From Medicare cuts to billing delays, Asbel Montes joins Rob Lawrence to share practical strategies EMS agencies can use to weather the reimbursement storm

In this episode of the EMS One-Stop podcast, we tackle the fast-moving realities of a federal shutdown and what it means for EMS finance, reimbursement and day-to-day operations.

Rob Lawrence sits down with Solutions Group’s Asbel Montes — a veteran of EMS reimbursement and policy expertise — to decode where Congress is (and isn’t), what CMS’s temporary claims hold really means, and how ambulance services can protect cash flow while preparing for potential reprocessing chaos if extenders aren’t promptly restored.

Beyond the headlines, Montes lays out a pragmatic playbook: build a Plan B for cash continuity, align with your billing team on reprocessing workflows, and model exposure across payers tied to the Medicare fee schedule. The conversation then widens to balance billing — why federal change is unlikely soon and why state-level action is delivering practical protections — before closing with leadership lessons on adaptation, data and telling EMS’s story as a guide, not the hero.

Memorable quotes from Asbel Montes

“Our extender expired — that’s that additional payment that we get from Medicare of that 2%, 3%, 22.6% — it expired September the 30th, and it was tied to the House-approved CR that went over to the Senate.”

“We’re solutions givers, as we say here at Solutions Group, not crisis managers. And if you have a plan, I can at least execute a plan.”

“What turned out to be a smaller amount, now the cost associated with it, you started to really understand the complexities that really happened in people’s AR.”

“If this lasts longer than 15 days … then I would basically have a plan in place. So I would be trying to find out from my billing team … what is your contingency plan to ensure I don’t see a hiccup in cash moving forward?”

“The only way government can really invoke change is to make it hit where it hurts. And that’s what’s going on right now. They’re hitting the pocketbook and our industry is grappling with it right now.”

Additional resources

Episode timeline & key moments

00:21 – Why the shutdown matters to EMS reimbursement and operations

01:21 – Montes’s 101: role at Solutions Group; 28 years in EMS finance and policy

02:40 – Historical context: number and length of shutdowns; current Hill outlook

03:48 – The ambulance extenders expired (2% urban, 3% rural, 22.6% super-rural); CMS claims hold window

05:03 – Planning posture: realistic timelines; “we’re solutions givers, not crisis managers”

06:12 – Back-of-the-napkin math: short-term dollars vs. long-term reprocessing burden

07:43 – 2015–2016 déjà vu: retroactive fixes and the heavy lift for back-office AR

10:26 – Secondary impacts: VA eligibility, appeals, enrollments during a prolonged shutdown

11:11 – The “three-legged stool” for leaders: (1) have a plan with billing; (2) reconcile accounts & patient balances; (3) prevent cash-flow lag if more than15 days

14:06 – Framing the moment: “hurricane shutdown” response and recovery mindset

15:43 – Balance billing at the federal level: committee work, political pain and why movement is unlikely soon

18:19 – State action wins: consumer protections and access; examples of Medicare-indexed approaches

20:24 – Why ground ambulance stayed out of federal NSA; local regulation and state primacy

22:42 – “All politics are local”: using EMS’s public visibility to advocate for patients and providers

23:09 – Adaptation over preservation: seize the 6-18 month window; let data and clinicians lead reform

27:13 – Lawrence’s “Darwinism” takeaway: adaptation as survival

28:31 – The Leadership Lab podcast: purpose, cadence and upcoming guests; Montes’s leadership journey

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.

In this episode of the EMS One-Stop podcast, our host, Rob Lawrence, sits down with Hollywood actor Rainn Wilson, who stars as Randy in “Code 3.”

Known worldwide for his role as Dwight Schrute in The Office, Wilson has stepped into the world of EMS, portraying the life of a burned-out paramedic with both grit and humor. In the conversation, Wilson reflects on the process of bringing this story to life, his ride-along experiences in Los Angeles, and the powerful realities he uncovered about our profession.

More than just a performance, Rainn has become an unexpected advocate for EMS. He speaks candidly about the underfunding of frontline providers, the emotional toll of the work and the sheer humanity that comes with being welcomed into people’s lives during their most vulnerable moments.

Alongside the serious themes, he reminds us that Code 3 is also a comedy — one that captures the gallows humor, camaraderie and resilience medics carry with them on every shift.

| MORE: Why ‘Code 3’ might be the most honest EMS film yet. From a ticking salary counter to fourth-wall confessions, this EMS road movie isn’t just another Hollywood take. It’s a love letter, a warning and a mirror.

“Most of all, I just fell in love with the character of Randy.”

“Bottom line, the fact that first responders are getting basically what people that work at Starbucks are getting paid really blew my mind.”

“Well, one thing I never thought of, maybe stupidly so, is how vulnerable everything is because you're going into people's homes and they're in crisis.”

“I think Rob, no one should be allowed to graduate from high school without their kind of basic CPR training.”

“Everything about EMS — the tone, the vibe, the gallows humor, certainly all the technical medical elements, the burnout, the camaraderie, the idea that there's a mission here — they do it because they love it.”

“Well, it was an honor to learn about this world and to make a movie that these workers are excited about and proud of.”

“I want to say from the bottom of my heart, you know, ‘thank you. Thank you for your work. And, you know, I think it's grossly underappreciated, but, you know, America needs you.’”

00:26 – Rainn Wilson on the vulnerability of entering people’s homes in crisis

00:57 – “All we want to do is save your life. Some of you don’t make it easy.”

02:53 – Rainn’s first impressions of the “Code 3” script

03:38 – Falling in love with the character of Randy

04:22 – Discovering the realities of EMS work and shocking pay disparities

06:09 – Lessons from Wilson’s Los Angeles ride-along

10:12 – Wilson on CPR training and why everyone should learn it

12:29 – “We’re essentially a tube and a pump.”

13:11 – Rehearsals and the importance of portraying EMS medicine accurately

15:09 – On burnout, PTSD and the need to support medics’ mental health

18:08 – Using “Code 3” salary comparison as an advocacy tool

19:07 – Wilson praises Rob Riggle’s ED doctor role and its realism

20:41 – Cherishing the chance to shed light on EMS

21:10 – Reminder that the film is also a comedy — “a good old time with a bucket of popcorn”

22:25 – Final message: “America needs you. Keep saving lives.”

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.

In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Patrick Pianezza, co-writer of the new EMS film “Code 3”, a deeply honest and compelling portrayal of life on the ambulance.

The film stars Rainn Wilson (“The Office”), Lil Rel Howery (“Free Guy”) and Aimee Carrero (“Elena of Avalor”), delivering a powerful performance that captures both the pressures and the humanity of EMS work. Using real-world experiences and stories from the field, “Code 3” highlights the passion, dedication and emotional toll experienced by EMS professionals every day. From burnout, to systemic challenges, the movie invites the public into the high-stakes world of emergency medical services, showing both the challenges and the heart behind the uniform.

Patrick and Rob discuss not only the storytelling process, but also the personal experiences that informed the movie. Pianezza candidly shares the emotional toll of EMS work, the reality of burnout and the importance of mental health support for first responders.

This episode is both a celebration of the dedication of those who serve in 911 and a call for awareness and gratitude for the vital work they perform. “Code 3” opens in selected cinemas on Sept. 12, 2025.

Memorable quotes

“I remember going to one of my old bosses and saying, ‘I think I'm burning out.’ The reaction I got was this dark chuckle … ‘We're all burnt out. Get back on the truck.’ That kind of festering mentality is not healthy.” — Patrick Pianezza

“Six out of six people that I have worked with have unfortunately [died by] suicide, and the suicide rates for first responders is double that of the regular population … which is a statistic we need to fix.” — Patrick Pianezza

“And it is … a good representation of life on the truck, on the street, with a guy who’s clearly burned out; but a person that cares, that has passion, commitment and will always do the right thing.” — Patrick Pianezza

“There was no way to confront the story without talking about salaries, without talking about reimbursements … No one's gonna see a movie about Medicare, Medicaid, but we are as honest as we can be.” — Patrick Pianezza

“This movie is nothing more than a gratitude tour for everyone who works in 911 … I’ll be a broken record here: thank you for what it is that you do because it matters. I’ve been in those boots and I’m here to tell you thank you.” — Patrick Pianezza

“And as I say in my review, those who know me know my ability to take tactical naps during movies. Well, this one got two eyes open and absolutely five stars.” — Rob Lawrence

00:00 – Introduction: Rob Lawrence introduces Patrick Pianezza and the film “Code 3” starring Rainn Wilson

02:31 – Origins of “Code 3:” How the project started and the vision behind telling an authentic EMS story

05:01 – Creative team & casting: working with actors, crew and Rainn Wilson

08:01 – On-the-Street authenticity: translating real EMS experiences into the film

12:01 – Depicting burnout: emotional and mental challenges in EMS work

16:01 – Mental health & seeking help: Autobiographical elements and confronting burnout

20:01 – Systemic issues: salaries, Medicare, and Medicaid reimbursement challenges

24:01 – Impact on families & relationships: emotional toll beyond the job

27:01 – Personal reflection: Patrick’s journey, struggles and growth in EMS

29:01 – Gratitude tour: purpose of the film and acknowledging EMS professionals

32:01 – Closing thoughts: film release details, upcoming trailer and final messages of appreciation

Enjoying the show? Send an email to [email protected] to share feedback or suggest guests for upcoming episodes. 

This breaking-news edition of EMS One-Stop dives straight into the announcement that the National EMS Advisory Council (NEMSAC) has been dissolved. Host Rob Lawrence is joined by Dr. Brandon Morshedi (NEMSAC chair-elect) and Brenden Hayden (immediate past chair), who explain what NEMSAC is, what it achieved and why its sudden dismissal has left the EMS community frustrated, concerned and searching for answers.

Together, they outline the role of NEMSAC as the sole statutory advisory body connecting EMS to the federal executive branch, describe the hundreds of volunteer hours that went into shaping advisories, and discuss what happens now that years of hard work and documents have been pulled from EMS.gov.

This episode sets the record straight, provides a clear explainer of the process, and captures the disappointment — yet determination — of leaders committed to moving EMS forward despite this setback.

Additional resources:

How NEMSAC is composed — who sits on the council and what types of expertise are represented

The NEMSAC’s statutory role advice/briefings at the federal level

NEMSAC’s key accomplishments

01:08 – Rob introduces the breaking news: NEMSAC dissolved

02:22 – What is NEMSAC? Brenden explains its statutory role

04:52 – How does NEMSAC differ from associations? Direct advisory to the executive branch

06:42 – Appointments, terms and how continuity usually worked

08:44 – The depth of work: meetings, subcommittees, advisories, letters

11:23 – Examples of major advisories and public comment process

14:27 – Shock: key advisories removed from EMS.gov

19:13 – Explainer: FICEMS and how advisories flow through federal government

26:25 – How members felt when dismissal was announced

30:18 – What happens to unfinished advisories and research

34:20 – Associations’ role in keeping the work alive

35:50 – The advisory each guest is most proud of

39:41 – Lessons learned: influence, unified voice, process

43:25 – Final reflections: leadership, advocacy, and what comes next

Enjoying the show? Email [email protected] to share feedback or suggest guests for a future episode. 

In this episode of the EMS One-Stop podcast, host Rob Lawrence climbs back onto his soapbox to discuss two topics that directly impact on every EMS agency in America — the CAAS Ground Vehicle Standards (GVS) 4.0 and the simple, inexpensive steps we can take to stop ambulance theft.

Joining Rob is longtime EMS leader and current CAAS GVS Administrator Mark Postma, who walks us through the origins of the standards, their national adoption and what’s new in the latest update.

From ambulance remounting, to structural safety testing, Mark explains how GVS 4.0 has evolved to keep pace with manufacturing realities, supply chain delays and operational needs. The conversation then shifts to a shared passion for protecting fleet assets.

Rob and Mark dissect the shockingly frequent problem of ambulance theft and how a $200 automatic immobilization device can prevent a $250,000 vehicle from disappearing — without relying on crews to remember to lock it.

Additional resources:

CAAS GVS V4.0 – Ground Vehicle Standard

Commission on Accreditation of Ambulance Services (CAAS) – The New Standard in Mobile Healthcare

Ambulance thefts in the U.S. surge: Over 40 stolen rigs in 18 months

6 ways to safety-proof your EMS fleet

"It’s no good going to City Council or to your board of directors on day 365 and saying, ‘I need a new truck for New Year day one’ — that’s not going to happen." — Rob Lawrence

"The ground vehicle standard has become the standard that most vehicles are being built to and that state EMS officials are using." — Mark Postma

"We spend a lot of time thinking about where things go in the box … add one more thing to your checklist: can the vehicle indeed be immobilized?" — Rob Lawrence

"There’s just no reason why ambulances are being stolen with the current technology that’s out there." — Mark Postma

00:45 – Rob introduces the topic: GVS 4.0 and ambulance theft concerns

01:34 – Mark introduction and CAAS GVS role

04:11 – How the CAAS standards were developed and adopted by 35-plus states

06:09 – Comparing CAAS GVS to NFPA ambulance standards

06:48 – The rise of remounting, especially during COVID supply shortages

10:26 – Discussion of ongoing vehicle delivery delays and need for replacement planning

15:04 – What’s new in GVS 4.0 — major changes and safety structure updates

19:38 – Ambulance theft statistics and the GVS anti-theft requirement

22:28 – Automatic immobilization and why manual systems fail

23:57 – Mark shares success story: zero thefts since installing devices

26:17 – Exceptions in standards and why state inspectors must enforce anti-theft

27:42 – Final thoughts on making anti-theft part of fleet planning

Enjoying the show? Email [email protected] to share feedback and suggest future guests. 

In this edition of the EMS One-Stop podcast, host Rob Lawrence Zooms (literally) from the U.K. to South Carolina to spotlight one of the nation’s most forward-thinking mobile integrated healthcare programs. Prisma Health’s team has taken community paramedicine beyond buzzwords, designing targeted, evidence-based programs that meet people where they are — both geographically and medically.

| MORE: How North Dakota EMS is confronting rising pediatric mental health crises 

Whether it's addiction medicine, rural HIV/HCV treatment or skilled nursing interventions, this team is shifting paradigms on what EMS can and should be doing.

Rob is joined by four key voices from the Prisma Health MIH program:

Luke Estes, director of MIH

Dr. Mirinda Gormley, epidemiologist and biostatistician

Wes Wampler, community paramedic specializing in addiction and infectious disease

Parker Bailes, community paramedic and research contributor

Together, they unpack how passion meets data to drive change, how to earn trust in communities overlooked by traditional systems, and why this work isn’t just novel — it’s necessary. This is EMS in its truest public health form.

“You delivered the goods—data-driven, community-connected care — and that’s what EMS in 2025 needs more of.” — Rob Lawrence

“When you see some of your people who have a passion for a certain pathway in EMS, you try to give them the reins and say, you're gonna do some good.” — Luke Estes

“One of the big things that we learned from his study was that we really needed to go out and make sure everybody was aware that addiction is a disease.” — Mirinda Gormley

“If we can gain their trust, there’s a lot more that we can kind of weasel our way into to help them solve and get them on a healthier trajectory.” — Wes Wampler

“Walking into the (care) facility with the mindset of, ‘I'm going to do everything I can to keep you here,’ was a big shift for me.” — Parker Bailes

“If we can set them up to be successful after they leave the hospital, I think that's the best way to get them reengaged with the hospital.” — Wes Wampler

“As their leader … all I have to say is, what do you need? I'm here to support you.” — Luke Estes

EMS Clinician Perceptions on Prehospital Buprenorphine Administration Programs: Prehospital Emergency Care: Vol 29 , No 4

Implementation Barriers of Prehospital Buprenorphine Administration Programs in the United States: A Scoping Review: Prehospital Emergency Care: Vol 29 , No 4

Using Community Paramedicine to Treat Hepatitis C Virus in Upstate South Carolina - PMC

Luke Estes BA, NRP, CCEMTP, PNCCT, FP-C, CP-C | LinkedIn

Wesley Wampler | LinkedIn

Support for harm reduction by community EMS

How does a community re-imagine compassion to avoid crisis whenever possible?

Breaking barriers: Hennepin EMS leads the way in safely implementing buprenorphine

00:51 ­– Introduction to Prisma Health MIH & guests

03:00 – Luke Estes overview of MIH models (ETS, SDOH, addiction)

05:00 – Dr. Gormley’s public health journey, data-opioid focus

08:00 – Buprenorphine pilot design and research outcomes

10:15 – Challenges: bias, stigma, barriers to addiction care

13:00 – Funding and sustainability conversation

14:00 – Wes Wampler on daily workflow in addiction medicine and HCV care

17:00 – Building trust with vulnerable populations

18:30 – Parker Bailes discusses traditional CP role and skilled nursing interventions

21:45 – Alternative destinations, lab draws and high-acuity decisions

25:30 – Training: internal education, ultrasound, medication management

28:15 – Prisma’s med school connection and disaster response evolution

30:00 – State-level partnerships: SC EMS Assn, FEMA typing, CP strike teams

31:56 – Academic next steps from Dr. Gormley: scaling, publishing, process evals

35:26 – Final reflections from Luke Estes: passion, team strength and mission

38:00 – Rob’s call to action: “If you want your own Prisma team — start now.”

Enjoying the show? Email [email protected] to share feedback or suggest future guests. 

In this high-impact edition of the EMS One-Stop podcast, host Rob Lawrence sits down with EMS influencer and educator Jimmy Apple, known widely across platforms as The EMS Avenger. With nearly 70,000 followers on TikTok and a growing presence on Instagram and Facebook, Jimmy has mastered the art of compressing complex clinical topics into digestible, engaging content.

| More: What the EMS Counts Act means for dual-role EMS providers 

In this conversation, Rob pulls back the curtain on the man behind the mobile screen — exploring Jimmy's journey from electrician to pediatric critical care paramedic, and now, one of EMS's most watched and listened-to voices.

Listeners will gain deep insight into Jimmy’s origin story, his social media strategies, his refusal to let bad information go unchallenged, and his passionate belief that “Saving lives begins with kindness.” The pair also tackle:

Content creation advice for EMS agencies

The challenges of tone and accuracy in short-form video

How to maintain compassion in the face of a toxic work culture

This episode is part masterclass in communication, part call to action for the future of EMS — and all heart.

“Saving lives begins with kindness. That is my motto, it is my philosophy.”

“You have to package something down to its bare essence … there's some nuance lost, but you have seconds to keep people's attention.”

“My goals going forward are to support people who are acting in good faith while correcting the misinformation.”

“Generally speaking, you will draw the engagement that you're looking for. If you're putting out content in good faith, you'll get good faith engagement.”

“We are responsible for ourselves and how we respond … and I believe we need to respond to everything that is happening in the world today with kindness.”

00:54 – Rob introduces Jimmy Apple, aka the EMS Avenger

01:20 – Jimmy’s background: from electrician to EMS

03:30 – The grandfather conversation that changed his life

04:50 – How pathophysiology sparked a love for learning

05:40 – Birth of the EMS Avenger: from student favorite to TikTok influencer

06:55 – Ginger Locke’s advice that redirected Jimmy’s podcast path

08:04 – Compressing content: "from textbook to bumper sticker"

10:00 – The content hook: “Are we getting rid of normal saline?”

11:00 – How Jimmy selects topics: research, news, curiosity and requests

13:00 – Hot topics in EMS: cricothyrotomy, TXA, ketamine, provider safety

14:40 – Rob discusses EMSIntel.org and ambulance theft data

16:00 – Can EMS agencies do what Jimmy does? The risks and the realities

18:30 – "Stop the finger": creating content that captures attention

20:00 – Rob on the risks of public messaging and backlash

21:00 – Calling out misinformation: the line between education and shame

23:00 – Jimmy’s growing reach across TikTok, Instagram and Facebook

24:45 – Managing Facebook’s deeper comments and nuanced conversations

26:45 – Jimmy’s rule: “Engage only with good faith”

27:50 – Final thought: EMS must rediscover kindness

29:00 – Closing remarks and where to follow Jimmy Apple online

Connect with Jimmy Apple, better known as The EMS Avenger:

TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger

Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger

X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger

Facebook — Join the group for discussions and shared insights: EMS Avenger community

Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series

AAA & AIMHI EMS Media Log: EMS Intel

Enjoying the show? Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.

In this special crossover edition of EMS One-Stop and The Bridge Podcast from the Kentucky Office of Rural Health, host Amelia Holliday leads the conversation, joined by Scott Helle, rural project manager at KORH; and Rob Lawrence, host of EMS One-Stop and EMS leader.

Recorded live at the 2025 Kentucky EMS Leadership Academy, this episode explores the evolution, design and impact of the Leadership Academy on Kentucky’s rural EMS landscape. The discussion dives into the Academy’s origins, structure, statewide reach and its mission to prepare the next generation of EMS leaders in some of the most resource-challenged communities in the country.

From the realities of low-volume, underfunded rural services, to the inspiring stories of leadership growth and resilience, this episode offers a thoughtful examination of the challenges facing EMS in Kentucky and beyond. Rob reflects on leadership principles drawn from his military and EMS career, while Scott provides a blueprint for how to build and sustain EMS talent in small communities. Together with Amelia’s thoughtful moderation, this episode highlights how mentorship, structured learning and network-building are transforming rural EMS leadership — one cohort at a time.

The Bridge Podcast (Contains additional discussion)

Center of Excellence in Rural Health: Established to address health disparities in rural Kentucky

Asking the big questions: Industry leaders weigh in on celebrating EMS Week amidst the forces shaping the EMS landscape

Cultivating the next generation of EMS: Leadership development, emotional intelligence and the importance of mentorship

“We’re promoting people above their level of competency — not because they’re not good, but because we haven’t prepared them for what’s next.” — Rob Lawrence

“We saw early on that EMS professionals were great at clinical care, but we were missing the leadership piece.” — Scott Helle

“Effective communication is the core of good leadership. You can’t lead without it.” — Amelia Holliday

“My six principles: pride, integrity, learning, humor, service and courage. They guide everything I do.” — Rob Lawrence

“It costs money to build people. That’s why we provide this Academy at no cost to participants.” — Scott Helle

“It’s hard to run EMS in a state where many counties don’t even have a tax base to support it.” — Scott Helle

“You’re always leading. Once you start, it never stops. People are always watching and listening.” — Rob Lawrence

“We’re not just building leaders — we’re building mentors, networks and future change-makers.” — Scott Helle

“Nobody becomes a good leader because they want power. The best leaders are those who understand the responsibility.” — Amelia Holliday

00:18 – Introduction to the Kentucky Leadership Academy and crossover with The Bridge Podcast

02:29 – How the Academy was formed and why it was needed

05:00 – Structure of the Academy, application process and regional representation

08:11 – EMS 2050, developing next-gen leaders, and avoiding the Peter Principle

11:00 – The importance of non-clinical leadership education

13:36 – Funding challenges in rural EMS, tax base realities and sustainable operations

17:41 – Rural EMS dynamics, local politics and the true cost of readiness

21:25 – Hospital closures and extended transport times — national rural EMS challenges

24:11 – Leadership is constant: visible, energetic and principle-driven

28:14 – Rob’s military leadership values and the weight of being observed

32:35 – Leadership as service and the power of building trust within teams

34:58 – Rob’s group dynamics “icebreaker” exercise and lessons on leadership styles

39:33 – Mentorship benefits both ways: mentees gain confidence, mentors renew purpose

44:49 – Academy success stories and graduates becoming leaders elsewhere in EMS

46:44 – Closing comments and podcast wrap-up with Amelia and Rob

Enjoying the show? Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.

In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with Danielle Thomas, chief operating officer, Lifeline EMS of Los Angeles, to explore how her team is harnessing “actual intelligence” — through a proprietary, closed-source AI platform called InCheck — to solve a perennial EMS headache: information overload. Thomas explains how embedding agency-specific protocols, an 800-page policy manual and multi-language translation into a single voice-activated app gives every crew member a “mentor in their pocket,” shrinking cognitive load, sharpening clinical decision-making and smoothing onboarding during the critical first 80 hours of employment.

| More: From 73 to 33 minutes: How Sacramento reinvented patient offload times 

The conversation ranges from her move from Boston to California and the regulatory culture shock that followed, to Lifeline’s recent CAAS accreditation push and the wider potential of AI-driven tools to boost recruitment, retention, compliance and patient safety.

In the second half, Rob and Danielle expanded the conversation from tools to leadership strategy, focusing on how EMS agencies can better support staff in high-pressure, multi-jurisdictional environments.

Thomas shares how her team tackled issues like protocol confusion, inconsistent policy knowledge and language barriers — not by adding more training sessions, but by rethinking how information is delivered, accessed and retained on the front lines. She emphasizes the importance of aligning education with the way today’s workforce learns, communicates and engages — especially during the critical first days of employment.

The episode closes with a preview of Danielle’s upcoming AAA conference presentation with Carly Strong, which challenges perceptions of gender in EMS leadership and spotlights the untapped potential of inclusive, thoughtful organizational development.

“If you can, as the leader in an EMS organization, figure out how to enhance not only that first 80 hours, but that team member experience.” — Danielle Thomas

“As everybody listening knows, I'm sure that every new policy probably has somebody's secret name attached to it because of what happened.” — Rob Lawrence

“It honestly solves our recruitment and retention issues because they want to come to work.” — Danielle Thomas

“I happen to believe that [AI is] an on-the-train or under at the moment kind of thing … we now have to move forward. It's part of our life. We have to embrace it and we have to employ it.” — Rob Lawrence

“The left coast is more highly regulated and so I was not used to the labor laws in California and I was not used to the way that the local EMS authorities work.” — Danielle Thomas

“I think every company I've worked at that that was a thing and so we had to create a solution to the problem we had, which was information overload.” — Danielle Thomas

01:25 – Welcome to Danielle Thomas

02:56 – East-to-West move and California’s regulatory maze

4:12 – Lifeline EMS footprint across Los Angeles, Orange and Riverside Counties

6:27 – The policy-overload dilemma in multi-county operations

10:01 – InCheck: turning 800 pages into actionable intel

14:53 – From AI skeptic to evangelist — programming county-specific protocols

18:30 – Five operating modes explained (Rampart, Angel, Nova, L-Chat Narrative)

28:00 – 100-language instant translation with Nova

34:51 – Building the tool in-house; cost and compliance advantages

38:43 – Preview of AAA Conference session, “Just one of the guys”

41:33 – Final takeaways: enhancing the first 80 hours and keeping crews engaged

42:44 – Closing remarks

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.

In this international edition of the EMS One-Stop podcast, host Rob Lawrence welcomes Lewis Andrews, the chief operating officer of the United Kingdom’s College of Paramedics, for an insightful discussion on two major topics shaping global paramedicine.

First up is International Paramedic Day, taking place on July 8, 2025. Now in its third year, the day honors the contribution of paramedics across the world and draws its inspiration from the birthday of Dominique-Jean Larrey, the father of battlefield ambulance care. Lewis explains how the day has grown from 50 initial partners to over 150 global organizations, with this year’s theme being “Unity and community.” The day aims to raise awareness of the profession, share innovations and bring together the global paramedic community.

MORE | How community paramedicine is thriving in the UK: Dr. Linda Dykes and Rom Duckworth discuss trans-Atlantic lessons in emergency management

In the second half of the show, Lewis delves into the structure and significance of the College of Paramedics, which represents nearly half of the UK’s registered paramedics. He describes how the UK paramedic profession is regulated and protected by law, with a rigorous educational pathway that now includes the potential for prescribing paramedics and direct-to-primary-care tracks.

Rob and Lewis explore how paramedics in the UK are increasingly working beyond emergency ambulances — in GP surgeries, urgent care centers and academic roles. Their conversation offers a rich comparison point for U.S. EMS leaders seeking to elevate paramedicine through autonomy, education and broader clinical roles.

“This is not a commercial platform — this is about us celebrating us.” — Lewis Andrews, on the ethos of International Paramedic Day

“Let’s not reinvent the wheel, but let’s look at what the wheel is for the environment that it’s required to roll in.” — Lewis Andrews, on global EMS collaboration

“The title ‘paramedic’ is protected by law in the UK — you can’t simply do a first aid course and call yourself one.” — Rob Lawrence

“Autonomy — in a word — that’s what makes a prescribing paramedic.” — Lewis Andrews, on expanding paramedic roles

“We’re also promoting the profession to those who don’t yet know they want to be in the profession.” — Lewis Andrews, on recruitment and professional identity

“We have a career framework … that actually shows that you can develop from that day one newly qualified right through to a consultant paramedic, chief paramedic, director, professor.” — Lewis Andrews

00:55 – Introduction to International Paramedic Day (IPD) and its origins

02:17 – Why July 8 was chosen: Dominique-Jean Larrey’s birthday

03:02 – Growth of IPD from 50 to over 150 partners

05:06 – 2025 theme: “Unity and community” and sub-objectives

06:45 – How to participate: share stories, use hashtags (#UnityAndCommunity and #IPD2025), connect globally

08:58 – The global nature of IPD and U.S. partners’ involvement

11:25 – Promoting awareness and the importance of celebrating paramedics

12:50 – Part 2 — The role of the College of Paramedics

14:09 – Overview of College functions: CPD, representation, research, advocacy

18:15 – Registration with HCPC, protected title and the regulator’s role

21:12 – Paramedic education in the UK: degree pathways, demand and cost

23:46 – Discussion on streaming directly into primary care roles

27:09 – Career framework: from graduate paramedic to chief paramedic/professor

30:16 – Prescribing paramedics: autonomy and improved patient experience

33:08 – Recap and call to action: visit www.internationalparamedicsday.com

34:17 – Like, subscribe and engage

ADDITIONAL RESOURCES

International Paramedics Day Resources

UK College of Paramedics

The standards of proficiency for paramedics

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