EMS One-Stop

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. Page, Wolfberg & Wirth was asked by the National EMS Information System (NEMSIS) Technical Assistance Center (TAC) to research frequently asked questions related to data in EMS patient care reports. PW&W analyzed these questions under applicable laws and guidance, and developed general answers and best practices contained in the new publication, “Patient Care Report Data QuickGuide - FAQs on owning, amending, retaining and sharing patient care report data.” In this week’s EMS One-Stop, available in both video and audio versions, Host Rob Lawrence speaks with the PW&W authors of the project, Ryan Stark, managing partner, and Steve Johnson, director of reimbursement consulting. They discuss the guide, why it’s needed, and the major FAQs and misconceptions about PCRs. The guide is broken down into four key areas of FAQs: PCRs’ legal status Amending PCRs PCR retention Transferring PCR data Top quotes from this episode “I would much rather defend an organization who regularly goes through a quality assurance process, whereby they make the provider and hold them responsible for the accuracy and completeness of the record.” — Ryan Stark “Others may say, we see a lot of amendments to your records. The answer is ‘yes, that’s because we care about getting it right’ – that’s the mantra of our organization.” — Ryan Stark “One of the things behind the importance of documentation is that it doesn’t live in a vacuum. We are in a day and age where it’s going to follow the patient for their lifetime, so you may have a rehab facility that wants to consult the medical record to determine the mechanism of injury or how the injury occurred and the only person [that knows that] is the EMS practitioner.” — Ryan Stark “Long gone are the days where we can give you a quick ticket, passing along the information to the receiving facility. Now we are marrying up records, electronic health exchanges and other mechanisms and the genesis of all this starts with the original call.” — Steve Johnson “Everyone should sign the patient care report. Why? Because everyone was a function of providing that particular service and we get a lot of pushback and they say ‘well now I’m legally responsible for everything that happened,’ and that’s not what the law says. The law says, for what you did, you are responsible for what you did and what you didn’t do when you had a legal duty to do something or withhold doing something because it was contraindicated. All that indicates is that yes, I reviewed it and to the best of my knowledge it’s true and accurate.” — Ryan Stark “The law will impose liability where it lands. Just because you’ve signed that particular patient care report, doesn’t mean you’re responsible for all the interventions and everything that I outlined in there, it would be whoever performed or withheld those interventions that would be responsible within the scope of practice.” — Ryan Stark Episode contents 1:09 – Introductions 1:30 – PWW history 3:30 – Introducing the PCR Data QuickGuide 4:20 – The circle of life of a PCR 11:00 – NEMSIS data/research license and EMS by the numbers 13:20 – Who owns PCR data 15:50 – Signatures! And legal responsibility 17:40 – Accuracy of documentation to defend your actions 18:30 – Why does the driver have to sign? 20:00 – Amending PCRs: When and why 22:33 – Who do you tell if a record is amended? 24:30 – Can your state request you to amend your PCR? 27:30 – How long should we keep documents? 30:50 – When an agency closes down or merges 33:30 – Body-worn camera content 35:30 – Transferring paper records to digital 37:15 – Bi-directional data and HIE – responsibilities 40:00 – Final thoughts Additional resources The PCR Data QuickGuide is available now, and we encourage all EMS professionals to download their copies and gain a deeper understanding of PCR data best practices. To download the guide, please follow the link: About NEMSIS About Page, Wolfberg & Wirth About our guests Ryan Stark Ryan Stark is a managing partner with Page, Wolfberg & Wirth, and is the firm’s resident “HIPAA guru.” He counsels clients on labor relations, privacy, security, reimbursement and other compliance matters affecting the ambulance industry. Ryan started in the healthcare field as a freshman in college, where he worked for a local hospital and a retail pharmacy. After college, he decided to become a lawyer, hoping to guide healthcare providers through the demanding legal issues they face. He has been with PW&W since 2007, fulfilling that ambition. Ryan is passionate about educating EMS professionals and loves collaborating with providers and CEOs alike. He is a featured speaker in PW&W seminars and webinars, including the firm’s signature abc360 Conference, where he hosts the abc360 Game Show. Alwa

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. This edition of the EMS One-Stop podcast spotlights the popular online education series Reel Emergency, which uses real bodycam footage to illustrate various types of medical emergencies. The footage is then discussed in a live broadcast by very well-known emergency medicine physicians, Drs. Peter Antevy, Mark Piehl and David Spiro. Reel Emergency offers free continuing education credit on the day of the Prodigy EMS based broadcast (you must be in the live audience to receive CE) and is then made available via YouTube for all to view and use as part of their clinical education. Reel Emergency has now produced 15 episodes and has been viewed tens of thousands of times as both individuals and departments benefit from the content, the expert analysis and commentary, as well as subject matter expert guests. In this podcast, Rob Lawrence chats with Reel Emergency’s regular host Hilary Gates, director of educational strategy for Prodigy EMS; and Zach Dunlap, clinical education specialist from 410 Medical. Zach also previously worked for an agency that pioneered the use of body-worn cameras in EMS and offers insight into their adoption and use. TOP QUOTES FROM THIS EPISODE “These real patient videos actually show what’s happening on a call. Where else do you get that? You can’t get that anywhere else and there’s something to be said for doing scenarios and having standardized patients or mannikins, but nothing beats watching the actual call itself because you also have all of the other elements of the call that are really hard to recreate in the classroom. You have all of the emotions all of the bystanders, all of the equipment, the communication aspects you have to worry about, and you have real human reactions” — Hilary Gates “If you are an educator, and you are teaching a certain topic – anatomy, physiology, scene management, all operations, whatever it is – and there is a way to illustrate that, you should be required to illustrate it with a video – there’s just no better way to do it.” — Hilary Gates “It should almost be a requirement at this point, the main reason people don’t want body cameras in EMS is because it’s grossly misunderstood.” — Zach Dunlap EPISODE CONTENTS 1:00 – Introductions 01:35 – REEL Emergency 02:20 – Everyone knows Drs. Spiro, Antevy and Piehl 4:00 – Using video for education 6:10 – Gaining free CE and watching on-demand 07:20 – Using body-worn cameras on the street 08:23 – Using BWCs for performance improvement 11:25 – Suggesting that BWC eventually become the standard of care 12:50 – Where does Reel emergency get its videos from? 14:00 – Filming the Falmouth Road Race and heat emergencies 15:20 – How to view Reel Emergency? ADDITIONAL RESOURCES ON THIS TOPIC Current Reel Emergency topics include sessions on HP CPR, heat emergencies, peds emergencies, junctional hemorrhage, ped airways, anaphylaxis, intracranial emergencies, delirium, end of life care, GSWs and altered mental status. Following are additional resources on incorporating body-worn cameras: Promoting transparency and accountability with BWCs Three outdated paradigms holding EMS back Leadership’s role in keeping our workforce safe How to buy body-worn cameras (eBook) ABOUT OUR GUESTS Zach Dunlap began his EMS career as a paramedic in Amarillo, Texas. After working in Oklahoma City, he returned to the Texas panhandle, where he worked as a flight paramedic for several years. Zach now resides in Houston, and has served as a flight paramedic and clinical director for a progressive 911 system. Currently, he is a clinical education specialist for a national medical company educating and training clinicians across the country on volume resuscitation. Zach obtained his bachelor’s in emergency health sciences and has always focused on providing excellent patient care through innovative approaches. Zach enjoys sports and spending time with his two children, Brogan and Brynlee, and their Goldendoodle, Claire. Zach is also the assistant treasurer of the Board of Commissioners of Harris County ESD11 in northern Houston. Hilary Gates, MAEd, NRP, is the director of educational strategy for Prodigy EMS and a volunteer paramedic in the Alexandria (Virginia) Fire Department. She is also a faculty member of the School of Education at American University in Washington, D.C., and teaches Introduction to Community Health in the EM Program at University of Pittsburgh. Beginning her career as a volunteer EMT with the Bethesda-Chevy Chase Rescue Squad in Montgomery County, Maryland, Hilary became a full-time paramedic, EMT instructor and FTO at AFD, and then served as senior editorial and program director for EMS World. She implemented AFD’s MIH/CP program in 2017 and has extensive experience as an EMS educator, symposium pr

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 edition of the EMS One-Stop podcast, Host Rob Lawrence speaks with Dr. Maia Dorsett and Paramedic Nikki Little to discuss the NAEMSP Quality Improvement and Safety Course, an exciting year-long course that provides EMS physicians and quality improvement leaders with the knowledge and skills necessary to lead QI and patient safety initiatives in their region, system or agency. Participants will develop an in-depth understanding of how to apply QI tools and strategies to their local needs to affect the care of patients. Dr. Dorsett and Little identify that the program will take participants on a journey to improve the quality of care and safety in their system through a multi-modal approach in sessions led by expert faculty, who will discuss key aspects of quality improvement. TOP QUOTES FROM THIS EPISODE “I think one of the things I love about this course is half the faculty are not physicians. There is a fair percentage of NAEMSP membership that are not physicians and the quality course especially is very deliberate. It has faculty from different backgrounds.” — Dr. Dorsett “Your system is complex; all of the policies and procedures and processes that you have set up for the folks to work in them, they don’t always work as designed.” — Nikki Little “Once a month, and even more often than that, because you meet with your mentees, you get to really collaborate idea-wise and work together with a group of people who are all there committed to making improvements in their system.” — Dr. Dorsett “So many quality leaders are still stuck in this in this moment, where they’re looking at 50% in May and 52% in June, and we’re just comparing these two numbers and making massive strategic decisions about things that might be seasonal or have abnormal variation and we could be really making some really dumb mistakes if we’re not looking at our data over time.” — Nikki Little EPISODE CONTENTS 02:00 – Introduction – Nikki Little 2:25 – Introduction – Dr. Maia Dorsett 02:40 – Description of the course 03:30 – Quality Course origin story 05:30 – Little’s experience as an inaugural participant 0745 – Month-by-month syllabus 10:00 – PDSAs and brevity in QI 13:00 – Capstone and results presentation 15:20 – Little’s course highlights 17:29 – Dorsett’s course highlights 21:25 – This course is not just for physicians 23:10 – Course overall timeline 24:30 – Cohort presentations at the annual meeting and poster presentations 26:20 – Class sign-up details ADDITIONAL RESOURCES ON THIS TOPIC NAEMSP Year-Long Quality Improvement and Safety Course ABOUT OUR GUESTS Maia Dorsett, MD, PhD, is an emergency medicine and EMS physician and educator. She completed her EMS fellowship at Washington University before moving to Rochester, New York, where she now serves as the medical director for EMS education at Monroe Community College and is the associate regional medical director for education and quality for the Monroe-Livingston Region. She is also the medical director for Gates Volunteer Ambulance as well as Prodigy EMS. Nationally, she serves on the board of the National Association of EMS Physicians and the National Registry of EMTs. She is involved in quality improvement implementation and education, serving as the co-course director for the NAEMSP Quality and Safety course. Nikki Little, FAEMS, has fulfilled many roles as a paramedic, including advanced care paramedic, district chief of paramedic operations, 911 communication supervisor, and quality and patient safety officer in almost 30 years in EMS. She has a passion for patient-centered quality improvement of systems and has advocated for policy advances in the areas of patient safety, team communication and opioid overdose. She has dedicated countless hours to improve the quality and safety of patients with non-transport dispositions, (especially elderly and at-risk persons) and to improve the care for patients experiencing acute coronary syndromes (with particular focus on gender disparities in care). She has also contributed through committee work by way of the Paramedic Chiefs of Canada and the Manitoba Chapter of the Canadian Women’s Heart Health Alliance. In the area of quality improvement and paramedic education, she is in her sixth year as faculty of the National Association of EMS Physicians (NAEMSP) Quality and Safety Year-Long capstone course and preconference workshop. Her dedication to furthering the educational mission of the organization, and skill in teaching patient safety and improvement science to paramedic professionals and EMS physicians was duly recognized when she was named co-director. CONNECT WITH OUR GUESTS Maia Dorsett Nikki Little

999, London Ambulance Service Deputy Director Simon Harding talks emergency planning for the royal gathering 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. Recorded with less than 24 hours to go before the coronation of King Charles III, of England, host Rob Lawrence sits down with Simon Harding, deputy director of the London Ambulance Service to discuss planning for the coronation. Harding also serves as deputy director of the London's 999 control centers. Harding begins by highlighting the construct of ambulance services in the United Kingdom, as well as the scope and operation of the London Ambulance Service, which serves 9 million citizens of the national capitol, plus visitors. LAS takes over 2 million 999 (the UK equivalent of 911) calls a year in addition to 2 million 111 calls (for non-emergency responses). Harding and Rob discuss how incident management operates in the UK, using the GOLD, SILVER and BRONZE levels of command, and the roles and responsibilities at each level. They talk about the plans for the coronation and how LAS – in partnership with public safety and military planners – are preparing to support the historic event. Resources mentioned in this episode London Ambulance Service John’s Ambulance Service Additional resources for mass gathering planning Boston EMS' Joe O'Hare: All hazards incident management EMS coverage for mass gatherings and public events How EMS can prepare for a mass gathering to become an MCI 7 ways to be prepared before the mass gathering turns into an MCI

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. Ginny Renkiewicz, PhD, is an assistant professor of healthcare administration in the College of Health Sciences and Human Services at Methodist University, Fayetteville North Carolina. Dr. Renkiewicz has been involved in EMS for 21 years as a credentialed paramedic, administrator and leader. Her specific research interests include defining predictors and profiling traumatic stress syndromes in EMS personnel and she recently had two papers published in the U.K. and U.S. on subjects related to her research interests. In this edition of EMS One-Stop, Rob Lawrence and Dr. Renkiewicz discuss her publications, “Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel,” which discusses the emotional countertransference that occurs between the clinician and patient, and “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic,” which analyses how the coronavirus disease pandemic has profoundly affected EMS professionals. TOP QUOTES FROM THIS EPISODE “I don’t think we will ever go back to normal; this is kind of like 911. There was before 9/11, and there was after 9/11, and this is going to be before COVID, and after COVID.” “Vicarious trauma is emotional counter, transference; essentially, you are feeling what the patient feels when they’re experiencing a traumatic event. Example being, if you had a call, for example, a stillbirth, you may for the following weeks or months have this weird aversion to children or things in which infants are involved and you may have a stress response to those situations in the same way that the patient would have.” “Post traumatic stress injury is not the only stress disorder that exists out there. It is the one that I think most frequently cited by educators and administrators, because we don’t know all of the other more insidious stress disorders, of which vicarious trauma is one.” “A predictor of having vicarious trauma as an EMS professional; my hypothesis is that if your parents or whomever your caregivers are do not teach you how to appropriately and emotionally cope with anything in any situation, it becomes very difficult for you to know how to do it properly in your adult life and so you overcompensate, and so vicarious trauma occurs in that population.” EPISODE CONTENTS 1:12 – Introduction: Dr. Ginny Renkiewicz 1:55 – Ginny’s academic career 3:00 – The development of research on EMS 4:50 – Paper discussion – secondary trauma response 09:00 – Education on stress disorders 11:24 – Therapy dog program 12:30 – Next steps/further work on resilience training 1530 – Maladaptive cognitions 17:20 – Getting published in the SOM Journal 19:00 – Learning, conclusions and takeaways 23:00 – The new normal 24:18 – Call to action for leaders 26:13 – NHTSA Listening Group on wellness, resilience and peer support programs 27:30 – Getting involved in research 31:00 – NAEMT Lighthouse leadership program ADDITIONAL RESOURCES ON THIS TOPIC Secondary trauma response in emergency services systems (STRESS) project: quantifying and predicting vicarious trauma in emergency medical services personnel “Maladaptive Cognitions in EMS Professionals as a Function of the COVID-19 Pandemic” ABOUT OUR GUEST Dr. Ginny Renkiewicz is an assistant professor of healthcare administration in the College of Health Sciences and Human Services Methodist University, Fayetteville, North Carolina. She has been involved in EMS for 21 years as a credentialed paramedic and Level II paramedic instructor. She has spent 17 years as a program director, division chair or department head and has been recognized for her contribution to the EMS profession as a Fellow of the Academy of Emergency Medical Services (FAEMS) through the National Association of EMS Physicians. She has won several national and international awards, including National EMS Educator of the Year and the global EMS10 Award for innovation in the field of EMS. She holds an Associate of Applied Science in Sign Language Interpreting degree from Wilson Community College, a Bachelor of Science in Emergency Medical Care with a concentration in EMS management and a Master of Health Science in EMS education (both from Western Carolina University), and a Ph.D. in Health Science with a concentration in Respiratory Care from Rush University. Dr. Renkiewicz is a reviewer for several peer-reviewed journals; serves as executive director of the Foundation for Prehospital Medicine Research; and is enthusiastic about research, innovation and student mentoring. She is also the vice chair of the North Carolina Association of EMS Educators. Her specific research interests include defining predictors and profiling traumatic stress sy

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. COVID-19 was declared a Public Health Emergency (PHE) on Jan. 31, 2020, and was extended a number of times, but it is now set to expire on May 11, 2023. In this episode of EMS One-Stop, Rob Lawrence is joined by Doug Wolfberg, Esq., of Page, Wolfberg & Wirth to discuss the immediate actions organizations should take (or should have already taken) to preserve documentation relating to the PHE, as well as adjust operational and documentation practices and procedures as we “return to normal.” Rob and Doug discuss issues such as rule changes that have become normal operating procedures over the last 2 years and the need to build a time capsule to preserve evidence. They also cover patient signatures, telehealth changes, transport to alternate destinations, agency licensing and Physician Certification Statements. Doug, a lifelong Beatles music fan, also shares that he has just published a book: “The Beatles: Fab but True: Remarkable Stories Revealed” and will be undertaking a book signing tour in the UK later in the year. TOP QUOTES FROM THIS EPISODE At the end of the PHE, “We revert back to the standard inflexible Medicare signature rules which means that the patient needs to be the signer, and the only time that you can get a signature from anyone else is if that patient is physically or mentally incapable of signing that statement.” EPISODE CONTENTS 1:12 – End of the PHE announced 2:00 – Rule changes have become normal operating procedures 2:20 – The need to build a time capsule to preserve evidence 4:30 – Big change ticket item number one – patient signatures 6:40 – A reminder to establish the reason the patient is unable to sign a PCR 7:20 – Telehealth changes 10:00 – Transport to alternative destination coverage ends (but place your pandemic local clinical guidance in your time capsule now!) 13:07 – ET3 – not affected and is separate 15:24 – Doug and the Beatles 17:52 – Ambulance staffing waver also going away 18:55 – Agency licensing back into full force – no more grace periods 21:12 – Physician Certification Statements (PCS) – do not cut corners on your PCS signatures 22:15 – Leaders pay attention to this podcast ADDITIONAL RESOURCES ON THIS TOPIC CMS Waivers, Flexibilities, and the Transition Forward from the COVID-19 Public Health Emergency Doug’s new book: “The Beatles: Fab but True: Remarkable Stories Revealed” ABOUT OUR GUEST Doug Wolfberg is a founding partner of Page, Wolfberg & Wirth, and one of the best-known EMS attorneys and consultants in the United States. Widely regarded as the nation’s leading EMS law firm, PWW represents private, public and non-profit EMS organizations, as well as billing companies, software manufacturers and others that serve the nation’s ambulance industry. Doug answered his first ambulance call in 1978 and has been involved in EMS ever since. Doug became an EMT at age 16, and worked as an EMS provider in numerous volunteer and paid systems over the decades. Doug also served as an EMS educator and instructor for many years. After earning his undergraduate degree in Health Planning and Administration from Pennsylvania State University in 1987, Doug went to work as a county EMS director. He then became the director of a three-county regional EMS agency based in Williamsport, Pennsylvania. He then moved on to work for several years on the staff of the state EMS council. In 1993, Doug went to the nation’s capital to work at the United States Department of Health and Human Services, where he worked on federal EMS and trauma care issues. Doug left HHS to attend law school, and in 1996 graduated magna cum laude from Widener University School of Law. After practicing for several years as a litigator and healthcare attorney in a large Philadelphia-based law firm, Doug co-founded PWW in 2000 along with Steve Wirth and the late James O. Page. As an attorney, Doug is a member of the Pennsylvania and New York Bar Associations, and is admitted to practice before the United States Supreme Court as well as numerous Federal and state courts. He also teaches EMS law at the University of Pittsburgh, and teaches health law at the Widener University School of Law, where he is also a member of the school’s Board of Overseers. Doug is a known as an engaging and humorous public speaker at EMS conferences throughout the United States. He is also a prolific author, having written books, articles and columns in many of the industry’s leading publications, and has been interviewed by national media outlets including National Public Radio and the Wall Street Journal on EMS issues. Doug is a Certified Ambulance Coder (CAC) and a founder of the National Academy of Ambulance Coding (NAAC). Doug also served as a commissioner of the Commission on Accreditation of Ambulance Servic

EMS One-Stop Show Notes - National EMS Museum 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 discusses the National EMS Museum (NEMSM) with President Dave Zaiman; Museum Director, Kristy Van Hoven; and Jon Krohmer, MD, immediate past-secretary and "We are EMS" coordinator. The National EMS Museum is a volunteer-led organization that collects, preserves and shares the history of emergency medical response in the United States in hopes of inspiring future professionals to take up the call. The National EMS Museum organization operates a virtual museum and produces traveling exhibitions that tour the country every year. The Collections at the National EMS Museum house over 300 years of history that cover the development of prehospital care in the United States, North America and around the world. TOP QUOTES FROM THIS EPISODE “We are here to educate the future. We are here not only to document the legacy, but here to provide a foundation and an education that EMS as a profession, as we move forward is respected, is understood, and maybe in a small part this museum can play a part in improving EMS altogether.” EPISODE CONTENTS 03:05 – Origins of the NEMSM 05:04 – The style and model of the NEMSM 07:00 – Changes underway – recruiting individuals with experience in museum activities 11:50 – President Dave Zaiman 13:20 – Getting EMS into the community 15:00 – Favorite artifacts 16:30 – From MAST pants to blood transfusion 17:20 – Fundraising effort in order to take the museum on the road 20:30 – Developing a traveling mobile “We are EMS” museum project 23:40 – How to book a traveling exhibit ADDITIONAL RESOURCES ON THIS TOPIC The National EMS Museum California Ambulance Association Siren special edition: Fifty Years of Wedworth-Townsend ABOUT OUR GUESTS Dave Zaiman Dave is currently Sales VP - Midwest at Pulsara. For over 30 years, Dave has been working in healthcare – both as an EMS professional as well as holding several leadership roles in the healthcare technology industry. Based in Minnesota, Dave spent his first 15 years working in the field as an EMT and paramedic in the Twin Cities metro area for both Allina and Hennepin County Medical Center. Kristy Van Hoven Kristy is the museum director for the National EMS Museum and PhD candidate at the University of Leicester. Over the last 3 years, Kristy has worked with the National EMS Museum’s Board of Trustees to develop and implement engaging e-volunteer opportunities and community programs that reach their digital audience. In addition to her work with the EMS Museum, Kristy volunteers at several local museums in Toronto, Ontario. Jon Krohmer, MD Dr. Krohmer served as the director of the NHTSA Office of EMS before his retirement in November 2021. During his tenure as director, Dr. Krohmer oversaw several milestones for the profession, including the creation of EMS Agenda 2050; major revisions to the National EMS Scope of Practice Model and the National EMS Education Standards; and improvements in the collection and use of EMS data through the expansion of the National EMS Information System. Soon after the onset of the COVID-19 pandemic, Dr. Krohmer was tapped to lead the prehospital/911 team as part of the Federal Healthcare Resilience Task Force. Prior to joining NHTSA, Dr. Krohmer had decades of experience as a local EMS medical director, initially in his home state of Michigan. His EMS career began as an EMT with a volunteer rescue squad. Like many EMS professionals, he was inspired by the television show “Emergency!” and by the emergence of the relatively new field of emergency medicine. He entered medical school at the University of Michigan knowing he wanted to make EMS his career. After becoming involved in EMS at the state and national level, he also served as president of the National Association of EMS Physicians from 1998 to 2000. In 2006, he came to Washington to serve as the first deputy chief medical officer for the Department of Homeland Security Office of Health Affairs and served in several other DHS roles before joining NHTSA in 2016. 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 [email protected] to share ideas, suggestions and feedback.

This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit lexipol.com. This week, Host Rob Lawrence welcomes back, Alexander Isakov, MD, MPH, professor of emergency medicine at Emory University School of Medicine, executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), and EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC). Returning guest, Dr. Isakov provides an update on the current emerging pathogens, diseases, outbreaks and fevers that have featured recently in the news. Candida auris, Marburg virus disease, avian influenza, Nipah virus are discussed as well as recaps on Ebola, COVID-19, polio and seasonal influenza. TOP QUOTES FROM THIS EPISODE “What’s concerning CDC officials and experts is there is a multi-drug resistant strain of Candida auris that is really picking up in their surveillance programs.” “While no one wants to be exposed to a multi-drug-resistant Candida auris, it’s really the ominous compromised patient that’s going to be likely most affected by it, so that means elderly patients or patients that are getting chemotherapy and have some immunosuppression consequence of that or people that are taking immunosuppressant drugs, they are the ones really at greatest risk.” “The likelihood that EMS personnel are going to encounter somebody with Marburg virus disease in the U.S. during routine operations is extremely low, but good to be vigilant about it and identifying that someone might have been exposed, and understanding their travel history, if someone is ill, has a fever or myalgia, GI complaints and has travelled within the last 21 days to equatorial Guinea or Tanzania, then it would raise suspicion.” ADDITIONAL RESOURCES ON THIS TOPIC CDC: Infection prevention and control for Candida auris CDC: Information for infection preventionists NETEC: Situation report: Marburg cases rise in equatorial Guinea and Tanzania NETEC: EMS guidelines for Marburg virus disease ABOUT OUR GUEST Alexander Isakov, MD, MPH, is a professor of emergency medicine at Emory University School of Medicine. He is certified by the American Board of Emergency Medicine in both emergency medicine and emergency medical services (EMS). Dr. Isakov is the director of the Section of Prehospital and Disaster Medicine whose faculty provides medical oversight for 911 communications centers, and ground and air EMS responders in metropolitan Atlanta. He is also the executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR), which serves as the center for Emory enterprise-wide planning for and coordinated response to catastrophic events. Dr. Isakov has provided leadership in emergency medical services and disaster preparedness locally and nationally. He serves as the medical director for the Sandy Springs Fire Department and Air Life Georgia. He is the founding medical director for the Emory-Grady EMS Biosafety Transport Program. He is the EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC) and is a designated Subject Matter Expert for the Assistant Secretary for Preparedness and Response, Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE). Dr. Isakov is also on the American College of Emergency Physicians Epidemic Expert Panel and is a member of the EMS sub-board for the American Board of Emergency Medicine. He previously served on the National Association of EMS Physicians board of directors and the Technical Expert Panel for NHTSA’s EMS Agenda 2050. Dr. Isakov has an MD from the University of Pittsburgh and an MPH from Boston University. He completed his emergency medicine residency training at the University of Massachusetts Medical Center and his EMS fellowship with Boston EMS. Dr. Isakov has lived and worked in Atlanta for 20 years. He practices clinically in the emergency department of Emory University Hospital. 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 [email protected] to share ideas, suggestions and feedback.

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. Russ Myers, Nikki Holm and Gwen Powell are chaplains at Allina Health Emergency Medical Services and in this episode, they join Rob Lawrence to discuss the role of chaplaincy in EMS. The guests discuss their role and responsibilities as well as the book, “Because We Care: A Handbook for Chaplaincy in Emergency Medical Services,” written by Russ Myers. Over the past half century, the field of chaplaincy has come to a fork in the road. Many will recognize the well-traveled path of traditional chaplaincy. Others will follow the newer but clearly marked way to professional chaplaincy: a clinically trained, evidence-based discipline, reflecting and serving the diverse expressions of spirituality in modern society. Until now, chaplaincy in EMS has been the terra incognita, the unknown land on the map. Drawing on three decades of clinical chaplaincy practice, scholarship and original research, Russell Myers charts the map, making the case for ambulance service chaplaincy: how to think about it and how to do it. TOP QUOTES FROM THIS EPISODE “For me it’s all about love, how can I bring some light, some life, some love into the world, and I am able to do that in these situations by just showing up as we call in chaplaincy – the ministry of presence.” —Gwen Powell “I do this work is to come alongside people and remind them of their humanity to help them break down their defenses and their shields to get back to the truth of who they are, to help them be seen and heard and taken care of.” —Nikki Holm EPISODE CONTENTS 1:23 – Introduction Russ Myers 2:43 – Introduction Nikki Holm 4:00 – Introduction Gwen 7:35 – Book discussion: Because We Care – The Role of the Chaplaincy in Emergency Services 11:20 – Terra Incognita 12:30 – What motivates a chaplain? 15:30 – A chaplaincy intervention story 20:15 – A chaplain’s workload 23:00 – Being Proactive: Establishing a trusting relationship with the workforce 23:30 – Being Reactive: when an incident or issue occurs 30:15 – Education and being a presence during training 34:58 – If you are thinking about introducing g a chaplain 36:30 – Moral Injury and the social contract 40:40 – Overcoming the staff stigma about coming forward 42:00 – Close ADDITIONAL RESOURCES ON THIS TOPIC “Because We Care: A Handbook for Chaplaincy in Emergency Medical Services” When EMS meets hospice. End-of-life care takes a heavy emotional toll: Seek support when needed ABOUT OUR GUESTS Russell Myers serves as a chaplain for Allina Health Emergency Medical Services, based in Minneapolis. He holds a BA from Ohio State University and a Doctor of Ministry degree from Luther Seminary, St. Paul, Minnesota. Russ is ordained by the Evangelical Lutheran Church in America and is board certified with the Association of Professional Chaplains. He lives in Saint Paul, Minnesota. Gwen Powell is an ordained episcopal priest and board-certified professional chaplain who has been working with Allina EMS since 2020. Prior to working for Allina, she provided spiritual care to patients and staff on the adolescent behavioral health units at the M Health Fairview University of Minnesota Medical Center. Gwen graduated from Valparaiso University with a degree in psychology in 2008 and earned her Master of Science in Psychology from Kansas State University in 2010. She earned her Master of Divinity from Luther Seminary in St. Paul, MN in 2014 and has been passionate about mental health chaplaincy since beginning her ministry work in 2015. In her free time, she likes to beat her husband and kids at Mario Kart, exercise, walk/hike with her family, watch baseball, and sing with the Northern Lights Chorale. Nikki Holm has been engaged in the meaningful work of EMS Chaplaincy through Allina Health since the Spring of 2020. Prior to making the transition to EMS, Nikki provided spiritual care and health education in an outpatient mental health setting for several years. Nikki was board certified with the Board of Chaplaincy Certification Inc. in 2017, graduated with a Master’s degree in Spirituality from St. John’s School of Theology in 2007 and with a Bachelor’s degree in Theology from The College of St. Benedict in 2005. Nikki lives in an earth home with her husband, their three beloved children, and three furry companions. Outside of soaking up life with her littles, Nikki enjoys rock climbing, writing, reading, yoga, gardening, and otherwise spending time with her tribe. Contact Nikki at [email protected]. RATE AND REVIEW THE EMS ONESTOP PODCAST Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.

This special episode of EMS One-Stop is part of 2023 First Responder Wellness Week. Do you want to improve your physical fitness, increase your resiliency, eat better and sleep longer? Get started with videos, articles and other resources at www.firstresponderwellnessweek.com. You can also learn more about what Lexipol is doing to support health, wellness and safety among first responders. In this special First Responder Wellness Week episode of EMS One-Stop, Host Rob Lawrence welcomes Mike Taigman and Kevin Pannell to discuss the many facets of wellness, why wellness is essential for first responders, and easy tips for getting started to improve fitness, nutrition, stress management and more. Memorable quotes “The work we do involves your cognitive abilities to think well and sort out challenging situations for patients and calls and circumstances. You’ve got to lift people and move them and those kinds of things, so there’s a whole physical component, and the stress management is absolutely part of the wellness, and if you don’t kind of have a handle on that, there’s a lot of stresses this world presents to you – and poorly managed stress, we know, tears down your physical, psychological and emotional wellness.” —Mike Taigman “If you’re in EMS or fire and you can’t carry the med box in one hand and the defibrillator in another up two flights of steps and you’re gassed and you can’t work when you get there, then you’re useless. And, for police, if you can’t wrestle with somebody because you’re exhausted in 30 seconds, it’s a problem.” —Kevin Pannell Together, they offer tips like: Pay attention to your plant-to-processed food ratio Start with pushups. You don’t need all the equipment they have at the CrossFit Games, Pannell notes. “You can get a smokin’ workout from just you and the ground.” Or take a walk. Take a holistic approach to fitness (weightlifting, something that makes you breathe hard and stretching); it’s about balance About our guests Mike Taigman uses more than four decades of experience to help EMS leaders and field personnel improve the care/service they provide to patients and their communities. Mike is the Improvement Guide for FirstWatch, a company which provides near-real time monitoring and analysis of data along with performance improvement coaching for EMS agencies. He teaches Improvement Science in the Master’s in Healthcare Administration and Interprofessional Leadership at the University of California San Francisco and the Emergency Health Services Management Graduate Program at the University of Maryland Baltimore County. Kevin Pannell works in program and project management in the healthcare IT space. He has previous experience as a public safety and military veteran, and produces wellness content. Resources mentioned in this episode Pannell5 Fitness Club KEV Talks Podcast Kevin Pannell on Twitter @pannellkg “Undo It!: How Simple Lifestyle Changes Can Reverse Most Chronic Diseases” by Dean Ornish, MD; and Anne Ornish “How Not to Die: Discover the Foods Scientifically Proven to Prevent and Reverse Disease” by Michael Greger, MD, FACLM; and Gene Stone

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 EMS One-Stop international edition, this month, Rob Lawrence talks with Professor Tony Walker, immediate past chief executive officer of Ambulance Victoria, a professor with the Faculty of Medicine, Nursing and Health Sciences and Bachelor Paramedic Studies at Monash University. While in charge of Ambulance Victoria, Tony led significant transformation to improve the health and well-being of their workforce and the response they provide to the community. In this broad-reaching discussion, Tony explains the structure, organization and funding models of EMS down under and then Rob and Tony identify current challenges, issues and solutions common to both the U.S. and Australia, including the dreaded hospital handover challenges as well as reduction in lights and siren responses. TOP QUOTES FROM THIS EPISODE “We know at least one in five people who call triple zero, our 911 equivalent, don’t require an emergency ambulance and so new models of care are being developed.” “When people call triple zero, they no longer expect that they will automatically get an ambulance, as often described to people, you don’t walk into a hospital triage and say I’d like you to admit me to the coronary care unit,, you get triaged, you work out what is wrong by a health professional and you get the care you need; that’s exactly the same being applied in the paradigm of ambulance service delivery here in Victoria and the rest of Australia.” “In the next decade or so, I wouldn’t be surprised if we see predominantly women making up the majority of staff working on frontline ambulances.” “New models of care have been developed. We have looked at the MPDS grid and where the disposition of those patients go to so we have reduced significantly the number of lights and sirens responses which has enabled us.” “Issues of transfer of care in hospital are a real challenge for ambulance services in the time it takes to transfer patients and there is no easy fix for that.” “If you are a paramedic who has gone to university, done your training, wants to deliver care and you are spending a significant proportion of your shift in an emergency department caring for your patient before he can offload it, that can be demoralizing and that probably goes against why you joined in the first place.” EPISODE CONTENTS 1:16 Introducing Tony Walker 2:00 The scale and scope of Australian Services 05:45 Healthcare funding – how does the patient get their healthcare 7:45 EMS system organization and deployment 09:15 Degrees and paramedic education 11:50 Student debt … or not! 14:10 Is Australia over-producing graduate medics? 16:40 Alternative treatment models 19:00 Reducing lights and siren responses 21:08 Public expectation education 23:02 Looking after your people 25:50 Handover delay at the ED – a global issue 27:00 Gender and diversity 27:34 Scheduling and rostering – creating a flexible roster that meets the needs of the individual and service 28:40 Hospital capacity and flow issues 31:08 How can you work in Australia? ADDITIONAL RESOURCES Additional EMS One-Stop podcast solutions to EMS staffing woes from down under: Australia EMS medics join the podcast to discuss their efforts to fill U.S. positions with their paramedic surplus On-Demand webinar: Ambulances held hostage: Strategies to unilaterally reduce ED wait times and get back into service Ambulances held hostage: EMS strategies for reducing ambulance offload times ABOUT OUR GUEST Professor Tony Walker, ASM, is a registered paramedic with over 36 years’ experience working across senior clinical, operational and leadership roles within the ambulance sector. He was previously chief executive officer of Ambulance Victoria, where he led significant transformation to improve the health and well-being of their workforce and the response they provide to the community. Tony is a Fellow of the Australasian College of Paramedicine and holds a Bachelor of Paramedic Studies, Graduate Certificate of Applied Management, Graduate Diploma of Emergency Health (MICA) and Master of Education. He is a non-executive director of the Prostate Cancer Foundation of Australia, the Emergency Services Foundation and TLC for Kids, a Director of Fairhaven Consulting Pty. Ltd., and an executive member of the Global Resuscitation Alliance and an Associate Investigator with the Australian Resuscitation Outcomes Consortium. He is a past non-executive director and chair of the Council of Ambulance Authorities (CAA), the peak body representing the eleven statutory ambulance services across Australia, New Zealand and Papua New Guinea, past chair of the Australian Resuscitation Council (Victorian branch) and past deputy convenor of the Australian Resuscitation Council ALS sub-committee. Tony is published in

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 employer’s 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. In this podcast, Host Rob Lawrence doesn’t talk about the EMTs on the truck – he talks to the EMTs on the truck. He gets their views on what keeps them on the job and what is driving them away. As Rob notes, “In talking to this amazing cohort of EMTs, it is clear that the passion to serve and care for those they treat is there, but the living wage they receive is not!” Recurring themes emerge from the discussions (which are reflected in various EMS industry surveys): Having a good and receptive boss/leader Camaraderie – good coworkers make the day fly by Training – keeping skills up to date. The ability to do the job; respond; if necessary, transport; hand over and repeat! … not delay About the guests Alyssa Catalan – EMT with Shoreline Ambulance based in Orange County California Doricela Mozo – EMT with. Medic 1 Ambulance based in Irwindale CA Tyler Coombes – EMT with PRN Ambulance based on North Hills California Ryan Walters – EMT with Falck Ambulance based in Orange County Lasalle Jones – EMT with AmbuServe Ambulance based on Gardena California Damian Henriquez - EMT with AmbuServe based in Gardena California Top quotes from this episode “We do have patients’ lives in our hands, and unfortunately, the pay does not reflect that whatsoever, so a lot of us are working two other jobs, like myself, I work here and I have another job and I have the most overtime than anyone else in the company and I still don’t have enough to pay my bills.” — Damien Henriquez “I have to work twice as much as a normal worker would have to to afford to live, and that’s one of the reasons why I’ve amassed about 40,000 work hours, I have a 20-year career but I’ve only been here 14 years.” — Ryan Walters “One of the great things about EMS – coming to work and not knowing what type of call you are going to get, whether it’s interfacility transport, 911, just never knowing what kind of call am I going to get, sometimes you get really cool calls, sometimes you get calls that are very difficult, but after the call, just knowing that you accomplished it and what it took to accomplish is really rewarding.” — Lasalle Jones “Do you realize EMS as a whole is a bubble that’s about ready to pop? Do you want to be proactive or reactive? Do you want to get ahead of it before it bursts or do you want to figure it out after? Right here, right now, we are trying to be proactive so everyone can get a living wage.” — Damien Henriquez Episode contents 01:25 – Meet the panel 02:56 – The view of the new EMTs 04:55 – Time served EMTs 07:17 – How can we help you make a living? 10:22 – What’s keeps you motivated and on the truck 13:56 – What is the FTO seeing as people come in? 21:40 – If you had a rider down the escalator with an elected official, what would you say to them? 25:54 – Get involved 26:24 – Final thoughts Additional resources on this topic California’s Fund First Responders Website California Ambulance Association 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 [email protected] to share ideas, suggestions and feedback.

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 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 [email protected] to share ideas, suggestions and feedback.

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 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 [email protected] to share ideas, suggestions and feedback.

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 [email protected] to share ideas, suggestions and feedback.

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 [email protected] to share ideas, suggestions and feedback. Listen on Apple Podcasts, Amazon Music, Spotify and RSS feed.

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.”

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.

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.

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.

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.

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.

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