EMS One-Stop

Sirens, transformation and trends

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
In this episode of EMS One-Stop, host Rob Lawrence welcomes Matt Zavadsky back to the podcast to catch up on three key ongoing issues and developments: MedStar’s EMS-on-demand model via their MedStarSaver+PLUS program, the recent article by Zavadsky and Dr. Doug Kupas on the reduction of red lights and sirens with the additional news that MedStar ceased all RLS use during the recent ice-related weather event.  Finally, Zavadsky discusses the recent National Association of Emergency Medical Technicians’ 2022 EMS Worker Engagement Survey and the top five takeaways.
Top quotes from this episode
“One of the mantras we have always said is if someone is going to get paid to reduce our call volume, it should be us.”
“We take an oath to do no further harm, if we know that we are doing something that causes further harm while we are getting to a call that probably doesn’t need an immediate response, then we are not fulfilling our oath.”
“Our medical director has implemented a directive in the same theme of bad weather, bad driving that no patient will be transported with CPR in progress, meaning that you are just not going to transport patients in cardiac arrest … there is no reason for us to relocate corpses from the field to the emergency room.”
“Community expectation ... is it really what the community expects or is it something we have taught them to expect because we are competing for contracts?”
Episode contents
1:52       MedStar Saver Plus Model
11:37    NAEMSP2023 discussion
13:15    Red lights and sirens reduction
15:11    MedStar suspends RLS
19:07    Political navigation to reduce use of RLS with local officials
23:06    We stink at communicating effectively with our workforce
23:45    We stink at providing feedback to our employees about their performance (and their patients)
24:59    We don’t pay our people enough
26:21    California’s Medi-Cal Campaign
29:10    Work-life balance is a real thing
32:13    This is a long-term challenge that needs long-term solutions
34:33    Zavadsky’s final thoughts
34:44    Drs. Larmon, Kazan and Mackey
Additional resources
EMS-on-demand the next big transformation for the profession?
Culture shift: Reducing lights and siren vehicle operation
The EMS workforce: Critical condition!
About our guest
Matt Zavadsky is the chief transformation officer for MedStar Mobile Healthcare, the Public Utility Model EMS system serving Fort Worth, and 14 other cities in Texas. He has 43 years of experience in EMS. He is an at-large director for NAEMT and chairs its EMS Economics Committee.
Connect with Matt Zavadsky
Online
Linkedin
Twitter: @MattZavadsky
Rate and review the EMS One-Stop Podcast
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Dr. Dave Williams: 12 questions to learn about your system

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
In a recent blog post, Dave Williams, PhD, noted that half to two-thirds of Dallas city general funds are dedicated to police, fire and EMS. With significant tax dollar investments, elected officials, community leaders, and the media want to be good stewards. Still, they are frequently not equipped with the knowledge or data to determine if their services are built to get results and where there are opportunities for improvement.
In this week’s podcast, host Rob Lawrence sat down with EMS thought leader, Dr. Dave Williams, to discuss and identify the 12 questions local leaders can use to learn about their communities. Each point discussed should generate ideas for more learning and improvement both inside an organization and for those citizens and elected officials that surround it.
Top quotes from this episode
“I have been to dozens of ambulance systems around the world and met with leaderships teams and I can count on one hand the number of times they started by talking to me about their clinical outcomes.”
“Almost all of your staff are not your generation … which means they have a totally different value system and a totally different prioritization of things.”
“One of your real powers is to be able to help your community and its leaders understand what’s happening in it. The data that you have is a huge enabler for others to be able to change policy.”
Additional resources on this topic
Williams’ Blog
To Err is Human: Building a Safer Health System
The EMS workforce: Critical condition! Why right-sizing EMS response is crucial to increasing pay and improving work-life balance
Crossing the Quality Chasm: A New Health System for the 21st Century
About our guest
Dave Williams, PHD, designs and improves ambulance systems. He is known for leading objective, ethical and collegial approaches focused on patient and community needs, and incorporating evidence-based and best practice methods. He is one of a few researchers to study EMS system design. His published doctoral research focused on patient-centric EMS system design.
Dr. Williams is a former paramedic, EMS commander and researcher. Previous leadership positions include the Institute for Healthcare Improvement, Fitch & Associates, and Austin-Travis County EMS.
Dr. Williams is faculty at the Institute for Healthcare Improvement and serves as a senior improvement advisor. He served as faculty in emergency health services at The George Washington University School of Medicine and public safety management at St. Edward’s University. He supported professional development programs, including the National Association of EMS Physicians Quality and Safety program, the American Ambulance Association Ambulance Service Manager Program, and the National Academies of Emergency Dispatch Communication Center Manager Program.
Dr. Williams served as the vice chairman of the Board of CommUnityCare, the Federally Qualified Health Center system serving the City of Austin, Texas, and was appointed by the Travis County Commissioners Court to serve as a member of the Advisory Board of Austin/Travis County EMS. He is an alumni of Leadership Austin (Essential 2013).
He has contributed to several EMS leadership and research textbooks and published dozens of peer-reviewed papers and industry articles. He is a frequent keynote speaker.
Dr. Williams earned a B.S. in EMS Management and an M.S. in Emergency Health Services Management. He also earned a Ph.D. in Organizational Systems, where his research focused on the obstacles to patient-centric EMS system design.
Connect with Dave Williams
Online
Twitter @davewilliamsATX
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.

Rwanda’s national EMS system: The jewel in the crown of African Ambulance Services

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
In this episode of EMS One-Stop, our host, Rob Lawrence, kicks off a series on international EMS, interviewing EMS leaders across the globe on how their systems are operated, the challenges they face and the successes they have had.
Rob begins his podcast journey with Rwanda, a country and EMS system close to his heart. Rob has advised the Rwandan EMS system and monitored their progress for many years. In this episode, he welcomes Rwandan EMS Leader Jean Marie Uwitonze from the Rwandan Ministry of Health, Division of EMS; and U.S. Trauma Surgeon Dr. Sudha Jayaraman, director of the Center for Global Surgery at the University of Utah.
Rwanda is one of the only countries in Sub-Saharan Africa to have a publicly run, national ambulance service, which was established in 2007. Uwitonze highlights the development of EMS, and training and certification levels in Rwanda, as well as the next major project to develop and enhance emergency communications across the country.
Dr. Jayaraman describes her involvement (for over a decade) in the development of EMS in the country and notes, “We all know that there is no point in having a wonderfully qualified surgeon in the hospital if there is no means to get the patient there.”

Empowering female first responders

The founders of the Women in Emergency Services association discuss their mission
This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
In this episode, Rob Lawrence chats with the founding advisors of the new EMS association – Women in Emergency Services (WiES):
Amy Gnojek, CPA, MPA, CACO, founder/principal consultant, Apex360
Michelle Anderson, BA, director of administration at Lakes Region EMS
Maria Bianchi, chief executive of the American Ambulance Association
The guests discuss the formation of WiES and its aims, mission and four pillars:
Empowerment
Networking
Mentorship
Education
They also discuss how they hope to influence and impact the lives of thousands of women working in the emergency services industry.
Bianchi and Anderson also discuss their roles in current legislation and the upcoming Cost Collection survey as well as the AAA Vanguards Awards, which will honor those who blazed the trail for fellow female EMS professionals. The Vanguards will be presented in collaboration with Women in Emergency Services.

Flattening the turnover curve

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
Host Rob Lawrence welcomes guest Scott Moore, Esq., owner of Moore EMS Consulting, LLC and an active EMT for over 30 years to discuss the fourth annual survey of employee turnover in the EMS industry prepared and authored by the American Ambulance Association; Newton 360; Doverspike Consulting; and Rosanna Miguel, PhD. The survey presents turnover data from 119 EMS organizations, representing more than 12,000 employees.
Up for discussion: how turnover rates have changed, the cost of replacing an EMT or paramedic and how turnover rates are increasing in part-time providers. Moore also shares one thing that has not changed in the 4 years of the AAA turnover survey: the dissatisfaction with pay and benefits.
Moore has held various executive positions, including chief executive officer, vice president, director of human resources and operations, at several ambulance services in Massachusetts. He is a licensed attorney, specializing in human resources, employment law, reimbursement, and compliance matters. Moore is the human resources and operational consultant to the American Ambulance Association and frequently lectures at EMS conferences.

An ‘aggressive and untested interpretation’ of the law

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
New York City Mayor Eric Adams recently announced a directive for police and emergency medical workers to hospitalize people on the streets and subways who have severe, untreated mental illness. Adams said the directive was an effort to curb a recent wave of crimes involving people experiencing homelessness and will allow law enforcement and EMS to involuntarily hospitalize people who pose a danger to themselves, even if they don't pose a risk to others.
The directive, which has been met with major concern – as voiced in a New York Times op-ed by an FDNY Paramedic Lieutenant, is fraught with concerns in the burden being placed on EMS to solve the mental health crisis.
In this episode of EMS One-Stop, Doug Wolfberg, EMS attorney and founding partner of Page, Wolfberg & Wirth, LLC, joins host Rob Lawrence to discuss how the directive is a departure from the usual mental health standard.
“The Mayor’s office is using a very aggressive and untested interpretation of the state mental health law to essentially deputize EMS clinicians to involuntarily remove anyone who is mentally ill and unable to meet their own basic needs,” Wolfberg notes.

Sending aid, well wishes to Ukraine

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
Following the invasion of Ukraine by Russia on February 24, 2022, Christopher Manson, vice president of government relations in the Illinois-based OSF Healthcare System, came up with the idea of sending American ambulances full of supplies to Ukraine.  
After reaching out to the Government in Kyiv and the Ukrainian Consulate in Chicago, and connecting with others working to send aid to Ukraine, on March 29, 2022, the first ambulance full of medical supplies and equipment left for Ukraine on a 747-800 aircraft. 
Since then, five additional shipments of ambulances have traveled from the United States to Ukraine via aircraft and ship for a current total of 18 ambulances and tons of medical supplies.
In this episode of EMS One-Stop, Host Rob Lawrence welcomes Christopher Manson and discusses the challenges, logistics and successes of the program, and also Mark Tenia, media manager for the Richmond (Virginia) Ambulance Authority, who highlights their recent donation of an ambulance for Ukraine and the process for gaining clearance for the donation. 

Kris Kaull: Think like a detective

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
Fresh back from Montana’s Big Sky EMS Symposium, in this episode of EMS One-Stop, Host Rob Lawrence chats with Kris Kaull on his history-taking session. They discuss Kaull’s 10 top hacks to improve your history taking, including:
Thinking like a detective
Thinking outside the box
Understanding medical medicine
Being a good listener
Kaull has driven innovation and positive change in EMS for over 25 years. After beginning his career as a firefighter and EMT, he started paramedic.com and co-founded EMS1. He is currently the chief marketing officer at Pulsara, a healthcare and mobile tech startup. He has worked as a firefighter captain, paramedic and ambulance service director, and continues his practice as a critical care flight paramedic covering southwest rural MT and Yellowstone National Park.
Kaull has shared his presentation and notes here.

Ray Barishansky’s takeaways on professional development

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
Dr. Ray Barishansky has recently delivered keynote addresses at a number of national and state conferences to much acclaim.
In this week’s episode of EMS One-Stop, Host Rob Lawrence discusses Barishansky’s key takeaways on professionalism in EMS and after the break, they move on to writing and speaking in the EMS environment. We conclude with an invitation to those interested in writing for EMS1 to reach out.

Diversity, equity and inclusion in U.S. EMS

This episode of EMS One-Stop with Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. 
This edition of EMS One-Stop looks at diversity, equity and inclusion in U.S. EMS. This episode takes a deep dive into two academic research papers recently published by members of NAEMSP’s Diversity Equity and Inclusion Committee who focus on the delivery of care and how that care may differ based on a patient’s ethnicity and race. 
Host Rob Lawrence welcomes:
Anjni Joiner, assistant professor of emergency medicine at Duke University School of Medicine, and medical director for Durham County EMS
Ameera Haamid, assistant professor of emergency medicine at the University of Chicago and associate medical director for Chicago South EMS
Andra Farcas, emergency physician at the University of Colorado - Anschutz Medical Campus
Jordan Rudman, emergency medicine resident at the Harvard Emergency Medical Residency at the Beth Israel Deaconess Medical Center
One of the two research papers discussed is now published:
Rudman JS, Farcas A, Salazar GA, et al. (2022) Diversity, Equity, and Inclusion in the United States Emergency Medical Services Workforce: A Scoping Review, Prehospital Emergency Care
The companion research paper on disparities in care has been peer reviewed and accepted for publication.