EMS One-Stop

Leading through momentum: Dr. Douglas Kupas on steering NAEMSP

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

The EMS Avenger returns: Jimmy Apple’s no-holds-barred take on tech, burnout and backboards

As the year wraps, Rob Lawrence welcomes back the “EMS Avenger” Jimmy Apple for a fast-moving, end-of-year pulse check on the EMS universe — through the lens of social media, research and what frontline clinicians are actually saying when the mic is on and the comments are open.
Building on last week’s data-and-trends conversation , this episode pivots into “the world according to Jimmy Apple” and his alter ego, the EMS Avenger, exploring what’s made providers lean in, push back or flat-out declare “enough is enough.”
| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond 
From burnout and workforce conditions to AI-assisted ECG interpretation and the rise of microlearning, the conversation lands on a central theme: the future of EMS isn’t just protocols — it’s people, technology and how we choose to learn, adapt and debate. Jimmy also names his “paper of the year” on spinal immobilization, explains how he handles disagreement without falling into “quicksand arguments,” and previews a packed 2026 speaking calendar — plus a relaunch of his podcast.
Memorable quotes
“If we can just verify that you’re retaining the information, that’s much more important than the veracity of how long it took you to get that information.” — Jimmy Apple
“You can catch more flies with honey than you can with vinegar.” — Jimmy Apple
“That’s the future; is that literally, we’re going to swipe it, absorb it and swipe away again.” — Rob Lawrence
“My paper of the year is the paper that was published on spinal mobilization … It does not support the use of backboards as anything other than an extrication tool.” — Jimmy Apple
“I think that a big push that I’m making this year is to really start talking about the EMS provider as the person.” — Jimmy Apple
Episode timeline
00:56 — Rob welcomes listeners, references year-in-review data and notes ambulance thefts continue to trend.
01:38 — Rob brings Jimmy back and asks for a quick summary of Jimmy’s year and growing reach, and the top themes Jimmy has seen.
04:12 — Jimmy identifies provider conditions and mindset as the dominant theme and describes discussion of collapse/collapsing systems.
06:12 — Jimmy explains social media as the pulse point and highlights burnout, anger and provider frustration.
06:52 — Jimmy pivots to technology’s growing role and EMS resistance to tech encroachment in practice.
07:23 — Rob connects the tech thread to conference observations (Axon, AI). Jimmy gives examples (AI 12-lead, apps) and argues tech advancement shouldn’t be rejected due to “skill deterioration” fears.
09:34 — Rob asks Jimmy’s “how do you explain complex concepts quickly?” Jimmy uses the Michelangelo anecdote to describe stripping concepts to essentials; critiques padded, time-gated education.
12:29 — Jimmy argues for education credit models that recognize microlearning and self-directed learning if retention can be verified.
14:04 — Rob asks for standout research; Jimmy discusses RSI/induction agent considerations, pressors debate and prehospital antibiotics.
16:47 — Rob and Jimmy preview NAEMSP’s annual meeting (“research Disney”), value of posters, networking and clinical depth.
18:26 — Jimmy names spinal immobilization evidence review as his “paper of the year” and explains its conclusions.
21:36 — Rob asks how Jimmy handles disagreement/detractors with a larger platform — Jimmy describes disagreement as healthy, focuses on respectful pushback and staying anchored in data.
29:00 — Final question: Jimmy emphasizes “provider as person,” healing the clinician and a sponsored podcast relaunch in January.
Additional resources
Meet the EMS Avenger: Saving lives with kindness and content. TikTok sensation and pediatric critical care paramedic Jimmy Apple shares his rise in EMS education, battling misinformation with heart and hustle
Jimmy Apple’s “paper of the year:” Millin MG, Innes JC, King GD, Abo BN, et al. “Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries — A NAEMSP Comprehensive Review and Analysis of the Literature.” Prehosp Emerg Care. 2025 Aug.
Connect with Jimmy Apple, better known as The EMS Avenger:
TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger
Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger
X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger
Facebook — Join the group for discussions and shared insights: EMS Avenger community
Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series
AAA & AIMHI EMS Media Log: EMS Intel
Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

EMS at the edge: Inside a year of reckoning and redesign

As EMS closes out 2025, host Rob Lawrence is joined by Matt Zavadsky (PWWAG) and Rodney Dyche (Patient Care EMS Solutions) for their second annual EMSIntel.org “year in review” conversation — a fast-moving tour through the biggest stories shaping the EMS profession.
Drawing from the EMSIntel news log (now 3,849 stories as of the morning of recording), the trio connects what’s making headlines to what EMS leaders are experiencing on the ground: unstable economics, governance pressure, system redesign and rising operational risk.
The discussion lands on several recurring themes: economic sustainability as the dominant issue; the real-world politics of tax levies and “essential service” designations; the ongoing obsession with response times (and what they cost); preventable ambulance thefts escalating in severity; and the importance of measuring and publishing clinical outcomes and meaningful performance metrics. The through-line: communities are being forced into more honest conversations about what they can afford — and what EMS should look like going into 2026.
| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond
Memorable quotes
“Having a thoughtful conversation about what your system needs to look like on the go forward is paramount.” — Rodney Dyche
“If you don’t talk about yourself, somebody else will, and then you don’t control the narrative.” — Rob Lawrence
“Our No. 1 focus really needs to be on the economic sustainability of these systems because we are past the breaking point.” — Matt Zavadsky
“Response times equals speed; speed equals crashes.” — Rob Lawrence
“These theft incidents are … in almost all cases, 100% preventable by an aftermarket device … probably for 100 or $150.” — Rodney Dyche
“Response times are expensive. The shorter that you want your response times, the more money it’s going to take.” — Matt Zavadsky
“Across every provider type … the fee-for-service revenue is 50% to 60% below the cost of providing service. So when somebody says to you, ‘I can do this for free,’ ask more questions.” — Matt Zavadsky
“Response times are used as a cudgel.” — Rodney Dyche
Episode timeline
01:11 – Rob introduces the end of 2025 reflection and 2026 look-ahead; welcomes Matt Zavadsky and Rodney Dyche for the second annual EMSIntel year-in-review.
02:26 – Rodney reports the EMSIntel log count (“3,849 as of this morning”); Rob explains EMSIntel’s purpose: curating national EMS stories to identify themes and brief stakeholders.
04:13 – Matt names the year’s biggest issue: economic sustainability; the fiscal model is broken and impacts everything else.06:32 – Matt walks through the “AnyTown EMS” trajectory: communities can’t sustain old models, must define service levels, use system intelligence, and redesign for a modern “2028 model.”
09:06 – Matt cites the Medicare/RAND cost collection findings and warns that fee-for-service revenue sits far below actual costs; “ask more questions” when someone promises “free.”
10:12 – The group discusses communities pursuing tax levies and essential-service framing; Rodney contrasts places that pass funding measures with places that don’t, and highlights local politics and competing priorities.
11:52 – Matt clarifies that “essential service” means different things to the public versus statute; agencies need trust, transparency and real community education to succeed at the ballot box.
13:50 – Rodney describes the “cost of readiness” misunderstanding (public sees mileage, not readiness); Matt pushes proactive reporting (monthly/quarterly/annual) to build credibility.
15:35 – Matt pivots to response times: they’re expensive, clinically relevant in a small fraction of cases, and should be approached with evidence-based expectations and better triage/EMD practices.
18:14 – Rodney connects hot responses to preventable intersection crashes and modern driver realities; the discussion frames safety risk as a growing operational storyline.
20:21 – Matt adds an editorial caution that crashes are not confined to any one sector; points to recent examples including serious injuries during responses.
22:37 – Rob returns to ambulance thefts; Rodney calls most thefts preventable; Matt argues the basic lock discipline exists already and presses for stronger accountability and accreditation-style best practice.
26:11 – Rob flags downstream legal and regulatory risk (litigation exposure after stolen-unit crashes; DEA-controlled substances security implications).
26:52 – Rodney raises staffing; notes fewer staffing stories than 2024 but questions whether the situation is truly better; mentions earn-to-learn pipeline concerns.
28:13 – Matt describes the shift toward tiered deployment and greater EMT utilization, reducing pressure to staff large numbers of paramedics for calls that don’t require that level.
30:17 – Matt emphasizes outcomes and meaningful performance metrics; argues many systems still report the wrong measures and should lead with clinical metrics, patient experience, and quality indicators.
31:08 – Rodney reinforces that response times get weaponized in governance decisions; notes boards can be swayed by “advanced skills” narratives rather than outcome data.
33:25 – Forward-looking wrap: Matt highlights daily calls from communities that “can’t afford this anymore” and urges leaders to seize the redesign opportunity; Rodney echoes the need for planning and honest community conversations.
Additional resources:
AAA & AIMHI EMS Media Log: EMS Intel
Fast & spurious: America keeps losing ambulances and the fix is cheap
Callouts, chaos and career killers: The biggest EMS stories of the year
Enjoying EMS One-Stop? Email editor@ems1.com to share feedback or suggest guests for future episodes. 

We deserve this: The Journey to a National EMS Memorial in D.C.

In this episode of the EMS One-Stop podcast, host Rob Lawrence revisits an issue close to the heart of every EMS professional: creating a permanent National EMS Memorial in Washington, D.C.
Rob is joined by Tony O’Brien and James Robinson from the National EMS Memorial Foundation to provide a clear, candid update on where the project stands, why it matters, and what still needs to be done.
From the Weekend of Remembrance to the dream of a year-round place of solace and reverence in the nation’s capital, this conversation lays out the long road from idea to reality — and why EMS, as James puts it, truly deserves this.
Tony and James walk listeners through the 24-step federal Commemorative Works Act process, the hard work of narrowing 312 potential sites down to three, and the current push to reauthorize the Foundation’s federal authority through House Resolution 2196 and Senate Bill 2546.
They explain the preferred site in front of the Hubert H. Humphrey Building (HHS), the partnership with MIT’s School of Architecture and Urban Risk Lab on a powerful design, and the practical realities of funding, sponsorship and bureaucracy.
Most importantly, they end with a clear call to action for the EMS community: contact your elected officials, donate what you can, and help spread the word so that a permanent memorial to EMS can finally take its place in Washington, D.C.
Additional resources
EMS Memorial
EMS Memorial Bills:
HR 2196 
S2546 
2025 National EMS Weekend of Honor recognizes 29 fallen EMS workers
‘Never forgotten’: 2025 Moving Honors procession honors 29 EMS providers lost in the line of duty
Episode timeline
00:44 – Rob introduces the episode, sets the scene for a revisit of the National EMS Memorial effort, and welcomes guests Tony O’Brien and James Robinson.
01:30 – Tony and James share their backstories.
03:53 – Tony explains the origins of the Foundation at the Weekend of Remembrance/Weekend of Honor and the realization that EMS needs a permanent memorial people can visit year-round.
06:54 – James outlines the Commemorative Works Act, the 24-step process, and how the Foundation has reached step 15-16 over roughly 15 years.
07:54 – Tony details the grueling site-selection work: visiting 312 sites, environmental and noise studies, traffic and solitude considerations, and narrowing to three candidate locations.
10:48 – James describes the need for an Act of Congress to begin, Congressman Stephen Lynch’s early sponsorship, and the 2018 authorization that started a 7-year clock — complicated by the pandemic and federal shutdowns.
13:12 – Tony explains how the initial authorization expired, the need for reauthorization and the most recent Senate subcommittee hearing on federal lands where James testified.
16:41 – James and Tony frame the new bills: Senate Bill 2546 and House Resolution 2196, their bipartisan sponsors and the push for more co-sponsors.
19:49 – Tony lays out the three-point call to action: contact Congress, donate via EMSMemorial.org, and follow/share @EMSMemorial on social media.
23:06 – Tony describes the three remaining sites and why Independence Ave. & 3rd St SW, in front of HHS, is the preferred location.
24:42 – Tony highlights the pro-bono design work by MIT’s School of Architecture and Urban Risk Lab, and the deep engagement with providers, families and survivors.
26:32 – James explains the historical nexus of EMS with HEW/HHS and why the Humphrey Building plaza offers the right reverence, proximity to the Capitol and connection to EMS history.
29:01 – Tony and James discuss next steps: reauthorization first, then finalizing site and design to approach major sponsors with clear answers on location, look and cost — while acknowledging the project has been bootstrapped so far.
32:03 – Tony reassures donors: the Foundation is a 501(c)(3), the board are all volunteers with only necessary professional services paid from donations.
33:13 – Tony gives shout-outs to the National EMS Memorial Service and the National EMS Memorial Bike Ride, and explains how the three organizations’ missions align.
37:12 – Rob recaps the journey, reinforces the call to action, and closes the show with thanks to Tony and James and a reminder to visit EMSMemorial.org and like/subscribe to EMS One-Stop.
Rate & 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.

Hyper-turbulent times: EMS economics and AI guardrails with Matt Zavadsky and Dr. Shannon Gollnick

Recorded on the floor of the EMS|MC EMSpire Conference in Charleston, South Carolina, this episode of EMS One-Stop finds host Rob Lawrence in conversation with long-time collaborator and EMS advocate Matt Zavadsky.
Fresh off the longest federal government shutdown in history, Rob and Matt unpack what the hyper-turbulence in Washington really means for EMS: suspended Medicare extenders, disrupted grant programs, agencies taking out loans just to meet payroll and training programs put on hold.
They break down NAEMT’s flash poll on the shutdown’s impact, the promise of the Treatment in Place (TIP) legislation, and why associations “hunting as a pack” on Capitol Hill matters more than ever.
Along the way, they spotlight EMSIntel.org as a national barometer of EMS funding, staffing and response time crises, and issue a clear call to action for providers, billers and leaders to use association tools to contact their members of Congress.
| MORE: Government reopens: What EMS providers need to know right now
In the second half, Rob is joined by Dr. Shannon Gollnick, paramedic, EMS leader and organizational psychologist, to explore how artificial intelligence is reshaping EMS — right now.
Shannon makes the case that AI is “not the future; it is the present,” and that agency leaders must urgently build literacy, policies and guardrails around its use. They dig into the difference between HIPAA-compliant, embedded AI in ePCR systems, and risky open tools like ChatGPT, touching on hallucinations, embedded code and emerging Medicare fraud-detection programs.
| MORE: Artificial to augmented intelligence. How Dr. Shannon Gollnick wants EMS to work smarter, not harder
Rob and Shannon talk about AI as a powerful but potentially dangerous tool — “like having a tiger” — and outline practical steps for chiefs:
Ask: “Do we have an AI policy?”
Define what AI can and cannot be used for
Insist that every AI-generated work product is double-checked by a human before it hits the record
Memorable quotes
“We weren't here to actually scare you off it. We're here to let you know that it's here, but it's like having a tiger, right? We all love to have a tiger, but it has to be contained in some sort of guard, otherwise it's going to run rife and cause havoc, and we don't want that.” — Rob Lawrence
“This is part of the hyper-turbulence that's occurring in EMS right now.” — Matt Zavadsky
“So I think the message for the profession right now is, now is not the time to put your foot on the brake. It's time to put your foot on the gas.” — Matt Zavadsky
“We put the fun into function.” — Dr. Shannon Gollnick
“I think it's important to understand that AI is not the future. It is the present. We are currently here right now. And it's nothing to be afraid of.” — Dr. Shannon Gollnick
“If you're not doing it, I promise you that your staff is doing it and they're playing around with AI.” — Dr. Shannon Gollnick
“Guardrails don't exist from a congressional standpoint. They don't exist from a regulatory standpoint. The technology is moving far too fast. So we as agency leaders have to take the lead in putting up some of those guardrails.” — Dr. Shannon Gollnick
“There are ePCR software out there that are using proprietary AI that will use AI-generated narratives. And that absolutely is 100% good to go. What we don't want to see is our crews putting in their ChatGPT to have ChatGPT write their narrative.” — Dr. Shannon Gollnick
“ChatGPT has embedded code inside of it that you can't see, but that code is there ... so what we're kind of afraid to do is to say, hey, what happens 6 months from now, 8 months from now when Medicare does an audit, they run your ePCRs and find all of this embedded code from ChatGPT ... you open yourself up for a lot of compliance issues.” — Dr. Shannon Gollnick
Additional resources:
EMS Intel EMS News Tracker
American Ambulance Association Advocacy
NAEMT Advocacy
EMS shutdown survival: What leaders need to know now
Charting the future: How AI is rewriting the EMS narrative
Episode timeline:
00:21 – Rob introduces guest Matt Zavadsky
02:02 – Rob recaps the 40-plus-day federal government shutdown, questions about reopening, and his upcoming return to Capitol Hill for renewed advocacy
02:02 – Matt frames the shutdown as part of the “hyper turbulence” in EMS; explains the regulatory suspensions, pauses in Medicare extenders and grants, and how cash-flow uncertainty forced some agencies to take out loans just to make payroll
03:04 – Matt details NAEMT’s flash poll (408 agency responses) showing suspended training and grant-funded programs, and warns of a possible repeat shutdown around January 30
03:54 – Rob and Matt discuss the reopening of government, ongoing bipartisan work, and the risk that everything “comes to a grinding halt” again if Congress can’t agree
04:51 – Matt explains why NAEMT released the shutdown-impact poll even as government reopened and stresses the need to keep pushing for permanent relief from Medicare extenders and advancement of key bills like Treatment in Place (TIP)
06:03 – Matt outlines the House and Senate TIP companion bills and why Medicare paying for treatment in place is better for patients, EMS, the health system and the Medicare trust fund
06:54 – Rob notes broad association/provider support and professional lobbyists on the Hill; Matt stresses that field providers, administrators and billers must still use association legislative portals to send letters to Congress
08:08 – Matt describes a surge in communities reevaluating their EMS delivery models because of staffing, finance and subsidy challenges — “a great time to be an EMS consultant”
09:09 – Rob introduces EMSIntel.org as a curated clearinghouse of EMS news, used to show communities they aren’t alone; describes failed tax measures and funding referenda
10:15 – Matt cites EMS Intel data: ~85% of stories each month involve funding, staffing or response times; Rob and Matt stress the ubiquity of these themes from big cities to small towns
11:09 – Rob highlights mutual aid tensions and taxpayers questioning why they “pay to send our resources somewhere else;” both emphasize that hyper-turbulence and funding gaps are national issues
13:23 – Rob resets the scene from the EMSpire conference and recaps Matt’s Hill update before introducing Dr. Shannon Gollnick
14:41 – Shannon gives his backstory: in EMS since 1996, paramedic since 2002, progression into EMS leadership, doctorate in organizational psychology and focus on how organizations function
15:14 – “We put the fun into function.”
15:24 – Rob invites Shannon to talk AI, calling it “the specter we are embracing everywhere,” and references HIPAA concerns; Shannon opens with the core message: AI is not the future, it’s the present, and nothing to be afraid of
16:03 – Shannon urges leaders to build AI literacy, noting that if agencies aren’t using it, their staff and the younger generation already are
16:28 – Shannon emphasizes policy and procedure: AI guardrails aren’t coming from Congress or regulators, so agency leaders must define how AI will be used and where its limits are
16:55 – Rob reminds listeners that AI in EMS isn’t new, citing early monitor rhythm interpretation in the UK; Shannon underscores that crews already use AI tools and that unmanaged cut-and-paste practices can create billing and compliance risks
17:24 – Shannon explains the dangers of using open tools like ChatGPT for ePCR narratives: potential PHI exposure in a “black box” system and AI hallucinations generating plausible but false patient information
18:21 – Shannon describes how AI “wants to answer your question and make you happy,” leading to made-up details, and shares examples from testing minimal-input scenarios that returned overly detailed, inaccurate narratives.
19:03 – Shannon calls ChatGPT “kind of a snitch,” explaining embedded code markers that fraud detection tools — and increasingly Medicare’s AI-based “Wiser” program — can use to identify AI-written content in documentation
19:59 – Shannon warns about retrospective audits and compliance exposure if ChatGPT-coded narratives are found in ePCRs, noting that AI rules are still emerging and tech is outrunning regulation
20:51 – Rob summarizes the mixed message: AI is here and being built into devices and software, but there are real dangers. They discuss data going “to the cloud” — which Shannon defines as “somebody else’s computer.”
21:24 – Shannon frames AI as a powerful tool that can “put a lot of holes in the wall” if misused; he references fraudulent AI uses and deepfakes as emerging issues
22:05 – Shannon compares AI’s impact to the internet’s paradigm shift; Rob gives a “spoiler alert” about his own workflow using transcripts and ChatGPT agents, and notes the importance of reading and checking any AI-generated output
22:45 – Shannon reinforces that AI makes mistakes and cannot understand human context; he uses his “How you doing?” Joey Tribbiani vs. Tony Soprano example to illustrate contextual nuance
23:06 – Rob expands the context point with the “Friends”/“Sopranos” slide and reminds listeners that once AI-written words are published, “you said it.” Shannon highlights the WebMD effect and AI-driven self-diagnosis risks.
24:02 – They note that ChatGPT can generate long, complex diagnoses without sufficient patient context, leading to errant or misleading outcomes if misused clinically
25:00 – Rob summarizes: AI is here and, used correctly, is a good thing; advises chiefs to ask their teams, “Do we have an AI policy?”
25:27 – Shannon outlines what an AI policy should contain: acknowledgment that AI is here; clear, non-fearful framing; specificity on what decisions AI can support; and clarity on which tools (e.g., embedded EPCR AI) are allowed versus prohibited uses of ChatGPT
26:17 – Shannon stresses AI should not be used for clinical decision-making or clinical narrative writing; its role should be administrative only, and all outputs must be double-checked
Enjoying the show? Email editor@ems1.com to share feedback or suggest a guest for a future episode. 

Jamaica Fire Brigade’s front line: Inside the Hurricane Melissa response

In this episode of the EMS One-Stop podcast, host Rob Lawrence welcomes Dr. Hezedean Smith, who spotlights the human and operational toll of Hurricane Melissa on Jamaica and the wider Caribbean.
Dr. Smith draws from first-hand perspective from the ground, detailing catastrophic damage to homes, utilities, roads and communications — which compounded the workload and emotional burden for Jamaica Fire Brigade (JFB) firefighters and EMS providers.
Dr. Smith highlighted the Brigade’s Amazon Wish List effort, which aims to route essential personal items and operational supplies directly to affected JFB members and stations to sustain continuity of operations and support responders’ families.
After the break, Dr. Smith switched hats as the newly elected President of NEMSMA to outline the association’s renewed momentum:
New association management support
Expanded member services and credentials
The inaugural NEMSMA Leadership Conference
The NEMSMA Leadership Conference will take place in Washington, D.C., March 23-24, 2026, intentionally adjacent to EMS on the Hill to create a leadership-plus-advocacy “two-fer.” Highlights include keynote Gen. Robert Neller (Ret.), plus a deep bench of EMS leaders and educators.
Memorable quotes from Dr. Hezedean Smith
“Many homes destroyed, utility systems interrupted, critical infrastructure in terms of communities having the ability to communicate, leaving thousands displaced, even fire stations having operational challenges as it relates to communication and interoperability ... ”
“I stayed in the local fire station. I wanted to be there with the men and women on the ground, to make sure that I had that communication, that constant contact with them.”
“My focus will be on the firefighters and ensuring that we get enough supplies to go directly to the firefighters.”
“We want to tear down silos. We want to redefine leadership and ensure that we continue to collaborate across this globe.”
Additional resources:
Jamaica Fire Brigade – Amazon Wish List
National EMS Management Association (NEMSMA)
NEMSMA Leadership Conference: Washington, D.C., March 23-24, 2026
EMS on the Hill, March 25-26, 2026, Arlington, Virginia
International Journal of Paramedicine
EMS One-Stop: General Robert Neller on ethical leadership and adaptability
Episode timeline:
00:46 – Quick industry/policy update
01:27 – Set-up: Hurricane Melissa overview; impact stats and current situation
02:12 – Welcome Dr. Hezedean Smith
02:26 – Dr. Smith’s backstory: Jamaica roots, USAF medic, Orlando FD, two fire chief roles, GES Consulting, Caribbean EMS focus
04:20 – First reactions to Melissa: scale of damage; compounded human toll
05:58 – Deployment cadence: aligning with JFB command, CDEMA, national EOC; travel hurdles; rapid integration on arrival
08:28 – Why existing relationships matter; staying in-station with crews; supporting leaders and frontline needs
11:13 – Call to action: Amazon wish list for responders’ personal and operational needs; distribution via JFB logistics
13:20 – Specific needs (PPE, boots, clothing, hygiene, basic medical supplies) and the ongoing recovery realities
17:46 – NEMSMA — new president, renewed energy, new AMC, who NEMSMA serves
20:14 – Board/leadership shout-outs; programs (FTEP, ACPE), member services, momentum
22:49 – Conference preview (Mar 23–24, 2026, D.C.): theme — disruptive leadership; Gen. Robert Neller keynote; speaker lineup; proximity to EMS on the Hill
26:29 – IJOP collaboration and research-to-podcast pipeline; communications and sponsorship improvements
28:29 – Closing thanks; unified call to support JFB and engage with NEMSMA initiatives
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.

EMS shutdown survival: What leaders need to know now

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

Rainn Wilson on ‘Code 3’ and the brutal beauty of EMS life

In this episode of the EMS One-Stop podcast, our host, Rob Lawrence, sits down with Hollywood actor Rainn Wilson, who stars as Randy in “Code 3.”
Known worldwide for his role as Dwight Schrute in The Office, Wilson has stepped into the world of EMS, portraying the life of a burned-out paramedic with both grit and humor. In the conversation, Wilson reflects on the process of bringing this story to life, his ride-along experiences in Los Angeles, and the powerful realities he uncovered about our profession.
More than just a performance, Rainn has become an unexpected advocate for EMS. He speaks candidly about the underfunding of frontline providers, the emotional toll of the work and the sheer humanity that comes with being welcomed into people’s lives during their most vulnerable moments.
Alongside the serious themes, he reminds us that Code 3 is also a comedy — one that captures the gallows humor, camaraderie and resilience medics carry with them on every shift.
| MORE: Why ‘Code 3’ might be the most honest EMS film yet. From a ticking salary counter to fourth-wall confessions, this EMS road movie isn’t just another Hollywood take. It’s a love letter, a warning and a mirror.
Memorable quotes from Rainn Wilson
“Most of all, I just fell in love with the character of Randy.”
“Bottom line, the fact that first responders are getting basically what people that work at Starbucks are getting paid really blew my mind.”
“Well, one thing I never thought of, maybe stupidly so, is how vulnerable everything is because you're going into people's homes and they're in crisis.”
“I think Rob, no one should be allowed to graduate from high school without their kind of basic CPR training.”
“Everything about EMS — the tone, the vibe, the gallows humor, certainly all the technical medical elements, the burnout, the camaraderie, the idea that there's a mission here — they do it because they love it.”
“Well, it was an honor to learn about this world and to make a movie that these workers are excited about and proud of.”
“I want to say from the bottom of my heart, you know, ‘thank you. Thank you for your work. And, you know, I think it's grossly underappreciated, but, you know, America needs you.’”
Episode timeline
00:26 – Rainn Wilson on the vulnerability of entering people’s homes in crisis
00:57 – “All we want to do is save your life. Some of you don’t make it easy.”
02:53 – Rainn’s first impressions of the “Code 3” script
03:38 – Falling in love with the character of Randy
04:22 – Discovering the realities of EMS work and shocking pay disparities
06:09 – Lessons from Wilson’s Los Angeles ride-along
10:12 – Wilson on CPR training and why everyone should learn it
12:29 – “We’re essentially a tube and a pump.”
13:11 – Rehearsals and the importance of portraying EMS medicine accurately
15:09 – On burnout, PTSD and the need to support medics’ mental health
18:08 – Using “Code 3” salary comparison as an advocacy tool
19:07 – Wilson praises Rob Riggle’s ED doctor role and its realism
20:41 – Cherishing the chance to shed light on EMS
21:10 – Reminder that the film is also a comedy — “a good old time with a bucket of popcorn”
22:25 – Final message: “America needs you. Keep saving lives.”
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.

Burnout, bravery and gratitude: The story behind ‘Code 3’

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

NEMSAC dismantled: Inside the fallout shaking federal EMS policy

This breaking-news edition of EMS One-Stop dives straight into the announcement that the National EMS Advisory Council (NEMSAC) has been dissolved. Host Rob Lawrence is joined by Dr. Brandon Morshedi (NEMSAC chair-elect) and Brenden Hayden (immediate past chair), who explain what NEMSAC is, what it achieved and why its sudden dismissal has left the EMS community frustrated, concerned and searching for answers.
Together, they outline the role of NEMSAC as the sole statutory advisory body connecting EMS to the federal executive branch, describe the hundreds of volunteer hours that went into shaping advisories, and discuss what happens now that years of hard work and documents have been pulled from EMS.gov.
This episode sets the record straight, provides a clear explainer of the process, and captures the disappointment — yet determination — of leaders committed to moving EMS forward despite this setback.
Additional resources:
How NEMSAC is composed — who sits on the council and what types of expertise are represented
The NEMSAC’s statutory role advice/briefings at the federal level
NEMSAC’s key accomplishments
Episode timeline
01:08 – Rob introduces the breaking news: NEMSAC dissolved
02:22 – What is NEMSAC? Brenden explains its statutory role
04:52 – How does NEMSAC differ from associations? Direct advisory to the executive branch
06:42 – Appointments, terms and how continuity usually worked
08:44 – The depth of work: meetings, subcommittees, advisories, letters
11:23 – Examples of major advisories and public comment process
14:27 – Shock: key advisories removed from EMS.gov
19:13 – Explainer: FICEMS and how advisories flow through federal government
26:25 – How members felt when dismissal was announced
30:18 – What happens to unfinished advisories and research
34:20 – Associations’ role in keeping the work alive
35:50 – The advisory each guest is most proud of
39:41 – Lessons learned: influence, unified voice, process
43:25 – Final reflections: leadership, advocacy, and what comes next
Enjoying the show? Email editor@ems1.com to share feedback or suggest guests for a future episode.