EMS One-Stop

Blood on Board: The second chance that changed everything

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

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

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

Blood on board: Lessons from Sacramento and LA County Fire

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

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

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

In this episode of EMS One-Stop, Rob Lawrence sits down with Kevin Hazzard to explore No One’s Coming, a gripping account of the 2014 Ebola outbreak and the extraordinary effort to rescue infected American aid workers from West Africa.
|WATCH NOW: FDNY’s future: AI, BWCs and pay parity with Commissioner Lillian Bonsignore 
What begins as a seemingly impossible mission evolved into a high-stakes, time-critical operation led by Phoenix Air — a team known for taking on the missions no one else will.
Hazzard traces the origins of this unconventional organization, from transporting explosives and nuclear materials, to pioneering aeromedical evacuation of the world’s most dangerous infectious patients.
The conversation moves beyond storytelling into operational reality. With no established protocols, limited knowledge of Ebola and widespread public fear, crews were forced to improvise, adapt and execute under intense pressure.
The episode examines the intersection of EMS readiness, public health hesitation and leadership under uncertainty. At its core, this is a study in preparation, risk tolerance and professional duty — illustrating how a small group of individuals stepped forward when systems hesitated, reinforcing the enduring EMS principle: when the call comes, you answer.
Key quotes from Kevin Hazzard
“This is as scary as it gets.”
“It is the largest and deadliest Ebola outbreak in human history.”
“We’ve got to figure out how to transport highly contagious patients — nobody does that.”
“They risked their lives. They risked their families’ lives for strangers.”
“Preparation is the most important thing.”
“We are notoriously short-minded … we’re not long-range thinkers.”
“There are people out there who are willing to step into the breach when needed.”
Episode timeline
00:00 – Opening context: Ebola outbreak severity and mission stakes
01:00 – Introducing Kevin Hazzard, author background
03:30 – Origins and evolution of Phoenix Air
08:00 – High-risk missions (including Libya nuclear extraction)
14:30 – Transition to EMS and infectious disease transport
16:00 – Development of the biocontainment system
20:00 – Ebola mission planning and execution challenges
27:00 – U.S. reception, EMS transport and public reaction
31:00 – Leadership lessons and EMS preparedness gaps
35:00 – Reflections on readiness, resilience and future threats
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‘Hydraulic debriefing:’ Alcohol, stress, and the hidden culture of EMS

In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers.
| MORE: First responders and alcohol – how much is too much?
Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture.
What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty.
The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians.
At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures.
Key quotes from Maria Koeppel
“Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.”
“EMS providers tend to drink a little bit more frequently than the general population — and that’s tied directly to stress.”
“It’s not just the big trauma calls — it’s the micro-stressors that add up over time.”
“A third of clinicians in our sample engaged in high-risk drinking behaviors.”
“Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.”
“Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.”
“Some described going out after shift as ‘hydraulic debriefing’ — using alcohol to process the day.”
“Gen Z is driving a more sober culture — they’re choosing connection without alcohol.”
“Leadership isn’t just policy — it’s culture, awareness and how you care for your people.”
“Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.”
Episode timeline
01:06 – Maria’s background: firefighter and researcher
02:24 – Overview of NIH/FEMA research and EMS focus
04:14 – Key findings: stress, frequency of drinking and EMS culture
05:08 – Micro-stressors vs. major trauma calls
06:54 – Risk factors: age, role, education, multiple jobs
10:11 – Culture and “hydraulic debriefing”
11:46 – Fire vs. private EMS cultural differences
14:38 – Generational shift: Gen Z and sober culture
19:24 – Alternative substances and coping trends
21:20 – Leadership roles: policy vs. culture
24:11 – Peer support gaps in EMS
26:41 – Workforce impact: sleep, stress, retention
27:14 – Education gap and need for EMS-specific training
29:11 – Conferences and future research dissemination
30:13 – Episode wrap-up
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FDNY’s future: AI, BWCs and pay parity

In this episode of EMS One-Stop, Rob Lawrence travels to New York City to sit down with Lillian Bonsignore, the 37th Commissioner of the Fire Department of the City of New York (FDNY). A 30-plus year veteran who rose through the ranks of EMS — from EMT in the South Bronx to Chief of EMS and now Commissioner — Bonsignore brings a ground-up understanding of the largest fire-EMS system in the United States.
She reflects on stepping into the role as “walking onto a fast-moving train,” immediately confronted with major incidents, severe weather and system pressures, while simultaneously building her leadership team and setting direction for the future.
| MORE: ‘We have to right the ship’: FDNY commissioner doubles down on EMS pay parity
The conversation explores the unique structure of FDNY, where the Commissioner operates as the executive leader “almost like CEO of the company,” while operational command sits with the Chief of Department.
Bonsignore is clear-eyed about the scale and demands of the system: over 2.2 million runs annually, with 1.6 million EMS-related, reinforcing her long-held position that EMS must be treated as an essential service with appropriate funding and career pathways.
Drawing on her experience leading through the COVID-19 pandemic and responding on Sept. 11, 2001, she emphasizes resilience, communication and presence — being visible in stations, honest with staff and committed to supporting those who “leave their own families behind to go serve a stranger.”
Bonsignore also addresses criticism of her appointment directly and without hesitation, framing it as a misunderstanding of the Commissioner’s role and the realities of modern emergency response. She underscores that FDNY is both fire and EMS, and that her career — spanning 9/11 response, pandemic leadership and decades of frontline service — positions her to lead the entire enterprise.
Looking ahead, she speaks to the need for infrastructure investment, workforce stabilization, mental health support, and the thoughtful adoption of technologies such as AI and body-worn cameras. As FDNY approaches the 25th anniversary of 9/11 and the nation’s 250th year, her focus remains clear: support the workforce, strengthen the system, and prepare the department for the next generation of service.
Key quotes from Commissioner Bonsignore
“Walking into a position like this is like walking onto a fast-moving train.”
“I understand the ground level challenges that go on because I lived them.”
“The commissioner is the administrative level, almost like CEO of the company.”
“We’re responding to over 2.2 million runs a year … 1.6 million of those runs are EMS-related runs.”
“We have to stabilize our system … it’s time that EMS is finally treated as an essential service.”
“I will always tell you the truth. You may not like my truth, but I will give it to you.”
“The decision of a first responder is to leave their own families behind … to go serve a stranger.”
“They are literally your heroes … they will put their lives on the line for you.”
Episode timeline
01:10 – First 100 days as Commissioner — “fast-moving train”
02:30 – Career journey and EMS roots shaping leadership
04:30 – Workforce trust, credibility and lived experience
06:30 – Pay parity and EMS as an essential service
09:00 – Structure of FDNY — Commissioner vs. operational command
11:30 – Setting direction and stabilizing the organization
13:30 – Relationship with the Mayor and political leadership
17:30 – Addressing criticism and misconceptions
19:30 – Leading through COVID — scale, innovation, mutual aid
23:30 – Morale, resilience and leadership presence
26:30 – Recruitment and retention challenges
30:30 – AI and future innovation in EMS
32:30 – Behavioral health response and BeHeard program
36:30 – First responder mental health and support systems
38:30 – Violence against EMS and workforce protection
41:00 – Body-worn cameras and transparency
43:30 – 9/11 reflections and legacy
50:30 – Commemoration planning and future outlook
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CAAS accreditation – More than a badge, a blueprint for excellence

This week on EMS One-Stop, Rob Lawrence sits down with Sarah McEntee, executive director of the Commission on Accreditation of Ambulance Services (CAAS), to unpack what accreditation really means for modern EMS systems.
Moving beyond the “sticker on the truck,” Sarah reframes CAAS as a living, breathing process — one that drives internal improvement, organizational alignment and long-term sustainability. From its origins within the American Ambulance Association in the 1990s, to the latest Version 4.0 standards, the conversation highlights how CAAS provides a unified, industry-driven framework that elevates agencies from compliant to high-performing.
Rob brings a practitioner’s perspective, reflecting on his own experience navigating multiple accreditation cycles, emphasizing how CAAS becomes a “guiding light” for governance, clinical care and operational excellence.
Together, they explore the structure of the standards, the application journey, and the cultural readiness required to succeed.
The key takeaway is clear: accreditation is not a project with an endpoint — it’s a continuous process that strengthens organizations from the inside out, identifying risks, improving systems, and ultimately delivering better care to patients and communities.
Episode timeline
01:30 – Origins of CAAS and need for unified standards
03:30 – Breakdown of CAAS standards (admin, clinical, operations)
06:30 – Deep dive into operational standards and structure
10:30 – Rob’s real-world experience with accreditation
12:30 – Accreditation as a process vs. project
16:00 – Value proposition: internal vs. external benefits
18:30 – Cost vs. value — and the risk of not being accredited
22:00 – Step-by-step accreditation journey (readiness → submission → review)
28:30 – Site visits and peer collaboration
31:30 – Resources, support and how to get started
34:30 – Final reflections and leadership call to action
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Live from NEMSMA: From battlefield to boardroom

This edition of EMS One-Stop, recorded at the inaugural National EMS Management Association conference in Arlington, Virginia, pairs two complementary conversations about leadership and the future of EMS.
 
In the first half, General Robert Neller brings a military leader’s lens to universal leadership truths: lead yourself first, remember that everyone is watching, stay humble, listen better and understand that decisiveness matters. His message is simple and sharp. People want leaders who will set the example, make the call when it matters, and balance standards with empathy.
 
| MORE: EMS Leadership Institute — AI and the future of EMS
 
In the second half, NEMSMA President Dr. Hezedean Smith reflects on a successful launch for the conference and looks ahead to where EMS leadership must go next. He frames this association as a growing home for mentorship, shared learning and strategic thinking, while also pointing to the disruptive forces already reshaping the profession:
Artificial intelligence
Redesigned systems
Recruitment and retention pressures
The possibility of autonomous ambulance operations
Taken together, the episode is both a leadership masterclass and a forward look at an EMS profession that cannot afford to stand still.
Episode timeline
00:39 – Rob sets the scene from the inaugural NEMSMA conference in Northern Virginia.
00:51 – Rob introduces General Neller as the opening keynote speaker.
01:38 – General Neller explains his leadership “roadmap,” beginning with leading yourself first.
03:38 – Rob and General Neller discuss how leaders are always being watched.
06:04 – Advice for the newly promoted EMS lieutenant: growth takes time, ask for advice, study and learn.
08:11 – General Neller reflects on what he wishes he had known earlier in his career: be a better listener.
09:41 – The “don’t eat the cake” story becomes a lesson in humility and example-setting.
11:42 – General Neller discusses when leaders must consult and when they must simply decide.
13:22 – Final leadership theme from General Neller: empathy strengthens standards rather than weakening them.
17:04 – Rob returns with Dr. Hezedean Smith, President of NEMSMA.
17:18 – Dr. Smith describes the early success of the inaugural conference and strong turnout.
18:12 – Dr. Smith confirms planning is already underway for next year because the event has outgrown the venue.
19:25 – Discussion shifts to the future direction of EMS leadership and system design.
19:49 – Dr. Smith highlights AI, system redesign, and recruitment and retention as major themes.
20:47 – Dr. Smith talks about self-driving ambulances, solar-powered systems and rapid technological change.
21:38 – Dr. Smith emphasizes that technology must make providers’ work easier, not harder.
22:22 – Rob asks why people should join NEMSMA.
22:28 – Dr. Smith outlines mentorship, information sharing and rapid organizational growth.
23:13 – Dr. Smith closes by reaffirming NEMSMA’s role in the EMS leadership space.
23:46 – Rob signs off from what he calls an “amazing time” at the conference.
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