EMS One-Stop

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

RATE & REVIEW

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In this vital episode of EMS One-Stop, host Rob Lawrence is joined by Matt Zavadsky and attorney Doug Wolfberg of Page, Wolfberg & Wirth for a deep-dive into three financial flashpoints currently impacting EMS.

First, the trio unpack the launch of the new PWW|AG/EMS|MC EMS Financial Index, a quarterly report leveraging billing and revenue cycle data from over 1,500 agencies nationwide. This unprecedented benchmarking tool allows EMS leaders to measure performance against regional and national trends, uncovering actionable insights into billing strategies, reimbursement rates, payer mixes and the economics of service delivery. It’s a critical step in helping agencies justify their value and improve their financial sustainability.

Next, the discussion turns to MedPAC — the Medicare Payment Advisory Commission — and its controversial response to cost data submitted by ambulance services under the CMS Ground Ambulance Data Collection System. Doug Wolfberg explains how MedPAC discarded over half of the data, labeling higher-cost services — often rural or government-run — as outliers. This move could justify lower or stagnant Medicare fee increases, potentially devastating many providers.

Finally, attention shifts to the “One Big Beautiful Bill” moving through Congress and now on its way to the Senate that would eliminate or severely restrict enhanced Medicaid funding mechanisms, such as supplemental payments and provider taxes. If passed, this legislation would reduce reimbursement for millions of transports, triggering funding crises across EMS systems — particularly in states like California and Illinois. The episode delivers a clear message: EMS leaders must prepare, advocate and act now.

00:41 – Rob introduces the three main topics: the PWW|AG/EMS|MC EMS Financial Index, MedPAC’s response to ambulance data and a major federal bill impacting Medicaid

01:59 – Part 1 — PWW|AG/EMS|MC Financial Index

03:37 – Matt explains that the index is built using data from over 1,500 EMS agencies via EMS|MC

05:43 – The importance of regional benchmarking

08:22 – First major finding: dramatic variation in ALS billing rates across regions

09:30 – Key insight: agencies that bill more tend to collect more revenue — agencies are encouraged to determine their true cost of service and align billing accordingly

12:37 – Collection percentage is debunked as a misleading metric; focus should be on dollars collected

15:36 – ALS vs. BLS billing levels explained, with a look ahead to Q2’s emergency-only data set

18:48 – How EMS agencies can better engage with insurers to cover non-transport and MIH services

20:46 – Part 2 — MedPAC

22:24 – Doug outlines how MedPAC discarded over half of the reported ambulance cost data

25:00 – Explanation of which data was discarded and why — primarily high-cost, rural and government-based services

28:22 – Doug asserts MedPAC is using cherry-picked data to suppress reimbursement increases

30:10 – Rob and Doug emphasize that EMS gave MedPAC quality input, but MedPAC is producing garbage output

32:08 – Doug outlines what MedPAC will do next and what EMS leaders must do in response

34:40 – Strong call to action: educate Congress, use real CMS data and don’t accept MedPAC’s narrative

36:59 – Doug emphasizes the importance of evidence-based deployment strategies for financial sustainability

37:31 – Part 3 — “One Big Beautiful Bill”

38:19 – Matt outlines how the bill would drastically limit Medicaid supplemental payments

39:43 – Federal/state Medicaid match rates explained with California as an example

42:51 – The looming reckoning: local governments may have to pay to maintain current EMS service levels

46:02 – Matt warns that the bill could trigger PAYGO cuts to Medicare as well

47:16 – Agencies are urged to plan now, talk to their communities and adjust operations

48:06 – Doug adds that pressure on U.S. senators, especially in red states, could still influence the bill

51:26 – Close and call to action

This episode underscores that EMS cannot remain reactive — leaders must proactively use data, engage legislators and educate their communities on the true cost of care. The EMS Financial Index, the MedPAC dismissal, and the pending bill all point to a critical need for informed, strategic advocacy.

When most people see red tape, they stop. Darin Johnson saw an opportunity. In this episode of Inside EMS, Chris and Kelly welcome Darin — a paramedic, operations supervisor and now urgent care owner — to break down how he helped spearhead Utah’s House Bill 14. The goal? Allow paramedics to practice to their full scope outside of traditional EMS settings. What started as a frustrating moment working in mobile IV therapy spiraled into a full-on legislative effort that took over 3 years to realize.

And guess what? It passed.

But Darin didn’t stop there. He then launched Mod Doc, a fusion-style urgent and primary care center in Draper, Utah, run with a team of paramedics, flight nurses and a nurse practitioner. The mission? Community-centered care that blends traditional and holistic approaches — and gives paramedics a real seat at the table.

This episode is a playbook for anyone ready to stop asking “Why not?” and start saying, “Watch this.”

“I'm just trying to create fusion medicine. Kind of like when you go to a restaurant and you get fusion food. I just want to bring all the best parts of medicine together and provide the best care for people so they can have good quality of life.”

“Paramedics should be expanding their scope of practice. We really should be utilizing our ability to operate in remote environments and in homes and everywhere else.”

“I had a moment where I just stopped and went, ‘Wait, huh? You'll let me do all these things if I'm working for an EMS agency, but if I have all the same things in place working private than I can't do that.’ And it started this whole journey of wanting to understand why paramedics weren't recognized for their scope of practice in the private setting.”

Enjoying the show? Email the Inside EMS team at [email protected] to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

In this episode of the EMS One-Stop podcast, host Rob Lawrence sits down with returning guest Chief Robbie MacCue of Colonie EMS (New York) to explore the transformative potential of the Safe Streets and Roads for All (SS4A) federal grant program.

Funded by the Infrastructure Investment and Jobs Act, SS4A aims to prevent roadway fatalities and enhance post-crash care. With $5 billion available nationwide and $900 million still on the table for FY25, this conversation is a call to action for EMS agencies across the country.

Chief MacCue shares the story of how his department, in collaboration with neighboring EMS and police agencies, secured $2.4 million in SS4A funding for a project focused on innovative vehicle alert systems, prehospital health information exchange and groundwork for whole blood deployment.

From demystifying the grant application to defining success metrics and compliance reporting, this episode breaks it all down — turning policy into practice, and complexity into impact.

Memorable quotes

ADDITIONAL RESOURCES

It’s EMS Week wrap-up time, and Chris Cebollero and Kelly Grayson are back in classic form in this episode of the Inside EMS podcast. From jokes about Sloppy Joe leftovers from Hospital Week to heartfelt gratitude for the medics still grinding it out day after day, this episode hits all the notes. Chris and Kelly talk about why EMS Week still matters; more than just stickers and slogans, it’s about recognizing the quiet pride, the commitment and the transformation that EMS professionals bring to their communities every single day.

The hosts challenge listeners to advocate for the profession, share their stories, and — most importantly — support one another. Whether you’re still running lights and sirens or mentoring the next generation, this one’s for you.

“You may be in EMS if you finish a trauma report while chewing beef jerky at 3 a.m.” — Kelly Grayson

 ”We need to treat EMTs, paramedics, dispatchers and supervisors with respect and do things for them 51 weeks of the year, and then take EMS Week off.” — Kelly Grayson

“This isn’t a flashy job, it’s not always recognized ... but it’s real. And it gets in your blood.” — Chris Cebollero

“Keep on being the rumpled angels of healthcare.” — Kelly Grayson

Enjoying the show? Contact the Inside EMS team at [email protected] to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

When it comes to taking criticism, EMS professionals are … not great. In this episode of Inside EMS, cohosts Chris Cebollero and Kelly Grayson get real about why criticism hits so hard and how we can start to deal with it like grownups (instead of defensive toddlers). They break down Chris’s recent article, “10 practical tips for responding to criticism,” sharing personal stories of defensiveness, arrogance and the long road to emotional intelligence.

From learning to separate emotion from feedback to asking for clarification and recognizing when there’s truth in someone’s harsh words, this episode is a masterclass in professional and personal growth. The duo also explores how criticism ties into self-awareness, communication with partners, and even romantic relationships. Whether you’re a seasoned medic or a brand-new EMT, these tips will help you take feedback like a pro without letting it wreck your day.

"We do not want our medicine criticized. We do not want our work ethics criticized. We just do not want criticism.” — Chris Cebollero

"Experience comes from mistakes. Mistakes come from lack of experience." — Chris Cebollero

 “Back in the day, I didn't care. I used to say the same thing. People either love me or hate me; there's no in the middle. But you know what? I wasn't looking at the bigger picture.” — Kelly Grayson

Enjoying the show? Email the Inside EMS team at [email protected] to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

In this episode of the EMS One-Stop podcast, host Rob Lawrence kicks off a special series spotlighting national EMS associations, beginning with a deep dive into the EMS Personnel Licensure Interstate CompAct (REPLICA). His guest, Donnie Woodyard Jr., executive director, Interstate Commission for EMS Personnel Practice, brings decades of EMS experience and leadership to the table to demystify what the EMS Compact is, how it operates, and why it matters to the profession today. From improving workforce mobility to protecting public safety during disasters, Woodyard Jr. provides clarity on this critical multi-state agreement.

The conversation covers everything from how EMS Compact came to be, to the significance of national registry standards, disaster response logistics, interstate licensure, and even leadership lessons from Woodyard Jr.’s latest book project, “Leadership in action: The Wisdom and stories of EMS innovators”. Whether you're a field provider or policymaker, this episode is a must-listen for understanding how collaborative legislation can shape the future of EMS.

In the episode, Woodyard Jr. candidly addresses the ongoing debate in North Carolina over transitioning from a state-only EMS certification exam to exclusive use of the National Registry. Woodyard Jr., while respectful of North Carolina’s long-standing EMS tradition, emphasizes the importance of national consistency. He acknowledged that the proposed legislation needed amendments, particularly around grandfathering existing providers, but stood firm in his belief that a single, legally defensible national standard is essential for provider mobility and professional integrity. Drawing on real-world examples, Woodyard Jr. described how providers are often caught off guard when relocating — only to discover their credentials aren't accepted elsewhere. “Maintaining a state-only exam is harmful to individuals,” he said, calling for unified testing standards that support workforce movement and strengthens the profession nationwide.

Memorable quotes from Donnie Woodyard Jr

Timeline

00:21 – Rob introduces the series on national EMS associations and welcomes Donnie Woodyard, Jr.

01:55 – Woodyard, Jr.shares his EMS journey from volunteer in Virginia to international disaster medicine and state leadership

03:41 – What is the EMS Compact and how does it work?

06:38 – Challenges of multistate EMS licensing pre-Compact

08:00 – Explaining the driver’s license analogy and compact accountability

11:17 – EMAC vs. EMS Compact for disaster response and liability concerns

15:31 – National Registry and grandfathering provisions

17:30 – Arkansas joins as the 25th compact state

18:56 – Model legislation and how states join the compact

21:22 – What REPLICA stands for and its legislative origin

22:20 – What California (and other non-compact states) should consider

24:33 – National Registry debate: North Carolina’s challenges and Woodyard, Jr.’s response

27:52 – Mobility, workforce attrition and job-sharing innovation

30:11 – The Commission and national EMS-coordinated database

35:17 – Final thoughts on fragmentation, collaboration and EMS unity

36:41 – Woodyard, Jr.’s leadership book, EMS charity support and Secretary Panetta’s forward

41:08 – Closing remarks and contact information

Additional resources

In this episode of the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson dig deep into one of EMS's most overlooked (and often forgotten) topics — toxidromes. You might remember the word from paramedic class, but today’s street calls demand more than a vague memory. With patients taking everything from grandma’s Ativan to street-made speed, understanding toxidromes is crucial for making quick, accurate clinical calls.

The crew breaks down the five major toxidromes every medic should know: anticholinergic, cholinergic, opioid, sympathomimetic and sedative-hypnotic. From classic mnemonics like “mad as a hatter” to real-life stories of fire ant poisonings, this episode serves up practical knowledge with EMS-grade humor.

Chris and Kelly cover telltale signs (sweaty vs. dry skin, pinpoint vs. dilated pupils), treatment pearls of wisdom (easy on that naloxone, folks), and the real-world complications of polypharmacy. Plus, they touch on lesser-known players like serotonin syndrome and hallucinogens.

This one’s a refresher you didn’t know you needed — but you’ll be grateful when you respond to your next overdose call.

Memorable quotes

“Antidotes are overrated. Supportive care will take care of most of the toxidromes out there.” — Kelly Grayson

“If they’re pleasantly stuporous but breathing effectively, it’s not an overdose. It’s just a dose.” — Kelly Grayson

“Narcan is not a punishment, it's a treatment. You don't slam it, you bump it just a little bit, just enough to get them breathing again.” — Kelly Grayson

Enjoying the show? Email the Inside EMS team at [email protected] to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

In this special data-driven edition of the EMS One-Stop podcast, host Rob Lawrence is joined by Dr. Brent Myers, chief medical officer, ESO, and Dr. Remle Crowe, ESO’s director of clinical and operational research, to unpack the newly released 2025 ESO EMS Index.

This annual report provides a powerful, real-world snapshot of national EMS trends — drawing on more than 14 million anonymized records to surface opportunities for clinical and operational improvement.

The conversation dives into key metrics that move beyond response times and into areas like pain management, opioid overdoses, airway confirmation, obstetric emergencies, whole blood use, pediatric behavioral health and high-utilization patient populations.

Throughout the episode, Drs. Myers and Crowe share the motivation behind each metric, explain how the data was gathered and analyzed, and reflect on how EMS agencies can use these insights to guide better care delivery and system design. From confronting equity in pain management, to pushing forward innovations like buprenorphine administration and whole blood programs, this is a compelling call to turn data into meaningful change.

Timeline

01:08 – Overview of the ESO EMS Index and its intent

02:59 – Origins of the report and data methodology

05:46 – Database scale: 14M+ records, 3,000+ agencies

07:14 – Metric 1: Pain management for long bone fractures

10:53 – Documentation, AI in EMS, and future documentation tools

14:30 – Metric 2: Suspected opioid overdose and buprenorphine use

18:51 – Best practices, COWS scoring, and naloxone delivery strategy

21:31 – Metric 3: Invasive airway confirmation using waveform capnography

28:06 – Metric 4: Obstetric emergencies (postpartum hemorrhage & hypertension)

34:34 – Metric 5: Prehospital whole blood surveillance

40:22 – Metric 6: Pediatric behavioral health and substance use disorder cases

44:54 – Metric 7: High utilization patient group (HUG)

52:48 – Final thoughts, calls to action, and Rob’s reflections

55:47 – Episode wrap-up and subscription reminder

This week on the Inside EMS podcast, hosts Chris Cebollero and Kelly Grayson tackle a metabolic monster that every EMS provider needs to master: diabetic ketoacidosis (DKA). They kick off with a common (but critical) 911 scenario: a 19-year-old with a history of Type 1 diabetes, confusion, vomiting and a blood sugar of 500. Sound familiar?

Kelly dives into the physiology of DKA, explaining how glucose can be sky-high while cells starve, triggering fat breakdown and ketone production that spirals into life-threatening acidosis. The hosts hit the must-know pathophysiology, signs and symptoms (hello, Kussmaul breathing!), and what providers often miss — like dehydration, vomiting and abdominal pain.

They break down how to spot DKA with capnography and EKG changes, especially when hyperkalemia mimics a STEMI. From EMS management tips (don’t shut down those fast respirations!) to fluid resuscitation caveats, this is a crash course in saving DKA patients before they crash.

Whether you’re running calls or managing chronic patients, this episode arms you with the clinical know-how and common-sense insight to handle DKA with confidence.

 “We're starting to see more increasing calls for type one diabetes, insulin-dependent type two diabetes ... and we need to be able to understand what we're doing. — Chris Cebollero

“One of the big clues in the scenario is the vomiting. Lots of DKA patients will have vomiting and abdominal pain.” — Kelly Grayson

“A lot of times, these hyperkalemia patients and these acidotic patients are going to be handled just fine by correcting their fluid deficits and correcting their glucose with an insulin drip. Just getting their glucose back down to normal level is going to manage the lion's share of the hyperkalemia.” — Kelly Grayson

Enjoying the show? Email [email protected] to suggest episode ideas or to pitch someone as a guest!