EMS One-Stop

Inside the EMS Compact: How REPLICA transforms disaster response, licensing & leadership

In this episode of the EMS One-Stop podcast, host Rob Lawrence kicks off a special series spotlighting national EMS associations, beginning with a deep dive into the EMS Personnel Licensure Interstate CompAct (REPLICA). His guest, Donnie Woodyard Jr., executive director, Interstate Commission for EMS Personnel Practice, brings decades of EMS experience and leadership to the table to demystify what the EMS Compact is, how it operates, and why it matters to the profession today. From improving workforce mobility to protecting public safety during disasters, Woodyard Jr. provides clarity on this critical multi-state agreement.
The conversation covers everything from how EMS Compact came to be, to the significance of national registry standards, disaster response logistics, interstate licensure, and even leadership lessons from Woodyard Jr.’s latest book project, “Leadership in action: The Wisdom and stories of EMS innovators”. Whether you're a field provider or policymaker, this episode is a must-listen for understanding how collaborative legislation can shape the future of EMS.
In the episode, Woodyard Jr. candidly addresses the ongoing debate in North Carolina over transitioning from a state-only EMS certification exam to exclusive use of the National Registry. Woodyard Jr., while respectful of North Carolina’s long-standing EMS tradition, emphasizes the importance of national consistency. He acknowledged that the proposed legislation needed amendments, particularly around grandfathering existing providers, but stood firm in his belief that a single, legally defensible national standard is essential for provider mobility and professional integrity. Drawing on real-world examples, Woodyard Jr. described how providers are often caught off guard when relocating — only to discover their credentials aren't accepted elsewhere. “Maintaining a state-only exam is harmful to individuals,” he said, calling for unified testing standards that support workforce movement and strengthens the profession nationwide.
Memorable quotes from Donnie Woodyard Jr
“Every EMT and paramedic in the United States should go through a fingerprint background check. You know, babysitters have to do it. Teachers have to do it. EMS personnel absolutely should do it.”
“Maintaining a state-only exam is harmful to individuals. It limits their mobility.”
“When you waive that requirement for licensure, you actually are removing essential elements of public protection and accountability.”
Timeline
00:21 – Rob introduces the series on national EMS associations and welcomes Donnie Woodyard, Jr.
01:55 – Woodyard, Jr.shares his EMS journey from volunteer in Virginia to international disaster medicine and state leadership
03:41 – What is the EMS Compact and how does it work?
06:38 – Challenges of multistate EMS licensing pre-Compact
08:00 – Explaining the driver’s license analogy and compact accountability
11:17 – EMAC vs. EMS Compact for disaster response and liability concerns
15:31 – National Registry and grandfathering provisions
17:30 – Arkansas joins as the 25th compact state
18:56 – Model legislation and how states join the compact
21:22 – What REPLICA stands for and its legislative origin
22:20 – What California (and other non-compact states) should consider
24:33 – National Registry debate: North Carolina’s challenges and Woodyard, Jr.’s response
27:52 – Mobility, workforce attrition and job-sharing innovation
30:11 – The Commission and national EMS-coordinated database
35:17 – Final thoughts on fragmentation, collaboration and EMS unity
36:41 – Woodyard, Jr.’s leadership book, EMS charity support and Secretary Panetta’s forward
41:08 – Closing remarks and contact information
Additional resources
Learn more about the EMS Compact
“Leadership in action: The Wisdom and stories of EMS innovators”, by Donnie Woodyard Jr.
“The future of emergency medical services: Artificial intelligence, technology & innovation”, by Donnie Woodyard Jr.

Insights, actions and the future of EMS: The 2025 ESO EMS Index

In this special data-driven edition of the EMS One-Stop podcast, host Rob Lawrence is joined by Dr. Brent Myers, chief medical officer, ESO, and Dr. Remle Crowe, ESO’s director of clinical and operational research, to unpack the newly released 2025 ESO EMS Index.
This annual report provides a powerful, real-world snapshot of national EMS trends — drawing on more than 14 million anonymized records to surface opportunities for clinical and operational improvement.
The conversation dives into key metrics that move beyond response times and into areas like pain management, opioid overdoses, airway confirmation, obstetric emergencies, whole blood use, pediatric behavioral health and high-utilization patient populations.
Throughout the episode, Drs. Myers and Crowe share the motivation behind each metric, explain how the data was gathered and analyzed, and reflect on how EMS agencies can use these insights to guide better care delivery and system design. From confronting equity in pain management, to pushing forward innovations like buprenorphine administration and whole blood programs, this is a compelling call to turn data into meaningful change.
Timeline
01:08 – Overview of the ESO EMS Index and its intent
02:59 – Origins of the report and data methodology
05:46 – Database scale: 14M+ records, 3,000+ agencies
07:14 – Metric 1: Pain management for long bone fractures
10:53 – Documentation, AI in EMS, and future documentation tools
14:30 – Metric 2: Suspected opioid overdose and buprenorphine use
18:51 – Best practices, COWS scoring, and naloxone delivery strategy
21:31 – Metric 3: Invasive airway confirmation using waveform capnography
28:06 – Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)
34:34 – Metric 5: Prehospital whole blood surveillance
40:22 – Metric 6: Pediatric behavioral health and substance use disorder cases
44:54 – Metric 7: High utilization patient group (HUG)
52:48 – Final thoughts, calls to action, and Rob’s reflections
55:47 – Episode wrap-up and subscription reminder

Barriers to prehospital whole blood implementation

In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Christine Carico and Dr. Matt Levy to discuss the peer-reviewed paper, “Nationwide Trends in Prehospital Blood Product Use After Injury.” The paper, published in “Transfusion” in April 2025, explores the use of blood products in prehospital trauma care.
Despite the proven benefits of blood transfusion in the field, their research uncovers the alarming reality that less than 1% of eligible patients receive prehospital blood products. This conversation dives into the study’s methodology, key findings and the significant barriers EMS systems face in implementing blood transfusion protocols. The discussion also touches on the evolving role of EMS in trauma care, regional variations in blood product access, and the future of prehospital blood transfusion programs.
Dr. Carico and Dr. Levy break down their work and reflect on the data, explaining how the study used National Emergency Medical Services Information System (NEMSIS) data to identify trauma patients who would have benefited from blood transfusions.
The episode delves into the operational challenges EMS systems face in obtaining and administering blood products in the field, the financial and logistical obstacles, and the potential life-saving impact of more widespread adoption of these protocols.
Timeline
00:00 – Intro and welcome: Rob Lawrence introduces Dr. Matt Levy and Dr. Christine Carico, setting up the discussion on prehospital blood product use
03:00 – Study overview: Dr. Carico explains the methodology of the study, focusing on the use of NEMSIS data and the inclusion criteria for the patient population
07:00 – Key findings: Dr. Carico reveals the key findings of the paper, including the low percentage of eligible patients receiving prehospital blood products
11:00 – Barriers to implementation: Dr. Levy discusses the main barriers to the widespread implementation of blood transfusion protocols in the field, including access to blood, logistics and training
17:00 – Regional variations: The speakers touch on the regional disparities in blood product availability and the differences in protocols across the country
23:00 – Data challenges: Dr. Levy and Dr. Carico discuss the challenges related to data accuracy, particularly in terms of blood product documentation
27:00 – Cost and reimbursement: Dr. Levy addresses the financial aspects of blood product programs, including cost, reimbursement challenges and funding opportunities
32:00 – The future of blood transfusion in EMS: Dr. Levy envisions the future of prehospital blood transfusion programs, including the potential for shelf-stable blood products and regional blood supply systems
37:00 – Closing thoughts: Both guests offer their final thoughts on the importance of continued research and data collection, and the need for EMS to embrace a more integrated role in acute care
Additional whole blood resources
Carico C, Annesi C, Clay Mann N, Levy MJ, et al. “Nationwide trends in prehospital blood product use after injury,” 2025. Transfusion – Wiley Online Library
Tracking the whole blood landscape as updated guidelines allow EMS to carry and administer whole blood
EMS One-Stop: Stop the bleed, fill the tank – The New Orleans EMS blood program
Insider analysis: Delaware’s statewide whole blood rollout sets a new EMS standard
Whole blood in EMS promises a revolution in resuscitation: How one county agency is saving lives with prehospital transfusions
Matthew Levy | LinkedIn
Christine Carico | LinkedIn

EMS in the ash zone: Alaska’s Mount Spurr and the volcanic challenge

In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Deputy Director Tracey Loscar from Mat-Su Borough EMS in Alaska. Together, they discuss the looming threat of Mount Spurr, a volcano located 75 miles west of Anchorage, which is currently showing signs of potential eruption.
Loscar provides insights into disaster management and preparedness in a region where EMS operations are stretched across vast, remote territories. The conversation also touches on how to plan for the unexpected, especially in an environment with limited resources and harsh geographical challenges. This episode delves into the logistical challenges faced by EMS in the face of volcanic activity and offers critical lessons in disaster management.
TIMELINE
00:22 – Rob Lawrence welcomes Deputy Director Tracey Loscar and sets the stage for a discussion on disaster management in Alaska
02:10 – Loscar gives a brief overview of Mat-Su Borough and its proximity to Mount Spurr
04:01 –Loscar discusses her transition from Newark, New Jersey, to Mat-Su Borough and the challenges of EMS in rural Alaska
06:00 – Lawrence and Loscar discuss the vast distances and limited resources available in the region
08:01 – Loscar explains the preparations for the potential ash fallout from Mount Spur, including messaging to the community and respiratory protection
10:04 – The conversation shifts to the nature of volcanic ash and the practical challenges it presents to infrastructure, vehicles and personal health
14:36 – Loscar shares lessons learned from previous seismic events, such as the 2018 earthquake, and emphasizes the importance of clear communication during disasters
17:06 – Lawrence and Loscar discuss EMS liaison roles and the need for better coordination between dispatch, EDs and field teams
18:01 – Loscar talks about the current status of the Mount Spur eruption, with no immediate risk but preparations ongoing, and discusses how Alaskans stay calm and prepared in the face of frequent natural events, from earthquakes to volcanic eruptions
20:03 – Loscar highlights the importance of including pets in emergency plans, emphasizing the need for respiratory protection for animals
21:00 – The role of pantyhose in volcano preparedness
RATE AND REVIEW
Enjoying the show? Contact the EMS One-Stop team at editor@EMS1.com to share ideas, suggestions and feedback.

The human side of EMS: Culture, compassion and clinical courage

In this episode of EMS One-Stop, recorded live from the ABC 360 and XI Conference, host Rob Lawrence chats with keynote speaker Catherine Kuhlmann, a firefighter-paramedic with over 26 years of experience.
 
Kuhlmann discusses the importance of understanding both internal and external customer service in EMS, emphasizing the need for a healthy organizational culture to ensure the best patient care. She reflects on the profound impact that first responders can have on individuals, drawing from her own experiences and personal tragedies to highlight the emotional resilience required in the profession.
 
Rob also speaks with Page Wolfberg & Wirth’s PWW/AG Principal Doug Wolfberg, long-time EMS lawyer and educator, about lessons learned from working in and around law enforcement during patient care. Wolfberg provides actionable insights into how EMS professionals can better collaborate with police officers, ensuring that patient care remains a priority while navigating complex, high-stress situations.
Together, Kuhlmann and Wolfberg offer invaluable perspectives on fostering better patient advocacy, maintaining professional integrity and refining EMS protocols to adapt to new challenges.
MEMORABLE QUOTES
“How many careers, professions are there that, more often than not, you can make somebody's worst day their best?" — Catherine Kuhlmann
"If you want to know what's going on in your hospital, ask housekeeping. Patients will not remember that you worked your butt off for 45 minutes to restart their heart … but they will remember that you tucked their feet in with a blanket underneath it." — Catherine Kuhlmann
"You have to have a healthy department in order to continue to be healthy. And a lot of times when people think that they have problems with an individual and their agency, sometimes it’s not actually a problem with the individual, it’s with the agency." — Catherine Kuhlmann
"We have a duty to the patient. We're not there to help the police. We're there to advocate and treat the patient." — Doug Wolfberg
"EMS cannot subordinate judgement to law enforcement. If a police officer says give this guy some juice and put him to sleep, we first have to do an assessment and figure out if clinically that's the right thing." — Doug Wolfberg
ADDITIONAL RESOURCES
ABC 360 and XI Conference is Page Wolfberg & Wirth Advisory Group’s all-day workshop for EMS leaders, chiefs, HR managers and compliance professionals.
Vodcast: Lessons from the McClain case: Protecting first responders and improving EMS practices
Balancing care and collaboration: Key lessons from EMS and law enforcement interactions
TIMELINE
00:37 – Catherine Kuhlmann introduces herself, detailing her extensive background in EMS, law enforcement, and as a justice of the peace. Rob then highlights the key themes of Kuhlmann’s keynote speech, which revolves around the importance of understanding the "why" in EMS.
02:16 – Kuhlmann discusses the importance of organizational culture in retaining quality personnel and how many individuals leave — not due to the work itself — but because of the agency's culture. Kuhlmann talks about the personal fulfillment that comes from EMS work, sharing a story about a young girl she saved who later became a doctor.
06:13 – Kuhlmann introduces the concept of "Murphy," a problematic employee in the agency, and suggests that sometimes these individuals may reflect a deeper organizational issue.
08:12 – Kuhlmann emphasizes the importance of communication, advising that EMS leaders should hold honest, one-on-one conversations with problematic staff before resorting to exit interviews.
12:04 – Kuhlmann reflects on the small gestures that have a lasting impact on patients, highlighting how seemingly minor acts of compassion can leave a lasting impression.
14:03 – Rob and Kuhlmann discuss the concept of bedside manner in EMS, stressing the importance of treating patients with dignity and respect. Kuhlmann closes with a powerful message about EMS professionals’ responsibility to treat others’ families with the same care and respect as they would their own.
21:06 – Rob Lawrence introduces Doug Wolfberg, who returns to discuss lessons on collaborating with law enforcement in EMS.
22:05 – Wolfberg explains the need for scenario-based training in chaotic environments to build muscle memory and advocate for patients.
23:11 – Wolfberg discusses the importance of EMS maintaining independent clinical judgment, even when law enforcement may request specific actions.
24:03 – Wolfberg stresses the need for clarity in determining whether a patient is in custody and how this affects EMS protocols.
25:06 – Wolfberg explains the importance of advocacy in EMS, particularly in law enforcement scenarios, and the significance of body camera footage for ensuring accountability.
27:13 – Wolfberg shares the potential consequences for EMS professionals who fail to act empathetically or professionally, especially when caught on body camera.
29:15 – Wolfberg speaks about the future of ABC 360, including their upcoming conferences and certifications.
Previously on EMS One-Stop

Future-proofing EMS: How a new course is building results-driven problem solvers

NOTE: Be sure to check out the Inside EMS podcast this month where Rob Lawrence will be joining Kelly Grayson as a guest cohost for Chris Cebollero. 
In this episode of the EMS One-Stop podcast, Dr. Dave Williams discusses an exciting new master's-level course designed for EMS and fire leaders, focused on advanced improvement science.
Along with Mike Taigman, Dr. Williams is leading this program, which aims to equip leaders with the tools and methods necessary to achieve results-driven improvement in their EMS systems. Over the course of 12 months, attendees will work on real-world projects, gaining the skills needed to make data-driven decisions and improve patient care outcomes within their organizations.
Dr. Williams also dives into the core concepts of improvement science, including understanding of variation and the importance of creating organizational systems that support sustainable improvements. He shares insights into the curriculum, the significance of benchmarking and how the course will help EMS leaders tackle systemic challenges by applying proven improvement methodologies. This conversation also touches on the future of EMS leadership and how innovation in data management, process design and leadership will shape the profession moving forward.
Timeline
02:22 – Dr. Williams explains the background of the course, highlighting how it builds on improvement science to drive better results in EMS systems. He and Mike Taigman aim to teach EMS leaders to use data and evidence to improve patient care outcomes.
06:16 – Quality improvement: Dr. Williams discusses the gap in EMS leadership regarding quality improvement, emphasizing that quality needs to be integrated into the leadership team’s responsibilities, not treated as a separate function.
11:01 – Why data matters: The conversation shifts to the importance of data in EMS improvement efforts. Dr. Williams highlights how collecting and analyzing data helps organizations understand system performance and drive change.
15:43 – The fleet management example: Rob shares a fleet management story where data was used to improve vehicle downtime, highlighting the real-world impact of using improvement science to solve practical challenges.
19:29 – Project-based learning in the course: Dr. Williams elaborates on the project-based nature of the course, explaining how each participant will bring a real-world project that directly impacts their organization and use improvement science to solve it.
23:09 – Practical applications: Dr. Williams talks about how the course will blend online learning with in-person workshops, providing practical tools and methods that participants can apply to their projects throughout the year.
31:08 – Course logistics: Dr. Williams discusses course deadlines and important dates, including the application deadline of April 18, 2025; and the course's first workshop in September 2025.
54:05 – ROI and the course's value: Dr. Williams emphasizes the return on investment for attending the course, explaining that solving organizational problems through improvement science will ultimately save money and improve results for EMS services.
1:00 – Final thoughts: Rob and Dr. Williams close the conversation by reiterating the uniqueness of the course and its potential to reshape EMS leadership through the application of improvement science.
ADDITIONAL RESOURCES
Next-level improvement science: New master-level course equips EMS and fire leaders with advanced improvement science skills
Course application deadline: April 18, 2025
Course start date: July 22, 2025
Workshop dates: September 2025; February 2026
Mastering data and EMS performance metrics with Mike Taigman: Exploring how data informs change, improves clinical outcomes and drives leadership decisions
Improve EMS quality with a model that works: The simple yet powerful Model for Improvement holds the key to making real changes to an EMS organization

Sleep, safety & fatigue: Improving EMS health with Dr. Dan Patterson

In this episode of EMS One-Stop, host Rob Lawrence is joined by Dr. Dan Patterson, a clinician-scientist specializing in safety in emergency care settings. Dr. Patterson’s work centers around critical factors in EMS safety, such as sleep health, shift work, fatigue and their combined effects on clinician well-being.
Timeline of key discussion points
00:00 – Introduction to Dr. Dan Patterson
Dr. Patterson’s background and how his clinical experience as a paramedic informs his research on EMS safety and sleep health
 
04:30 – The Impact of Shift Work and Fatigue on EMS Providers
Discussing the direct effects of fatigue on EMS professionals, including medical errors, cognitive performance and decision-making
 
10:00 – The Science of Sleep in EMS
Why sleep is critical for EMS personnel and the unique challenges they face in getting adequate rest during shift work
 
15:00 – Development of Safety Measurement Tools
Dr. Patterson explains the creation of safety tools to track fatigue, sleep health and workplace injury rates in EMS settings
 
20:30 – Experimental Studies and Interventions
Overview of studies testing novel approaches to mitigating fatigue, including practical solutions and interventions in EMS environments
 
25:00 – Creating a Safety Culture in EMS
The role of leadership and teamwork in reducing fatigue-related errors and fostering a culture of safety in EMS organizations
 
30:00 – Key Takeaways and How Agencies Can Implement Changes
Final thoughts on how EMS agencies can integrate Dr. Patterson's findings and create healthier, safer work environments for their teams

Emerging threat update: Avian influenza, Mpox, Ebola, seasonal flu

In this episode of EMS One-Stop, host Rob Lawrence welcomes back Dr. Alex Isakov, a leading expert in infectious diseases from NETEC and Emory University in Atlanta. Dr. Isakov provides valuable updates on current and emerging infectious diseases; their global impact; and the critical role EMS professionals play in identifying, isolating and protecting themselves and their patients.
This discussion highlights key infectious diseases, including H5N1 (avian flu/bird flu), Mpox (previously known as monkeypox), Ebola, Marburg, Lassa fever and seasonal flu, providing EMS personnel with essential knowledge and safety protocols in light of ongoing global health concerns.
Throughout the episode, Dr. Isakov offers insights into the latest outbreaks, the importance of vaccinations, and strategies for responding to potential infectious disease threats. He stresses the necessity of remaining vigilant and prepared for high-consequence diseases while maintaining optimal patient care.
From the evolving threat of H5N1 to the resurgence of seasonal influenza, Dr. Isakov ensures that EMS professionals are equipped with the most relevant and up-to-date information needed to protect both themselves and their communities.
Summary of key infectious diseases covered by Dr. Isakov
H5N1 (avian influenza/bird flu): Dr. Isakov provides an update on the H5N1 outbreak in poultry and dairy herds, stressing the importance of limiting human exposure and watching for potential mutations that could lead to human-to-human transmission.
Mpox (Clade 1B): Dr. Isakov discusses the risk of Mpox, particularly Clade 1B, which remains prevalent in Central Africa but has now spread to other countries, including the United States. He highlights the importance of identifying travel history and unusual rashes, along with strict protective measures for EMS clinicians.
Ebola and Marburg: These diseases continue to present a risk, with smaller outbreaks currently ongoing in Uganda (Ebola) and Tanzania (Marburg). Dr. Isakov notes the importance of being prepared to identify and isolate individuals who may have been exposed during travel to these regions.
Lassa fever: Dr. Isakov points out the ongoing concern of Lassa fever in West Africa and emphasizes that EMS professionals should be on alert for symptoms in travelers who have visited affected regions.
Seasonal influenza: The seasonal flu outbreak is particularly severe this year, and Dr. Isakov underscores the importance of vaccination, especially for vulnerable populations, to reduce serious illness and hospital strain.
Timeline
00:00 – Introduction to the episode and guest, Dr. Alex Isakov
01:33 – Uupdate on Mpox (Clade 1B) and its global spread
05:24 – Ebola and Marburg outbreaks: ongoing concerns in Uganda and Tanzania
08:01 – Lassa Fever in West Africa and its impact on EMS professionals
13:05 – The importance of travel vaccinations for high-risk areas like malaria zones
15:13 – Mystery illness in the Democratic Republic of Congo and the investigation into its cause
17:01 – H5N1 and avian influenza concerns, including potential human transmission risks
22:02 – Severity of the current seasonal flu outbreak and vaccination recommendations
25:24 – EMS community's role in flu and measles vaccination advocacy
29:05 – Discussing surge conditions and excess mortality during pandemics
32:01 – Closing remarks, including updates on new NITEC EMS resources
Additional infectious disease resources
National Emerging Special Pathogens Training & Education Center
Emergency Medical Services (EMS) Featured Resources | NETEC
Symptoms of Malaria | Malaria | CDC
Lassa Fever Suspected in Death of U.S. Traveler Returning from West Africa | CDC Newsroom
CDC A(H5N1) Bird Flu Response Update February 26, 2025 | Bird Flu | CDC
Mpox | Mpox | CDC
Healthcare Workers: Could it be Ebola?

The $21M Texas EMS recruitment and retention initiative

Recruiting and retaining EMS professionals has been an ongoing challenge across the U.S., made worse by the COVID-19 pandemic. In this episode of the EMS One–Stop podcast, host Rob Lawrence sits down with Joe Schmider, Texas State EMS director, to discuss the $21M Texas EMS Workforce Initiative — a data-driven approach to recruiting and retaining EMS providers statewide.
Schmider details how Texas identified a 40% non-utilization rate among certified EMS professionals, successfully secured state funding, and launched an innovative recruitment and retention campaign. With over 10,915 new personnel added since 2019, this program serves as a model for other states struggling with EMS workforce shortages. This episode is full of actionable insights for EMS leaders, policymakers and recruiters alike.
Key quotes from Joe Schmider
"We were seeing about 40% of our certified people — licensed paramedics, EMTs, advanced EMTs — were not using their skills on an ambulance."
"We worked with our associations here in Texas, the Texas EMS Alliance and the Texas Ambulance Association. They went and met with some legislators, worked the room a bit, and we got $21 million of federal dollars through the state to us for 2 years to put in place a recruitment and retention program."
"We pushed out 3,152 scholarships. An EMT scholarship was worth $2,000, an advanced EMT scholarship was $3,200 and a paramedic scholarship was $8,000. The money went directly to the education program, not to the student. They had 1 year to complete their training and then had to serve 96 hours a month on an ambulance — either as a paid or volunteer position — for 1 year at the EMT level and 2 years at the paramedic level."
"We spent $1.5 million on an advertising campaign throughout the state of Texas. We hired a media company to develop commercials, billboards and social media campaigns. The use of social media was incredible — 50 million views over 2 years, which was an incredible number. We never expected that."
"The second thing people do [when considering EMS careers] is they watch us as EMS professionals. Do I want to work with these people? Do I want to be a part of this? I once saw two EMTs standing on the back of an ambulance smoking a cigarette at an event. I went up to them and said, ‘Are you kidding? What message are we putting out when we do stuff like that?’ We have to think about our image."
"People leave the EMS profession for two reasons: money or the way they’re treated. Depending on which survey you look at, it could be money first or treatment first, but it’s always those two reasons."
Episode timeline
00:08 – Rob Lawrence introduces guest Joe Schmider, Texas EMS director
00:26 – The EMS staffing crisis and how COVID-19 accelerated workforce shortages
01:36 – How Texas used data to identify a 40% EMS non-utilization rate
02:51 – How Texas EMS leaders secured $21 million in funding
04:31 – Structuring EMS scholarships and training requirements
06:41 – The success of the recruitment campaign: 3,152 scholarships awarded
08:46 – How Texas reached 50 million views in its EMS recruitment campaign
11:16 – EMS workforce retention: The challenges of pay and treatment
13:46 – Addressing rural EMS shortages and workforce gaps
16:01 – How Texas EMS associations helped advocate for change
18:21 – The future of EMS funding and advocacy efforts
21:01 – Lessons from corporate retention strategies: What EMS can learn from HEB grocery stores
24:01 – The importance of EMS provider wellness: Texas’ Wellness Wednesday initiative
26:01 – Final takeaways: Lessons for other states and EMS leaders
28:01 – Closing thoughts and how to access Texas EMS resources
Additional resources
Connect with Joe Schmider: joseph.schmider@dshs.texas.gov/512-484-5470
Texas EMS Careers and Education

‘The leader must own it’: General Robert Neller on ethical leadership and adaptability

In this special episode of EMS One-Stop, host Rob Lawrence welcomes General Robert B. Neller, the 37th commandant of the United States Marine Corps, to discuss leadership, decision-making, team building and the evolving challenges facing public safety professionals.
General Neller shares his perspective on leading under pressure, making critical decisions, and fostering an ethical and resilient organizational culture. With decades of military leadership experience, he provides actionable insights that apply not only to the armed forces but also to EMS, law enforcement, and fire and rescue personnel.
Throughout the episode, General Neller emphasizes the importance of training, adaptability and the role of leadership in guiding organizations through times of uncertainty. He highlights the significance of ethical leadership, followership and how leaders must take responsibility for failures while empowering their teams.
The discussion also explores the impact of emerging technologies, such as AI and body-worn cameras on public safety, and the crucial need for ongoing training despite staffing and funding challenges. This thought-provoking conversation delivers key takeaways for current and aspiring leaders across all branches of public safety.
15 leadership quotes from General Robert B. Neller
“Making decisions is part of your training — you’re expected to make them, and you have to do it in critical moments.”
“If I could wave a magic wand, I’d put everyone at 110% staffing so they had the time to train properly.”
“The leader’s job is to set the example — how you carry yourself, how you treat others, and how you communicate matters.”
“Good leaders anticipate. They don’t just react — they look ahead and keep their teams informed.”
“Followership isn’t blind obedience; it’s about understanding the mission, contributing ideas, and executing effectively.”
“Accepting responsibility is a core tenet of leadership — when things go wrong, the leader must own it.”
“Change is inevitable, and good leaders learn to embrace it while preparing their people for what’s ahead.”
“Take care of yourself — physically, mentally and morally — because leadership starts with personal discipline.”
“As a leader, you have to accept that sometimes you’ll make the right call, and things still won’t go your way — that’s part of the job.”
“You have to train and rehearse because time spent on reconnaissance is seldom wasted.”
“The worst thing you can hear as a leader is that ‘you don’t care’ — your people need to know that you do.”
“To build culture and cohesion, you set the example — you take the physical fitness test, you wear the uniform properly, and you carry yourself the right way.”
“Good leadership is not about the complete suppression of ideas — if you have time, get input, because someone might have a better idea than you.”
“If you have good followers, being a leader is significantly easier — if you don’t, it’s a challenge every day.”
“Change is inevitable — if you’re not evolving, you’re not making progress, and that’s a problem.”