EMS One-Stop

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 Orleans 01:22 – Chief Salmeron describes the initial setup and EMS operations in the French Quarter 03:26 – Incident details: the truck’s path, immediate EMS response, and the scale of injuries 06:01 – Incident command and mutual aid coordination, including the deployment of 13 ambulances 09:43 – Managing hospital capacities and patient transport logistics during the MCI 15:11 – The discovery of explosive devices and the role of EMS in securing and retreating from the scene 23:01 – Post-incident response: staff debriefings, mental health support and lessons learned 33:31 – Preparing for future events like the Super Bowl and Mardi Gras under heightened security 41:06 – Five key takeaways for leading and managing mass casualty incidents 50:28 – Closing thoughts and appreciation for first responders’ dedication and resilience Additional resources New Orleans EMS

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

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.

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!

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

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

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.

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.

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.

In this edition of the EMS One-Stop podcast, host Rob lawrence welcomes Todd Stout and Mike Taigman of FirstWatch as they introduce the 2024 Jack Stout Fellow, Mary Meeks, district chief of night shift at Chatham Emergency Services. The Jack Stout EMS Fellowship, endowed by FirstWatch, aims to empower emerging EMS leaders by equipping them with the knowledge and skills necessary to guide EMS systems effectively in the future. Developed by FirstWatch in cooperation with the Fitch EMS Foundation, the Fellowship underscores the commitment to leadership development and community service. Named in honor of Jack Stout, a pioneer in high-performance EMS systems, the Fellowship teaches principles such as people-centered leadership, data-driven decision-making, improvement science and systems thinking. As the chosen Fellow, Meeks will attend the 2024 Pinnacle EMS Leadership Forum, participate in either the Fitch Ambulance Service Manager or Communication Center Manager program, and benefit from a customized mentorship led by Mike Taigman, renowned for his contributions to EMS quality improvement. This comprehensive program not only honors Jack Stout’s legacy but also ensures that his visionary principles continue to shape the future of EMS. Additional resources IHI Framework for Improving Joy in Work | Institute for Healthcare Improvement The Jack Stout EMS Fellowship, endowed by FirstWatch Pinnacle EMS leadership conference

In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Fayetteville, North Carolina’s Cumberland County EMS Chief David Grovdahl and Behavioral Health Community Paramedic Tara Tucker to discuss the Cape Fear Valley Mobile Integrated Health Behavioral Health Community Paramedicine programs. The Cape Fear MIH Team is composed of four community paramedics, one social worker and a peer support specialist. The team focusses in particular on overdoses/request for substance use treatment, suicide related calls – ideation/attempts as well as youth calls related to mental health and substance use, and also EMS referrals and associated case management. Fayetteville is home to Fort Liberty and Pope Army Air Base, and is the sixth most populous city in North Carolina with a high number of uninsured and underinsured patients. Fifteen percent of Cumberland County’s population is military-affiliated and it is the third busiest EMS system in North Carolina. Cumberland’s affiliated ED, CFVMC Emergency Department, had 90,595 visits in 2021 for adults, and 30% of those (27,300) were for behavioral-health related issues, creating the need for a Behavioral Health service line employing community paramedics. In addition to discussing their mobile integrated healthcare system, Grovdahl also shares about the North Carlina whole blood programs and their progress.

In this special, on-site episode of EMS One-Stop, host Rob Lawrence takes us to the 2024 North Carolina EMS Expo in Greensboro, North Carolina, a well-attended conference with over 1,200 attendees. Rob spent time with several conference faculty. EMS lawyer Matt Streger joins Rob to discuss just culture, HR issue spotting, leadership communication and employee engagement. Kevin Collopy joins Rob to discuss the outstanding prehospital training being delivered to medics in Ukraine and also discusses this years “Stand and Deliver” new speaker event (a now annual event held as EMS World Expo). Rob discusses whole blood and its national rollout with Dr. Randall Schaeffer and David Grovdahl. To close, Peter Dworsky of the National EMS Safety Conference provides an overview of the current top EMS industry safety themes. Enjoying the show? Email [email protected] to send in guest suggestions, episode feedback or questions for our host.

Editor’s note: 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 the EMS One-Stop podcast, host Rob Lawrence welcomes back Matt Zavadsky to discuss the latest development in the move to fund treatment in place and the recent disclosure from CMS about the potential savings to Medicare identified in the analysis of the limited ET3 program. Matt discusses the potential legislative moves regarding EMS funding, highlighting bipartisan support and urging listeners to engage with elected officials to support bills benefiting EMS. The conversation underscores the need for sustained advocacy efforts and highlights the level of interest shown by key policymakers. Rob and Matt also discuss the recent developments in the City of Fort Worth and the decision to absorb MedStar into the Fort Worth Fire Department, emphasizing the need to ensure equitable treatment for EMS personnel transitioning to new roles. Top quotes from this episode “We can officially say that the net savings to Medicare after they pay EMS and after they pay the tertiary provider telemedicine, whatever it is, is still $550 to $570 per enrolled ET3 participant. And when you do the math, that's a billion dollars or more of savings to the Medicare program, which now CBO can use to evaluate the benefit, economically of doing a treat, no transport, treatment-in-place model. So it's big news.” — Matt Zavadsky “Nobody benefits from a knock-down, drag-out fight. But as you indicated, there are now people in the community and people across the country that are saying why and what does this mean? We don't have all those answers, but again, it's the decision from the folks who are elected to represent the community and if that's what they want to do, that's great. Our role is to try and do as much as we can to maintain a transition into a new provider system that keeps those core tenants – the high performance, high value mobile, integrated healthcare, flexible deployment. All those things that have really made the system a world class EMS system, even though it might say something different on the side of the ambulance and the employees might be wearing a different uniform.” — Matt Zavadsky “It's going to be a long transition – 12 to 18 months, and it's not just branding and rebranding, it's really infusing the culture of a group of people who are used to doing 7-10 calls in 12 hours and used to having things operate with a certain cadence that's going to be totally different when they start a different type of organization.” — Matt Zavadsky Episode contents 00:00 – Introduction 02:15 – ET3/TIP: Challenging CMS outcome data 03:15 – Cost savings per intervention 04:00 – CMS data showing net savings to Medicare 04:30 – Congressional Budget Office score based on savings 06:00 – Net savings of a billion dollars or more 07:00 – Applying this new information for the good and benefit of the industry 09:00 – Congress is, is what Congress does 10:40 – Meeting with Congress to push TIP 14:30 – Fort Worth and the PWW Advisory Group 14:50 – Fort Worth economies and level of service 17:30 – Matt Zavadsky to join the PWW Advisory Group 19:15 – The staffing issues as Med star staff transit to the FD fire department 21:00 – Ensuring the staff is protected 25:00 – Call to action-how we communicate all value to elected officials 26:00 – Final Thoughts About our guest Matt Zavadsky is the former chief transformation Officer at MedStar Mobile Healthcare, formerly the exclusive emergency and non-emergency public utility model EMS system for Fort Worth and 14 other cities in North Texas. Coming to MedStar in 2008 as the operations director, Matt made significant changes to the EMS delivery model, and in 2010, successfully eliminated the need for the tax subsidy that MedStar had been operating on since its inception in 1986. He has helped guide the development and implementation of numerous innovative programs with healthcare partners that have transformed MedStar fully as a Mobile Integrated Healthcare (MIH) provider, including high utilizer, CHF readmission reduction, observational admission reduction, hospice revocation avoidance, 911 nurse triage programs and partnerships with home health agencies. He is also the co-author of the book “Mobile Integrated Healthcare – Approach to Implementation,” published by Jones and Bartlett Publishing. He has 42 years’ experience in EMS and holds a master’s degree in Health Service Administration with a graduate certificate in Healthcare Data Management. Matt is a frequent speaker at national conferences and has consulted on numerous EMS issues, specializing in high-performance EMS operations, finance, mobile integrated healthcare, public/media relations, public policy, transformative economic strategies and EMS research.

In this episode of the EMS One-Stop podcast, Dr. Edward Racht and Matt Zavadsky join Rob Lawrence to discuss their recent attendance at the U.S. House Committee on Ways & Means hearing on “Access to Health Care in America: Ensuring Resilient Emergency Medical Care,” which took place in an off-site hearing in Denton, Texas, on March 18, 2024. Dr. Racht, chief medical officer of Global Medical Response; and Zavadsky, chief transformation officer for the Metropolitan Area EMS Authority (MedStar Mobile Healthcare) discuss the evidence and the key issues they conveyed to the committee. Dr. Racht's testimony included: The significant advancements made in emergency medicine over the past decades, leading to reduced mortality and disability rates for patients. The importance of updating Medicare reimbursement rates for ambulance services, which have not been revised for over 20 years. Advocating for wholesale reform of Medicare's coverage of emergency medical services to align with contemporary practices, such as covering treatment in place and transportation to alternative healthcare sites. Matt Zavadsky's testimony included: The impact of CMS payment policies on EMS, which incentivize unnecessary transportation of patients to the emergency room. Innovative programs initiated by EMS agencies to prevent unnecessary 911 calls and navigate patients to appropriate care settings. Legislative changes required to provide EMS with flexibility in patient navigation, including treatment in place and transport to alternate destinations. The challenges faced by ambulance services nationwide, especially in rural areas, exacerbated by the COVID-19 pandemic. Top quotes from this episode “We are the front of the frontline in medicine.” — Dr. Ed Racht "Our coordinated and integrated EMS and healthcare system now gives gravely injured patients ... the opportunity for rapid surgical intervention and a chance at full recovery." — Dr. Ed Racht "Emergency healthcare professionals pride ourselves on our ability to dramatically decrease morbidity and mortality from unexpected and sudden illness and injury." — Dr. Ed Racht "CMS payment policy is such that we are incentivized to transport every 911 patient to the ER because that is the only time we get paid." — Matt Zavadsky "Ambulance services are a vital component of our local and national healthcare and emergency response systems." — Matt Zavadsky "Innovative EMS agencies ... have initiated patient-centric programs designed to prevent 911 calls and navigate patients to the most appropriate care setting." — Matt Zavadsky "Ambulance services across the nation, especially in rural areas, are facing unprecedented challenges." — Matt Zavadsky Episode contents 0:05 – Introduction 0:55 – Guest introduction 1:40 – Explaining the Ways and Means Committee 2:30 – We are being noticed! 3:40 – Preparing for a congressional hearing 5:40 – The impact of having a congressional hearing in an EMS location 5:58 – The genuine interest of the committee members 9:00 – Dr. Ed Racht testimony to the Congressional Ways and Means Committee 14:24 – Matt Zavadsky testimony to the Congressional Ways and Means Committee 20:52 – Dr. Racht and Zavadsky’s reactions to the evidence they gave and the feedback 29:00 – Zavadsky’s key points he wished to reinforce during his evidence session 31:45 – Balanced billing, patient protections and removing the patient from the middle of the process 32:50 – Independent Dispute Resolution (IDR) and its challenges. 38:29 – Questions for Secretary Becerra on Capitol Hill 44:00 – Final thoughts 45:00 – A call to action to become one and present a united front “When we unify, we are unstoppable.” 48:00 – You the listener are the great politician