EMS One-Stop

Lessons from the McClain case: Protecting first responders and improving EMS practices

In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Shana Beggan, Esq.; and Mike Pellow, Esq., defense attorneys representing one of the firefighters involved in the tragic Elijah McClain case.
Beggan and Pellow discuss the complex legal and systemic issues surrounding the incident, including communication breakdowns, inadequate training, and the challenges faced by EMS and fire personnel when operating in chaotic environments. They also address the broader implications for EMS professionals, highlighting the importance of proper documentation, the use of body-worn cameras, and the need for stronger inter-agency collaboration between police and EMS teams.
This interview provides invaluable insights into the case and the steps necessary to improve EMS practices moving forward.
Beggan and Pellow share their experiences navigating the criminal and civil aspects of the case, emphasizing the importance of understanding the limitations and constraints that EMS providers face in high-pressure situations. They also advocate policy changes, such as enhanced training, better resource allocation and the introduction of body-worn cameras to protect both first responders and the patients they serve.
Their passionate discussion sheds light on the need for reform within EMS, encouraging listeners to reflect on their own practices and consider how they can contribute to a safer and more effective emergency response system.
Key quotes
"First responders are people who run towards difficulties and trauma when many run away, and to see somebody be charged in this situation and the fallout from it ... has become a very strong passion for myself and for Mike." — Shana Beggan
"You take somebody – basically the bottom of an entire healthcare system – and say, let's blame this person, let's criminalize this. That is the wrong thing to do." — Mike Pellow
"I think that we need to allow for honest conversations in a safe way, not a blame-the-finger approach." — Shana Beggan
"We need to be better at helping first responders, not making them look over their shoulders and thinking, ‘Where am I going to get whacked in the back of the head if something goes wrong?’" — Mike Pellow
"We perform the way we train, and here the training was poor. We condone or even promote what we fail to address." — Shana Beggan
Takeaways and actionable items
Improve documentation practices. Ensure that EMS providers document not only their actions, but also their thought processes. This can help prevent misinterpretation of their actions in high-stress situations and provide valuable context in legal proceedings.
Advocate for body-worn cameras. Implement body-worn cameras for EMS teams to improve transparency, protect first responders, and provide better evidence for both patient care and legal purposes. However, ensure that funding for such programs comes from appropriate sources, rather than placing additional strain on already underfunded EMS budgets.
Enhance training and protocols. EMS and police departments should collaborate on joint training sessions, focusing on clear communication, proper patient handoffs, and how to handle complex situations, like excited delirium. Ensure that protocols are updated regularly and that training is implemented in real-world scenarios.
Timeline
01:48 – Introduction: Rob Lawrence introduces the episode and guests Shana Beggan, Esq.; and Mike Pellow, Esq.
04:21 – Case background: Pellow provides a brief overview of the Elijah McClain case, the charges against the paramedics, and the current status of the case.
07:10 – Communication breakdowns: Beggan discusses the major issues surrounding communication between police and EMS, particularly the lack of information shared between the different teams at the scene.
10:35 – Documentation and reporting: Beggan and Pellow emphasize the importance of documentation in EMS, especially in legal situations, and discuss how inadequate reporting and the failure to document actions and decisions contributed to the case.
12:01 – Body-worn cameras: Pellow advocates for the use of body-worn cameras in EMS to provide better documentation and protect both patients and responders.
19:25 – Police and EMS collaboration: Beggan and Pellow discuss the importance of training police and EMS teams together to improve coordination and response.
28:00 – Legal implications and criminalization of EMS: Beggan and Pellow discuss the growing trend of criminalizing medical practice in EMS and the need to protect providers from unjust legal consequences.
46:11 – Support from fire leadership: Beggan shares the support from the Aurora fire chief, who highlighted systemic failures and underscored the importance of better training and protocols.
50:57 – Closing remarks: Rob thanks Beggan and Pellow for sharing their insights and the discussion closes with a focus on the need for systemic change within EMS and emergency response. 

From chaos to command: Lessons from the New Year’s Day tragedy in New Orleans

In this sobering episode of EMS One-Stop, host Rob Lawrence sits down with Chief Bill Salmeron of New Orleans EMS to discuss the tragic events that unfolded on New Year’s Day 2025, when a vehicle plowed through crowds in the French Quarter, resulting in 15 fatalities and 57 injuries, including two police officers.
Chief Salmeron provides a detailed account of the incident, the immediate EMS response, and the coordinated efforts with law enforcement and hospitals to manage the mass casualty incident.
The conversation also delves into the psychological impact on EMS personnel, the value of training and preparedness, and lessons learned from handling such a large-scale event.
Chief Salmeron emphasizes the importance of communication, mutual aid and the mental wellbeing of first responders, offering insights into how New Orleans EMS plans to support its teams in the long recovery process ahead.
Key quotes from the episode
“You don’t teach that level of decision-making in EMT class. Telling a family member or police officer that you can’t help their loved one is one of the hardest things you’ll ever do.” — Chief Bill Salmeron
“The recovery from an incident like this doesn’t take days or weeks – it takes years.” —Rob Lawrence
“I told my team to go back to headquarters. I needed to put eyes on every single one of them and make sure they were OK.” — Chief Bill Salmeron
“Situational awareness and incident command are critical. It’s about restoring order from chaos.” —Rob Lawrence
“What we do is a unique calling. It’s critical to appreciate and take care of each other and ourselves.” — Chief Bill Salmeron
“This episode is a masterclass for anyone planning for mass casualty incidents. Listen, learn and prepare.” —Rob Lawrence
Timeline
00:21 – Introduction to the episode and overview of 2025’s challenging start, including the New Year’s Day tragedy in New Orleans01:22 – Chief Salmeron describes the initial setup and EMS operations in the French Quarter03:26 – Incident details: the truck’s path, immediate EMS response, and the scale of injuries06:01 – Incident command and mutual aid coordination, including the deployment of 13 ambulances09:43 – Managing hospital capacities and patient transport logistics during the MCI15:11 – The discovery of explosive devices and the role of EMS in securing and retreating from the scene23:01 – Post-incident response: staff debriefings, mental health support and lessons learned33:31 – Preparing for future events like the Super Bowl and Mardi Gras under heightened security41:06 – Five key takeaways for leading and managing mass casualty incidents50:28 – Closing thoughts and appreciation for first responders’ dedication and resilience
Additional resources
New Orleans EMS

Navigating extreme weather: Insights from DHS Chief Meteorologist, Sunny Wescott

Join Rob Lawrence on EMS One-Stop as he welcomes Sunny Wescott, chief meteorologist at the Department of Homeland Security, for an eye-opening discussion about the impact of extreme weather on emergency services and critical infrastructure.
Sunny shares her expertise on meteorological trends, the challenges of preparing for severe weather events, and the evolving role of EMS in managing climate-induced emergencies. From hurricanes and polar vortices, to the implications of electric vehicle adoption during extreme weather, this episode is packed with actionable insights for public safety leaders and EMS professionals.
Rob and Sunny explore the complex interplay between extreme weather and emergency response, emphasizing the importance of proactive planning and reliable information sources. Sunny delves into the science behind weather phenomena like atmospheric rivers, Rex blocks and heatwaves, connecting them to real-world challenges faced by first responders.
During this edition of EMS One-Stop discover the tools, resources and strategies Sunny recommends for staying ahead of severe weather impacts on both infrastructure and personnel, and gain practical advice for improving communication with the public during weather crises, ensuring safety and minimizing risk.
Key quotes from this episode
“The uneven heating of our planet is amplifying weather events, making them stronger and more unpredictable.” — Sunny Wescott
“The weather affects everything – and for EMS leaders, preparation isn't optional, it's essential.” — Rob Lawrence
“We’re seeing infrastructure pushed to its breaking point by weather extremes – things we couldn’t anticipate when they were built.” — Sunny Wescott
“Sometimes, the hardest command decision is telling your crews, ‘We’re hunkering down now.’ It’s the right call, but it’s never an easy one.” — Rob Lawrence
“Your life means so much more than the possessions inside your home. Evacuate early – it’s always the safest choice.” — Sunny Wescott
“Let’s face it: weather is as much a part of public safety planning as personnel and resources.” — Rob Lawrence
“Weather preparedness isn’t just about forecasts; it’s about collaboration, data sharing and breaking down silos across sectors.” — Sunny Wescott
Timeline
00:24 – Rob’s introduction and reflections on weather in the UK and US
01:22 – Sunny explains global weather patterns and their cascading impacts
03:32 – Sunny describes her role at DHS and how critical infrastructure is assessed against weather risks
11:13 – Hurricane trends, preparedness and landfall impacts for 2025
20:00 – EMS-specific challenges during extreme heat and cold, including effects on equipment and personnel
24:04 – How to interpret long-term weather forecasts and model reliability
30:06 – Operational decisions during extreme weather events, like grounding helicopters and using resources wisely
36:06 – Final thoughts on misinformation, insurance concerns, and public safety resilience
Additional resources
EMS in a changing climate: Understanding the impact of extreme weather
Snowfall Reports from past events
Annual Lightning Report 2024 – Xweather
NWS Probabilistic Precipitation Portal
National Fire News | National Interagency Fire Center
AirNow Fire and Smoke Map
Incidents | CAL FIRE
Evaporative Demand Drought Index (EDDI): NOAA Physical Sciences Laboratory
Zoom Earth | Live Weather Map & Hurricane Tracker
Nullschool Earth :: a global map of wind, weather, and ocean conditions
National Weather Service
 

An inside look at the New Orleans EMS body-worn camera program

In this insightful episode of EMS One-Stop, host Rob Lawrence revisits New Orleans EMS to explore their pioneering use of body-worn cameras, joined by Chris Keller, chief of operations at New Orleans EMS.
The discussion dives into the motivations, challenges and successes of implementing this technology. From its initial deployment on tactical medic teams in 2018, to its current broader rollout, Chris shares the journey of navigating legal frameworks, staff buy-in and operational logistics. The conversation also highlights how body-worn cameras enhance patient care documentation, bolster staff safety and provide an unbiased account of events, positioning them as an emerging industry standard.
This episode offers practical advice on policy development, procurement processes and operational use cases, including their application during Mardi Gras and high-acuity events. With the aim to demystify the implementation process, Chris emphasizes the importance of collaboration, adaptability and using technology to improve EMS practices. Rob and Chris also discuss future goals for the program, funding challenges, and the potential for body-worn cameras to become a cornerstone of EMS operations nationwide.

NEMSQA 2024: Dr. Jeff Jarvis on airway safety and the path to EMS improvement

Dr Jeff Jarvis joins Rob Lawrence to discuss the recently released National EMS Quality Alliance (NEMSQA) Measures Report – “Enhancing airway management one measure at a time.”
The report begins with the following robust Foreword: “NEMSQA is not satisfied with the state of airway management safety in EMS. As you will see, the data clearly shows that we can do much better across our industry! Partnering with experts and EMS agencies around the country, NEMSQA is leading the second national EMS Quality Improvement Partnership (EQuIP), the Airway Management Collaborative to put the new NEMSQA airway measures to work.”
“Enhancing airway management one measure at a time” is the sequel to the Lights and Siren Collaborative and will utilize the Institute for Healthcare Improvement’s Breakthrough Series collaborative model. The goal of the project is to support national improvement in the safety and effectiveness of invasive airway management by focusing on two goals:
Reducing the adverse events, such as peri-intubation hypoxia and hypotension
Improving the use of waveform capnography to confirm and monitor all invasive airways
Rob and Dr. Jarvis discuss the report and actions individuals and their agencies should take to improve their personal and organizational airway management and patient outcome results.
Find more EMS One-Stop episodes here!

Stop the bleed, fill the tank – The New Orleans EMS blood program

In this episode of EMS One-Stop, host Rob Lawrence dives into the trending topic of pre-hospital blood administration with guests from New Orleans EMS: Tom Dransfield, the quality assurance and safety officer, and Dr. David Rayburn, deputy medical director.
This in-depth discussion explores the development and execution of the New Orleans EMS blood program, focusing on packed red blood cells (PRBC) and the challenges, successes and ongoing research surrounding cold blood administration in trauma and medical emergencies. New Orleans EMS is leading the charge in pushing the boundaries of pre-hospital blood, providing innovative solutions for penetrating trauma, GI bleeds and other critical cases.
Dransfield and Dr. Rayburn share the journey of New Orleans EMS in implementing the program, including their logistics, lessons learned and the vital impact of their interventions on patient outcomes.
The episode emphasizes the collaboration between EMS and trauma centers as well as blood suppliers to reduce mortality rates, while also tackling key questions, such as the supply chain, funding and future research.
Memorable quotes
"For every minute we delay blood administration, there's an 11% increase in mortality – this isn't just a theory; it's life and death." — Dr. David Rayburn
"We were topping the charts in the wrong categories – violence and stuff like that. So, our medics were frustrated with the old scoop and run. We're not just scooping and running anymore. We're providing definitive care." — Tom Dransfield
"We’re seeing no change in temperature for patients receiving two units of cold PRBCs in the pre-hospital environment, and that’s groundbreaking." — Dr. David Rayburn
"If we’re doing blood, we’re literally saving lives. But without reimbursement, it’s an uphill battle." — Rob Lawrence
"Our paramedics are pushing the envelope – it's no longer just about trauma; we’re now treating GI bleeds, OB cases and renal patients with blood administration." — Dr. David Rayburn
Find more episodes: https://www.ems1.com/ems-one-stop

Quality as an organizational strategy

In this episode of EMS One-Stop, host Rob Lawrence is joined by quality improvement expert, Dr. Dave Williams, recent co-author of the book, “Quality as an Organizational Strategy,” and Dr. Jonathan Studnek, executive director of Wake County EMS.
Together they discuss the five activities for organization’s leaders to provide the structure to begin working on making quality their strategy.
These activities are centered on:
Purpose
Viewing the organization as a system
Obtaining information
Planning to improve
Managing improvement efforts
These five activities form a system for the leaders of an organization to focus their learning, planning and actions.
Memorable quotes
"Leadership's job is to build systems where staff can be rock stars and bring their best selves every day." — Dr. Dave Williams
"Understanding your purpose as an EMS agency, like being responsible for cardiac arrest survival, is essential in improving performance." — Dr. Jon Studnek
"Our secret weapon in improvement is the Plan-Do-Study-Act (PDSA) cycle, where we learn fast by making low-risk, small-scale changes." — Dr. Dave Williams
"These five activities are the key elements that leaders should be engaging with to drive their organizations forward." — Dr. Jon Studnek
Highlights
01:14 – Dr. Dave Williams shares his background in quality improvement and EMS
02:12 – Dr. Jon Studnek introduces himself and talks about his journey in EMS leadership
03:56 – Dr. Williams discusses his book, “Quality as an Organizational Strategy” and its origins, and outlines the five core activities of quality as an organizational strategy
15:02 – Dr. Studnek describes implementing the quality framework in EMS, using cardiac arrest survival as a real-world example
23:36 – Rob and Dr. Studnek discuss interconnectedness in EMS systems and fleet maintenance
30:00 – Dr. Williams explains how small-scale changes using the PDSA cycle help improve EMS operations
35:00 – Final thoughts from Dr. Studnek on leadership and quality as a guide for day-to-day work

Mastering data and EMS performance metrics with Mike Taigman

In this episode of the EMS One-Stop podcast, host Rob Lawrence welcomes back data and EMS expert Mike Taigman for a deep dive into the evolving role of performance metrics in EMS systems.
Together, they discuss two key publications – “Joint Position Statement on EMS Performance Measures Beyond Response Times” by Kupas and Zavadsky, et al., and the White Paper from the National EMS Quality Alliance in Collaboration with FirstWatch, titled, “Taking the Pulse of your System – Performance Measurement for Improvement.”
Lawrence and Taigman explore how data informs change, improves clinical outcomes and drives leadership decisions. Whether you’re a seasoned leader or new to the field, this conversation provides essential insights into how EMS organizations can better utilize data to elevate their services.

Measuring how well we are doing

In this special edition of EMS One-Stop, host Rob Lawrence discusses the Joint Position Statement on EMS Performance Measures – Beyond Response Times published yesterday by the leading EMS and public policy associations with Matt Zavadsky, MS-HSA, EMT, vice president of PWW|AG, and one of the primary authors of the position statement.
Rob and Matt discuss the statement in detail, examining all of the recommended metrics, the reasons for placing them in the paper and why response times are not recommended as a primary measure of system performance.
Rob and Matt begin by discussing the signatories of the statement – in particular, the sign off from the International City/County Managers Association (ICMA) and the pivotal role they play in ensuring EMS delivery in their communities.
The many associations that joined the statement recommend that communities and governments modernize EMS performance assessments by evaluating various domains with key performance indicators (KPIs). These KPIs should be measured, tracked over time, benchmarked against similar EMS systems or national data and regularly published for local community stakeholders.

H5N1 (and other infectious diseases) update with Dr. Alex Isakov

In this episode of EMS One-Stop, host Rob Lawrence welcomes back infectious disease expert Dr. Alexander P. Isakov, MD, MPH, founding executive director of the Office of Critical Event Preparedness and Response (CEPAR), and professor of emergency medicine at Emory University.
Rob begins by discussing his real-life experience with an H5N1 outbreak in the UK as an ambulance service leader, and Dr. Isakov discusses the current H5N1 emergence in the U.S.
The discussion covers the current U.S. H5N1 outbreak, bird and swine flus, and the spillover from bird to mammal populations. They also address three recent U.S. cases of H5N1 among agricultural workers. They go on to discuss signs and symptoms of H5N1, index of suspicion, the Hierarchy of Controls in infectious diseases, universal and standard precautions, and fit testing respirators. They also cover resources available at NETEC.
Dr. Isakov concludes with a roundup of other global issues, including viral hemorrhagic fever (VHF), Ebola, Marburg and smallpox.