EMS One-Stop

AI may feel like the newest revolution in EMS, but the industry's relationship with data has been evolving for decades. In this episode of EMS One-Stop, Rob Lawrence sits down with FirstWatch founder Todd Stout, whose 28 years working with EMS data gives him a particularly long view of where the industry has been and where it is heading.
Todd traces the journey from an era when monthly reports printed on green-bar paper were considered normal, to today's world of real-time dashboards, cloud-based systems and enormous volumes of operational and clinical information. The challenge has changed: EMS no longer suffers primarily from a lack of data; leaders now need technology that can identify what matters, separate signal from noise and turn information into decisions.
That makes AI extraordinarily promising — and potentially dangerous. Todd explains why he is more excited about the next 3-5 years than at any point in his career, while simultaneously being more concerned about the next 8-10 months. Rob and Todd discuss unreliable AI outputs, data security, HIPAA and privacy, the risks associated with startups and what EMS leaders should ask before entrusting vendors with organizational or patient data. They also examine the urgent need for EMS agencies to establish AI policies and train their workforce on responsible use.
Todd concludes with a preview of FirstWatch's next generation of AI-enabled tools and a broader message for EMS leaders: the organizations that thrive through this technology shift will not necessarily be those with the newest technology, but those capable of adapting, learning and using it responsibly.
Additional resources:
EMS1 Leadership Institute: 2026 Spotlight on AI in EMS: On-demand: Smart tools, strategic choices: EMS puts AI into action
Why EMS must measure the human side of care: What patients remember
No rulebook is coming: EMS must take control of AI now: Why EMS must govern AI locally as adoption accelerates
Hyper-turbulent times: EMS economics and AI guardrails with Matt Zavadsky and Dr. Shannon Gollnick: Why EMS needs AI guardrails and Medicare reform today
Memorable quotes
"I'm more excited about the next 3-5 years than I've ever been, I am also more scared about the next 8-10 months for our industry than I've ever been because it's so messy." — Todd Stout
"Nobody gets into EMS to be excellent data enterers." — Todd Stout
"AI well formed — with the proper bumpers, guidelines, rules around it — is astonishingly good at processing through lots of data." — Todd Stout
"If you're not paying for the thing that you're using, you are the product." — Todd Stout
"AI to many people seems like magic. And it's the opposite of magic almost. It's a lot of work and plumbing to get it right." — Todd Stout
Episode timeline
00:27 – Rob introduces the episode and the evolution of EMS data, information and AI
01:54 – Twenty-eight years of FirstWatch: from Stout Solutions to today's real-time data environment
03:57 – Looking back at EMS's early adoption of real-time operational data
05:18 – Why immediate data can improve individual performance and expose problems with systems and protocols
06:24 – The "ah, buts:" gut instinct versus what the data actually shows
07:19 – Dirty data, disconnected systems and why organizations sometimes don't believe their own numbers
09:45 – EMS has moved from too little information to information overload
10:31 – How AI can sift through enormous amounts of data and identify what leaders actually need to know
11:22 – The accuracy problem: AI can produce impressive outputs while struggling with surprisingly basic tasks
12:39 – Todd explains why he is simultaneously excited and concerned about the immediate future of AI in EMS
14:35 – How EMS leaders can become better, more discerning customers of AI technology
15:10 – Established technology partners versus innovative AI startups
17:00 – What happens to your organization's data if an AI vendor fails or goes out of business?
17:41 – HIPAA, privacy, cybersecurity and employee data obligations
18:11 – Sponsor break
19:26 – Part two: protecting patient and organizational information when using AI
20:18 – AI training models, data sharing and why leaders need to understand vendors' default settings
22:44 – The pace of change: today's AI expertise can become outdated within weeks
23:08 – Preparing for the wave of "AI everything" appearing in EMS exhibit halls
23:45 – Questions EMS leaders should ask prospective AI vendors
25:20 – Why AI isn't magic — and why implementation requires significant work behind the scenes
27:08 – The case for every EMS organization having an AI policy now
27:41 – Todd warns that employees are almost certainly already using AI, sometimes without understanding the privacy implications
28:21 – Why AI education should resemble cybersecurity education: policy, training, suspicion and continual reinforcement
30:13 – Preview of FirstWatch Collaborate and the company's next generation of technology
31:02 – FirstWatch 2.0, AI-enabled mobile tools and workload management
31:55 – Reflect: incorporating patient satisfaction alongside operational and clinical performance
33:34 – Why rapid patient feedback can be more meaningful to crews than retrospective monthly scores
35:19 – Todd's closing message: EMS is good at adapting and improvising, and technology can make the job easier
36:22 – Rob's takeaway: adapt, innovate, become a discerning AI customer and establish an organizational AI policy
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This week on EMS One-Stop, I sit down with Liz Harney, almost a year after I first walked into a classroom at EMS World Expo looking for another session to report on and found what I later described as “the keynote I didn’t know I needed.”
Liz’s presentation was built around a part of EMS education we routinely acknowledge but rarely give equal billing: the affective domain — empathy, communication, professionalism, self-awareness and the ability to connect with another human being in what may be the worst moment of their life.
But the real power came from Liz herself. Before she was a paramedic, educator and EMS leader, she was the patient. At the lowest point of a decade-long struggle with addiction, one paramedic looked beyond the overdose, the circumstances and the judgement, and treated her as a person who still mattered.
Liz credits that interaction not simply with helping save her clinically, but with changing the trajectory of her life. She recovered, entered EMS and ultimately became the kind of paramedic she had encountered that day.
It is a remarkable journey from patient to paramedic, and in this conversation, Liz explains why that experience now sits at the heart of everything she teaches about the human side of EMS.
| MORE: Liz Harney — the affective domain is the heart of EMS, so why aren’t we teaching it?
Our discussion also catches up with where Liz’s thinking has evolved since. In her recent EMS1 article, “Shiny Happy People,” she takes that same belief in people and applies it to EMS leadership, challenging professionals that is exceptionally good at identifying everything that might go wrong not to let that instinct extinguish every new idea before it gets moving.
Together, we connect those themes: the provider who changed one patient’s life, the importance of deliberately teaching the affective domain, turning cynics into champions, recognizing burnout through QA and QI, and creating leadership teams with enough optimism and emotional intelligence (EI) to make change happen.
At a time when EMS is increasingly consumed by another form of intelligence (AI), the conversation comes back to a proposition I think matters more and more: if we are going to get good at AI, we first need to get much better at EI.
Additional resources:
Liz Harney: Shiny happy people. The leadership power of optimism
Rob Lawrence: The affective domain is the heart of EMS — so why aren’t we teaching it?
Inside EMS: Tactical empathy: The leadership tool you’re not using enough
Colby Davis: Can emotional intelligence be taught?
Shannon L. Gollnick: The paradox of progress — emotional intelligence as the differentiator in an AI-augmented workforce
Key quotes
“It truly was a paramedic that not only saved me in a clinical sense, but she saved me in a human sense.” — Liz Harney
“Everybody has a story and they’re all a little the same, but they’re all very different at the same time.” — Liz Harney
“It’s our role as educators and program directors to be able to ensure that we are instilling, improving the affective domain, just as we are the cognitive and the psychomotor.” — Liz Harney
“You created from the cynic, turned them into the champion, and then the champion then took that back to their own service.” — Rob Lawrence
“I am the dreamer, probably because I have forged myself out of the depths of hell.” — Liz Harney
“Look at me, anything is possible. Like there is never a ‘no’ in my language.” — Liz Harney
“In order to build, in order to make change, in order to move the needle, you have to have folks that are strong in EI to make that happen.” — Liz Harney
“There’s always room for improvement.” — Liz Harney
“I may not be able to teach everyone to care, but I absolutely think you can teach people what caring looks like in practice.” — Liz Harney
“No one’s ever complained about the gauge of needle that we used, but they’ve certainly complained that the medic was mean.” — Rob Lawrence
“People underestimate the power of storytelling, but I’m here to tell you that is what creates the change into someone, that changes their perspective.” — Liz Harney
Episode timeline
00:00 — Harney on surviving addiction, being written off and the potential EMS providers have to influence another person’s future
01:02 — Rob welcomes listeners to EMS One-Stop and introduces Liz Harney
02:14 — How Rob first encountered Harney at EMS World Expo and why he describes her presentation as “the keynote I didn’t know I needed”
02:40 — Liz Harney 101: critical care paramedicine, organizational leadership, Baptist Health, Kentucky EMS workforce initiatives and Paramedic Pathways
04:10 — Harney reflects on the rapid growth of her speaking platform and why sharing her story remains difficult but necessary
05:32 — The human side of EMS: affect, emotional intelligence and why clinical competence alone is not enough
08:10 — AI versus EI: why Lawrence argues that increasingly intelligent technology makes human emotional intelligence even more important
09:00 — From patient to paramedic: Harney recounts the interaction with the paramedic who changed the direction of her life
18:33 — Revealing her past to colleagues and students, and how that story changes attitudes toward people experiencing addiction
22:08 — Why simply telling EMS students to care does not work — and how Harney began using clinical rotations and direct patient interaction to build the affective domain
23:18 — “Everybody has a story:” students hear directly from people in addiction recovery
25:23 — The cynic-to-champion story: a student’s dismissive attitude toward patients with addiction is transformed through one clinical rotation
31:00 — Educating not simply for cognitive and psychomotor competence, but for the clinician the student is becoming
32:15 — Harney moves from education into leadership and begins seeing the same issues around decision-making tables
33:19 — The case for optimism: Harney describes herself as a dreamer and explains how persistent negativity can kill innovation
34:04 — Lawrence’s rule: “If we do what we always did, we’ll get what we always got”
36:27 — Why potential barriers matter — but introducing every possible objection too early can destroy an idea before it develops
38:02 — “Shiny, happy people:” the discussion turns to Harney’s article on optimism, innovation and assembling teams capable of making change
39:02 — Harney describes Kentucky’s EMS workforce committee and what happened when a group of optimistic problem-solvers started building ideas without immediately saying “no”
41:00 — Choosing the right people for decision-making groups: why names, titles and tenure should not outweigh emotional intelligence
41:59 — Harney defines EI: self-awareness, self-regulation, communication and empathy
45:00 — “You can teach people what caring looks like in practice.”
45:15 — Lawrence asks whether EMS can genuinely change the affect and attitudes of a generation of clinicians
46:39 — Protecting the workforce: recognizing behavioral changes, cumulative exposure and the early warning signs of burnout
47:41 — QA/QI as more than clinical oversight: documentation can expose frustration and changes in provider behavior
48:07 — The leadership question: “What can I do for you?”
49:27 — The power of storytelling to challenge judgment and change perspectives
49:49 — Harney returns to her own experience: addiction, being cast off and ultimately demonstrating that recovery and transformation are possible
51:10 — Harney’s closing message: “You don’t have to understand someone’s life to understand your responsibility to them.”
52:41 — Turning QA/QI from a fault-finding function into a mechanism for recognizing providers, celebrating success and checking on people carrying heavy cognitive and emotional loads
54:10 — Lawrence recommends seeing Harney speak: “You will come away emotional but enlightened.”
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EMS research has grown rapidly, but finding the studies that truly matter to everyday clinical practice remains a challenge. In this edition of EMS One-Stop, Rob Lawrence is joined by Dr. Christopher Richards, EMS and emergency physician at the University of Cincinnati; and Dr. Christian Martin-Gill, chief of the Division of EMS at the University of Pittsburgh and former president of the Prehospital Guidelines Consortium, to discuss the recently published EMS research reading list and the effort to identify the most important evidence EMS clinicians and medical directors should know about.
The discussion explores how the reading list was created; why a significant gap remains between publication and implementation; and how EMS can better translate research into education, protocols and patient care.
Richards and Martin-Gill explain the mix of evidence-based guidelines, position statements, systematic reviews and original research included in the project, while highlighting major gaps in behavioral emergencies, pediatrics, obstetrics, workforce wellness and EMS operations.
The message is clear: EMS practitioners should not wait for new research to appear in their protocols. They should read it, discuss it, question current practice and, where evidence is lacking, consider contributing to research that closes the gap.
Additional resources:
Richards CT, Cash RE, Crowe RP, et al. 2026. “Developing an emergency medical services research reading list for emergency medical services practitioners.” Prehospital Emergency Care, 1-6. https://doi.org/10.1080/10903127.2026.2693158
EMS1 Research Center. A central access point for critical research that can help drive operational and policy changes
Understanding research and its impact on patient care. David Page, MS; Hezedean Smith, DM; and Ayanna Walker, MD, share best practices for evaluating and interpreting prehospital research 
Key quotes
“With EMS research, there's always something missing. There's always more that we can do.” — Dr. Christian Martin-Gill
“What we're seeing here, particularly over the last decade, is these organizations working less as silos and moving more towards working together when it makes sense to do that.” — Dr. Christian Martin-Gill
“We didn't go in actually feeling like we needed to identify 10 primary research or professional statements that complemented the guidelines that were already identified through the systematic review. But there was just a natural break point there.” — Dr. Christopher Richards
“There are a number of position statements that are published by national and international organizations that are key scientific literature out there that people need to be paying attention to.” — Dr. Christian Martin-Gill
“Still there is research lacking in what the EMS clinicians themselves experience as part of the workforce — safety on scene, wellness, these sort of questions.” — Dr. Christopher Richards
“The behavioral emergency space I think is really important right now.” — Dr. Christian Martin-Gill
Episode timeline
01:09 – Rob introduces the episode and welcomes Drs. Christopher Richards and Christian Martin-Gill
02:16 – Dr. Richards introduces his EMS, emergency medicine and research background
03:18 – Dr. Martin-Gill discusses his role at the University of Pittsburgh, UPMC and the Prehospital Guidelines Consortium
04:15 – Why does EMS need a dedicated research reading list?
07:11 – Where can EMS practitioners currently go to identify the research that really matters?
09:13 – Moving research into protocols, practice and clinical care
11:15 – Can the Prehospital Guidelines Consortium help align the many organizations producing EMS clinical guidance?
13:41 – Breaking down the different categories of publications on the reading list
14:47 – Evidence-based guidelines included in the broader reading list
15:49 – Position statements covering hemorrhage, restraint, air medical utilization and workforce issues
16:26 – Systematic reviews addressing airway management and prehospital evidence-based guidelines
16:51 – Four original research papers, including refractory VF, pain disparities, evidence integration and midazolam use
18:58 – How the research reading list was actually developed
19:32 – The open call for EMS research submissions
20:10 – The project is ongoing, with submissions continuing for the next iteration
20:42 – Expert panel review, scoring and the natural cutoff that produced the final 10
23:18 – What important EMS research is still missing?
24:37 – Gaps in airway, pediatric and behavioral emergency evidence
26:08 – Dr. Richards highlights workforce, safety, wellness and operational research gaps
28:18 – Which areas should future EMS researchers investigate?
28:31 – Martin-Gill highlights behavioral, obstetric and pediatric emergencies as priorities
30:12 – Richards explains how everyday frustrations in EMS can become important research questions
32:12 – Final thoughts on the paper and the breadth of the reading list
33:37 – Martin-Gill discusses access to research and why highlighting important publications matters
35:05 – Turning reading into discussion, protocol review and further research
35:58 – Rob closes with a challenge to read, question, discuss and contribute to EMS research
Enjoying the show? Email editor@ems1.com to share feedback. 

In this episode of EMS One-Stop, Rob Lawrence speaks with Wesley Brookshear, critical care paramedic and FTO program supervisor with AMR in Knoxville, Tennessee, about a community-led effort that is changing how EMS responds to the city’s Mission District. What began as an attempt to understand unusually high 911 utilization has evolved into a multidisciplinary outreach program bringing EMS, public health, addiction services, shelter providers, clinicians and other community organizations directly to Knoxville’s unhoused population. By concentrating on relationships, consistency and basic human needs, the initiative has produced a reported 32% reduction in traditional EMS call volume while dramatically expanding access to wound care, food, addiction treatment, mental health support, nurse navigation and other services.
Wesley explains why the program’s success is less about creating another specialized EMS unit and more about connecting people to the resources that already exist. The team initially arrived without uniforms, handed out fruit, listened and built trust before attempting to provide care. Two years later, the program has recorded thousands of encounters, helped more than 140 people enter treatment or sober living and generated remarkably few ambulance transports from its outreach activity. The conversation explores how other EMS systems can identify high-utilization areas, develop community partnerships, protect the mental health of outreach staff and start small—even with a single motivated employee.
Above all, Wesley argues that EMS has an opportunity to move beyond simply transporting patients and instead become the connector that gets people to the care and resources they actually need.
Additional resources:
Global Medical Response - AMR Mission District Medical Team Program Sees 32 Percent Decline in 911 Calls
eBook: How to fund community paramedicine
Very high EMS utilizers: 7 strategies for local action
From sirens to solutions: Guiding paramedics to a patient-centered mindset
Public health at the front door: An MIH model to emulate
Key quotes
“We did go down without our EMS uniforms on. We went in black t-shirts, blue jeans and started making connections.” — Wesley Brookshear
“We have noticed a 32% reduction in our normal call volume down at the mission since we started this program 2 years ago.” — Wesley Brookshear
“MIH, mobile integrated healthcare, isn't a title; it's actually a list. It's mobile, it's integrated and it's healthcare.” — Rob Lawrence
“This is not Wesley Brookshear, this is not AMR, this is an entire community of Knox County citizens that are coming together to support.” — Wesley Brookshear
“We talk about the homeless or the unhoused, and I do use both terms, but the unhoused, and we act like it's those individuals; it's never those individuals, those are humans within your community.” — Wesley Brookshear
“My mission wasn't admission avoidance, it was arrival avoidance.” — Rob Lawrence
“Our folks are wrapping their own wounds now. We are providing supplies. We are giving education.” — Wesley Brookshear
“Do not go down with the idea that you're going to cure this idea that homelessness is going to go away.” — Wesley Brookshear
Episode timeline
00:49 – Rob introduces the episode and the concept of specialist teams focused on populations at risk
01:52 – Wesley introduces himself, AMR Knoxville and the multidisciplinary Mission District outreach team
03:25 – Identifying concentrated 911 utilization around the North Broadway area
04:22 – The headline result: a 32% reduction in normal call volume after 2 years
05:08 – Building services around Maslow’s hierarchy of needs: food, water, shelter and safety
06:10 – How the project began with surveys asking community members what they actually needed
06:50 – Wesley emphasizes that homelessness should be understood as a human and community issue
08:05 – Building partnerships and establishing a consistent Tuesday outreach presence
08:28 – Why the team initially attended in jeans and black t-shirts rather than EMS uniforms
10:10 – Rotating team members to manage emotional and mental-health pressures
11:27 – Training new outreach personnel and protecting the culture of the program
12:10 – The practical work: washing wounds, basic dressings and human contact
13:02 – Patients begin managing and dressing their own wounds with education and supplies
13:26 – Taking CPR and Stop the Bleed education directly into the Mission District
14:00 – Using GMR nurse navigation to expand access to alternative care and follow-up
16:09 – Nurse navigation, mental-health pathways and bypassing the emergency department when appropriate
18:28 – Discussion resumes: community paramedicine versus mobile integrated healthcare
19:23 – Rob defines MIH as “mobile, integrated and healthcare”
20:01 – Building relationships with partner organizations beyond the street-level outreach work
21:23 – Program numbers: approximately 4,800 encounters, 515-plus people served, 140-plus entering treatment or sober living, and only nine outreach encounters requiring ambulance transport
22:14 – A frostbite patient whose feet were saved through coordinated community intervention
24:23 – Wesley reflects on severe wounds, winter outreach and the impact of simple acts of care
25:18 – Where another EMS chief should start: find the hot spots and find someone who cares
26:39 – Starting small and expanding services gradually through community partnerships
27:08 – Why handing someone a resource list is not enough
27:36 – EMS as clinicians and navigators rather than simply a transport service
28:50 – Rob discusses “arrival avoidance” and directing patients into appropriate pathways of care
29:51 – The minimum viable program: one person who builds connections and physically links patients to resources
30:42 – Costs, donated supplies and the operational value of reducing unnecessary 911 demand
31:55 – The broader return: increased ambulance availability and potentially improved workforce engagement
33:14 – What not to do: don't approach outreach expecting to “solve homelessness”
33:43 – Managing compassion fatigue and rotating team members
34:58 – Food, coffee and small gestures as tools for relationship-building
35:26 – Challenging assumptions about who becomes unhoused
36:51 – Wesley's closing message: seek opportunities for EMS to grow and approach vulnerable populations with compassion
38:38 – Rob closes the episode with a challenge to EMS leaders: start something, even if it is small
Enjoying the show? Email editor@ems1.com to share feedback. 

Finding grant funding can feel overwhelming, particularly for smaller EMS and fire agencies where one person often wears multiple hats.
In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Lexipol Grant Writer and Colorado Firefighter-Paramedic Anya Otterson to demystify the grant-writing process.
From identifying funding priorities and locating grant opportunities, to building a compelling case backed by data, Anya provides a practical roadmap for agencies looking to secure funding for equipment, staffing and operational improvements. She explains why success starts with clearly defining organizational needs, understanding grant priorities, and assembling evidence that demonstrates both community impact and operational necessity.
The discussion explores the complete grant lifecycle, from preparing competitive applications, through to post-award reporting and compliance. Anya emphasizes that strong grant applications combine hard data with real patient stories, while Rob shares lessons learned from managing successful Assistance to Firefighters Grants (AFG) and transportation safety grants.
They also discuss how AI tools such as ChatGPT can accelerate research when used appropriately — but caution against relying on AI to write narratives outright. The episode concludes with encouragement for agencies to not be discouraged by unsuccessful applications, reminding listeners that grant writing is an iterative process where persistence and continual improvement often lead to success.
Additional resources
EMS1 GrantFinder: Our suite of solutions gives agencies direct access to seasoned grant professionals—backed by over 500 years of combined experience—along with a comprehensive tailored grant database
Assistance to Firefighters Grants: Meeting firefighting and emergency response needs
On-demand webinar: Grants Day — Your funding playbook. Get the insights, expert advice and tools to help your agency score big on grants
Key quotes
"The data and statistics are incredibly important when writing grants, but to try to set yourself apart, I do like to have a little bit more of a personal touch." — Anya Otterson
"Figure out what kinds of things you want funding for and prioritize it." — Anya Otterson
"You've got to be in it to win it." — Rob Lawrence
"Give yourself enough time. This is not a day-before kind of thing." — Anya Otterson
"Making sure that everybody's on the same page is critical because this is not something you can really do in a silo." — Anya Otterson
"Never be afraid to reach out to the funding agency with questions. Their job is to help you through the process." — Anya Otterson
"ChatGPT should not be writing your narratives for you." — Anya Otterson
"If you don't get funded the first time, keep trying." — Anya Otterson
"The juice is worth the squeeze." — Rob Lawrence
Episode timeline
00:00 – Introduction and why so many EMS leaders struggle to know where to begin with grants
01:30 – Meet Firefighter-Paramedic and Lexipol Grant Writer Anya Otterson
03:00 – The first step: identifying and prioritizing organizational funding needs
04:00 – Where to find grants, including GrantFinder, ChatGPT, state resources and direct outreach
05:45 – Overview of FEMA's Assistance to Firefighters Grant (AFG) program
07:00 – Understanding funding priorities and why high-priority requests have the greatest chance of success
09:00 – Building a compelling grant narrative using statistics, research and patient stories
12:30 – Grant writing best practices: answer the questions, proofread thoroughly and involve leadership early
15:50 – Importance of organizational buy-in and internal communication
17:20 – Understanding grant requirements, matching funds and funding conditions before applying
18:40 – Post-award responsibilities, reporting requirements and maintaining compliance
20:40 – Rob shares practical lessons from administering successful federal grants
23:20 – Lexipol's GrantFinder platform and professional grant writing services
25:45 – Using ChatGPT responsibly to support grant research while avoiding AI-generated narratives
29:35 – Final advice: persistence, continual improvement and learning from unsuccessful applications
Enjoying the show? Email editor@ems1.com to share feedback. 

Matt Zavadsky explains how a commercial insurer’s reimbursement proposal — and looming Medicaid changes — could reshape EMS funding
In this week’s episode of EMS One-Stop, we examine two major financial threats facing EMS reimbursement.
Host Rob Lawrence is joined by Matt Zavadsky to analyze the recent Elevance (Anthem) Health Public Policy Institute paper, which argues that commercial insurers should reimburse ambulance services at approximately 160% of the Medicare fee schedule.
Zavadsky, EMS/mobile healthcare consultant with PWW | Advisory Group, explains why this paper is significant, noting that Medicare already reimburses below the actual cost of providing ambulance services. If policymakers adopt or even believe Elevance's recommendations, commercial reimbursement could fall dramatically, removing one of the few revenue sources that currently offsets chronic underpayments from Medicare and Medicaid. The discussion highlights the growing influence of commercial insurers in state legislatures and stresses the need for EMS leaders to counter policy proposals with credible cost and operational data rather than anecdotal arguments.
The conversation then shifts to CMS's proposed Medicaid supplemental payment rule (GEMT), where Matt predicts that most of the proposed changes are likely to survive into the final rule despite industry opposition. Both hosts discuss their review of the public comments, noting differing impressions of stakeholder sentiment but agreeing that agencies should begin financial planning now for a potential reduction in supplemental Medicaid revenue beginning in 2029.
Throughout the episode, the recurring theme is that EMS must become far more effective at explaining both the cost of readiness and the consequences of underfunding. The episode concludes on a more positive note by highlighting the newly released What Paramedics Want in 2026 report as a practical roadmap for improving workforce satisfaction while the industry continues addressing long-term reimbursement challenges.
Additional resources
The 160% mirage: Why every EMS leader should read the Elevance Ambulance Report
When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding
What Paramedics Want in 2026
Key quotes
"The commercial insurance industry is creating a story that elected officials may perceive as reasonable. We need to combat that story with facts." — Matt Zavadsky
"Medicare reimbursement is already below cost, so using it as the benchmark automatically discounts ambulance services." — Matt Zavadsky
"We do a great job telling stories about the lives we save. We do a poor job telling the story of what it costs to provide that service." — Matt Zavadsky
"The balance billing issue is going to be the No. 1 issue in the next 12 months." — Matt Zavadsky
"The first time local elected officials hear there's a problem is usually when the sky is already falling. We need to tell the story before the sky falls." — Matt Zavadsky
"Know your costs; know your costs at different service levels, and begin educating your local community." — Matt Zavadsky
"This isn't necessarily good news, but it's something we need to understand and all work together to deal with." — Rob Lawrence
Episode timeline00:00 – Introduction and the Elevance Health Public Policy Institute report
02:00 – Matt explains who Elevance Health is and why the report should be viewed as a commercial insurer's policy position
03:30 – Discussion of state balance billing legislation and how commercial insurers are successfully pushing lower reimbursement benchmarks
06:15 – Breakdown of what percentages of Medicare actually mean using national EMS financial data
08:30 – Why using Medicare as the reimbursement benchmark is fundamentally flawed because Medicare itself pays below cost
10:30 – Discussion on the political influence of insurers and why EMS must counter with data-driven messaging
12:30 – Why EMS has historically struggled to tell its financial story despite being effective at telling patient care stories
14:20 – Matt predicts balance billing legislation will become the industry's No. 1 policy issue over the next year
16:10 – Potential consequences if commercial reimbursement falls to 160% of Medicare
17:30 – Discussion on community funding, essential service models and matching service expectations with available revenue
22:20 – Transition to CMS's proposed Medicaid supplemental payment (GEMT) rule
22:45 – Review of public comments submitted on the CMS proposal and differing observations about stakeholder support
25:00 – Matt predicts the CMS rule will largely move forward and agencies should prepare accordingly
27:45 – California and other states discussed as examples of systems likely to experience significant reductions in supplemental Medicaid funding
30:45 – Closing on a positive note with discussion of the What Paramedics Want workforce survey

The 2026 AIMHI Excellence in Public Information or Education Award recognizes organizations that create innovative programs which improve health, educate communities and demonstrate measurable outcomes. This year’s recipient, the Medic Keep the Beat Foundation, earned national recognition for a groundbreaking fall-prevention initiative that is helping older adults remain independent, reducing repeat 911 calls and preventing avoidable hospital admissions. The award celebrates programs that move EMS beyond emergency response into proactive, community-based healthcare.
In this episode of EMS One-Stop, Rob Lawrence sits down with Jimmy Pierson, president and COO of Medic Ambulance; and Angeline Pierson, occupational therapist with the Medic Keep the Beat Foundation, to explore the award-winning program in depth. The discussion covers everything from home safety assessments and occupational therapy interventions, to public-private partnerships, sustainable funding, EMS workforce innovation and why prevention may be one of the greatest opportunities facing EMS today.
Key quotes
“You’ve taken the frequency out of a faller.” — Rob Lawrence
“We don’t want healthier transports; we want a healthier community.” — Jimmy Pierson
“This isn’t a business model; it’s a community model.” — Jimmy Pierson
“We want to keep people safe and independent in their own homes.” — Angeline Pierson
“With this program they can stay at home instead of moving into a skilled nursing facility.” — Angeline Pierson
“The key is finding partners who see you as a partner; not as a subcontractor.” — Jimmy Pierson
“The Australian paramedics became part of our family; they weren’t temporary staff.” — Jimmy Pierson
Additional resources
Awards – AIMHI
Medic Keep the Beat Foundation
Fall prevention: EMS patient education tips after the lift assist
Fall hazard reduction and emergency alerting
Geriatric slips, trips and falls: 3 assessment considerations
9 fall prevention tips for EMS providers to share
Episode timeline
01:00 – Meet Jimmy and Angeline Pierson
02:00 – Inside the award-winning fall prevention program
06:45 – How patients enter the program
08:30 – Why preventing falls starts inside the home
12:30 – Measuring outcomes and demonstrating return on investment
15:00 – Funding, grants and building community partnerships
17:00 – Public-private partnerships with California fire departments
22:00 – Sonoma County Fire and collaborative EMS delivery
28:00 – Workforce rebuilding after COVID-19
31:30 – Recruiting Australian paramedics and creating a sustainable workforce
34:30 – Final reflections on prevention, partnerships and the future of EMS
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This week on the EMS One-Stop podcast, Rob Lawrence sits down with emergency management and large-scale exercise expert Mike Marsh to explore what really goes into preparing agencies, communities and public safety partners for major events.
With the FIFA World Cup underway, America 250 upon us, and countless local events happening every weekend, the conversation focuses on the practical realities of planning, exercising and pressure-testing emergency response systems before the big day arrives.
| MORE: Training hard and fighting easy. Creating an effective tabletop training exercise for pre-planning MCI response
Drawing on decades of EMS leadership experience and his current work through Marsh EMS Consulting, Mike shares how agencies can move beyond "grant compliance exercises" and build meaningful operational readiness.
From tabletop exercises and ROC drills, to stakeholder coordination, communication failures and after-action reviews, Mike provides a masterclass in how to build resilient systems from the operator up.
His central premise is simple: exercises should be designed to break the system in a safe environment so weaknesses can be identified and corrected before a real incident occurs.
Whether you're preparing for a World Cup match, a county fair, or simply reviewing your MCI plans, this episode offers practical lessons for agencies of every size.
Notable quotes
"Our team is hired to break your system and rebuild it together." — Mike Marsh
"The scene will be bigger than they are. And it is OK to ask for help." — Mike Marsh
"We don't walk in and say, 'You don't understand ICS.' Actually, you do understand ICS, you just don't know that you're using it." — Mike Marsh
"Identifying and learning are two different activities; and they have to be cemented in." — Rob Lawrence
"Trust your people, know that you can't do it all, get a team together, train them, drill them, pressure them." — Mike Marsh
"Prior preparation and planning prevents pathetic performance." — Rob Lawrence
| MORE: 5 lessons for special events standby services and emergency response
Episode timeline
00:00 – Introduction and why major events require planning, exercises and preparation
02:25 – Mike's journey from California EMS leadership to emergency management consulting in Texas
04:53 – The biggest misconceptions about exercises and tabletop planning
06:30 – What frontline EMTs and supervisors need to know when the incident is bigger than they are
08:07 – The first questions Mike asks when planning a major event
10:13 – Communication, stakeholder engagement and identifying operational gaps
12:16 – Translating ICS and NIMS concepts into practical operational language
17:08 – Planning a county fair exercise: where to start and why capability gaps matter
19:46 – Who should be at the planning table and why executive participation matters
21:23 – The role of public works, politicians, emergency managers and public information officers
22:29 – The best and worst exercises Mike has ever experienced
25:29 – How to challenge leaders who believe their plans don't need testing
28:01 – Exercise planning for small and rural systems with limited resources
30:22 – After-action reviews and turning lessons identified into lessons learned
32:11 – Advice for agencies that have never exercised their plans before
33:54 – Mike's biggest leadership lesson from a career in EMS and emergency management
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The countdown to Pinnacle is on. Returning this year to San Diego from July 13-16, Pinnacle remains one of the most influential leadership and management conferences in EMS. Now entering its 22nd year, the event continues to attract executives, clinical leaders, innovators, educators and industry partners who gather not simply to learn, but to debate, challenge assumptions and shape the future direction of EMS. EMS1 is proud to be the premier media partner of Pinnacle.
| MORE: What Paramedics Want in 2026: Bookmark this page to get your copy
Joining EMS One-Stop this week is Anthony Minge, senior partner at Fitch & Associates and one of the driving forces behind Pinnacle. Anthony previews the major themes emerging this year, including workforce retention, leadership development, burnout and wellness, preparedness, artificial intelligence, blood delivery, drone technology and the ever-popular What Paramedics Want report.
Throughout the discussion, Anthony emphasizes that Pinnacle's value extends beyond the classroom. The real learning often happens in the conversations between sessions, over meals and among peers facing the same challenges across the country.
The conversation explores why retention has overtaken recruitment as EMS's primary workforce concern, how leaders must take greater responsibility for organizational culture, and why emerging technologies such as AI and drone-delivered medical supplies are changing the profession faster than many realize.
Anthony also offers a preview of keynote speakers, including preparedness expert and author William Forstchen, and highlights sessions covering leadership, resilience, operational excellence, workforce wellness and healthcare innovation.
As always, Pinnacle promises to deliver practical takeaways, provocative discussions, and the opportunity to connect with some of the brightest minds in EMS.
Key quotes
"If we can keep our people, we don't need to spend as much time trying to replace them."
"People don't leave organizations, they leave managers."
"Burnout is still too high. One suicide is way too many."
"We can't push it into the dark corners of our organizations and just hope it goes away."
"AI is here to stay. It's going to help us. It's going to do some great things."
"It is never meant to replace this computer right here."
"We practice healthcare. We practice extremely innovative healthcare out there."
"It's amazing the things that are happening out there."
"Good leaders share."
"Being responsible leaders is probably one of our largest challenges."
Additional resources
Pinnacle EMS 2026: Conference information, agenda details, speakers and registration
Conference dates: July 13-16, 2026
Location: Sheraton San Diego Resort
Pinnacle Early Bird Offer: provide the code “EMS26”. This gives early-bird offer provides $100 off the current/regular price
What Paramedics Want: 2026 Report debuts July 13, 2026
William Forstchen’s books
Episode timeline
03:00 – The major themes of Pinnacle 2026. Discussion of retention, leadership, financial sustainability, workforce wellness, preparedness, AI and emerging technologies.
06:30 – Recruitment vs. retention. Why keeping employees has become more important than finding new ones and how organizations can build careers rather than simply fill vacancies.
08:15 – Leadership beyond operations. The role of leadership in employee engagement, succession planning, data-driven decision-making and lessons from Matthew McConaughey's book Greenlights.
11:00 – Burnout, wellness and resilience. Why burnout remains a major challenge for EMS and how leaders must confront it rather than ignore it.
13:00 – Preparedness for the next crisis. A preview of keynote speaker William Forstchen and discussions around resilience, disaster readiness and planning for both natural and man-made events.
19:00 – AI Comes to EMS. Anthony discusses the opportunities and risks associated with artificial intelligence, from documentation and CAD integration, to clinical decision support.
24:00 – Blood, drones and clinical innovation. A look at how blood products, AEDs, naloxone and other critical supplies are increasingly being delivered through innovative technologies, including drones.
29:00 – What Paramedics Want in 2026. A preview of the latest survey findings and the issues currently weighing most heavily on the minds of EMS professionals.
30:00 – Why Pinnacle matters. Anthony explains why networking, relationship building and peer-to-peer learning remain among the conference's greatest strengths.
32:00 – The conversation EMS needs to have. Anthony identifies leadership responsibility and accountability as one of the most important — and often avoided — topics facing EMS today.
Enjoying the show? Email editor@ems1.com to share feedback. 

At a time when EMS reimbursement faces unprecedented scrutiny and pressure, Shawn Baird joins the EMS One-Stop podcast to explain what is happening in Washington, D.C., why it matters to every ambulance service in America and what EMS leaders can do about it.
| MORE: When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding
A former Paramedic, ambulance service owner, CEO, American Ambulance Association resident, and now Vice President of Government Affairs for the AAA, Baird brings a unique perspective that spans frontline care, operations and national advocacy.
In this episode, Rob Lawrence and Baird unpack the growing threats to Medicare and Medicaid funding, discuss the proposed changes to Medicaid supplemental payment programs, and explore the work of the National EMS Payment Reform Committee.
The conversation also previews the AAA Legislative Fly-In, and highlights efforts to secure EMS workforce funding, streamline military medic transitions into civilian EMS and advance federal fuel tax relief. Most importantly, Baird delivers a clear message: EMS professionals must tell their story, engage with elected officials and advocate for the future of mobile healthcare.
This episode serves as both an explainer and a call to action. As federal policymakers debate Medicaid funding, EMS reimbursement, workforce development and healthcare spending, Baird makes the case that every EMS professional has a role to play. Whether through legislative fly-ins, ride-alongs, town halls or simply telling the EMS story, advocacy is no longer optional. It is essential to preserving access to emergency medical care in communities across America.
Notable quotes
"We're hoping to make some proposals for real long-term reform on Medicare that will shore up the EMS system, not just to survive day to day, but really to thrive." — Shawn Baird
"We are more than just a ride. We are mobile healthcare." — Rob Lawrence
"We really have not been able to find a lot of data to support a bunch of waste, fraud and abuse in the EMS system. What there is, is a lot of misunderstanding." — Shawn Baird
"If we don't get paid ourselves, how can we pay other people? How can we then afford to deliver excellent healthcare to our patients?" — Rob Lawrence
"First of all, talk about the patient because the patient is the most important part of this whole discussion; second of all, talk about the medical care you provide because that's what the patient needs." — Shawn Baird
"We're the safety net. We're access to critical emergency care in many communities that don't have other healthcare." — Shawn Baird
"Probably the most important thing that folks listening to your show can do is attend a town hall and raise your hand and say, 'I'm just worried about our ambulance service.'" — Shawn Baird
"We have the greatest story of all to tell." — Shawn Baird
Additional resources
AAA Advocacy Call to Action – Contact your member of Congress here
2026 Ambulance Ride-Along Toolkit
Episode timeline
01:00 – Rob introduces the episode and outlines the challenges facing EMS reimbursement and federal healthcare funding.
02:07 – Shawn Baird's EMS Journey — from paramedic intern at Grady Hospital to rural EMS operator, company owner, AAA president and government affairs leader.
03:00 – Why healthcare reimbursement decisions are increasingly shifting from Washington to state legislatures.
06:45 – The National EMS Payment Reform Committee and the search for long-term solutions to EMS financing.
09:13 – Medicaid, waste, fraud and abuse — understanding misconceptions about EMS reimbursement and why ambulance services are being caught in broader healthcare debates.
11:33 – EMS is more than transportation — reframing EMS as healthcare first, transportation second.
13:20 – The threat to Medicaid supplemental funding — provider taxes, GEMT programs and proposed federal changes that could impact ambulance services nationwide.
15:15 – Proposed CMS rule changes — why EMS leaders are concerned about being included in Medicaid funding reductions.
17:40 - How national EMS organizations are coordinating efforts to speak with one voice.
20:08 – The AAA Legislative Fly-In — what it is, how it works and why provider participation matters.
21:45 – Federal legislative priorities — EMS workforce development funding, military medic-to-civilian certification pathways and federal fuel tax relief for ambulance services.
26:50 – How EMS providers can engage when legislation is moving.
27:40 – The importance of local advocacy — town halls, community events and direct engagement with elected officials.
29:30 – Ride-alongs as an advocacy tool — why seeing EMS firsthand changes policymakers' perspectives.
32:00 – Final thoughts — politics is ultimately about relationships, storytelling and helping decision-makers understand EMS.
Enjoying the show? Email editor@ems1.com to share feedback.