EMS One-Stop

Leadership and labor: Saving California’s 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. 
Like many other states across the U.S., California’s ambulance services are both understaffed and underfunded.  In what has turned into a vicious circle, poor reimbursement levels hamper the employers’ ability to increase pay and compete with other sectors that offer better hourly rates for less risky or skilled employment. In fact, California has not had an increase in its Medi-Cal (Medicaid) rate in 20 years.
As part of the ongoing legislative campaign, California’s ambulance service owners and operators have created a coalition with all the labor unions that represent EMS in the state to campaign for increases.
In this episode of EMS One-Stop, both labor and leadership sit down with Rob Lawrence to discuss politics, funding and working as a team.
About our guests
Melissa Harris - president and CEO of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; and board member and treasurer of the California Ambulance Association
Shelly Huddleson - national labor representative for the International Association of EMTs and Paramedics
Chad Druten - COO Emergency Ambulance Service based in Brea, California; president of the Los Angeles County Ambulance Association, president of the Ambulance Association of Orange County
Ryan Walters - president of IAEP Local 370 representing EMTs and paramedics working at Falck in Orange County and Los Angeles
Jim Karras - vice president and chief operating officer of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; vice president, Los Angeles County Ambulance Association; and secretary of the Ambulance Association of Orange County
Top quotes from this episode
“EMTs are one missed shift away from poverty. This is the industry I love. I’ve seen people leave, people that I wish we could hold on to, but they have to provide for their families.” — Ryan Walters
“Unlike the In and Outs, the Jack in the Boxes, the Del Tacos who can raise their prices to meet the escalating minimum wage and escalating inflationary pressures that they are feeling, we don’t have the ability to do that. Our rates are set for us by the government and by government payers and they are capped and in some cases, they are fixed, so we are beholden to the State of California to help us and give us some relief.” — Jim Karras
“If we don’t do something soon with our Medi-Cal rates, then our EMS system is going to implode, it’s going to implode because our ambulance companies are either going to stop taking these Medi-Cal patients because they can’t afford them and so who is going to take care of them or they are going to start shutting their doors. When they shut their doors, our members lose jobs.” — Shelly Huddleson
“The patient is the one that’s most important here, the medical recipient, they are the ones that stand to lose the most and they are the only reason we exist, they are the only reason any of us have jobs and we can’t lose sight of that, so we are not just advocating for our industry, we are advocating for the citizens of California.” — Chad Druten
Episode contents
0:30 Rob sets the scene
1:00 Meet the guests
2:05 The campaign to increase reimbursement
3:08 EMTs are one missed shift away from poverty
3:45 Management and labor alliance
6:30 How labor and management can work together on political campaigns
9:00 We share a common humanity
11:00 We as an industry are not good at going hat in hand
13:00 The politicians are astonished at what we pay and that we are losing people to fast-food chains
14:00 Medi-Cal is for the patient to have equal access to healthcare
17:00 This is an economic nightmare
18:30 If you were in an elevator with a politician, what would your pitch be?
21:45 Find your champions – those elected officials that will fight for you
23:00 Acting as a coalition
24:40 Ambulance companies with staffing issues
26:10 Workers deserve a long and dignified career
28:30 The patient is at the center
30:00 A call to action
Additional resources on this topic
California’s Fund First Responders
California Ambulance Association
International Association of EMTs and Paramedics
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Norway EMS: Telehealth, educational requirements and future plans

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 the second EMS One-Stop international edition, Host Rob Lawrence welcomes Steinar Olsen, director for emergency medical services and national preparedness in the Norwegian Directorate of Health. Steiner describes the composition and deployment of EMS services across Norway – a country with the second largest coastline in the world and 1,100 miles from North to South (the distance from Seattle to San Diego or Chicago to Miami). Norway has one government/healthcare run system consisting of 400 stations, 520 ambulances, 4,500 EMTs and paramedics, aided by 14 helicopters and 12 fixed wing aircraft.
Educational requirements, current initiatives and future plans are discussed. Lawrence and Steiner also identify that EMS systems around the world encounter similar challenges, and international best practice exchange is always welcomed and encouraged. 
TOP QUOTES FROM THIS EPISODE
“Looking at just response times – you can waste a lot of money that could be used wisely in other parts of the service to create more health.”
“Between 25-30% of calls are handled with just a phone call or a combination of phone and video conference with the patient.”
“EMS in the next 20 years will develop from just lights and sirens to being an advanced platform for performing healthcare in the patients’ home instead of moving them to the hospital.”
EPISODE CONTENTS
1:13: Introduction – Steinar Olsen
2:08: Description of EMS in Norway
4:05: Ambulance stations, helicopters and fixed wing aircraft
6:07: Paramedic training and education
7:17: EMS as a gateway to healthcare
9:38: Norwegian support to international disasters and events (Turkey and Ukraine)
14:00: The next big things for EMS in Norway
16:00: Response times can waste a lot of money
17:35: Hear and treat – Nurse triage
20:00: The need for EMS nations to learn from each other
21:00: The challenge for treating patients in the future
23:34: The relationship between fire and EMS in Norway
24:50 : Vehicle extrication – Norwegian style!
26:15: Steiner Olsen’s final thoughts
27:10: Contact details
ABOUT OUR GUEST
Steinar Olsen is a RN and paramedic with 38 years of clinical and high-level management background from EMS and specialized healthcare services. He now serves as the director for emergency medical services and national preparedness in the Norwegian Directorate of Health. Steinar is also the regional chair of the European Regional Group for EMTs and national focal point to NATO joint Civil Military Health group. His previous experiences include serving in various positions in national healthcare, ranging from field disaster management to hospital management, project management through various national and international projects, including heading Norway’s contribution to Sierra Leone during the Ebola outbreak in 2014/15 and followed by various deployments to international humanitarian and consular crises.
ADDITIONAL RESOURCES ON THIS TOPIC
Patient Quick Release Extrication Paper
Norwegian Telemedicine and Nurse Triage Video (in Norwegian)
CONNECT WITH STEINAR OLSEN
Linkedin  
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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
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.

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.