EMS One-Stop

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.

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 hypotension Improving the use of waveform capnography to confirm and monitor all invasive airways Rob 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!

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

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 Highlights 01:14 – 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

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.

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.

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.

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

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.

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 editor@ems1.com to send in guest suggestions, episode feedback or questions for our host. 

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 contents 00:00 – 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.

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 contents 0:05 – 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

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 Lawrence Episode 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 program AAA’s Advocacy program RATE AND REVIEW THE EMS ONE-STOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

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 Zavadsky Episode 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 tracker Analysis 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 podcast Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

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. On October 7, 2023, the Palestinian group Hamas launched a surprise attack on Israel at dawn during the Jewish holiday of Simchat Torah – with armed assailants breaching security barriers and a barrage of rockets fired from Gaza. The attack came 50 years and a day after Egyptian and Syrian forces launched an assault during the Jewish holiday of Yom Kippur in an effort to retrieve territory Israel had taken during a brief conflict in 1967. As the world has seen, terrorists entered Israel. Militants burst into houses, shooting residents begging for their lives and taking others – including women, children and the elderly – hostage, driving the terrified captives back into Gaza. Operating as part of the initial and ongoing response to the events unfolding in Israel is United Hatzalah, a network of more than 6,500 EMS volunteers, with a fleet of emergency medical vehicles, who in peacetime, are able to respond to more than 2,000 medical emergencies per day in an average response time of less than 3 minutes (and in major cities, often less than 90 seconds). Since October 7, United Hatzalah has been pushed to its absolute limits and has expended the majority of its disposable medical equipment. In this special edition of EMS One-Stop, Rob Lawrence speaks with Dov Maisel, United Hatzalah’s Vice President of Operations. Donate to support United Hatzalah’s EMS response: United Hatzalah – Israel is at War | The Chesed Fund TOP QUOTES FROM THIS EPISODE “We are a multi-faith organization, but we are an organization of human beings. What we've underwent here in the past week has nothing to do with human beings. This is barbaric. This is something that I've never witnessed. And I've been through terror waves here in my 30 years of EMS. I've seen buses blown up. I've seen suicide bombers in dozens. Nothing on this scale. This is something that Isis did, we all remember watching the videos of what ISIS did, years ago. This overcomes all of that.” — Dov Maisel “I would say that the amount of tourniquets that we put out in the first 36 hours was in the thousands ... thousands of tourniquets. We treated over 3,000 victims on the ground. The amount of tourniquets, bandages, chest seals, trachs, chest drains, needle applications, tubes that were put out in this first 36, 48 hours of operation is more than what we use, I would say in half a year.” — Dov Maisel “Our ground rule is in EMS, you don't enter a danger zone, but the volunteers getting on the radios with me, I was in HQ when it started, before I headed actually down to the field – they’re calling and screaming for help … the IDF soldiers that started the defense process were understaffed and they had no capabilities to rescue the victims out from the scene. And our volunteers simply, I told them, ‘it's up to you. Literally, it's up to you;’ and they all went in.” — Dov Maisel “There were so many, just try to wrap your thoughts around having 3, 4, 5, 10 gunshot wound patients thrown at you – at one or two medics with one ambulance. You can't pile them up one on top of another. You had volunteers going with their private cars, throw them in the backseats, literally with tourniquets on them. Imagine – tourniquets on all extremities, all extremities, needle in their chest, chest seals – thrown in the back seats of cars driven out two, three kilometers out to the ambulance crews that were waiting there that can treat them.” — Dov Maisel ABOUT OUR GUEST With 30 years of experience, Dov Maisel has dedicated his life to saving the lives of others. When Dov was just 9 years old, he was walking home from school when he witnessed a horrific accident in which a 6-year-old girl was hit by a bus. He decided he never wanted to be helpless when someone in his vicinity so desperately needed lifesaving treatment. By the age of 14, he began volunteering on an ambulance. Maisel has served as a combat paramedic in the Israeli Defense Forces (IDF) in four different wars. After his army service, he began working as an EMT, dispatcher and driver for Israel’s national ambulance service. During the 2000-2003 terror wave in Israel, Maisel personally responded to and managed EMS teams at thousands of terror attacks. Maisel is the inventor and developer of numerous medical devices, including a pocket BVM airway management device, which is used internationally in many armies, including the U.S. Military. In 2006, he was one of the founders of United Hatzalah, Israel’s first all-volunteer EMS organization. He serves as the director of operations, managing national and international operations along with the Israeli police, IDF and Ministry of Health as well as other government bodies. He invented what is now United Hatzalah’s Uber-like GPS-based dispatch system which locates and sends the EMT closest to the medical emergency. Maisel graduated from several NATO- and Red Cross-led international workshops on disaster management and led international relief missions in Haiti, Nepal, Mumbai and, most recently, in both Houston and Florida, after the devasting hurricanes, as the head of international operations of United Hatzalah. He continues to serve as a volunteer, instructor and mass casualty incident manager. He has received the Israel President’s Award for volunteerism and sits on the International Editorial Board of JEMS Magazine. RATE AND REVIEW THE EMS ONESTOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

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. This edition of EMS One-Stop was recorded in New Orleans at the 2023 EMS World Expo.  Host Rob Lawrence is joined by a range of guests who discuss the sessions they presented and the latest developments in clinical medicine. Alexia Jobson, director of public relations at REMSA, discusses top tips for dealing with the media, and she then interviews media pre-con student Katherine Robillard.  Peter Antevy, MD, describes his conference session, titled “Five protocol changes you're too afraid to make.” Brian Maloney of Plum EMS, in Pennsylvania, talks culture of safety, and lights and sirens reduction (and their results within the NEMSQA L&S reduction program). Doug Wolfberg, Esq., of Page, Wolfberg & Wirth, steps in to discuss leadership lessons from the Beatles and his new book – "Beatles FAB but True." The episode concludes with veteran EMS podcasters Chris and Anne Monterra, who offer tips on the art of podcasting. TOP QUOTES FROM THIS EPISODE “‘No comment is a comment!’ So you really want to avoid that as part of your media strategy and work to develop some transparent and honest information when those tough questions come.” — Alexia Jobson “Anything that you say to a reporter is considered on the record and can be used in a news story.” — Alexia Jobson “Top tips for going on camera: You want to make sure that they are knowledgeable about what they are going to be talking about, you want them to be a willing participant and able to re-frame and be positive about the content they are going to cover.” — Alexia Jobson “It's important for you to just spend a little time looking inside your organization, recognize those important stories that you want to share, and then make sure that you commit some time and resources to building those relationships with your audiences ... having that positive relationship in place will go a long way. And it's also important as a profession that we work together to kind of raise the profile of out of hospital healthcare and EMS.” — Alexia Jobson “Getting out the door, our shoot time is the No. 1 thing that can decrease our response times. It's not driving lights and sirens; it's not driving recklessly or speeding or not obeying the laws ... it's getting out that door quick from the time of dispatch to the time our truck's pulling out of the garage.” — Brian Maloney “When we first started looking at the use of lights and sirens during transport to the hospital, which is right there, that increases our chance of getting in a wreck threefold and so it's very dangerous. When we first started it, we were at 26% of the time using lights and sirens during transport; we're down to almost 2%, for transport to the hospital. For response to calls, we were about 46-48% of the time using lights and sirens; we’re down to 7% of the time now.” — Brian Maloney “Antibiotics for sepsis, so a lot of people are fearful of giving antibiotics, and why? Because the hospital says we need to have a culture, a blood culture. Turns out that's not true. If the patient's hypotensive, they're fixing to die, as they say. And we in Palm Beach County can give the antibiotics within 12 minutes of the 911 call. And our own data shows that the hospital is giving antibiotics at 120 minutes. That's a 10-fold difference in that. So, antibiotics for sepsis are, I think, a major item.” — Dr. Peter Antevy “There's a story about how the Beatles had a drummer for a couple of years before Ringo. He wasn't quite the right fit for that band. He's a good drummer. But when they got Ringo in, they took off, right? So, in EMS, we tend to think if somebody has a pulse and a patch, let's hire them or let's bring them in. But we need the right people.” — Doug Wolfberg “Recognize your own limitations, I tell a story about how the Beatles sort of came on hard times when their manager died, but weren't quite wise enough to know what they didn't know. They thought ‘we can manage ourselves,’ and so it’s to also recognize your limitations and get the skills that you need, if you don't possess them yourself, with your team.” — Doug Wolfberg EPISODE CONTENTS 01:15 – Media management with Alexia Jobson (REMSA) 09:22 – Alexia Jobson interviews Katherine Robillard (LA Office of EMS) 11:37 – Brian Maloney (Plum EMS) talks culture of safety and lights and sirens reduction 20:15 – Dr. Peter Antevy on the five protocol changes you're too afraid to make 23:54 – Doug Wolfberg Esq. (Page, Wolfberg & Wirth) on leadership lessons from the Beatles 28:13 – Chris and Anne Monterra on the art of podcasting ABOUT OUR GUESTS Alexia Jobson REMSA Alexia Bratiotis Jobson is the director of public relations and serves the organization by expanding opportunities for engagement, promotion, communication and relationship-building. She has more than two decades of business and communications experience. Prior to joining REMSA Health, Alexia worked as a senior account director with KPS3, where she managed REMSA’s client account, as well as accounts related to industrial real estate and higher education. She held communications-related positions with Renown Health and the Nevada Museum of Art. She holds an Accreditation in Public Relations (APR). This certification asserts professional competence, high ethical standards and mastery of progressive public relations industry practices. She is a Nationally Registered Emergency Medical Technician and is a graduate of the University of Nevada, Reno’s Reynold’s School of Journalism. She serves as the immediate past president of the board of directors for Western Industrial Nevada (WIN), Chair of the Public Relations Committee of AIMHI and chair of the American Ambulance Association Communications Committee. Dr. Peter Antevy Peter M. Antevy, MD. is a pediatric emergency medicine (EM) physician practicing in-hospital emergency medical care at Joe DiMaggio Children’s Hospital, a level I trauma and tertiary care center in South Florida. Board-certified in pediatrics, emergency medicine and the complex subspecialty of EMS, he is also the founder and chief medical officer of Handtevy – Pediatric Emergency Standards, Inc.; and he serves as the medical director for Davie Fire-Rescue, Coral Springs-Parkland Fire Rescue, Southwest Ranches Fire Rescue and United Medical Transport, all in South Florida. Dr. Antevy also serves as associate medical director for several other agencies, including Palm Beach County, Florida, and he is also the longstanding medical director for two highly regarded paramedic training programs as well as several mobile integrated healthcare (MIHC) programs in greater Broward County, Florida. Brian Maloney Brian Maloney has been working in EMS for over 24 years as a practitioner, educator and leader. His EMS career began while attending the University of Pittsburgh, where he obtained his paramedic certification and bachelor’s degree in emergency medicine. Later, he continued his education and achieved his Master of Science degree from Carlow University. He has spent most of his career working in the field and had the opportunity to teach with the Center for Emergency Medicine and the University of Pittsburgh. Currently, he is the director of operations of Plum EMS, where he has been for the past 5 years. His love and appreciation for the EMS profession run deep, and he continuously strives to help make it that much better. Doug Wolfberg, Esq. Doug Wolfberg has been a well-known national EMS leader for decades. He is an EMS attorney and consultant, and a founding partner of Page, Wolfberg & Wirth. He has served as an EMS practitioner and has held positions at the county, regional, statewide and federal levels in his EMS career prior to becoming an attorney. He has written hundreds of articles and has been one of the most highly rated presenters at EMS conferences throughout the U.S. He earned his law degree magna cum laude from Widener University School of Law and holds an undergraduate degree from Penn State University. Doug also serves as an adjunct professor of law at Commonwealth Law School and as an adjunct professor at the University of Pittsburgh. Chris Montera Christopher Montera has more than 34 years of experience in paramedic services, public health, and the fire service. He is the director of State and Federal Programs for ESO and the former chief executive officer at Eagle County Health Service District and holds a master’s degree in health leadership. Chris is serving as the National EMS Museum Treasurer for 2023. Anne Montera Anne Montera received a master’s degree in health leadership from Western Governors University and a BSN from Bethel College. She has over 20 years of nursing experience in public health, labor and delivery, patient safety/quality improvement, and EMS coordination in urban and rural hospitals and community settings, including the use of telemedicine. In her previous role as the senior VP of quality for Ready Responders, she worked to research, develop and implement quality matrix to demonstrate program cost savings and health impact. She was also the executive director for the Central Mountains RETAC, supporting a 6-county EMS and trauma region in Colorado. She is the co-creator and public health partner for the first National Community Paramedic Pilot Program in rural Eagle, Colorado. She received the State of Colorado EMS Region of the year in 2019 and Colorado Nightingale Luminary Award for Innovation work on the Colorado community paramedic program in 2011. ADDITIONAL RESOURCES Team-driven improvement in the use of lights and sirens – Plum EMS use cases demonstrate when the risk of using L&S is lower than the risk of delaying a lifesaving intervention RATE AND REVIEW THE EMS ONE-STOP PODCAST Enjoying the show? Please take a moment to rate and revie

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 August 2020, Shawky S. Amine Eddine, MD, became the EMS commander for the Beirut Port Explosion – the largest non-nuclear explosion in history. The blast killed 200, injured 6,500, and resulted in excess of 300,000 people suffering home damages and losses. In terms of medical facilities in the blast area, four hospitals we rendered totally out of action, with eight further healthcare centers damaged. The explosion added to an already pressurized healthcare system, as the country was at the height of the pandemic, as well as hosting over 900,000 refugees from war-torn Syria. In this episode of EMS One-Stop, Dr. Eddine joins host Rob Lawrence to discuss the backstory and devastation of the explosion, as well as the challenges to access, hospital capacity, communication, record keeping and the management of the dead. Tune in as Dr. Eddine shares 10 takeaways and lessons for responding to a large-scale MCI both identified from that eventful day (discussed in full in the broadcast): Don’t fish in the same lake Factor emotions Leadership tokens are earned in management and spent in command Even in crisis … plan The importance of data Decision making You are not alone – coordinate and communicate Rescuers’ wellbeing is a priority Don’t forget yourself and don’t lose yourself amidst the crisis We make mistakes About our guest Dr. Shawky Amine Eddine, MD, is a medical doctor with special interest in prehospital care, healthcare quality management and disaster management. He has served as an EMT in the Lebanese Red Cross (LRC) since 2007 and as head of station for Damour EMS Station, and is currently acting as LRC director for learning and development, assistant EMS director for training and quality, and COVID-19 response coordinator. Dr. Amine Eddine has commanded multiple crises including Lebanon fires in 2019, Lebanon floods in 2019, protests in 2019-2020, COVID-19 outbreak in 2020 and the Beirut port explosion in 2020. He has led the real-time evaluations of COIVD-19 response. Dr. Amine Eddine is also a disaster management instructor in the Humanitarian Leadership Diploma, offered by Global Health Institute at AUB, an assistant professor at the Faculty of Nursing of the Lebanese Red Cross and a consultant for multiple local, regional and global NGOs. Connect with Dr. Amine Eddine: Twitter: @SAmineeddine LinkedIn EPISODE CONTENTS 1:00 – Introduction Shawky S. Amine Eddine, MD 1:30 – Description of EMS in Lebanon 04:43 – The role of Jerry Overton in the development of EMS in Lebanon 06:18 – Setting the 2020 scene in Lebanon. 09:00 – Ammonium Nitrate – a bomb in the warehouse 12:00 – Gathering the situation: The fog of war! 14:00 – Loss of medical infrastructure due to the blast 17:00 – EMS resources deployed 18:00 – Command and control: The UK GOLD, SILVER and BRONZE system 23:00 – Lessons identified versus lessons learned 23:50 – Don’t fish in the same lake 28:00 – Factor emotions 30:00 – Leadership tokens are earned in management and spent in command 33:00 – Even in crisis … plan 37:00 – The importance of data 40:00 – Decision making 41:40 – You are not alone: Coordinate and communicate 43:00 – Rescuers’ wellbeing is a priority 45:30 – Don’t forget yourself and don’t lose yourself amidst the crisis 48:00 – I make mistakes Additional resources Rapid Response: Beirut blast serves as stark reminder of the power of energetic materials Beirut and beyond: Planning for explosives in your community Forensic review: The Beirut port explosion UN Report: Beirut blast

“Instead of responding to the majority of 999 calls we receive every day, we want to flip that so we only go to those patients who really, really need a double staffed paramedic emergency ambulance quickly.” 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. It’s very clear that Ryan Reynolds and Rob McElhenney have raised the profile of the country of Wales with their “Welcome to Wrexham” football (soccer) team and series, but one Welsh organization – the Welsh Ambulance Service NHS trust – has a vision and world class level of service delivery that should receive equal attention. In this audio and video edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Professor Jason Killens, Chief Executive of the Welsh Ambulance Service.  As the 999 emergency system that serves over 3 million Welsh citizens emerges into a post-pandemic world, Jason describes service delivery, the training and education of its medics and the fact that it is a about to operate without a medical director – in itself a move that identifies that clinical and academic paramedicine has come of age.  As Jason tells Rob, “We are transforming the way we deliver our service here in Wales, looking to tip the service model on its head essentially. Instead of responding to the majority of 999 calls we receive every day, we want to flip that so we only go to those patients who really, really need a double staffed paramedic emergency ambulance quickly … car crashes, broken legs, falls from height, cardiac arrest; and the rest we would service by the means of telephone or video advice, upstream with clinicians in our contact center or with advanced practice clinicians in the community.” TOP QUOTES FROM THIS EPISODE When a patient calls 999, “you could see a traditional road ambulance, but increasingly here in Wales and in other services across the UK, you could see a disposal which includes telephone or video triage and advice from our clinicians in our contact centers – they could be either nurses or paramedics … and we are closing now here in Wales about 15% of all of our emergency calls every day by way of telephone or video consultation without turning a wheel or sending an ambulance” — Jason Killens “If we do respond to the scene, it could be a traditional ambulance or increasingly it could be what we call an advanced paramedic practitioner, so that is an experienced paramedic, who has a degree, who has gone on to masters/education – those advanced paramedic practitioners with a master’s degree, increasingly we are seeing a non-conveyance rate some 35-40% higher than a regular paramedic crew, so what that means is we are able to safely close episodes of care in the community and not respond with a double staffed ambulance/not convey the patient to the emergency department.” — Jason Killens “Fire Brigades and Departments in the UK aren’t associated with medical response – It is the exception in the UK rather than the rule.” — Rob Lawrence “We are not transport organizations anymore, we do transport, but increasingly, we are providers of great clinical care in our communities … but we are looking to stretch and grow so we provide better outcomes for all patients here in Wales, and only convey them to the emergency department when we really need to and we think the solution to that is advance practice in communities with our own people.” — Jason Killens “We have just agreed with our board that when our medical director retires at the end of this year, we will not replace him. We will be the first ambulance service in the UK not to have a medical director on the governance board. Instead, here, we will have our senior clinician leadership provided by our executive director of paramedicine and we are the first ambulance service in the UK to have that role on the board. And we have taken that point of view simply because the paramedic profession has developed over the last two decades, to the point now where we believe we have sufficiently experienced senior clinicians in the paramedic workforce that are able to provide that senior level governance leadership, and direction for our clinical strategy. It is an important signal and message to our paramedic workforce that the glass ceiling is broken and paramedics to join us at 21/22 years old from university can absolutely see a pathway through to senior leadership, to a director on the board, and ultimately to jobs like mine as a paramedic if that’s what they aspire to.” — Jason Killens EPISODE CONTENTS 1:10 –  Introduction of Professor Jason Killens 3:30 – Recruiting Australian paramedics to work in London 4:30 – Explaining EMS organization and control in England, Scotland, Northern Ireland and Wales 8:30 – In the UK, healthcare is free at the point of delivery 11:30 – Geographical distribution of ambulance services in Wales 12:38 – The provision of helicopter emergency medical services (which are mostly charity based, relying on donations to operate) 14:30 – What happens when a citizen calls 999 – how call taking and response is organized 15:30 – Hear and treat and advanced paramedic practitioners 21:10 – The journey of continuous service improvement 23:00 – Paramedic degree and advanced degree education, and career pathways 27:49 – Co-responding agencies including police, fire, the military and citizen responders 29:59 – Future plans for the Welsh Ambulance Service 31:00 – Senior clinical leadership provided by paramedics and not a medical director 34:00 – Fantastic people doing fantastic stuff ABOUT OUR GUEST Professor Jason Killens has spent his career working in Ambulance Services in the UK and Australia. He progressed through the ranks in London Ambulance Service from an EMT to executive director of operations. He was appointed as the chief executive of the South Australia Ambulance Service in 2015 before joining the Welsh Ambulance Service as chief executive in September, 2018. He is an honorary professor at Swansea University’s College of Human and Health Sciences, and the chief executive lead for operations at the Association of Ambulance Chief Executives. About Welsh Ambulance Services NHS Trust Welsh Ambulance Services NHS Trust (WAST) provides healthcare services for people across Wales, delivering high quality and patient-led clinical care, wherever and whenever needed Services include: The blue light emergency ambulance services: including call taking, remote clinical consultation, see-and-treat, and, if necessary, conveyance to an appropriate hospital or alternative treating facility. Non-emergency patient transport service: taking patients to and from hospital appointments, and transferring them between hospitals and treatment facilities. The 111 service: a free-to-call service which incorporates the NHSDW service and the call taking and first stage clinical triage for the out-of-hours GP service. The number was live throughout 2021/22 and the full service was rolled out in Betsi Cadwaladr, Cardiff and Vale University Health Boards in 2021/22, making the complete service universally available across Wales. WAST also supports community first responders, co-responders and uniformed responders to provide additional resources to respond to those most in need of help. During the pandemic, WAST provided the mobile PCR testing service for the whole of Wales. RATE AND REVIEW THE EMS ONESTOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

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 EMS One-Stop international edition, Host Rob Lawrence welcomes Dr. Linda Dykes, an emergency medicine physician from the UK, and Rom Duckworth, fire captain and paramedic EMS coordinator for Ridgefield (CT) Fire Department. The discussion begins with the demise of the U.S. ET3 program, and then the group examine how community paramedicine is thriving in the UK and the lessons to be taken away. Rob and Linda also discuss the EMS World Expo “International Roundup” session they have jointly delivered together for the last 7 years and how they extract best practices from all international attendees. Rob, Rom and Linda then discuss the similarities and differences in emergency management tactics, techniques and procedures, and identify trans-Atlantic lessons already being exchanged. About our guests Dr. Linda Dykes Dr. Linda Dykes qualified from Newcastle (UK) Medical School in 1996, trained in the northeast and Mersey regions, and is one of only a handful of doctors in the UK who are dual-qualified in both Emergency Medicine & Primary Care/General Practice. Even fewer remain active in both specialties, and she is believed to be the only dual-qualified EM/GP in the UK who has also gained experience working in acute community geriatrics, in a "Hospital at Home" service. Linda also spent 2 years working regular shifts in Ambulance Control, and has dabbled in the development of telephone algorithms via a short secondment to NHS111 Cymru/Wales. Equipped with this unique skillset – plus a track record of successfully building up services – Linda sees the NHS through a unique lens, and loves to work at bridging the gap between hospital and community services. Rom Duckworth Rom Duckworth is a dedicated emergency responder, author and educator with more than 30 years of experience working in career and volunteer fire departments, hospital healthcare systems, and private emergency medical services. Rom is currently a career fire captain and paramedic EMS coordinator for Ridgefield (CT) Fire Department, the founder and director of the New England Center for Rescue and Emergency Medicine; and is the recipient of the American Red Cross Hero award, Sepsis Alliance Sepsis Hero award, and the JEMS EMS 10 Innovators award. As the author of chapters in more than a dozen EMS, fire, rescue and medical textbooks, as well as over 100 published articles in firefighting and EMS magazines and websites, Rom is working to advance leadership in modern emergency services education. Learn more Rob, Linda and Rom will also be delivering an international seminar: “Major Incidents & Disasters – an International Masterclass” on Saturday August 5.   For most emergency services personnel, major incidents are a rare event – maybe a handful at most in a career; maybe none. Few will become experts from personal experience alone, so learning from events that have gone before is crucial to preparedness at national, organizational and individual levels. This unique webinar brings you five world-class speakers, each of whom has operational, tactical and/or strategic experience (and some of them all of the above!) of major incidents from the UK, U.S., and Lebanon. Between them, they have responded to incidents ranging from boots on the ground at 9/11, to coordinating the pandemic response for an entire country, and everything in between … bus crashes, train derailments, gas explosions, bioterrorism, forest fires, floods, and hurricanes. This is an event where theory, research and first-hand experiences come together. Our speakers will share not only what they’ve learned from their personal experiences, but what they wish they’d known beforehand and what crucial points they now find themselves passing to others. This webinar is aimed at those who may have to plan for, and/or respond to, major incidents. As well as the obvious emergency service personnel, think also of hospital staff outside ED, council workers, undertakers, utility companies, coroners’ teams and many more. The event is also open to the general public, and promises to be a fascinating and absorbing morning.