EMS One-Stop

Breaking the system to make it stronger

This week on the EMS One-Stop podcast, Rob Lawrence sits down with emergency management and large-scale exercise expert Mike Marsh to explore what really goes into preparing agencies, communities and public safety partners for major events.
With the FIFA World Cup underway, America 250 upon us, and countless local events happening every weekend, the conversation focuses on the practical realities of planning, exercising and pressure-testing emergency response systems before the big day arrives.
| MORE: Training hard and fighting easy. Creating an effective tabletop training exercise for pre-planning MCI response
Drawing on decades of EMS leadership experience and his current work through Marsh EMS Consulting, Mike shares how agencies can move beyond "grant compliance exercises" and build meaningful operational readiness.
From tabletop exercises and ROC drills, to stakeholder coordination, communication failures and after-action reviews, Mike provides a masterclass in how to build resilient systems from the operator up.
His central premise is simple: exercises should be designed to break the system in a safe environment so weaknesses can be identified and corrected before a real incident occurs.
Whether you're preparing for a World Cup match, a county fair, or simply reviewing your MCI plans, this episode offers practical lessons for agencies of every size.
Notable quotes
"Our team is hired to break your system and rebuild it together." — Mike Marsh
"The scene will be bigger than they are. And it is OK to ask for help." — Mike Marsh
"We don't walk in and say, 'You don't understand ICS.' Actually, you do understand ICS, you just don't know that you're using it." — Mike Marsh
"Identifying and learning are two different activities; and they have to be cemented in." — Rob Lawrence
"Trust your people, know that you can't do it all, get a team together, train them, drill them, pressure them." — Mike Marsh
"Prior preparation and planning prevents pathetic performance." — Rob Lawrence
| MORE: 5 lessons for special events standby services and emergency response
Episode timeline
00:00 – Introduction and why major events require planning, exercises and preparation
02:25 – Mike's journey from California EMS leadership to emergency management consulting in Texas
04:53 – The biggest misconceptions about exercises and tabletop planning
06:30 – What frontline EMTs and supervisors need to know when the incident is bigger than they are
08:07 – The first questions Mike asks when planning a major event
10:13 – Communication, stakeholder engagement and identifying operational gaps
12:16 – Translating ICS and NIMS concepts into practical operational language
17:08 – Planning a county fair exercise: where to start and why capability gaps matter
19:46 – Who should be at the planning table and why executive participation matters
21:23 – The role of public works, politicians, emergency managers and public information officers
22:29 – The best and worst exercises Mike has ever experienced
25:29 – How to challenge leaders who believe their plans don't need testing
28:01 – Exercise planning for small and rural systems with limited resources
30:22 – After-action reviews and turning lessons identified into lessons learned
32:11 – Advice for agencies that have never exercised their plans before
33:54 – Mike's biggest leadership lesson from a career in EMS and emergency management
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Pinnacle 2026 preview: Leadership, retention, AI and the future of EMS

The countdown to Pinnacle is on. Returning this year to San Diego from July 13-16, Pinnacle remains one of the most influential leadership and management conferences in EMS. Now entering its 22nd year, the event continues to attract executives, clinical leaders, innovators, educators and industry partners who gather not simply to learn, but to debate, challenge assumptions and shape the future direction of EMS. EMS1 is proud to be the premier media partner of Pinnacle.
| MORE: What Paramedics Want in 2026: Bookmark this page to get your copy
Joining EMS One-Stop this week is Anthony Minge, senior partner at Fitch & Associates and one of the driving forces behind Pinnacle. Anthony previews the major themes emerging this year, including workforce retention, leadership development, burnout and wellness, preparedness, artificial intelligence, blood delivery, drone technology and the ever-popular What Paramedics Want report.
Throughout the discussion, Anthony emphasizes that Pinnacle's value extends beyond the classroom. The real learning often happens in the conversations between sessions, over meals and among peers facing the same challenges across the country.
The conversation explores why retention has overtaken recruitment as EMS's primary workforce concern, how leaders must take greater responsibility for organizational culture, and why emerging technologies such as AI and drone-delivered medical supplies are changing the profession faster than many realize.
Anthony also offers a preview of keynote speakers, including preparedness expert and author William Forstchen, and highlights sessions covering leadership, resilience, operational excellence, workforce wellness and healthcare innovation.
As always, Pinnacle promises to deliver practical takeaways, provocative discussions, and the opportunity to connect with some of the brightest minds in EMS.
Key quotes
"If we can keep our people, we don't need to spend as much time trying to replace them."
"People don't leave organizations, they leave managers."
"Burnout is still too high. One suicide is way too many."
"We can't push it into the dark corners of our organizations and just hope it goes away."
"AI is here to stay. It's going to help us. It's going to do some great things."
"It is never meant to replace this computer right here."
"We practice healthcare. We practice extremely innovative healthcare out there."
"It's amazing the things that are happening out there."
"Good leaders share."
"Being responsible leaders is probably one of our largest challenges."
Additional resources
Pinnacle EMS 2026: Conference information, agenda details, speakers and registration
Conference dates: July 13-16, 2026
Location: Sheraton San Diego Resort
Pinnacle Early Bird Offer: provide the code “EMS26”. This gives early-bird offer provides $100 off the current/regular price
What Paramedics Want: 2026 Report debuts July 13, 2026
William Forstchen’s books
Episode timeline
03:00 – The major themes of Pinnacle 2026. Discussion of retention, leadership, financial sustainability, workforce wellness, preparedness, AI and emerging technologies.
06:30 – Recruitment vs. retention. Why keeping employees has become more important than finding new ones and how organizations can build careers rather than simply fill vacancies.
08:15 – Leadership beyond operations. The role of leadership in employee engagement, succession planning, data-driven decision-making and lessons from Matthew McConaughey's book Greenlights.
11:00 – Burnout, wellness and resilience. Why burnout remains a major challenge for EMS and how leaders must confront it rather than ignore it.
13:00 – Preparedness for the next crisis. A preview of keynote speaker William Forstchen and discussions around resilience, disaster readiness and planning for both natural and man-made events.
19:00 – AI Comes to EMS. Anthony discusses the opportunities and risks associated with artificial intelligence, from documentation and CAD integration, to clinical decision support.
24:00 – Blood, drones and clinical innovation. A look at how blood products, AEDs, naloxone and other critical supplies are increasingly being delivered through innovative technologies, including drones.
29:00 – What Paramedics Want in 2026. A preview of the latest survey findings and the issues currently weighing most heavily on the minds of EMS professionals.
30:00 – Why Pinnacle matters. Anthony explains why networking, relationship building and peer-to-peer learning remain among the conference's greatest strengths.
32:00 – The conversation EMS needs to have. Anthony identifies leadership responsibility and accountability as one of the most important — and often avoided — topics facing EMS today.
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Policy, payment reform and why EMS must engage

At a time when EMS reimbursement faces unprecedented scrutiny and pressure, Shawn Baird joins the EMS One-Stop podcast to explain what is happening in Washington, D.C., why it matters to every ambulance service in America and what EMS leaders can do about it.
| MORE: When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding
A former Paramedic, ambulance service owner, CEO, American Ambulance Association resident, and now Vice President of Government Affairs for the AAA, Baird brings a unique perspective that spans frontline care, operations and national advocacy.
In this episode, Rob Lawrence and Baird unpack the growing threats to Medicare and Medicaid funding, discuss the proposed changes to Medicaid supplemental payment programs, and explore the work of the National EMS Payment Reform Committee.
The conversation also previews the AAA Legislative Fly-In, and highlights efforts to secure EMS workforce funding, streamline military medic transitions into civilian EMS and advance federal fuel tax relief. Most importantly, Baird delivers a clear message: EMS professionals must tell their story, engage with elected officials and advocate for the future of mobile healthcare.
This episode serves as both an explainer and a call to action. As federal policymakers debate Medicaid funding, EMS reimbursement, workforce development and healthcare spending, Baird makes the case that every EMS professional has a role to play. Whether through legislative fly-ins, ride-alongs, town halls or simply telling the EMS story, advocacy is no longer optional. It is essential to preserving access to emergency medical care in communities across America.
Notable quotes
"We're hoping to make some proposals for real long-term reform on Medicare that will shore up the EMS system, not just to survive day to day, but really to thrive." — Shawn Baird
"We are more than just a ride. We are mobile healthcare." — Rob Lawrence
"We really have not been able to find a lot of data to support a bunch of waste, fraud and abuse in the EMS system. What there is, is a lot of misunderstanding." — Shawn Baird
"If we don't get paid ourselves, how can we pay other people? How can we then afford to deliver excellent healthcare to our patients?" — Rob Lawrence
"First of all, talk about the patient because the patient is the most important part of this whole discussion; second of all, talk about the medical care you provide because that's what the patient needs." — Shawn Baird
"We're the safety net. We're access to critical emergency care in many communities that don't have other healthcare." — Shawn Baird
"Probably the most important thing that folks listening to your show can do is attend a town hall and raise your hand and say, 'I'm just worried about our ambulance service.'" — Shawn Baird
"We have the greatest story of all to tell." — Shawn Baird
Additional resources
AAA Advocacy Call to Action – Contact your member of Congress here
2026 Ambulance Ride-Along Toolkit
Episode timeline
01:00 – Rob introduces the episode and outlines the challenges facing EMS reimbursement and federal healthcare funding.
02:07 – Shawn Baird's EMS Journey — from paramedic intern at Grady Hospital to rural EMS operator, company owner, AAA president and government affairs leader.
03:00 – Why healthcare reimbursement decisions are increasingly shifting from Washington to state legislatures.
06:45 – The National EMS Payment Reform Committee and the search for long-term solutions to EMS financing.
09:13 – Medicaid, waste, fraud and abuse — understanding misconceptions about EMS reimbursement and why ambulance services are being caught in broader healthcare debates.
11:33 – EMS is more than transportation — reframing EMS as healthcare first, transportation second.
13:20 – The threat to Medicaid supplemental funding — provider taxes, GEMT programs and proposed federal changes that could impact ambulance services nationwide.
15:15 – Proposed CMS rule changes — why EMS leaders are concerned about being included in Medicaid funding reductions.
17:40 - How national EMS organizations are coordinating efforts to speak with one voice.
20:08 – The AAA Legislative Fly-In — what it is, how it works and why provider participation matters.
21:45 – Federal legislative priorities — EMS workforce development funding, military medic-to-civilian certification pathways and federal fuel tax relief for ambulance services.
26:50 – How EMS providers can engage when legislation is moving.
27:40 – The importance of local advocacy — town halls, community events and direct engagement with elected officials.
29:30 – Ride-alongs as an advocacy tool — why seeing EMS firsthand changes policymakers' perspectives.
32:00 – Final thoughts — politics is ultimately about relationships, storytelling and helping decision-makers understand EMS.
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Johnny and Roy inspired a generation. Now they're telling EMS's toughest truths

What happens when the stars of the television series that introduced America to paramedicine decide it's time to tell the real story?
In this episode of EMS One-Stop, Rob Lawrence is joined by EMS pioneer Dr. Baxter Larmon and award-winning filmmaker Tom Putnam to discuss Into the Unknown: The Paramedics' Journey.
| MORE: ‘Emergency!’ stars launch Kickstarter campaign to expand reach of paramedic documentary, “Into the Unknown,” backed by Steve Buscemi, Randolph Mantooth and Kevin Tighe
Born from the vision of Emergency! stars Randolph Mantooth and Kevin Tighe, and backed by Steve Buscemi, the documentary follows paramedics, dispatchers, volunteers, flight crews and their families across America, revealing the realities of modern EMS. From Baton Rouge to Sparks, from volunteer rescue squads in Virginia, to helicopter rescue teams in California, the film explores not only what paramedics do, but what the job does to them.
The conversation examines workforce shortages, mental health, resilience, public misunderstanding of EMS, and the role the film could play in educating communities, policymakers and future generations.
The episode also explores the documentary's Kickstarter campaign and plans for worldwide release. If Emergency! introduced America to paramedics 50 years ago, Into the Unknown seeks to explain the people behind the uniform.
Notable quotes
"One of the things that I'm probably most proud about in the movie is that these first responders are now allowing their family members and their friends to be able to see what they go through every single day." — Dr. Baxter Larmon
"The call volume, I mean, they used to sit in the station, they'd joke in the station, they'd eat, they'd have dinner, they'd complete their whole dinner and they would never get a call. That just doesn't happen anymore." — Dr. Baxter Larmon
"Our fourth goal is to get recognition by governmental agencies to understand what EMS is, to be able to recognize its importance in the community, but more importantly, to fund it appropriately as well." — Dr. Baxter Larmon
"I honestly had no idea what I was getting into with this and how intense the personal interactions were gonna be." — Tom Putnam
"By the time that particular run was over, I just think I was wide-eyed and said, wow, we're making a war movie." — Tom Putnam
"For the right person, this is the best job in the world." — Tom Putnam
Episode timeline
00:00 – Trailer and opening montage
01:41 – Rob introduces the episode and guests
03:18 – The origin story of Into the Unknown
05:13 – The lasting impact of Emergency! on EMS and what story the documentary is trying to tell
08:32 – Tom explains why he said “yes” immediately
10:52 – The first EMS call filmed and realizing the scale of the project
12:15 – Locations featured in the documentary
16:22 – How EMS has changed since Johnny Gage and Roy DeSoto
17:54 – Stories that surprised Tom most
20:15 – The emotional burden of the profession
22:40 – Calls Tom "can't unsee"
24:00 – EMS as the safety net for society
25:07 – Burnout, resilience and humanity
27:30 – Why families need to see this film
28:06 – Why the project launched a Kickstarter campaign, funding goals and distribution plans
33:30 – Using the film as an EMS advocacy tool
35:43 – Lightning round
38:03 – Why EMS might be the best job in the world
39:05 – Dr. Richard Carmona's role in the film
40:16 – Final thoughts and call to action
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Blood on Board: The second chance that changed everything

In Episode 4 of the EMS One-Stop Blood on Board Series, host Rob Lawrence brings together two powerful perspectives on prehospital blood transfusion.
First, retired Army trauma nurse and national blood advocate Randi Schaefer discusses the work of the Prehospital Blood Transfusion Initiative Coalition and the ongoing effort to remove barriers to blood product availability across the United States.
Drawing on lessons learned from military deployments and civilian implementation efforts, Schaefer explains why successful blood programs require collaboration among EMS agencies, hospitals, blood banks, legislators and funding partners. She emphasizes that while every system is different, the goal remains the same: getting lifesaving blood to patients before they reach the hospital.
The second half of the episode focuses on the story behind the statistics. Dr. Kate Krause, an emergency physician from Dallas, recounts her near-fatal postpartum hemorrhage just weeks after giving birth to her daughter. After she lost more than two liters of blood at home, Dallas Fire-Rescue paramedics recognized the severity of her condition and secured authorization to administer prehospital blood. That decision, combined with rapid transport and seamless hospital coordination, helped save her life.
Today, fully recovered and back to practicing medicine, Dr. Krause has become a compelling advocate for prehospital blood programs, reminding policymakers and EMS leaders that behind every protocol, funding request and unit of blood is a patient whose future depends on receiving the right treatment at the right time.
Previous Blood on Board episodes:
Blood on Board: Everything is bigger in Texas
Blood on board: Lessons from Sacramento and LA County Fire
Blood on Board: Federal funding paves the way for EMS blood programs
Impactful quotes
"I had a severe postpartum hemorrhage and had my life saved by a prehospital blood transfusion." — Dr. Kate Krause
"I'm here. I have no deficits. I'm healthy. I'm back to being a physician. I'm back to being a wife and being a mother to my beautiful little baby girl." — Dr. Kate Krause
"The coalition wants to make blood products available to those EMS agencies that want to carry them."  — Randi Schaefer
"This is a brand-new relationship. So there's a lot of learning how each other's worlds work." — Randi Schaefer
"We were not going to let people die of preventable death." — Randi Schaefer
"Keep pressing forward. We will find a way to yes." — Randi Schaefer
"Blood is one of those things that really makes a difference when it's given early." — Dr. Kate Krause
Additional resources
Prehospital Blood Transfusion Coalition
Episode timeline
00:00 – Introduction to Episode 4 and recap of the Blood on Board series and overview of previous episodes covering local, state and national blood initiatives.
02:18 – Introduction of Randi Schaefer and Dr. Kate Krause. Schaefer discusses military deployments and early blood program experiences, while Dr. Krause outlines her journey from lifeguard, to EMT, to emergency physician.
05:05 – Origins and mission of the Prehospital Blood Transfusion Initiative Coalition, military lessons learned, funding challenges, sustainability concerns, the importance of legislative support and reimbursement
13:57 – Dr. Krause recounts her postpartum hemorrhage.
19:03 – Discussion of non-trauma indications for prehospital blood and the importance of medic judgment and protocol flexibility
20:22 – Dr. Krause discusses recovery and advocacy efforts, and Dallas City Council appearance and public awareness activities.
24:24 – Dr. Krause delivers a concise advocacy message supporting blood programs nationwide.
25:01 – Schaefer reflects on meeting blood recipients and the impact of seeing survivorship firsthand.
27:47 – Closing remarks from Dr. Krause and Schaefer
29:03 – Lawrence wraps up the four-part Blood on Board series and reinforces the need for continued advocacy and funding.
This episode is sponsored by Triad of Life. After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That’s why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. Learn how your team can put the Triad of Life into practice.
Enjoying the show? Email editor@ems1.com to share feedback. 

Blood on Board: Everything is bigger in Texas

Texas is taking prehospital whole blood to scale. In this second installment of the Blood on Board series, the conversation moves from pioneering local programs to a statewide initiative backed by legislation, trauma system collaboration and a $10 million investment in EMS blood capability.
Host Rob Lawrence welcomes Dr. Jeff Jarvis, chief medical officer and system medical director, Fort Worth Office of the Medical Director; Dr. C.J. Winckler, deputy medical director for the San Antonio Fire Department; and Jorie Klein, director of EMS-Trauma Systems Section, Texas Department of State Health Services.
From San Antonio’s early adoption to Fort Worth’s operational maturity and the Texas Department of State Health Services’ statewide rollout, this episode examines how Texas built one of the most ambitious prehospital blood programs in the country.
The discussion goes beyond clinical theory. The guests tackle implementation, logistics, blood stewardship, wastage concerns, rural access, legislative strategy and the realities of getting physicians, transfusion medicine specialists, EMS leaders and lawmakers aligned around a shared mission.
The episode also explores the expanding use of whole blood beyond trauma, including GI bleeds, obstetrics and surgical hemorrhage, while reinforcing the operational mantra repeated throughout the show: systems save lives.
| MORE: Blood on board: Lessons from Sacramento and LA County Fire
Impactful quotes
“You can’t quarterback it from your office. You have to be engaged and be out there with them.” — Jorie Klein
“Little did I know that it would take almost every waking minute of my life to get blood on an ambulance.” — Dr. C.J. Winckler
“We’re not improving overall mortality yet, but we are improving mortality in the first six hours.” — Dr. C.J. Winckler
“When you work together as a system, you can do amazing things.” — Dr. Jeff Jarvis
“In the last 13 months, we’ve given 259 units to 211 patients.” — Dr. Jeff Jarvis
“Our definition of wastage is anything that doesn’t go into a patient.” — Dr. Jeff Jarvisv
“It turns out this stuff works.” — Dr. Jeff Jarvis
“It’s all about communication and trust.” — Dr. C.J. Winckler
“Five years ago, we knew those patients would not survive. Now we have new tools.” — Jorie Klein
“My dad was saved by prehospital whole blood.” — Dr. C.J. Winckler
“Talk to the clinicians who are giving this blood and ask them about the impact it’s making.” — Dr. Jeff Jarvis
Episode timeline
00:00 – Opening message. Jorie Klein outlines the central lesson for other states: engage frontline providers and avoid managing programs remotely.
00:40 – Introduction. Rob Lawrence introduces Episode 2 of the Blood on Board series, shifting focus from local systems to statewide implementation in Texas.
01:20 – Meet the guests. Jorie Klein, Dr. Jeff Jarvis and Dr. C.J. Winckler introduce themselves and their roles in Texas EMS and trauma care.
03:22 – The San Antonio origin story Dr. Winckler explains how military medicine, trauma surgeons and Texas delegated medical practice helped launch San Antonio’s whole blood program.
06:04 – Building the first protocols. Dr. Winckler discusses creating guidelines from scratch, operationalizing blood administration and securing funding support from city leadership.
08:52 – Going system-wide. San Antonio launches whole blood citywide in October 2018 without a pilot project.
10:13 – Ethics and evidence. Discussion shifts to mortality data, prehospital physiology and whether balanced blood resuscitation should already be considered standard of care.
12:14 – Fort Worth follows. Dr. Jarvis explains how San Antonio’s system inspired adoption in Fort Worth and highlights the importance of regional collaboration.
14:03 – Texas goes statewide. Klein explains the legislative process that resulted in a $10 million statewide prehospital whole blood initiative.
17:24 – Rural Texas and blood access. The conversation focuses on plasma options, rural hospital shortages and improving access for remote communities.
23:45 – The data discussion. Dr. Jarvis shares Fort Worth operational metrics, transfusion volumes and remarkably low wastage rates.
28:49 – Whole Blood Academy. Drs. Jarvis and Winckler discuss the National Whole Blood Academy and how Texas is teaching other EMS systems to replicate their success.
32:00 – Trust, logistics and blood stewardship. Dr. Winckler explains the importance of relationships between EMS and transfusion medicine physicians, emphasizing operational discipline and trust.
36:20 – What comes next? Dr. Klein discusses statewide reporting, future funding requests and sustaining the Texas model long term.
40:15 – Final lessons for other states. The guests close with advice on advocacy, clinician engagement and building support from the ground up.
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Blood on Board: Federal funding paves the way for EMS blood programs

The EMS One-Stop Blood on Board series moves to the federal level in Episode 3, exploring how the National Highway Traffic Safety Administration Safe Streets and Roads for All (SS4A) grant program is opening new funding pathways for prehospital blood programs.
Host Rob Lawrence is joined by three leaders directly involved in building regional blood capability through federal funding.
Julie Stilley, PhD, is an EMS researcher at the University of Missouri, whose team secured a $4.6 million SS4A demonstration grant focused on advanced post-crash care, including prehospital blood administration.
Jason White represents the Mid-America Regional Council in Kansas City, a multi-jurisdictional regional planning organization coordinating EMS, trauma systems, hospitals and transportation partners around a regional whole blood strategy.
Mark Heath is chief of EMS for the Kansas City Kansas Fire Department and one of the operational leaders preparing to launch whole blood in the field as part of the Kansas City regional effort.
Rather than focusing solely on clinical practice, this episode examines the realities of applying for, winning and administering federal grant funding. The guests discuss building regional coalitions, engaging blood banks, developing standardized protocols, navigating compliance requirements and preparing operational rollouts.
From Missouri’s $4.6 million demonstration grant, to Kansas City’s regional planning initiative, this episode provides a practical roadmap for EMS leaders looking to transform roadway safety funding into lifesaving trauma care capability.
Watch episode 1: Blood on Board: Lessons from Sacramento and LA County Fire
Watch episode 2: Blood on Board: Everything is bigger in Texas
Impactful quotes
“Don’t be afraid of applying for a big, scary federal grant.” — Mark Heath
“EMS is the perfect partner to try to understand how to address the post-crash care component of a safety action plan.” — Julie Stilley
“If you’re going to do it as a region, you’ve got to hang together.” — Jason White
“The data points on the backside will set you free.” — Mark Heath
“If my blood is closer to the next address over, just because there’s a river in the way doesn’t mean we can’t get across the bridge.” — Mark Heath
“What started initially as an absolute ‘no’ became, ‘Wait, let me listen to you some more.’” — Julie Stilley
“The juice is worth the squeeze.” — Rob Lawrence
“Firefighters and EMS are cowboys, and blood banks are accountants.” — Mark Heath
“Cowboys do marry accountants.” — Jason White
“Run, don’t walk, to your local blood bank.” — Mark Heath
“It’s your blood in your community and going into you on your ambulances.” — Mark Heath
“We’re moving toward reducing mortality and reducing long-term injury.” — Julie Stilley
Additional resources
Safe Streets and Roads for All (SS4A) Grant Program | US Department of Transportation
NHTSA's Office of Emergency Medical Services | EMS.gov
Accessing the Safe Streets and Roads for All EMS grant program
Researchers receive $4.6 million to pilot advanced EMS response program
Episode timeline
00:00 – “Free money is free money”. Chief Mark Heath opens with encouragement for agencies considering federal grant applications and urges smaller communities not to be intimidated by the process.
00:44 – Introduction to Episode 3. Rob Lawrence recaps Episodes 1 and 2 of the Blood on Board series before introducing the SS4A grant focus and the featured guests.
02:07 – Meet the guests. Julie Stilley introduces her role at the University of Missouri and reveals her project’s $4.6 million award. Jason White and Mark Heath outline the Kansas City regional collaboration.
04:19 – Why apply for SS4A? Julie Stilley explains how frustration around operational barriers to blood implementation motivated her grant application.
05:38 – Understanding demonstration grants. Discussion on the difference between planning and demonstration grants, and how post-crash care fits into regional traffic safety action plans.
06:51 – Building regional coalitions. Jason White discusses Kansas City’s existing regional EMS partnerships and how those relationships became the foundation for the grant application.
10:30 – Regional protocols and data. Mark Heath explains how Kansas City agencies standardized protocols, agreed on shared data points and committed to a coordinated regional approach.
13:04 – Pulling together the application. Julie Stilley outlines the process of bringing together planners, EMS leaders, trauma centers and blood banks to support the grant proposal.
15:02 – Equipment, compliance and logistics. Discussion shifts to blood warmers, storage systems, chain-of-custody monitoring and the operational realities of safely carrying blood products in the field.
18:25 – Planning grants and future implementation. Jason White explains how the Kansas City effort uses a planning grant to build toward larger implementation funding opportunities.
23:22 – Busting myths about blood. Mark Heath describes how data and national experience changed his thinking about whether whole blood matters in urban EMS systems with short transport times.
27:19 – The reality of grant administration. Julie Stilley and Jason White explain federal reimbursement structures, compliance requirements and why strong administrative partners are essential.
31:37 – Sustainability and reimbursement. Discussion on long-term funding, legislative advocacy and the need for reimbursement models for prehospital blood administration.
33:43 – Final lessons learned. The guests share advice on partnerships, blood bank relationships, data collection and not being afraid of “big scary federal grants.”
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About the sponsor
After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That’s why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. To learn how your team can put the Triad of Life into practice visit the link to get started.

Blood on board: Lessons from Sacramento and LA County Fire

EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving
Whole blood in the field is no longer theoretical; it is operational, measurable and increasingly expected. In this EMS One-Stop episode, host Rob Lawrence brings together two of California’s leading medical directors — Drs. Clayton Kazan and Kevin Mackey — to compare and contrast their prehospital blood programs.
From concept to deployment, both systems demonstrate how data, relationships and persistence can translate innovation into lives saved.
This discussion goes beyond theory. It addresses real-world barriers — regulation, blood bank skepticism, funding gaps — and pairs them with practical solutions.
The result is a clear message: EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving. For agencies considering similar programs, this episode provides a roadmap grounded in experience, outcomes and operational reality.
Notable quotes
“When there's someone who wants to see your program, talk about your program.” — Kevin Mackey
“I kind of never believed it really possible to put it on a paramedic truck until I saw what the military was able to do.” — Clayton Kazan
“If the five minutes matter, why wouldn’t we want to do it 5, 10, 15, 20 minutes sooner?” — Clayton Kazan
“Never say ‘no,’ never say ‘die.’” — Kevin Mackey
“They’re never tired of trying to find new ways to save people’s lives.” — Clayton Kazan
Episode timeline
00:00 – Opening message. “Never say ‘no,’ never say ‘die’” sets the tone for program development and persistence
01:00 – Series introduction. Rob frames the episode as part of a broader national discussion on blood in EMS
02:00 – Guest introductions. Dr. Kazan and Dr. Mackey outline their EMS and medical backgrounds
03:20 – Program overviews. LA County: April 2025 launch, 11 squads, 58 transfusions; Sacramento: December 2025 launch after 15-month build
05:20 – Origins and catalysts. Influence from San Antonio and New Orleans programs; leadership support as a trigger
07:00 – Military influence. Translation of battlefield success into civilian EMS feasibility
08:50 – Building the business case. Data-driven forecasting using ePCR systems
11:00 – Overcoming resistance. Regulatory hurdles, skepticism and blood bank concerns
15:00 – Survivor stories. Real-world saves that validate the programs and influence policymakers
18:00 – Funding realities. Grant-based models, no current reimbursement, cost-benefit framed in life-years saved
21:45 – Equipment and logistics. Cold chain, monitoring systems, delivery devices and operational considerations
24:40 – Training and deployment. Targeted rollout using heat maps and trauma incidence data
27:45 – Early challenges. Blood recirculation, cold chain validation and system integration issues
31:50 – QA/QI and research. 100% case review and participation in multi-county data collaboratives
34:10 – Patient populations. Primarily trauma, with emerging medical indications
36:00 – Sustainability and scaling. Political engagement and expansion planning
38:15 – Rapid fire lessons learned. Transparency, persistence, relationships
42:50 – Myths and realities. Frontline providers embrace innovation; capability concerns disproven
44:00 – Final takeaways. Appreciation, relationships and system-wide collaboration as keys to success
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Special report: Andes Hantavirus risk assessment

In this special EMS One-Stop update, Rob Lawrence is joined by returning guest Dr. Alex Isakov to break down the rapidly developing Andes Hantavirus outbreak linked to the expedition cruise ship MV Hondius. What began as a handful of unexplained respiratory illnesses aboard a South Atlantic voyage has evolved into an internationally monitored infectious disease event involving multiple countries, quarantine operations, public health investigations and the repatriation of exposed passengers to specialized containment facilities in the United States.
| MORE: Hantavirus outbreak aboard cruise ship sends Americans to biocontainment quarantine units
Dr. Isakov is professor of emergency medicine at Emory University School of Medicine and executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR). He also serves as EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC), where he helps lead national preparedness efforts for high-consequence infectious diseases.
In the episode, he explains how Andes Hantavirus differs from other hantaviruses already present in North America because it is capable of person-to-person transmission in limited circumstances.
The discussion covers transmission dynamics, incubation periods, PPE recommendations, public health monitoring and why experts continue to assess the overall public risk as low. Listeners are also directed toward the excellent educational resource hub on preparedness and response available through NETEC Hantavirus Resources.
Episode timeline
00:00 – Introduction to the Special Edition. Rob Lawrence introduces the emergency update format and welcomes Dr. Alex Isakov to discuss the emerging Andes Hantavirus outbreak.
00:50 – Understanding hantaviruses. Dr. Isakov explains the difference between common North American hantaviruses and Andes Virus, emphasizing the rare person-to-person transmission capability.
03:13 – The cruise ship incident. Discussion of the outbreak aboard the MV Hondius, including onboard transmission concerns, severe illness development and international evacuation efforts.
05:16 – U.S. monitoring and quarantine. Review of quarantine operations in Nebraska and ongoing public health monitoring of exposed American passengers.
07:21 – Incubation and EMS risk assessment. Dr. Isakov outlines the prolonged incubation period and explains why frontline EMS encounters remain unlikely.
11:17 – PPE guidance for EMS personnel. Specific PPE recommendations are reviewed, including standard, contact and airborne precautions with eye protection.
13:17 – Looking ahead to World Cup 2026. The discussion turns to international travel, mass gatherings and why clinicians must maintain awareness of rare infectious diseases tied to travel history.
14:32 – EMS and public health resources. Dr. Isakov directs listeners to CDC, WHO and NETEC resources for ongoing guidance and EMS-specific updates.

When systems hesitate, they deploy: The rogue air crews who faced Ebola head-on

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.
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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
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