Inside EMS

‘You hope it never happens’: Responding to an MCI on Bourbon Street

New Year’s celebrations in New Orleans are always a spectacle, but this year, tragedy struck at 3:15 a.m. A truck barreled into the crowds, triggering what first responders feared was a vehicle-ramming attack. Within moments, New Orleans EMS was in full mass casualty mode — triaging, treating and coordinating with law enforcement amid the unfolding chaos. But things quickly escalated. As Chief Bill Salmeron recounts, responders soon discovered not only multiple critical patients, but also a shootout, a downed suspect and the chilling realization that explosive devices had been planted nearby. 

In this gripping episode, Chief Salmeron shares the inside story of how his team handled one of the most intense incidents in recent New Orleans history. He walks through the initial response, communication challenges and how well-drilled interagency coordination played a pivotal role. But beyond the logistics, he also speaks to the emotional toll — how EMS crews handled the psychological weight of triaging patients, working alongside grieving families and processing the magnitude of the event in the days after. 

Top quotes

“You don’t see that many fatalities in one place with possible explosives, an active shooter — or at least you shouldn’t in a civilian EMS world — but we do.” — Chief Bill Salmeron

"Anybody can command a scene. You don't have to be a paramedic. You don't have to be a chief or a doctor or whatever it is." — Chief Bill Salmeron

Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

Why every EMS agency needs a mental health game plan

In this episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson are joined by Nick Maltby, chief of service for New Hartford Volunteer Ambulance Service, and a clinical psychologist specializing in anxiety and PTSD. Nick brings a unique perspective, blending frontline EMS experience with mental health expertise to tackle one of the biggest issues in EMS today — mental health support that actually works.

Memorable quotes

• “Depression is a voice that whispers to you that you can't do all the things that bring you joy.” — Kelly Grayson

• “The first step to a problem getting worse is thinking, ‘I can't tell anybody, because if I did, they would ostracize me, they would fire me, they wouldn't be my friend,’ but it’s all in your head.” — Nick Maltby

Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

News flash: Don’t treat patients with an expired certification

In this week’s episode of the Inside EMS Podcast, hosts Chris Cebollero and Kelly Grayson discuss some of the biggest news stories in EMS from the month.

First up: A fire chief in Colorado is under investigation for running nearly 300 medical calls on an expired paramedic certification from 2019. What happens when leadership sets a bad example for their crews?

The pair also discuss several mental health initiatives, including the University of Washington’s new first responder training program and the mental health teams supporting evacuees of California’s wildfires.

Plus, Chris reacts to an idea floated by the new White House administration to reduce FEMA’s role, and Kelly gives his take on why the agency – despite its flaws – is a necessity.

Have an EMS-related news story you want Chris and Kelly to analyze? Send an email to theshow@ems1.com.

Memorable quotes

•  “If you don't want to pay for it, then, then don't gripe about poor response times ... or inadequate care, because you wouldn't pay for it.” — Kelly Grayson

• “ You know, during COVID, we were heroes.  And we squandered that goodwill and let ourselves be pushed onto the back burner until something horrific happens to California. And then firefighting leaps into the breach again. Then, those citizens are incredibly grateful, but when this is all over, they'll fade back into obscurity again.” — Kelly Grayson

This episode of the Inside EMS Podcast is sponsored by Philips. Time to take pre-hospital emergency care to the next level. Time for Tempus.

Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest. 

Male-centric medicine: Why women’s health is EMS’s next big challenge

In this episode of Inside EMS, Chris and Kelly are joined by Tim Redding, founder and CEO of Emergency Education Consultants, to explore a topic that’s reshaping how we think about medicine: male-centric healthcare. Tim shares insights from Dr. Alyson J. McGregor’s groundbreaking book, “Sex Matters”, which explores how medical research and education have historically centered on white male patients, leaving women underserved and misdiagnosed.

From cardiac care to drug research, Tim explains how biases have permeated everything from symptom recognition to treatment protocols. Did you know that women experiencing heart attacks rarely exhibit the “classic” symptoms, like chest pain? Or that 8 out of 10 drugs pulled from the market between 1997 and 2001 were due to severe side effects in women?

If you’re someone passionate about improving patient outcomes, this episode will make you rethink what you know – and don’t know – about women’s health in EMS.

Memorable quotes

“Medicine historically has been white males doing the doctoring, writing the textbooks and doing the studies. So, what that has led to, by no one’s fault, is to this very male-centric view of medicine.”

“The most accurate tool for confirming and diagnosing MI in women is an MRI and that really blew my mind.  I can’t think of any time that I’ve heard a doc say, ‘Let’s get an MRI for that cardiac female patient.’”

Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

The science behind shock: Why providers must understand the RAAS

Ever wonder what really happens inside the body during shock? This week, Chris Cebollero and Kelly Grayson dive into the renin angiotensin aldosterone system (RAAS).  From vasoconstriction to fluid retention, they break down this complex topic with real-life examples, a sprinkle of humor and practical tips for how EMS providers can apply this knowledge in the field.

Kelly shares the importance of understanding the “why” behind shock presentations, from recognizing when fluids won’t work to knowing when vasopressors are the answer. With anecdotes like treating a sepsis patient on ACE inhibitors and using pulse ox waveforms for clues, this episode blends science with field-tested wisdom. Whether you’re an EMT, paramedic, or just an anatomy nerd, you’ll walk away with a clearer picture of how the RAAS keeps us alive – and how we, as EMS professionals, can work smarter alongside it.

Memorable quotes

• “It's called, ‘The Renan Angiotensin Aldosterone System – not just a planetary belt in Star Wars’”. — Kelly Grayson

• “So, the kidneys now say, ‘We're not getting enough blood. Here's this renin that we're gonna send out because we've gotta fix this problem.’ What the body doesn't know is that Chris Cebollero and Kelly Grayson and you are out there trying to fix it. So it’s trying to fix itself.” — Chris Cebollero

Related resources:

• Understanding push dose pressors

• Understanding prehospital vasopressors: Dopamine, epinephrine or norepinephrine?

• A basic overview of shock for EMS

• Compensated vs. decompensated shock: what you need to know

ABOUT THE SPONSOR

Whether replacing radio reports, alerting specialty teams, or managing mass casualty incidents, Pulsara simplifies communication. Pulsara scales to meet your dynamic communication needs. From routine patient alerts to managing large-scale emergencies, every responder and clinician connects seamlessly. Familiar yet powerful, Pulsara streamlines your response, from routine transfers to regional disasters. One tool. Every day. Regardless of event. Discover more at Pulsara.com.

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Catch a new episode of the Inside EMS podcast every Friday. Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

‘Be curious, not judgmental’: What Ted Lasso can teach EMS

In this episode of Inside EMS, hosts Chris Cebollero and Kelly Grayson explore leadership insights drawn from a recent post by The Humbled Medic blog, which highlights lessons from the hit Apple TV show “Ted Lasso.” Known for its humor and heart, the show serves as a surprising but fitting blueprint for leadership, especially for EMS educators and professionals. 

The hosts discuss the importance of embracing the philosophy “be curious, not judgmental,” a guiding principle that urges EMS providers to set aside assumptions about patients and colleagues. Other takeaways include the value of challenging oneself to grow, the significance of second chances, and the power of building a trusted support system.  

From embracing discomfort, to cultivating belief in others and finding small ways to show kindness, the episode encourages EMS professionals to lead with both heart and purpose. 

ABOUT THE SPONSOR 
Whether replacing radio reports, alerting specialty teams, or managing mass casualty incidents, Pulsara simplifies communication. Pulsara scales to meet your dynamic communication needs. From routine patient alerts to managing large-scale emergencies, every responder and clinician connects seamlessly. Familiar yet powerful, Pulsara streamlines your response, from routine transfers to regional disasters. One tool. Every day. Regardless of event. Discover more at Pulsara.com. 

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Enjoying the show? Email theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest. 

When the unthinkable happens: 2024’s most unbelievable EMS calls

This year, EMS brought more than its fair share of jaw-dropping moments, and as we wrap up 2024, we’re revisiting five of the craziest stories that made headlines. From a massive chemical plant fire in Texas prompting a shelter-in-place order, to a sand hole tragedy on a Florida beach, these events highlight the unpredictability of EMS work.

Ever had a crash victim ejected so far from their vehicle, they landed on a roof? That’s exactly what happened in Michigan. Or a tractor-trailer cab dangling precariously off a bridge? Louisville firefighters made a daring rescue of a semi-driver in just such a predicament. And let’s not forget the aquarium at a Texas hospital that literally cushioned the blow of a car crashing into the ER. Turns out, those tropical fish weren’t just for decoration after all.

These stories remind us that no call is ever routine, and the unpredictable nature of EMS keeps us on our toes. It’s also a good reminder to revisit training and be ready for the “what-ifs,” from trench rescues to chemical response protocols.

Quotables

• “In public safety, everybody’s an expert about someone else’s call.”
• “If you work a wreck after midnight and don’t find a drunk, keep looking — someone is missing.”
• “The body can take a crazy amount of trauma and still survive.”
• “All I can think is some hospital administrator somewhere is saying, ‘See? That aquarium was worth it.’”
• “Dark humor isn’t always the best coping mechanism, but it’s how we survive the job.”

Top 5 craziest EMS calls of 2024

• Aquarium likely saved lives when car crashed into Texas ED
• 2 dead, dozens injured in hazmat leak at Texas refinery
• 911 calls from fatal Fla. sand hole collapse released
• Ejected in fiery crash, Mich. driver lands on roof of house
• Dash cam video shows Ky. truck left hanging off bridge after crash

Enjoying the show? Email the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

ABOUT THE SPONSOR
Whether replacing radio reports, alerting specialty teams, or managing mass casualty incidents, Pulsara simplifies communication. Pulsara scales to meet your dynamic communication needs. From routine patient alerts to managing large-scale emergencies, every responder and clinician connects seamlessly. Familiar yet powerful, Pulsara streamlines your response, from routine transfers to regional disasters. One tool. Every day. Regardless of event. Discover more at Pulsara.com.

Pay to stay: Why EMS providers are voting with their feet

EMS pay and retention – or the lack thereof – is at the heart of this week’s episode of Inside EMS. Hosts Chris Cebollero and Kelly Grayson tackle a news item out of Dougherty County, Georgia, where a recent exodus of EMS professionals spurred long-overdue pay raises and bonuses.

The discussion then shifts to Pickens County, Alabama, where a lack of funding led to a total EMS shutdown. Chris and Kelly explore how underfunded systems collapse under the weight of low reimbursement rates, poor public understanding of EMS costs, and systemic inaction until tragedy strikes.

Through real-world examples, the hosts unpack why it’s essential to “vote with your feet” as an EMS professional and how agencies can keep talent by either paying well or fostering loyalty – though they can’t afford to fail at both. If you’ve ever wondered why EMS seems stuck in a financial rut, this episode offers insights that hit close to home.

ABOUT THE SPONSOR

Whether replacing radio reports, alerting specialty teams, or managing mass casualty incidents, Pulsara simplifies communication. Pulsara scales to meet your dynamic communication needs. From routine patient alerts to managing large-scale emergencies, every responder and clinician connects seamlessly. Familiar yet powerful, Pulsara streamlines your response, from routine transfers to regional disasters. One tool. Every day. Regardless of event. Discover more at Pulsara.com.

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Enjoying the show? Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.

Accountability in action: Building a culture that sticks in EMS

In this week’s episode of the Inside EMS podcast, cohosts Chris Cebollero and Kelly Grayson dive into a vital topic: the culture of accountability in EMS. Sparked by FireRescue1’s Chief Marc Bashoor’s thought-provoking article, "Where is our culture of accountability?", the hosts explore why change is so difficult to embrace, how leadership impacts culture and what steps agencies can take to help foster accountability across an organization. From managing expectations to addressing fairness in discipline, our cohosts discuss the challenges of enforcing standards and avoiding the normalization of deviance. Whether it's implementing safety protocols or shifting organizational norms, this episode unpacks how leaders and teams can work together to inspire meaningful change.

Quotable takeaways

• “The only one who likes change is a wet baby.” — Kelly Grayson
• “If you don’t correct something, that thing becomes the new standard.” — Kelly Grayson
• “Vision is where we’re going; strategy is how we’re going to get there and culture is the behavior of the organization in reaching the vision.” — Chris Cebollero
• “Turnover isn’t the end of the world.” — Kelly Grayson

Read the rest of this entry »

Making every data point count: Strengthening EMS operations through technology

EMS agencies are facing mounting challenges, from staffing shortages and rising operational costs to increasingly complex compliance requirements. However, advanced data systems and integrated technology offer solutions to these persistent issues.

 

In this episode of Inside EMS, Clinical and Business Consultants Jason Bartholomai and Chuck Sweeney of ZOLL Data Systems discuss how robust EPCR systems and streamlined workflows can reduce inefficiencies, improve patient care and ease the burden on EMS teams.

 

Here are top takeaways leaders can learn from this episode about overcoming today’s EMS challenges.

1. Staffing shortages: Doing more with less

Use technology to reduce workload inefficiencies and support field personnel.

 

Staffing shortages are a top concern for EMS leaders nationwide. Long shifts, redundant documentation and poor integration between field and dispatch operations exacerbate the stress on paramedics. EPCR systems can alleviate some of these pressures by:

• Streamlining documentation with intuitive workflows that reduce time spent on reports

• Improving coordination between field crews, dispatchers and billing teams through integrated software solutions

• Enhancing employee satisfaction by minimizing administrative burdens and allowing more focus on patient care and recovery time

By implementing systems that improve efficiency, EMS agencies can help retain personnel and maximize the output of limited resources.

2. Compliance made simpler: Staying ahead of standards

Holistic software ecosystems can simplify compliance and improve data accuracy.

 

Compliance with NEMSIS standards and other reporting requirements is growing increasingly complex. Leaders must ensure that their systems capture accurate data to meet clinical, operational and legal standards to:

• Prevent incomplete reports from moving forward

• Highlight missing critical fields, such as patient signatures or demographic data, which can stall reimbursement

• Provide real-time feedback for quality improvement (QA/QI)

Integrating compliance directly into workflows ensures fewer errors and smoother billing cycles, saving agencies time and resources.

3. Faster reimbursement through smarter workflows

Improving cash flow starts with high-quality data entry at the source.

 

EMS leaders often overlook how documentation practices impact financial performance. Efficient EPCR systems improve clean claim rates by:

• Guiding paramedics to include all required information during documentation

• Automating processes like importing EKG results and demographic data

• Flagging incomplete or incorrect entries before claims are submitted

By speeding up documentation and addressing gaps early, EMS agencies can ensure faster reimbursements and predictable cash flow.

4. Breaking down silos: Building an integrated ecosystem

Aligning workflows across departments enhances efficiency and collaboration.

 

EMS operations are not limited to field crews. Dispatchers, billers and managers play critical roles in delivering care and sustaining operations. Integrated systems ensure that:

• Dispatchers, paramedics and billers share a unified platform, fostering communication and reducing friction

• Teams are trained holistically to understand each other’s roles and responsibilities

• Operational, clinical and financial data flow seamlessly across departments

Such alignment reduces redundancies, boosts productivity and allows agencies to operate more effectively under tight constraints.

5. Preparing for legal challenges with better documentation

Accurate, detailed reports protect EMS providers in legal scenarios.

 

In EMS, thorough documentation is not just a requirement – it’s a safeguard against legal liability. EPCR systems help paramedics document essential details clearly and accurately, reducing the risk of errors that could be exploited in court. Training crews to use these tools effectively ensures that charts provide a source of truth in any legal or compliance review.

Final thoughts

Jason Bartholomew summed it up best: “Doing something is better than doing nothing.” EMS agencies should start small, focusing on one area for improvement, such as data validation or staff training, before expanding into comprehensive ecosystem integration. Chuck Sweeney emphasized the importance of buy-in from all levels, noting that shared understanding and collaboration across departments are critical to long-term success.

 

By adopting robust technology and fostering teamwork, EMS leaders can tackle the headaches of staffing shortages, compliance demands, and financial uncertainty – all while improving the quality of patient care.

 

EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.

About the sponsor

ZOLL Data Systems’ cloud-based solution suite of EMS and Fire solutions covers the scope of your operations, from dispatch to patient care, to incident and operational reporting, to billing. Learn how ZOLL software can help improve clinical, operational and financial performance of your organization at zolldata.com.

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Catch a new episode of the Inside EMS podcast every Friday on Apple Podcasts, SoundCloud, Amazon Music, Stitcher, Spotify, and RSS feed.

 

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the Inside EMS team at theshow@ems1.com to share ideas, suggestions and feedback, or let us know if you’d like to join us as a guest.