EMS One-Stop

10 MCI lessons from the Beirut port explosion

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

Tipping the traditional EMS service model on its head with Welsh Ambulance Service

“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.
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How community paramedicine is thriving in the UK

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.

Getting emergency resources into Ukraine

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.
Ambulances for Ukraine lead Chris Manson returns to provide an update on the program that is now not only sending ambulances, but also fire trucks and SUVs to Ukraine. To date. U.S. Ambulances for Ukraine has delivered 38 ambulances and 6 fire trucks to Ukraine. A further 12 ambulances, 2 fire engines and several SUVs are to be shipped in July.
Host Rob Lawrence and Chris recap the program so far and the tasks that the donated vehicles are be put to in country. Sadly, some of the ambulances donated earlier in the year have been destroyed due to hostile action. Chris issues a further call to action for donating ambulances, fire trucks and SUVs. Ukraine has now moved from defensive to offensive operations, and every vehicle is needed. As Chris describes, “If anyone gives me an ambulance, a fire engine or an SUV, I will get that vehicle into the fight.”
In the video edition of this episode of EMS One-Stop, Chris has provided photos of the vehicles on their way to Ukraine as well as images and video of the vehicles in action and the brave crews on the front lines that operate them.
 TOP QUOTES FROM THIS EPISODE
“The reality is the Russians in this conflict are targeting first responders, and it is one of the things they like to do. They will shell an area, cause havoc in an area with some sort of military strike, and then they will wait until the first responders respond, and when they do, they will target them.”
“Like any firefighter in any city department, what’s the first thing you want to do when a kid wanders around the fire truck? You want to sit them in the seat or put the helmet on right? So we put the first kid in, got them out, put the second kid in, I turned around and 20 kids are lined up. I went through those 20 kids and the 20 turned into 100, it felt like the entire town came out.”
“I feel fairly confident now, that several of those vehicles have been destroyed.”
“If anyone gives me an ambulance, a fire engine or an SUV, I will get that vehicle into the fight.”
EPISODE CONTENTS
0:30 – Rob intro
01:17 – Introduction Chris Manson
01:38 – U.S. Ambulances for Ukraine backstory
04:53 – Why would we give serviceable ambulances to Ukraine if we still have a shortage in the U.S.?
06:38 – Current stats of vehicles donated
07:30 – The logistics of shipping a vehicle to Ukraine
10:34 – The road drive from Germany and through Poland
11:21 – Tracking ambulances – a big no-no!
12:40 – Distribution of vehicles in Ukraine
14:36 – The moment Chris arrives to hand over a vehicle down range
16:50 – Vehicles in military units liveried into camouflage paint
19:00 – The need for fire trucks and SUV/patrol vehicles
22:01 – Call to action – we need ambulances, fire trucks and SUVs – now!
24:00 – Where the fire trucks are deployed
25:15 – The Ukrainians can fix anything (so it doesn’t matter if the donated vehicle has a few faults)
27:55 – Final thoughts
ADDITIONAL RESOURCES ON THIS TOPIC
ABOUT OUR GUEST
Chris Manson is the vice president of government relations for OSF HealthCare, a 15-hospital health system operating out of Peoria, Ill. He is a former firefighter from California and he served in the U.S. Marine Corps Reserves.
CONNECT WITH OUR GUEST
U.S. Ambulances for Ukraine @ambulancesU 

Generational codes: Retaining your primary customers – your people

Steve Grau, Anna Liotta and Steve Wirth join hosts Rob Lawrence and Chris Cebollero at the American Ambulance Association Annual Conference 2023
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/Inside EMS crossover podcast, Chris Cebollero teams up with Rob Lawrence to report on the 2023 American Ambulance Association Annual Conference from the MGM Grand, in Las Vegas. Rob and Chris discuss their own personal highlights and Rob’s leadership session, delivered with Acadian Ambulance President, Justin Back.
Rob and Chris are joined by Page, Wolfberg & Wirth Founding Partner, Steve Wirth, Esq., and discuss bias, the topic of Steve’s conference session.  Rob then interviews AAA keynote speaker, Anna Liotta, together with Royal Ambulance President Steve Grau, as they discuss:
Generational codes in the workforce
The revolving door of employment
Creating the milestones of forward progression
Understanding that your people are you primary customer
TOP QUOTES FROM THIS EPISODE
“In dealing with bias, self-awareness is absolutely critical – you have to do an inventory of your life and say ‘where are these things that I’ve experienced and how do they affect my decision making today and my interaction with other people,’ so self-awareness is really the first step.” — Steve Wirth
“When you go to a conference, go up to somebody. The reason that you have a nametag, with your first name in very large font is so that I can say, ‘Hello Chris, I’m Rob, pleased to meet you. What do you do?’ and that’s how a network occurs.” — Rob Lawrence
“Having this culture of a high-level of engagement is really focusing on our employees as our primary customer and making sure that we understand what their goals, ideals, passions are, and how to meet them.” — Steve Grau
“Just by the way they answered a simple question ‘so, what do you do?’ I could tell if they had been working there 2-3 weeks if they answer with a bright sparkle, ‘I work at Amazon.’ But if they had been there 2-3 months, they would pause, ‘well … I work at Amazon,’ And 6 months, they would drop a codeword, ‘I currently work at Amazon.’” — Anna Liotta
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Watch for more
https://www.ems1.com/leadership/articles/the-10-commandments-of-servant-leadership-OkBq610vz8C12Gb1/
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EPISODE CONTENTS
Part 1: Rob Lawrence and Chris Cebollero – Serving to lead
00:30 – Rob and Chris introduction
1:30 – Car seat safety (not rated for ambulances)
3:30 – Rob’s leadership session with Acadian President Justin Back on the principles of leadership, serving to lead
05:30 – Chris discusses leadership as a science
06:30 – What we want from our leaders
Part 2: Steve Wirth – Overcoming bias
07:30 – Welcome Steve Wirth
08:00 – Steve discusses his conference session, “We are all prejudiced” delivered in partnership with Macara Trusty (GMR)
11:30 – The importance of networking and meeting professional friends
14:56 – Chris talks about his leadership series on EMS1
Part 3: Anna Liotta and Steve Grau – Retaining your primary customer
16:00 – Introduction: Anna and Steve
17:00 – Generational difference - Have you seen a “Star Wars” movie?
17:30 – Anna: Common sense is not that common
18:30 – The Royal Ambulance (award winning) Career Bridge Program
20:00 – Generational codes in the workforce
22:50 – The revolving door of employment
24:00 – Creating the milestones of forward progression
25:00 – Anna’s Experience with Fortune 500 companies
25:30 – Understanding that your talent and people are your primary customer
26:00 – Creating an arc of experience
28:00 – Not allowing yourself to say “that’s how I did it”
29:00 – Fostering the whole human
30:00 – Pulling talent forward
31:00 – Rob and Chris close
ABOUT OUR GUESTS
Anna Liotta
Anna Liotta, creator of Generationally Savvy Communication Solutions, is an award-winning speaker, business consultant and author. She engages audiences with her practical strategies for attracting, growing and retaining top talent and loyal clients from every generation.
Anna integrates communications, sociology, business psychology and demography to unify workplaces and dramatically improve company performance. Her expertise and insight have helped such companies as Pike Place Market, Intel, Wells Fargo, Microsoft, Amazon, the PGA, NBA and United Way.
Steve Grau
Steve Grau and his family emigrated from Ukraine in 1989, arriving in San Francisco with $80 to their name. He became interested in healthcare 15 years later, when he took a hands-on role caring for his grandfather after a series of debilitating strokes. Witnessing how emotional support impacted physical healing, Steve was inspired to leave the tech industry to start an ambulance service that focused on patient experience.
Steve Wirth
Steve Wirth is a founding partner of Page, Wolfberg & Wirth. In a distinguished four-decade public safety career, Steve has worked in virtually every facet of EMS – as first responder, firefighter, EMT, paramedic, flight paramedic, EMS instructor, fire officer and EMS executive. He was one of central Pennsylvania’s first paramedics. Steve brings a pragmatic and business-oriented perspective to his diverse legal practice, having served for almost a decade as senior executive of a mid-sized air and ground ambulance service, helping to build the company from the ground up.

10 things we need to fix in EMS

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.
Our EMS One-Stop Host Rob Lawrence was recently invited attend the keynote session at the North Carolina EMS Expo, and to deliver an after-dinner speech at the banquet. The title of Rob’s session was “Elephants in the EMS room,” in which he addressed 10 things we must acknowledge and fix in order to improve the health of our profession.
As soon as he left the keynote stage, Rob joined Bradley Dean and David Blevans from the EMS Handoff Podcast to discuss the key issues raised in Rob’s presentation.
The biggest elephant in the room currently is recruiting and retention, and in addition to discussing inside industry suggestions, Rob looked to the outside world and got his inspiration from Glass Door, and identified what stands EMS apart from the nation's top 50 companies to work in.
The discussion also covers data and politics, cost collection and surprise billing, amongst the other elephants in the EMS room.
TOP QUOTES FROM THIS EPISODE
“I don’t talk about surprise billing, I talk about surprise payment, the surprise is what the insurance company actually gives you.” — Rob Lawrence
“A lot of local authorities will describe what they want to see in their EMS system when they bid them out and these are wholly unaffordable, in fact, they describe the cruise liner, when they can only afford a rowboat.” — Rob Lawrence
“We have to stop thinking that we are the UN and start to thinking like NATO, because NATO is an attack on one is an attack on all so, we have to start changing our mindset.” — Rob Lawrence
EPISODE CONTENTS
00:53 – Introduction
01:15 – Bradley Dean and David Blevins
2:10 – Elephants in the room
2:58 – Recruiting and retention
4:00 – Looking for clues via Glassdoor
5:05 – Is EMS in a pickle?
6:00 – Surprise billing
6:22 – EMS costs
7:00 – The cost of readiness
7:30 – Ground Ambulance and Patient Billing Committee
9:46 – Four little words – all those in favor!
10:20 – We are all politicians
11:30 – Degree or no degree – that is the question
15:40 – If you are going to get a degree anyway, why not a paramedicine degree!
17:00 – Data and making use of it
20:00 – Wall time
24:00 – The importance of advocacy
28:00 – National organizations working together
37:00 – The Peter Principle and training our people for the next position
39:00 – Close

Acknowledging the importance of EMS in the fire service

Dr. Lori Moore-Merrell announces plans to rename the USFA to the U.S. Fire and EMS Administration 
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.
EMS One-Stop Host Rob Lawrence recently travelled to Florida to attend the Metropolitan Medical Directors Gathering of Eagles Conference. In this week’s episode, he shares video from key sessions and interviews with a number of leading EMS medical directors, including Dr. Jim Augustine, medical director of Lee County, Florida.
The Eagles also gave the floor to the U.S. Fire Administrator Dr. Lori Moore-Merrell, who identified how the Metropolitan Medical Directors will work closely in the future with the U.S. Metropolitan Fire Chiefs – and identified that a name change to USFA may soon follow.
TOP QUOTES FROM THIS EPISODE
“Seventy-five percent of what we do in the fire response space is in fact EMS, and something that I shared with these guys yesterday is an action, I won't say a movement yet, but an action under way, we may in fact in the near term actually rename the U.S. Fire Administration the U.S. Fire and EMS Administration.” — Dr. Lori Moore Merrell
“We have just stood up in January an EMS branch within our National Fire and EMS Programs Division. That is a huge move for USFA, so we are going to be moving toward even bigger announcements in the near future ... but we need to embrace what we do in the fire service, that is greater than 70%, most departments 75% and up of EMS.”  — Dr. Lori Moore Merrell
EPISODE CONTENTS
01:00 - Takeaways from Brandon Morshedi, MD; Peter Antevy, MD; Joseph Zalkin; Petar and Amber Hossick
02:00 - Introducing the comments from Dr. Moore-Merrell
04:00 - Recorded comments from Dr. Moore Merrell
09:00 - Discussion with Dr. James Augustine
24:00 - Closing commentary

Mindset over matter

Paramedic Amanda King shares her story of thru-hiking the Appalachian Trail and overcoming EMS burnout
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.
After realizing she was suffering from burnout, Paramedic Amanda King decided to leave her service and take on one of the most physically challenging trails in the United States. Amanda made a decision that changed how she saw people, how she viewed the world and how she understood herself.
Three months after resigning, selling her house and storing her furniture, Amanda was dropped off in Georgia, alone, with one goal: to hike the entire Appalachian Trail. With her hiker home packed into a rucksack on her back, she embarked on a seven-and-a-half month epic adventure which saw her hike nearly 2,200 miles. She endured harsh weather, a regional drought, rugged terrain and so much more on a journey that evolved her in ways she could not have ever imagined.
After deciding to return to EMS, Amanda chats with Rob Lawrence about her experience, the individuals she met along the way and how her experiences can be translated back into life as a medic. Amanda also reflects on her life before the trail and offers inspiration and takeaways for all.
TOP QUOTES FROM THIS EPISODE
“I think my biggest regret is, it's a very simple word. It's two letters long and it's the word ‘no!’ Don't be afraid to say no. Take time for yourself, because you are the most important person. You know, if you're not happy and if you're not safe, how can you expect to keep other people happy and safe? I think that's the biggest thing, don't work so much overtime, don't inconvenience yourself to do all of these things that's asked of you, in return you're not taking care of yourself. So, one thing that I decided if I got back into EMS, is I would use my vacation time. So I'll put it to you this way. When I was at the former employer, I took a vacation maybe twice in 6 years or something like that, like an actual vacation. I've already taken two vacations since I started here at Novant, since November – so that's a huge difference.”
“I don't want to say yes, a 7-month hike in the woods cured all my problems, because that's not at all the case. I think that it's an ongoing process that, once you reach that point of burnout, it's number one up to you. It's not up to anybody else to help you. It's up to you to help you. And you have to want that change. I think that it's an everyday thing. Every day I need to do things that keep me on that path of not going back down that road again.”
“I think that was a symptom of the burnout where I was at, I had no patience whatsoever and it showed. It showed to my partner, it showed to family members that I would encounter on a call. And I hate to admit all that; it's embarrassing, but that's where I was, that was the point where I was at. I think now, after all that time off, and all that time to self-reflect, I think I'm more patient because I believe that I'm more empathetic, which is also something that I can't say that I possessed before I left.”
EPISODE CONTENTS
02:29 – Introducing Amanda King
05:06 – Symptoms of burnout
07:16 – The moment you realize you are done
10:57 – Selling and putting everything in storage
13:23 – Hiking with friends
15:53 – Packing for a 2,000 mile walk
18:48 – Mental fortitude
22:47 – Trail angels
24:40 – Trail magic
26:32 – Becoming ‘moss’
29:49 – Hindsight is 20/20
31:16 – Keeping a journal
33:30 – Taking a zero: how to use down time
41:14 – 2,000 miles later …
48:05 – Developing patience
51:02 – Message to those heading into crisis or breakdown
54:13 – Contact details
ADDITIONAL RESOURCES ON THIS TOPIC
Reignite EMS passion by banishing burnout (eBook)
On-demand webinar: Navigating a path to career satisfaction
5 EMS tips for a work-life balance
EMS Burnout Repair Kit: Reigniting your EMS passion
ABOUT OUR GUEST
Amanda King is a paramedic from the coast of North Carolina. Prior to joining EMS, she obtained a Bachelor of Arts degree from the University of North Carolina at Wilmington. During her first 10 years in EMS, she was promoted to field training officer, became an EMS instructor, developed a field training and evaluation program for her former agency, taught EMS classes for the local community college and earned a real estate license. She left EMS and thought she’d never return. Now, after becoming one of just over 1,000 people to thru-hike the Appalachian Trail in 2022, she has returned to EMS and now works for Novant Health Mobile Integrated Health. She is currently in graduate school to obtain a master’s degree in public administration.
CONNECT WITH OUR GUEST
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PW&W’s Stark and Johnson provide legal insight into PCRs

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.
Page, Wolfberg & Wirth was asked by the National EMS Information System (NEMSIS) Technical Assistance Center (TAC) to research frequently asked questions related to data in EMS patient care reports. PW&W analyzed these questions under applicable laws and guidance, and developed general answers and best practices contained in the new publication, “Patient Care Report Data QuickGuide - FAQs on owning, amending, retaining and sharing patient care report data.”
In this week’s EMS One-Stop, available in both video and audio versions, Host Rob Lawrence speaks with the PW&W authors of the project, Ryan Stark, managing partner, and Steve Johnson, director of reimbursement consulting. They discuss the guide, why it’s needed, and the major FAQs and misconceptions about PCRs.
The guide is broken down into four key areas of FAQs:
PCRs’ legal status
Amending PCRs
PCR retention
Transferring PCR data
Top quotes from this episode
“I would much rather defend an organization who regularly goes through a quality assurance process, whereby they make the provider and hold them responsible for the accuracy and completeness of the record.” — Ryan Stark
“Others may say, we see a lot of amendments to your records. The answer is ‘yes, that’s because we care about getting it right’ – that’s the mantra of our organization.” — Ryan Stark
“One of the things behind the importance of documentation is that it doesn’t live in a vacuum. We are in a day and age where it’s going to follow the patient for their lifetime, so you may have a rehab facility that wants to consult the medical record to determine the mechanism of injury or how the injury occurred and the only person [that knows that] is the EMS practitioner.” — Ryan Stark
“Long gone are the days where we can give you a quick ticket, passing along the information to the receiving facility. Now we are marrying up records, electronic health exchanges and other mechanisms and the genesis of all this starts with the original call.” — Steve Johnson
“Everyone should sign the patient care report. Why? Because everyone was a function of providing that particular service and we get a lot of pushback and they say ‘well now I’m legally responsible for everything that happened,’ and that’s not what the law says. The law says, for what you did, you are responsible for what you did and what you didn’t do when you had a legal duty to do something or withhold doing something because it was contraindicated. All that indicates is that yes, I reviewed it and to the best of my knowledge it’s true and accurate.” — Ryan Stark
“The law will impose liability where it lands. Just because you’ve signed that particular patient care report, doesn’t mean you’re responsible for all the interventions and everything that I outlined in there, it would be whoever performed or withheld those interventions that would be responsible within the scope of practice.” — Ryan Stark
Episode contents
1:09 – Introductions
1:30 – PWW history
3:30 – Introducing the PCR Data QuickGuide
4:20 – The circle of life of a PCR 
11:00 – NEMSIS data/research license and EMS by the numbers
13:20 – Who owns PCR data
15:50 – Signatures! And legal responsibility
17:40 – Accuracy of documentation to defend your actions
18:30 – Why does the driver have to sign?
20:00 – Amending PCRs: When and why
22:33 – Who do you tell if a record is amended?
24:30 – Can your state request you to amend your PCR?
27:30 – How long should we keep documents?
30:50 – When an agency closes down or merges
33:30 – Body-worn camera content
35:30 – Transferring paper records to digital
37:15 – Bi-directional data and HIE – responsibilities
40:00 – Final thoughts
Additional resources
The PCR Data QuickGuide is available now, and we encourage all EMS professionals to download their copies and gain a deeper understanding of PCR data best practices. To download the guide, please follow the link:
About NEMSIS
About Page, Wolfberg & Wirth
About our guests
Ryan Stark
Ryan Stark is a managing partner with Page, Wolfberg & Wirth, and is the firm’s resident “HIPAA guru.”  He counsels clients on labor relations, privacy, security, reimbursement and other compliance matters affecting the ambulance industry. 
Ryan started in the healthcare field as a freshman in college, where he worked for a local hospital and a retail pharmacy.  After college, he decided to become a lawyer, hoping to guide healthcare providers through the demanding legal issues they face.  He has been with PW&W since 2007, fulfilling that ambition.  
Ryan is passionate about educating EMS professionals and loves collaborating with providers and CEOs alike. He is a featured speaker in PW&W seminars and webinars, including the firm’s signature abc360 Conference, where he hosts the abc360 Game Show. Always enthusiastic, Ryan has been invited to speak at many state and regional EMS conferences, as well as national industry events. He is also an adjunct professor at Creighton University in the school’s Master of Science in Emergency Medical Services Program. 
Ryan developed, and is the primary instructor for, the nation’s first and only HIPAA certification for the ambulance industry – the Certified Ambulance Privacy Officer.  He also co-authored PWW’s widely used Ambulance Service Guide to HIPAA Compliance.  
Ryan volunteers with local community nonprofit organizations. He was also a big brother with the Big Brothers Big Sisters program for over a decade and keeps in touch with his “little.” Ryan also enjoys hiking, running, kayaking and traveling, and spending time with son Oliver.   
Steve Johnson
Steve began his career in the EMS industry in 1985, gaining valuable experience while serving as an EMT and later as director of a municipal ambulance service in Minnesota. As an ambulance service manager, Steve established his expertise in areas of operations, billing and administration.  
Steve also has significant EMS educational experience. He established and served as training coordinator and lead instructor for a State Certified EMS Training Institution for EMTs and First Responders.  
Steve served on both the Rules Work Group and the EMS Advisory Council to the Minnesota State Department of Health.
He joined the staff of a large, national billing and software company, where he was a frequent lecturer at national events and software user group programs. For over 7 years, Steve served as director of a national ambulance billing service and was responsible for all aspects of managing this company, including reimbursement, compliance and other activities for ambulance services throughout the nation.
Steve served as founding executive director of the National Academy of Ambulance Coding (NAAC), overseeing all activities of the Academy, including the Certified Ambulance Coder program, the nation’s only coding certification program specifically for ambulance billers and coders.  
As the director of reimbursement consulting with Page, Wolfberg & Wirth, Steve is involved in all facets of the firm’s consulting practice. Steve works extensively on billing and reimbursement-related activities, performing billing audits and reviews, improving billing and collections processes, providing billing and coding training, conducting documentation training programs, and performing many other services for the firm’s clients across the United States.  
Steve is also a licensed private pilot, and enjoys an active role in his church.
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.

The power of video in EMS education

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 the EMS One-Stop podcast spotlights the popular online education series Reel Emergency, which uses real bodycam footage to illustrate various types of medical emergencies. The footage is then discussed in a live broadcast by very well-known emergency medicine physicians, Drs. Peter Antevy, Mark Piehl and David Spiro.
Reel Emergency offers free continuing education credit on the day of the Prodigy EMS based broadcast (you must be in the live audience to receive CE) and is then made available via YouTube for all to view and use as part of their clinical education. 
Reel Emergency has now produced 15 episodes and has been viewed tens of thousands of times as both individuals and departments benefit from the content, the expert analysis and commentary, as well as subject matter expert guests.
In this podcast, Rob Lawrence chats with Reel Emergency’s regular host Hilary Gates, director of educational strategy for Prodigy EMS; and Zach Dunlap, clinical education specialist from 410 Medical.
Zach also previously worked for an agency that pioneered the use of body-worn cameras in EMS and offers insight into their adoption and use. 
TOP QUOTES FROM THIS EPISODE
“These real patient videos actually show what’s happening on a call. Where else do you get that? You can’t get that anywhere else and there’s something to be said for doing scenarios and having standardized patients or mannikins, but nothing beats watching the actual call itself because you also have all of the other elements of the call that are really hard to recreate in the classroom. You have all of the emotions all of the bystanders, all of the equipment, the communication aspects you have to worry about, and you have real human reactions” — Hilary Gates
“If you are an educator, and you are teaching a certain topic – anatomy, physiology, scene management, all operations, whatever it is – and there is a way to illustrate that, you should be required to illustrate it with a video – there’s just no better way to do it.” — Hilary Gates
“It should almost be a requirement at this point, the main reason people don’t want body cameras in EMS is because it’s grossly misunderstood.” — Zach Dunlap
EPISODE CONTENTS
1:00 – Introductions
01:35 – REEL Emergency
02:20 – Everyone knows Drs. Spiro, Antevy and Piehl
4:00 – Using video for education
6:10 – Gaining free CE and watching on-demand
07:20 – Using body-worn cameras on the street
08:23 – Using BWCs for performance improvement
11:25 – Suggesting that BWC eventually become the standard of care
12:50 – Where does Reel emergency get its videos from?
14:00 – Filming the Falmouth Road Race and heat emergencies
15:20 – How to view Reel Emergency?
ADDITIONAL RESOURCES ON THIS TOPIC
Current Reel Emergency topics include sessions on HP CPR, heat emergencies, peds emergencies, junctional hemorrhage, ped airways, anaphylaxis, intracranial emergencies, delirium, end of life care, GSWs and altered mental status.
Following are additional resources on incorporating body-worn cameras:
Promoting transparency and accountability with BWCs
Three outdated paradigms holding EMS back
Leadership’s role in keeping our workforce safe
How to buy body-worn cameras (eBook)
 
ABOUT OUR GUESTS
Zach Dunlap began his EMS career as a paramedic in Amarillo, Texas. After working in Oklahoma City, he returned to the Texas panhandle, where he worked as a flight paramedic for several years. Zach now resides in Houston, and has served as a flight paramedic and clinical director for a progressive 911 system. Currently, he is a clinical education specialist for a national medical company educating and training clinicians across the country on volume resuscitation. Zach obtained his bachelor’s in emergency health sciences and has always focused on providing excellent patient care through innovative approaches. Zach enjoys sports and spending time with his two children, Brogan and Brynlee, and their Goldendoodle, Claire. Zach is also the assistant treasurer of the Board of Commissioners of Harris County ESD11 in northern Houston.
Hilary Gates, MAEd, NRP, is the director of educational strategy for Prodigy EMS and a volunteer paramedic in the Alexandria (Virginia) Fire Department. She is also a faculty member of the School of Education at American University in Washington, D.C., and teaches Introduction to Community Health in the EM Program at University of Pittsburgh. Beginning her career as a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, Maryland, Hilary became a full-time paramedic, EMT instructor and FTO at AFD, and then served as senior editorial and program director for EMS World. She implemented AFD’s MIH/CP program in 2017 and has extensive experience as an EMS educator, symposium presenter and quality improvement trainer.
ABOUT THE REEL EMERGENCY PANEL
Dr. David Spiro is a pediatric emergency physician and professor at University of Arkansas Medical System, and he is chief medical officer of Reel Dx. Dr. Peter Antevy is a nationally recognized lecturer and expert in the field of prehospital pediatrics and cofounder of Handtevy Pediatric Emergency Standards. He currently serves as the EMS medical director for multiple fire and rescue departments in Florida. Dr. Mark Piehl is a board-certified pediatrician and pediatric intensivist at WakeMed Hospital in Raleigh, North Carolina, and co-founder of 410 Medical.
CONNECT WITH OUR GUESTS
Hilary Gates:
Linkedin
Twitter
Zach Dunlap:
Linkedin
Twitter
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.