EMS One-Stop

In this episode of EMS One-Stop, Rob Lawrence speaks with Wesley Brookshear, critical care paramedic and FTO program supervisor with AMR in Knoxville, Tennessee, about a community-led effort that is changing how EMS responds to the city’s Mission District. What began as an attempt to understand unusually high 911 utilization has evolved into a multidisciplinary outreach program bringing EMS, public health, addiction services, shelter providers, clinicians and other community organizations directly to Knoxville’s unhoused population. By concentrating on relationships, consistency and basic human needs, the initiative has produced a reported 32% reduction in traditional EMS call volume while dramatically expanding access to wound care, food, addiction treatment, mental health support, nurse navigation and other services.

Wesley explains why the program’s success is less about creating another specialized EMS unit and more about connecting people to the resources that already exist. The team initially arrived without uniforms, handed out fruit, listened and built trust before attempting to provide care. Two years later, the program has recorded thousands of encounters, helped more than 140 people enter treatment or sober living and generated remarkably few ambulance transports from its outreach activity. The conversation explores how other EMS systems can identify high-utilization areas, develop community partnerships, protect the mental health of outreach staff and start small—even with a single motivated employee.

Above all, Wesley argues that EMS has an opportunity to move beyond simply transporting patients and instead become the connector that gets people to the care and resources they actually need.

Additional resources:

Global Medical Response - AMR Mission District Medical Team Program Sees 32 Percent Decline in 911 Calls

eBook: How to fund community paramedicine

Very high EMS utilizers: 7 strategies for local action

From sirens to solutions: Guiding paramedics to a patient-centered mindset

Public health at the front door: An MIH model to emulate

“We did go down without our EMS uniforms on. We went in black t-shirts, blue jeans and started making connections.” — Wesley Brookshear

“We have noticed a 32% reduction in our normal call volume down at the mission since we started this program 2 years ago.” — Wesley Brookshear

“MIH, mobile integrated healthcare, isn't a title; it's actually a list. It's mobile, it's integrated and it's healthcare.” — Rob Lawrence

“This is not Wesley Brookshear, this is not AMR, this is an entire community of Knox County citizens that are coming together to support.” — Wesley Brookshear

“We talk about the homeless or the unhoused, and I do use both terms, but the unhoused, and we act like it's those individuals; it's never those individuals, those are humans within your community.” — Wesley Brookshear

“My mission wasn't admission avoidance, it was arrival avoidance.” — Rob Lawrence

“Our folks are wrapping their own wounds now. We are providing supplies. We are giving education.” — Wesley Brookshear

“Do not go down with the idea that you're going to cure this idea that homelessness is going to go away.” — Wesley Brookshear

00:49 – Rob introduces the episode and the concept of specialist teams focused on populations at risk

01:52 – Wesley introduces himself, AMR Knoxville and the multidisciplinary Mission District outreach team

03:25 – Identifying concentrated 911 utilization around the North Broadway area

04:22 – The headline result: a 32% reduction in normal call volume after 2 years

05:08 – Building services around Maslow’s hierarchy of needs: food, water, shelter and safety

06:10 – How the project began with surveys asking community members what they actually needed

06:50 – Wesley emphasizes that homelessness should be understood as a human and community issue

08:05 – Building partnerships and establishing a consistent Tuesday outreach presence

08:28 – Why the team initially attended in jeans and black t-shirts rather than EMS uniforms

10:10 – Rotating team members to manage emotional and mental-health pressures

11:27 – Training new outreach personnel and protecting the culture of the program

12:10 – The practical work: washing wounds, basic dressings and human contact

13:02 – Patients begin managing and dressing their own wounds with education and supplies

13:26 – Taking CPR and Stop the Bleed education directly into the Mission District

14:00 – Using GMR nurse navigation to expand access to alternative care and follow-up

16:09 – Nurse navigation, mental-health pathways and bypassing the emergency department when appropriate

18:28 – Discussion resumes: community paramedicine versus mobile integrated healthcare

19:23 – Rob defines MIH as “mobile, integrated and healthcare”

20:01 – Building relationships with partner organizations beyond the street-level outreach work

21:23 – Program numbers: approximately 4,800 encounters, 515-plus people served, 140-plus entering treatment or sober living, and only nine outreach encounters requiring ambulance transport

22:14 – A frostbite patient whose feet were saved through coordinated community intervention

24:23 – Wesley reflects on severe wounds, winter outreach and the impact of simple acts of care

25:18 – Where another EMS chief should start: find the hot spots and find someone who cares

26:39 – Starting small and expanding services gradually through community partnerships

27:08 – Why handing someone a resource list is not enough

27:36 – EMS as clinicians and navigators rather than simply a transport service

28:50 – Rob discusses “arrival avoidance” and directing patients into appropriate pathways of care

29:51 – The minimum viable program: one person who builds connections and physically links patients to resources

30:42 – Costs, donated supplies and the operational value of reducing unnecessary 911 demand

31:55 – The broader return: increased ambulance availability and potentially improved workforce engagement

33:14 – What not to do: don't approach outreach expecting to “solve homelessness”

33:43 – Managing compassion fatigue and rotating team members

34:58 – Food, coffee and small gestures as tools for relationship-building

35:26 – Challenging assumptions about who becomes unhoused

36:51 – Wesley's closing message: seek opportunities for EMS to grow and approach vulnerable populations with compassion

38:38 – Rob closes the episode with a challenge to EMS leaders: start something, even if it is small

Enjoying the show? Email [email protected] to share feedback. 

Finding grant funding can feel overwhelming, particularly for smaller EMS and fire agencies where one person often wears multiple hats.

In this episode of the EMS One-Stop podcast, host Rob Lawrence is joined by Lexipol Grant Writer and Colorado Firefighter-Paramedic Anya Otterson to demystify the grant-writing process.

From identifying funding priorities and locating grant opportunities, to building a compelling case backed by data, Anya provides a practical roadmap for agencies looking to secure funding for equipment, staffing and operational improvements. She explains why success starts with clearly defining organizational needs, understanding grant priorities, and assembling evidence that demonstrates both community impact and operational necessity.

The discussion explores the complete grant lifecycle, from preparing competitive applications, through to post-award reporting and compliance. Anya emphasizes that strong grant applications combine hard data with real patient stories, while Rob shares lessons learned from managing successful Assistance to Firefighters Grants (AFG) and transportation safety grants.

They also discuss how AI tools such as ChatGPT can accelerate research when used appropriately — but caution against relying on AI to write narratives outright. The episode concludes with encouragement for agencies to not be discouraged by unsuccessful applications, reminding listeners that grant writing is an iterative process where persistence and continual improvement often lead to success.

EMS1 GrantFinder: Our suite of solutions gives agencies direct access to seasoned grant professionals—backed by over 500 years of combined experience—along with a comprehensive tailored grant database

Assistance to Firefighters Grants: Meeting firefighting and emergency response needs

On-demand webinar: Grants Day — Your funding playbook. Get the insights, expert advice and tools to help your agency score big on grants

"The data and statistics are incredibly important when writing grants, but to try to set yourself apart, I do like to have a little bit more of a personal touch." — Anya Otterson

"Figure out what kinds of things you want funding for and prioritize it." — Anya Otterson

"You've got to be in it to win it." — Rob Lawrence

"Give yourself enough time. This is not a day-before kind of thing." — Anya Otterson

"Making sure that everybody's on the same page is critical because this is not something you can really do in a silo." — Anya Otterson

"Never be afraid to reach out to the funding agency with questions. Their job is to help you through the process." — Anya Otterson

"ChatGPT should not be writing your narratives for you." — Anya Otterson

"If you don't get funded the first time, keep trying." — Anya Otterson

"The juice is worth the squeeze." — Rob Lawrence

00:00 – Introduction and why so many EMS leaders struggle to know where to begin with grants

01:30 – Meet Firefighter-Paramedic and Lexipol Grant Writer Anya Otterson

03:00 – The first step: identifying and prioritizing organizational funding needs

04:00 – Where to find grants, including GrantFinder, ChatGPT, state resources and direct outreach

05:45 – Overview of FEMA's Assistance to Firefighters Grant (AFG) program

07:00 – Understanding funding priorities and why high-priority requests have the greatest chance of success

09:00 – Building a compelling grant narrative using statistics, research and patient stories

12:30 – Grant writing best practices: answer the questions, proofread thoroughly and involve leadership early

15:50 – Importance of organizational buy-in and internal communication

17:20 – Understanding grant requirements, matching funds and funding conditions before applying

18:40 – Post-award responsibilities, reporting requirements and maintaining compliance

20:40 – Rob shares practical lessons from administering successful federal grants

23:20 – Lexipol's GrantFinder platform and professional grant writing services

25:45 – Using ChatGPT responsibly to support grant research while avoiding AI-generated narratives

29:35 – Final advice: persistence, continual improvement and learning from unsuccessful applications

Enjoying the show? Email [email protected] to share feedback. 

Matt Zavadsky explains how a commercial insurer’s reimbursement proposal — and looming Medicaid changes — could reshape EMS funding

In this week’s episode of EMS One-Stop, we examine two major financial threats facing EMS reimbursement.

Host Rob Lawrence is joined by Matt Zavadsky to analyze the recent Elevance (Anthem) Health Public Policy Institute paper, which argues that commercial insurers should reimburse ambulance services at approximately 160% of the Medicare fee schedule.

Zavadsky, EMS/mobile healthcare consultant with PWW | Advisory Group, explains why this paper is significant, noting that Medicare already reimburses below the actual cost of providing ambulance services. If policymakers adopt or even believe Elevance's recommendations, commercial reimbursement could fall dramatically, removing one of the few revenue sources that currently offsets chronic underpayments from Medicare and Medicaid. The discussion highlights the growing influence of commercial insurers in state legislatures and stresses the need for EMS leaders to counter policy proposals with credible cost and operational data rather than anecdotal arguments.

The conversation then shifts to CMS's proposed Medicaid supplemental payment rule (GEMT), where Matt predicts that most of the proposed changes are likely to survive into the final rule despite industry opposition. Both hosts discuss their review of the public comments, noting differing impressions of stakeholder sentiment but agreeing that agencies should begin financial planning now for a potential reduction in supplemental Medicaid revenue beginning in 2029.

Throughout the episode, the recurring theme is that EMS must become far more effective at explaining both the cost of readiness and the consequences of underfunding. The episode concludes on a more positive note by highlighting the newly released What Paramedics Want in 2026 report as a practical roadmap for improving workforce satisfaction while the industry continues addressing long-term reimbursement challenges.

Additional resources

Key quotes

"The commercial insurance industry is creating a story that elected officials may perceive as reasonable. We need to combat that story with facts." — Matt Zavadsky

"Medicare reimbursement is already below cost, so using it as the benchmark automatically discounts ambulance services." — Matt Zavadsky

"We do a great job telling stories about the lives we save. We do a poor job telling the story of what it costs to provide that service." — Matt Zavadsky

"The balance billing issue is going to be the No. 1 issue in the next 12 months." — Matt Zavadsky

"The first time local elected officials hear there's a problem is usually when the sky is already falling. We need to tell the story before the sky falls." — Matt Zavadsky

"Know your costs; know your costs at different service levels, and begin educating your local community." — Matt Zavadsky

"This isn't necessarily good news, but it's something we need to understand and all work together to deal with." — Rob Lawrence

Episode timeline

02:00 – Matt explains who Elevance Health is and why the report should be viewed as a commercial insurer's policy position

03:30 – Discussion of state balance billing legislation and how commercial insurers are successfully pushing lower reimbursement benchmarks

06:15 – Breakdown of what percentages of Medicare actually mean using national EMS financial data

08:30 – Why using Medicare as the reimbursement benchmark is fundamentally flawed because Medicare itself pays below cost

10:30 – Discussion on the political influence of insurers and why EMS must counter with data-driven messaging

12:30 – Why EMS has historically struggled to tell its financial story despite being effective at telling patient care stories

14:20 – Matt predicts balance billing legislation will become the industry's No. 1 policy issue over the next year

16:10 – Potential consequences if commercial reimbursement falls to 160% of Medicare

17:30 – Discussion on community funding, essential service models and matching service expectations with available revenue

22:20 – Transition to CMS's proposed Medicaid supplemental payment (GEMT) rule

22:45 – Review of public comments submitted on the CMS proposal and differing observations about stakeholder support

25:00 – Matt predicts the CMS rule will largely move forward and agencies should prepare accordingly

27:45 – California and other states discussed as examples of systems likely to experience significant reductions in supplemental Medicaid funding

30:45 – Closing on a positive note with discussion of the What Paramedics Want workforce survey

The 2026 AIMHI Excellence in Public Information or Education Award recognizes organizations that create innovative programs which improve health, educate communities and demonstrate measurable outcomes. This year’s recipient, the Medic Keep the Beat Foundation, earned national recognition for a groundbreaking fall-prevention initiative that is helping older adults remain independent, reducing repeat 911 calls and preventing avoidable hospital admissions. The award celebrates programs that move EMS beyond emergency response into proactive, community-based healthcare.

In this episode of EMS One-Stop, Rob Lawrence sits down with Jimmy Pierson, president and COO of Medic Ambulance; and Angeline Pierson, occupational therapist with the Medic Keep the Beat Foundation, to explore the award-winning program in depth. The discussion covers everything from home safety assessments and occupational therapy interventions, to public-private partnerships, sustainable funding, EMS workforce innovation and why prevention may be one of the greatest opportunities facing EMS today.

“You’ve taken the frequency out of a faller.” — Rob Lawrence

“We don’t want healthier transports; we want a healthier community.” — Jimmy Pierson

“This isn’t a business model; it’s a community model.” — Jimmy Pierson

“With this program they can stay at home instead of moving into a skilled nursing facility.” — Angeline Pierson

“The key is finding partners who see you as a partner; not as a subcontractor.” — Jimmy Pierson

“The Australian paramedics became part of our family; they weren’t temporary staff.” — Jimmy Pierson

01:00 – Meet Jimmy and Angeline Pierson

02:00 – Inside the award-winning fall prevention program

06:45 – How patients enter the program

12:30 – Measuring outcomes and demonstrating return on investment

15:00 – Funding, grants and building community partnerships

17:00 – Public-private partnerships with California fire departments

22:00 – Sonoma County Fire and collaborative EMS delivery

28:00 – Workforce rebuilding after COVID-19

31:30 – Recruiting Australian paramedics and creating a sustainable workforce

34:30 – Final reflections on prevention, partnerships and the future of EMS

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 week on the EMS One-Stop podcast, Rob Lawrence sits down with emergency management and large-scale exercise expert Mike Marsh to explore what really goes into preparing agencies, communities and public safety partners for major events.

With the FIFA World Cup underway, America 250 upon us, and countless local events happening every weekend, the conversation focuses on the practical realities of planning, exercising and pressure-testing emergency response systems before the big day arrives.

| MORE: Training hard and fighting easy. Creating an effective tabletop training exercise for pre-planning MCI response

Drawing on decades of EMS leadership experience and his current work through Marsh EMS Consulting, Mike shares how agencies can move beyond "grant compliance exercises" and build meaningful operational readiness.

From tabletop exercises and ROC drills, to stakeholder coordination, communication failures and after-action reviews, Mike provides a masterclass in how to build resilient systems from the operator up.

His central premise is simple: exercises should be designed to break the system in a safe environment so weaknesses can be identified and corrected before a real incident occurs.

Whether you're preparing for a World Cup match, a county fair, or simply reviewing your MCI plans, this episode offers practical lessons for agencies of every size.

"Our team is hired to break your system and rebuild it together." — Mike Marsh

"The scene will be bigger than they are. And it is OK to ask for help." — Mike Marsh

"We don't walk in and say, 'You don't understand ICS.' Actually, you do understand ICS, you just don't know that you're using it." — Mike Marsh

"Identifying and learning are two different activities; and they have to be cemented in." — Rob Lawrence

"Trust your people, know that you can't do it all, get a team together, train them, drill them, pressure them." — Mike Marsh

"Prior preparation and planning prevents pathetic performance." — Rob Lawrence

| MORE: 5 lessons for special events standby services and emergency response

00:00 – Introduction and why major events require planning, exercises and preparation

02:25 – Mike's journey from California EMS leadership to emergency management consulting in Texas

04:53 – The biggest misconceptions about exercises and tabletop planning

06:30 – What frontline EMTs and supervisors need to know when the incident is bigger than they are

08:07 – The first questions Mike asks when planning a major event

10:13 – Communication, stakeholder engagement and identifying operational gaps

12:16 – Translating ICS and NIMS concepts into practical operational language

17:08 – Planning a county fair exercise: where to start and why capability gaps matter

19:46 – Who should be at the planning table and why executive participation matters

21:23 – The role of public works, politicians, emergency managers and public information officers

22:29 – The best and worst exercises Mike has ever experienced

25:29 – How to challenge leaders who believe their plans don't need testing

28:01 – Exercise planning for small and rural systems with limited resources

30:22 – After-action reviews and turning lessons identified into lessons learned

32:11 – Advice for agencies that have never exercised their plans before

33:54 – Mike's biggest leadership lesson from a career in EMS and emergency management

Enjoying the show? Email [email protected] to share ideas, suggestions and feedback.

The countdown to Pinnacle is on. Returning this year to San Diego from July 13-16, Pinnacle remains one of the most influential leadership and management conferences in EMS. Now entering its 22nd year, the event continues to attract executives, clinical leaders, innovators, educators and industry partners who gather not simply to learn, but to debate, challenge assumptions and shape the future direction of EMS. EMS1 is proud to be the premier media partner of Pinnacle.

| MORE: What Paramedics Want in 2026: Bookmark this page to get your copy

Joining EMS One-Stop this week is Anthony Minge, senior partner at Fitch & Associates and one of the driving forces behind Pinnacle. Anthony previews the major themes emerging this year, including workforce retention, leadership development, burnout and wellness, preparedness, artificial intelligence, blood delivery, drone technology and the ever-popular What Paramedics Want report.

Throughout the discussion, Anthony emphasizes that Pinnacle's value extends beyond the classroom. The real learning often happens in the conversations between sessions, over meals and among peers facing the same challenges across the country.

The conversation explores why retention has overtaken recruitment as EMS's primary workforce concern, how leaders must take greater responsibility for organizational culture, and why emerging technologies such as AI and drone-delivered medical supplies are changing the profession faster than many realize.

Anthony also offers a preview of keynote speakers, including preparedness expert and author William Forstchen, and highlights sessions covering leadership, resilience, operational excellence, workforce wellness and healthcare innovation.

As always, Pinnacle promises to deliver practical takeaways, provocative discussions, and the opportunity to connect with some of the brightest minds in EMS.

Key quotes

Additional resources

Episode timeline

03:00 – The major themes of Pinnacle 2026. Discussion of retention, leadership, financial sustainability, workforce wellness, preparedness, AI and emerging technologies.

06:30 – Recruitment vs. retention. Why keeping employees has become more important than finding new ones and how organizations can build careers rather than simply fill vacancies.

08:15 – Leadership beyond operations. The role of leadership in employee engagement, succession planning, data-driven decision-making and lessons from Matthew McConaughey's book Greenlights.

11:00 – Burnout, wellness and resilience. Why burnout remains a major challenge for EMS and how leaders must confront it rather than ignore it.

13:00 – Preparedness for the next crisis. A preview of keynote speaker William Forstchen and discussions around resilience, disaster readiness and planning for both natural and man-made events.

19:00 – AI Comes to EMS. Anthony discusses the opportunities and risks associated with artificial intelligence, from documentation and CAD integration, to clinical decision support.

24:00 – Blood, drones and clinical innovation. A look at how blood products, AEDs, naloxone and other critical supplies are increasingly being delivered through innovative technologies, including drones.

29:00 – What Paramedics Want in 2026. A preview of the latest survey findings and the issues currently weighing most heavily on the minds of EMS professionals.

30:00 – Why Pinnacle matters. Anthony explains why networking, relationship building and peer-to-peer learning remain among the conference's greatest strengths.

32:00 – The conversation EMS needs to have. Anthony identifies leadership responsibility and accountability as one of the most important — and often avoided — topics facing EMS today.

Enjoying the show? Email [email protected] to share feedback. 

At a time when EMS reimbursement faces unprecedented scrutiny and pressure, Shawn Baird joins the EMS One-Stop podcast to explain what is happening in Washington, D.C., why it matters to every ambulance service in America and what EMS leaders can do about it.

| MORE: When the spreadsheet meets the siren: How CMS’s Proposed GEMT Rule could reshape EMS funding

A former Paramedic, ambulance service owner, CEO, American Ambulance Association resident, and now Vice President of Government Affairs for the AAA, Baird brings a unique perspective that spans frontline care, operations and national advocacy.

In this episode, Rob Lawrence and Baird unpack the growing threats to Medicare and Medicaid funding, discuss the proposed changes to Medicaid supplemental payment programs, and explore the work of the National EMS Payment Reform Committee.

The conversation also previews the AAA Legislative Fly-In, and highlights efforts to secure EMS workforce funding, streamline military medic transitions into civilian EMS and advance federal fuel tax relief. Most importantly, Baird delivers a clear message: EMS professionals must tell their story, engage with elected officials and advocate for the future of mobile healthcare.

This episode serves as both an explainer and a call to action. As federal policymakers debate Medicaid funding, EMS reimbursement, workforce development and healthcare spending, Baird makes the case that every EMS professional has a role to play. Whether through legislative fly-ins, ride-alongs, town halls or simply telling the EMS story, advocacy is no longer optional. It is essential to preserving access to emergency medical care in communities across America.

Notable quotes

"We're hoping to make some proposals for real long-term reform on Medicare that will shore up the EMS system, not just to survive day to day, but really to thrive." — Shawn Baird

"We are more than just a ride. We are mobile healthcare." — Rob Lawrence

"We really have not been able to find a lot of data to support a bunch of waste, fraud and abuse in the EMS system. What there is, is a lot of misunderstanding." — Shawn Baird

"If we don't get paid ourselves, how can we pay other people? How can we then afford to deliver excellent healthcare to our patients?" — Rob Lawrence

"First of all, talk about the patient because the patient is the most important part of this whole discussion; second of all, talk about the medical care you provide because that's what the patient needs." — Shawn Baird

"We're the safety net. We're access to critical emergency care in many communities that don't have other healthcare." — Shawn Baird

"Probably the most important thing that folks listening to your show can do is attend a town hall and raise your hand and say, 'I'm just worried about our ambulance service.'" — Shawn Baird

"We have the greatest story of all to tell." — Shawn Baird

Additional resources

Episode timeline

01:00 – Rob introduces the episode and outlines the challenges facing EMS reimbursement and federal healthcare funding.

02:07 – Shawn Baird's EMS Journey — from paramedic intern at Grady Hospital to rural EMS operator, company owner, AAA president and government affairs leader.

03:00 – Why healthcare reimbursement decisions are increasingly shifting from Washington to state legislatures.

06:45 – The National EMS Payment Reform Committee and the search for long-term solutions to EMS financing.

09:13 – Medicaid, waste, fraud and abuse — understanding misconceptions about EMS reimbursement and why ambulance services are being caught in broader healthcare debates.

11:33 – EMS is more than transportation — reframing EMS as healthcare first, transportation second.

13:20 – The threat to Medicaid supplemental funding — provider taxes, GEMT programs and proposed federal changes that could impact ambulance services nationwide.

15:15 – Proposed CMS rule changes — why EMS leaders are concerned about being included in Medicaid funding reductions.

17:40 - How national EMS organizations are coordinating efforts to speak with one voice.

20:08 – The AAA Legislative Fly-In — what it is, how it works and why provider participation matters.

21:45 – Federal legislative priorities — EMS workforce development funding, military medic-to-civilian certification pathways and federal fuel tax relief for ambulance services.

26:50 – How EMS providers can engage when legislation is moving.

27:40 – The importance of local advocacy — town halls, community events and direct engagement with elected officials.

29:30 – Ride-alongs as an advocacy tool — why seeing EMS firsthand changes policymakers' perspectives.

32:00 – Final thoughts — politics is ultimately about relationships, storytelling and helping decision-makers understand EMS.

Enjoying the show? Email [email protected] to share feedback.

What happens when the stars of the television series that introduced America to paramedicine decide it's time to tell the real story?

In this episode of EMS One-Stop, Rob Lawrence is joined by EMS pioneer Dr. Baxter Larmon and award-winning filmmaker Tom Putnam to discuss Into the Unknown: The Paramedics' Journey.

| MORE: ‘Emergency!’ stars launch Kickstarter campaign to expand reach of paramedic documentary, “Into the Unknown,” backed by Steve Buscemi, Randolph Mantooth and Kevin Tighe

Born from the vision of Emergency! stars Randolph Mantooth and Kevin Tighe, and backed by Steve Buscemi, the documentary follows paramedics, dispatchers, volunteers, flight crews and their families across America, revealing the realities of modern EMS. From Baton Rouge to Sparks, from volunteer rescue squads in Virginia, to helicopter rescue teams in California, the film explores not only what paramedics do, but what the job does to them.

The conversation examines workforce shortages, mental health, resilience, public misunderstanding of EMS, and the role the film could play in educating communities, policymakers and future generations.

The episode also explores the documentary's Kickstarter campaign and plans for worldwide release. If Emergency! introduced America to paramedics 50 years ago, Into the Unknown seeks to explain the people behind the uniform.

"One of the things that I'm probably most proud about in the movie is that these first responders are now allowing their family members and their friends to be able to see what they go through every single day." — Dr. Baxter Larmon

"The call volume, I mean, they used to sit in the station, they'd joke in the station, they'd eat, they'd have dinner, they'd complete their whole dinner and they would never get a call. That just doesn't happen anymore." — Dr. Baxter Larmon

"Our fourth goal is to get recognition by governmental agencies to understand what EMS is, to be able to recognize its importance in the community, but more importantly, to fund it appropriately as well." — Dr. Baxter Larmon

"I honestly had no idea what I was getting into with this and how intense the personal interactions were gonna be." — Tom Putnam

"By the time that particular run was over, I just think I was wide-eyed and said, wow, we're making a war movie." — Tom Putnam

"For the right person, this is the best job in the world." — Tom Putnam

00:00 – Trailer and opening montage

01:41 – Rob introduces the episode and guests

03:18 – The origin story of Into the Unknown

05:13 – The lasting impact of Emergency! on EMS and what story the documentary is trying to tell

08:32 – Tom explains why he said “yes” immediately

10:52 – The first EMS call filmed and realizing the scale of the project

12:15 – Locations featured in the documentary

16:22 – How EMS has changed since Johnny Gage and Roy DeSoto

17:54 – Stories that surprised Tom most

20:15 – The emotional burden of the profession

22:40 – Calls Tom "can't unsee"

24:00 – EMS as the safety net for society

25:07 – Burnout, resilience and humanity

27:30 – Why families need to see this film

28:06 – Why the project launched a Kickstarter campaign, funding goals and distribution plans

33:30 – Using the film as an EMS advocacy tool

35:43 – Lightning round

38:03 – Why EMS might be the best job in the world

39:05 – Dr. Richard Carmona's role in the film

40:16 – Final thoughts and call to action

Enjoying the show? Email [email protected] to share feedback. 

In Episode 4 of the EMS One-Stop Blood on Board Series, host Rob Lawrence brings together two powerful perspectives on prehospital blood transfusion.

First, retired Army trauma nurse and national blood advocate Randi Schaefer discusses the work of the Prehospital Blood Transfusion Initiative Coalition and the ongoing effort to remove barriers to blood product availability across the United States.

Drawing on lessons learned from military deployments and civilian implementation efforts, Schaefer explains why successful blood programs require collaboration among EMS agencies, hospitals, blood banks, legislators and funding partners. She emphasizes that while every system is different, the goal remains the same: getting lifesaving blood to patients before they reach the hospital.

The second half of the episode focuses on the story behind the statistics. Dr. Kate Krause, an emergency physician from Dallas, recounts her near-fatal postpartum hemorrhage just weeks after giving birth to her daughter. After she lost more than two liters of blood at home, Dallas Fire-Rescue paramedics recognized the severity of her condition and secured authorization to administer prehospital blood. That decision, combined with rapid transport and seamless hospital coordination, helped save her life.

Today, fully recovered and back to practicing medicine, Dr. Krause has become a compelling advocate for prehospital blood programs, reminding policymakers and EMS leaders that behind every protocol, funding request and unit of blood is a patient whose future depends on receiving the right treatment at the right time.

Previous Blood on Board episodes:

Impactful quotes

"I had a severe postpartum hemorrhage and had my life saved by a prehospital blood transfusion." — Dr. Kate Krause

"I'm here. I have no deficits. I'm healthy. I'm back to being a physician. I'm back to being a wife and being a mother to my beautiful little baby girl." — Dr. Kate Krause

"The coalition wants to make blood products available to those EMS agencies that want to carry them."  — Randi Schaefer

"This is a brand-new relationship. So there's a lot of learning how each other's worlds work." — Randi Schaefer

"We were not going to let people die of preventable death." — Randi Schaefer

"Keep pressing forward. We will find a way to yes." — Randi Schaefer

"Blood is one of those things that really makes a difference when it's given early." — Dr. Kate Krause

Additional resources

Episode timeline

00:00 – Introduction to Episode 4 and recap of the Blood on Board series and overview of previous episodes covering local, state and national blood initiatives.

02:18 – Introduction of Randi Schaefer and Dr. Kate Krause. Schaefer discusses military deployments and early blood program experiences, while Dr. Krause outlines her journey from lifeguard, to EMT, to emergency physician.

05:05 – Origins and mission of the Prehospital Blood Transfusion Initiative Coalition, military lessons learned, funding challenges, sustainability concerns, the importance of legislative support and reimbursement

13:57 – Dr. Krause recounts her postpartum hemorrhage.

19:03 – Discussion of non-trauma indications for prehospital blood and the importance of medic judgment and protocol flexibility

20:22 – Dr. Krause discusses recovery and advocacy efforts, and Dallas City Council appearance and public awareness activities.

24:24 – Dr. Krause delivers a concise advocacy message supporting blood programs nationwide.

25:01 – Schaefer reflects on meeting blood recipients and the impact of seeing survivorship firsthand.

27:47 – Closing remarks from Dr. Krause and Schaefer

29:03 – Lawrence wraps up the four-part Blood on Board series and reinforces the need for continued advocacy and funding.

This episode is sponsored by Triad of Life. After traumatic injury, patients may enter the “Triad of Death” — a dangerous cycle of hypothermia, acidosis, and coagulopathy that can rapidly lead to fatal outcomes without timely intervention. That’s why Delta Development Team partners with Qinflow and Lifeflow to combat these life-threatening conditions with the Triad of Life. Learn how your team can put the Triad of Life into practice.

Enjoying the show? Email [email protected] to share feedback. 

Texas is taking prehospital whole blood to scale. In this second installment of the Blood on Board series, the conversation moves from pioneering local programs to a statewide initiative backed by legislation, trauma system collaboration and a $10 million investment in EMS blood capability.

Host Rob Lawrence welcomes Dr. Jeff Jarvis, chief medical officer and system medical director, Fort Worth Office of the Medical Director; Dr. C.J. Winckler, deputy medical director for the San Antonio Fire Department; and Jorie Klein, director of EMS-Trauma Systems Section, Texas Department of State Health Services.

From San Antonio’s early adoption to Fort Worth’s operational maturity and the Texas Department of State Health Services’ statewide rollout, this episode examines how Texas built one of the most ambitious prehospital blood programs in the country.

The discussion goes beyond clinical theory. The guests tackle implementation, logistics, blood stewardship, wastage concerns, rural access, legislative strategy and the realities of getting physicians, transfusion medicine specialists, EMS leaders and lawmakers aligned around a shared mission.

The episode also explores the expanding use of whole blood beyond trauma, including GI bleeds, obstetrics and surgical hemorrhage, while reinforcing the operational mantra repeated throughout the show: systems save lives.

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“You can’t quarterback it from your office. You have to be engaged and be out there with them.” — Jorie Klein

“Little did I know that it would take almost every waking minute of my life to get blood on an ambulance.” — Dr. C.J. Winckler

“We’re not improving overall mortality yet, but we are improving mortality in the first six hours.” — Dr. C.J. Winckler

“When you work together as a system, you can do amazing things.” — Dr. Jeff Jarvis

“In the last 13 months, we’ve given 259 units to 211 patients.” — Dr. Jeff Jarvis

“Our definition of wastage is anything that doesn’t go into a patient.” — Dr. Jeff Jarvisv

“It turns out this stuff works.” — Dr. Jeff Jarvis

“It’s all about communication and trust.” — Dr. C.J. Winckler

“Five years ago, we knew those patients would not survive. Now we have new tools.” — Jorie Klein

“My dad was saved by prehospital whole blood.” — Dr. C.J. Winckler

“Talk to the clinicians who are giving this blood and ask them about the impact it’s making.” — Dr. Jeff Jarvis

00:00 – Opening message. Jorie Klein outlines the central lesson for other states: engage frontline providers and avoid managing programs remotely.

00:40 – Introduction. Rob Lawrence introduces Episode 2 of the Blood on Board series, shifting focus from local systems to statewide implementation in Texas.

01:20 – Meet the guests. Jorie Klein, Dr. Jeff Jarvis and Dr. C.J. Winckler introduce themselves and their roles in Texas EMS and trauma care.

03:22 – The San Antonio origin story Dr. Winckler explains how military medicine, trauma surgeons and Texas delegated medical practice helped launch San Antonio’s whole blood program.

06:04 – Building the first protocols. Dr. Winckler discusses creating guidelines from scratch, operationalizing blood administration and securing funding support from city leadership.

08:52 – Going system-wide. San Antonio launches whole blood citywide in October 2018 without a pilot project.

10:13 – Ethics and evidence. Discussion shifts to mortality data, prehospital physiology and whether balanced blood resuscitation should already be considered standard of care.

12:14 – Fort Worth follows. Dr. Jarvis explains how San Antonio’s system inspired adoption in Fort Worth and highlights the importance of regional collaboration.

14:03 – Texas goes statewide. Klein explains the legislative process that resulted in a $10 million statewide prehospital whole blood initiative.

17:24 – Rural Texas and blood access. The conversation focuses on plasma options, rural hospital shortages and improving access for remote communities.

23:45 – The data discussion. Dr. Jarvis shares Fort Worth operational metrics, transfusion volumes and remarkably low wastage rates.

28:49 – Whole Blood Academy. Drs. Jarvis and Winckler discuss the National Whole Blood Academy and how Texas is teaching other EMS systems to replicate their success.

32:00 – Trust, logistics and blood stewardship. Dr. Winckler explains the importance of relationships between EMS and transfusion medicine physicians, emphasizing operational discipline and trust.

36:20 – What comes next? Dr. Klein discusses statewide reporting, future funding requests and sustaining the Texas model long term.

40:15 – Final lessons for other states. The guests close with advice on advocacy, clinician engagement and building support from the ground up.

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