus27:45 – Major legal session format and why legal content draws a crowd29:28 – Space constraints and future planning: small convention centers; San Diego “buyout” scale31:49 – Research explosion: oral abstracts, posters, receptions; better ways to access abstracts34:39 – “Meat of the conference:” operations, clinical topics, international speakers/learning36:49 – Closing question: Bill details Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode.

As EMS closes out 2025, host Rob Lawrence is joined by Matt Zavadsky (PWWAG) and Rodney Dyche (Patient Care EMS Solutions) for their second annual EMSIntel.org “year in review” conversation — a fast-moving tour through the biggest stories shaping the EMS profession. Drawing from the EMSIntel news log (now 3,849 stories as of the morning of recording), the trio connects what’s making headlines to what EMS leaders are experiencing on the ground: unstable economics, governance pressure, system redesign and rising operational risk. The discussion lands on several recurring themes: economic sustainability as the dominant issue; the real-world politics of tax levies and “essential service” designations; the ongoing obsession with response times (and what they cost); preventable ambulance thefts escalating in severity; and the importance of measuring and publishing clinical outcomes and meaningful performance metrics. The through-line: communities are being forced into more honest conversations about what they can afford — and what EMS should look like going into 2026. | SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond Memorable quotes “Having a thoughtful conversation about what your system needs to look like on the go forward is paramount.” — Rodney Dyche “If you don’t talk about yourself, somebody else will, and then you don’t control the narrative.” — Rob Lawrence “Our No. 1 focus really needs to be on the economic sustainability of these systems because we are past the breaking point.” — Matt Zavadsky “Response times equals speed; speed equals crashes.” — Rob Lawrence “These theft incidents are … in almost all cases, 100% preventable by an aftermarket device … probably for 100 or $150.” — Rodney Dyche “Response times are expensive. The shorter that you want your response times, the more money it’s going to take.” — Matt Zavadsky “Across every provider type … the fee-for-service revenue is 50% to 60% below the cost of providing service. So when somebody says to you, ‘I can do this for free,’ ask more questions.” — Matt Zavadsky “Response times are used as a cudgel.” — Rodney Dyche Episode timeline 01:11 – Rob introduces the end of 2025 reflection and 2026 look-ahead; welcomes Matt Zavadsky and Rodney Dyche for the second annual EMSIntel year-in-review. 02:26 – Rodney reports the EMSIntel log count (“3,849 as of this morning”); Rob explains EMSIntel’s purpose: curating national EMS stories to identify themes and brief stakeholders. 04:13 – Matt names the year’s biggest issue: economic sustainability; the fiscal model is broken and impacts everything else.06:32 – Matt walks through the “AnyTown EMS” trajectory: communities can’t sustain old models, must define service levels, use system intelligence, and redesign for a modern “2028 model.” 09:06 – Matt cites the Medicare/RAND cost collection findings and warns that fee-for-service revenue sits far below actual costs; “ask more questions” when someone promises “free.” 10:12 – The group discusses communities pursuing tax levies and essential-service framing; Rodney contrasts places that pass funding measures with places that don’t, and highlights local politics and competing priorities. 11:52 – Matt clarifies that “essential service” means different things to the public versus statute; agencies need trust, transparency and real community education to succeed at the ballot box. 13:50 – Rodney describes the “cost of readiness” misunderstanding (public sees mileage, not readiness); Matt pushes proactive reporting (monthly/quarterly/annual) to build credibility. 15:35 – Matt pivots to response times: they’re expensive, clinically relevant in a small fraction of cases, and should be approached with evidence-based expectations and better triage/EMD practices. 18:14 – Rodney connects hot responses to preventable intersection crashes and modern driver realities; the discussion frames safety risk as a growing operational storyline. 20:21 – Matt a

Recorded on the floor of the EMS|MC EMSpire Conference in Charleston, South Carolina, this episode of EMS One-Stop finds host Rob Lawrence in conversation with long-time collaborator and EMS advocate Matt Zavadsky. Fresh off the longest federal government shutdown in history, Rob and Matt unpack what the hyper-turbulence in Washington really means for EMS: suspended Medicare extenders, disrupted grant programs, agencies taking out loans just to meet payroll and training programs put on hold. They break down NAEMT’s flash poll on the shutdown’s impact, the promise of the Treatment in Place (TIP) legislation, and why associations “hunting as a pack” on Capitol Hill matters more than ever. Along the way, they spotlight EMSIntel.org as a national barometer of EMS funding, staffing and response time crises, and issue a clear call to action for providers, billers and leaders to use association tools to contact their members of Congress. | MORE: Government reopens: What EMS providers need to know right now In the second half, Rob is joined by Dr. Shannon Gollnick, paramedic, EMS leader and organizational psychologist, to explore how artificial intelligence is reshaping EMS — right now. Shannon makes the case that AI is “not the future; it is the present,” and that agency leaders must urgently build literacy, policies and guardrails around its use. They dig into the difference between HIPAA-compliant, embedded AI in ePCR systems, and risky open tools like ChatGPT, touching on hallucinations, embedded code and emerging Medicare fraud-detection programs. | MORE: Artificial to augmented intelligence. How Dr. Shannon Gollnick wants EMS to work smarter, not harder Rob and Shannon talk about AI as a powerful but potentially dangerous tool — “like having a tiger” — and outline practical steps for chiefs: Ask: “Do we have an AI policy?” Define what AI can and cannot be used for Insist that every AI-generated work product is double-checked by a human before it hits the record Memorable quotes “We weren't here to actually scare you off it. We're here to let you know that it's here, but it's like having a tiger, right? We all love to have a tiger, but it has to be contained in some sort of guard, otherwise it's going to run rife and cause havoc, and we don't want that.” — Rob Lawrence “This is part of the hyper-turbulence that's occurring in EMS right now.” — Matt Zavadsky “So I think the message for the profession right now is, now is not the time to put your foot on the brake. It's time to put your foot on the gas.” — Matt Zavadsky “We put the fun into function.” — Dr. Shannon Gollnick “I think it's important to understand that AI is not the future. It is the present. We are currently here right now. And it's nothing to be afraid of.” — Dr. Shannon Gollnick “If you're not doing it, I promise you that your staff is doing it and they're playing around with AI.” — Dr. Shannon Gollnick “Guardrails don't exist from a congressional standpoint. They don't exist from a regulatory standpoint. The technology is moving far too fast. So we as agency leaders have to take the lead in putting up some of those guardrails.” — Dr. Shannon Gollnick “There are ePCR software out there that are using proprietary AI that will use AI-generated narratives. And that absolutely is 100% good to go. What we don't want to see is our crews putting in their ChatGPT to have ChatGPT write their narrative.” — Dr. Shannon Gollnick “ChatGPT has embedded code inside of it that you can't see, but that code is there ... so what we're kind of afraid to do is to say, hey, what happens 6 months from now, 8 months from now when Medicare does an audit, they run your ePCRs and find all of this embedded code from ChatGPT ... you open yourself up for a lot of compliance issues.” — Dr. Shannon Gollnick Additional resources: EMS Intel EMS News Tracker American Ambulance Association Advocacy NAEMT Advocacy EMS shutdown survival: What leaders need

From Medicare cuts to billing delays, Asbel Montes joins Rob Lawrence to share practical strategies EMS agencies can use to weather the reimbursement storm In this episode of the EMS One-Stop podcast, we tackle the fast-moving realities of a federal shutdown and what it means for EMS finance, reimbursement and day-to-day operations. Rob Lawrence sits down with Solutions Group’s Asbel Montes — a veteran of EMS reimbursement and policy expertise — to decode where Congress is (and isn’t), what CMS’s temporary claims hold really means, and how ambulance services can protect cash flow while preparing for potential reprocessing chaos if extenders aren’t promptly restored. Beyond the headlines, Montes lays out a pragmatic playbook: build a Plan B for cash continuity, align with your billing team on reprocessing workflows, and model exposure across payers tied to the Medicare fee schedule. The conversation then widens to balance billing — why federal change is unlikely soon and why state-level action is delivering practical protections — before closing with leadership lessons on adaptation, data and telling EMS’s story as a guide, not the hero. Memorable quotes from Asbel Montes “Our extender expired — that’s that additional payment that we get from Medicare of that 2%, 3%, 22.6% — it expired September the 30th, and it was tied to the House-approved CR that went over to the Senate.” “We’re solutions givers, as we say here at Solutions Group, not crisis managers. And if you have a plan, I can at least execute a plan.” “What turned out to be a smaller amount, now the cost associated with it, you started to really understand the complexities that really happened in people’s AR.” “If this lasts longer than 15 days … then I would basically have a plan in place. So I would be trying to find out from my billing team … what is your contingency plan to ensure I don’t see a hiccup in cash moving forward?” “The only way government can really invoke change is to make it hit where it hurts. And that’s what’s going on right now. They’re hitting the pocketbook and our industry is grappling with it right now.” Additional resources Asbel Montes: The government shutdown’s ripple effect on healthcare The Leadership Lab with Asbel Montes Episode timeline & key moments 00:21 – Why the shutdown matters to EMS reimbursement and operations 01:21 – Montes’s 101: role at Solutions Group; 28 years in EMS finance and policy 02:40 – Historical context: number and length of shutdowns; current Hill outlook 03:48 – The ambulance extenders expired (2% urban, 3% rural, 22.6% super-rural); CMS claims hold window 05:03 – Planning posture: realistic timelines; “we’re solutions givers, not crisis managers” 06:12 – Back-of-the-napkin math: short-term dollars vs. long-term reprocessing burden 07:43 – 2015–2016 déjà vu: retroactive fixes and the heavy lift for back-office AR 10:26 – Secondary impacts: VA eligibility, appeals, enrollments during a prolonged shutdown 11:11 – The “three-legged stool” for leaders: (1) have a plan with billing; (2) reconcile accounts & patient balances; (3) prevent cash-flow lag if more than15 days 14:06 – Framing the moment: “hurricane shutdown” response and recovery mindset 15:43 – Balance billing at the federal level: committee work, political pain and why movement is unlikely soon 18:19 – State action wins: consumer protections and access; examples of Medicare-indexed approaches 20:24 – Why ground ambulance stayed out of federal NSA; local regulation and state primacy 22:42 – “All politics are local”: using EMS’s public visibility to advocate for patients and providers 23:09 – Adaptation over preservation: seize the 6-18 month window; let data and clinicians lead reform 27:13 – Lawrence’s “Darwinism” takeaway: adaptation as survival 28:31 – The Leadership Lab podcast: purpose, cadence and upcoming guests; Montes’s leadership journey Rate and review the EMS One-Stop podcast Enjoying the show? Please take a moment to rate

In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Patrick Pianezza, co-writer of the new EMS film “Code 3”, a deeply honest and compelling portrayal of life on the ambulance. The film stars Rainn Wilson (“The Office”), Lil Rel Howery (“Free Guy”) and Aimee Carrero (“Elena of Avalor”), delivering a powerful performance that captures both the pressures and the humanity of EMS work. Using real-world experiences and stories from the field, “Code 3” highlights the passion, dedication and emotional toll experienced by EMS professionals every day. From burnout, to systemic challenges, the movie invites the public into the high-stakes world of emergency medical services, showing both the challenges and the heart behind the uniform. Patrick and Rob discuss not only the storytelling process, but also the personal experiences that informed the movie. Pianezza candidly shares the emotional toll of EMS work, the reality of burnout and the importance of mental health support for first responders. This episode is both a celebration of the dedication of those who serve in 911 and a call for awareness and gratitude for the vital work they perform. “Code 3” opens in selected cinemas on Sept. 12, 2025. Memorable quotes “I remember going to one of my old bosses and saying, ‘I think I'm burning out.’ The reaction I got was this dark chuckle … ‘We're all burnt out. Get back on the truck.’ That kind of festering mentality is not healthy.” — Patrick Pianezza “Six out of six people that I have worked with have unfortunately [died by] suicide, and the suicide rates for first responders is double that of the regular population … which is a statistic we need to fix.” — Patrick Pianezza “And it is … a good representation of life on the truck, on the street, with a guy who’s clearly burned out; but a person that cares, that has passion, commitment and will always do the right thing.” — Patrick Pianezza “There was no way to confront the story without talking about salaries, without talking about reimbursements … No one's gonna see a movie about Medicare, Medicaid, but we are as honest as we can be.” — Patrick Pianezza “This movie is nothing more than a gratitude tour for everyone who works in 911 … I’ll be a broken record here: thank you for what it is that you do because it matters. I’ve been in those boots and I’m here to tell you thank you.” — Patrick Pianezza “And as I say in my review, those who know me know my ability to take tactical naps during movies. Well, this one got two eyes open and absolutely five stars.” — Rob Lawrence Episode timeline 00:00 – Introduction: Rob Lawrence introduces Patrick Pianezza and the film “Code 3” starring Rainn Wilson 02:31 – Origins of “Code 3:” How the project started and the vision behind telling an authentic EMS story 05:01 – Creative team & casting: working with actors, crew and Rainn Wilson 08:01 – On-the-Street authenticity: translating real EMS experiences into the film 12:01 – Depicting burnout: emotional and mental challenges in EMS work 16:01 – Mental health & seeking help: Autobiographical elements and confronting burnout 20:01 – Systemic issues: salaries, Medicare, and Medicaid reimbursement challenges 24:01 – Impact on families & relationships: emotional toll beyond the job 27:01 – Personal reflection: Patrick’s journey, struggles and growth in EMS 29:01 – Gratitude tour: purpose of the film and acknowledging EMS professionals 32:01 – Closing thoughts: film release details, upcoming trailer and final messages of appreciation Enjoying the show? Send an email to editor@ems1.com to share feedback or suggest guests for upcoming episodes.

In this episode of the EMS One-Stop podcast, host Rob Lawrence climbs back onto his soapbox to discuss two topics that directly impact on every EMS agency in America — the CAAS Ground Vehicle Standards (GVS) 4.0 and the simple, inexpensive steps we can take to stop ambulance theft. Joining Rob is longtime EMS leader and current CAAS GVS Administrator Mark Postma, who walks us through the origins of the standards, their national adoption and what’s new in the latest update. From ambulance remounting, to structural safety testing, Mark explains how GVS 4.0 has evolved to keep pace with manufacturing realities, supply chain delays and operational needs. The conversation then shifts to a shared passion for protecting fleet assets. Rob and Mark dissect the shockingly frequent problem of ambulance theft and how a $200 automatic immobilization device can prevent a $250,000 vehicle from disappearing — without relying on crews to remember to lock it. Additional resources: CAAS GVS V4.0 – Ground Vehicle Standard Commission on Accreditation of Ambulance Services (CAAS) – The New Standard in Mobile Healthcare Ambulance thefts in the U.S. surge: Over 40 stolen rigs in 18 months 6 ways to safety-proof your EMS fleet Memorable quotes "It’s no good going to City Council or to your board of directors on day 365 and saying, ‘I need a new truck for New Year day one’ — that’s not going to happen." — Rob Lawrence "The ground vehicle standard has become the standard that most vehicles are being built to and that state EMS officials are using." — Mark Postma "We spend a lot of time thinking about where things go in the box … add one more thing to your checklist: can the vehicle indeed be immobilized?" — Rob Lawrence "There’s just no reason why ambulances are being stolen with the current technology that’s out there." — Mark Postma Episode timeline 00:45 – Rob introduces the topic: GVS 4.0 and ambulance theft concerns 01:34 – Mark introduction and CAAS GVS role 04:11 – How the CAAS standards were developed and adopted by 35-plus states 06:09 – Comparing CAAS GVS to NFPA ambulance standards 06:48 – The rise of remounting, especially during COVID supply shortages 10:26 – Discussion of ongoing vehicle delivery delays and need for replacement planning 15:04 – What’s new in GVS 4.0 — major changes and safety structure updates 19:38 – Ambulance theft statistics and the GVS anti-theft requirement 22:28 – Automatic immobilization and why manual systems fail 23:57 – Mark shares success story: zero thefts since installing devices 26:17 – Exceptions in standards and why state inspectors must enforce anti-theft 27:42 – Final thoughts on making anti-theft part of fleet planning Enjoying the show? Email editor@ems1.com to share feedback and suggest future guests.

In this high-impact edition of the EMS One-Stop podcast, host Rob Lawrence sits down with EMS influencer and educator Jimmy Apple, known widely across platforms as The EMS Avenger. With nearly 70,000 followers on TikTok and a growing presence on Instagram and Facebook, Jimmy has mastered the art of compressing complex clinical topics into digestible, engaging content. | More: What the EMS Counts Act means for dual-role EMS providers In this conversation, Rob pulls back the curtain on the man behind the mobile screen — exploring Jimmy's journey from electrician to pediatric critical care paramedic, and now, one of EMS's most watched and listened-to voices. Listeners will gain deep insight into Jimmy’s origin story, his social media strategies, his refusal to let bad information go unchallenged, and his passionate belief that “Saving lives begins with kindness.” The pair also tackle: Content creation advice for EMS agencies The challenges of tone and accuracy in short-form video How to maintain compassion in the face of a toxic work culture This episode is part masterclass in communication, part call to action for the future of EMS — and all heart. Memorable quotes from Jimmy Apple: The EMS Avenger “Saving lives begins with kindness. That is my motto, it is my philosophy.” “You have to package something down to its bare essence … there's some nuance lost, but you have seconds to keep people's attention.” “My goals going forward are to support people who are acting in good faith while correcting the misinformation.” “Generally speaking, you will draw the engagement that you're looking for. If you're putting out content in good faith, you'll get good faith engagement.” “We are responsible for ourselves and how we respond … and I believe we need to respond to everything that is happening in the world today with kindness.” Episode timeline 00:54 – Rob introduces Jimmy Apple, aka the EMS Avenger 01:20 – Jimmy’s background: from electrician to EMS 03:30 – The grandfather conversation that changed his life 04:50 – How pathophysiology sparked a love for learning 05:40 – Birth of the EMS Avenger: from student favorite to TikTok influencer 06:55 – Ginger Locke’s advice that redirected Jimmy’s podcast path 08:04 – Compressing content: "from textbook to bumper sticker" 10:00 – The content hook: “Are we getting rid of normal saline?” 11:00 – How Jimmy selects topics: research, news, curiosity and requests 13:00 – Hot topics in EMS: cricothyrotomy, TXA, ketamine, provider safety 14:40 – Rob discusses EMSIntel.org and ambulance theft data 16:00 – Can EMS agencies do what Jimmy does? The risks and the realities 18:30 – "Stop the finger": creating content that captures attention 20:00 – Rob on the risks of public messaging and backlash 21:00 – Calling out misinformation: the line between education and shame 23:00 – Jimmy’s growing reach across TikTok, Instagram and Facebook 24:45 – Managing Facebook’s deeper comments and nuanced conversations 26:45 – Jimmy’s rule: “Engage only with good faith” 27:50 – Final thought: EMS must rediscover kindness 29:00 – Closing remarks and where to follow Jimmy Apple online Additional resources Connect with Jimmy Apple, better known as The EMS Avenger: TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger Facebook — Join the group for discussions and shared insights: EMS Avenger community Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series AAA & AIMHI EMS Media Log: EMS Intel Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.