EMS One-Stop

EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving

Whole blood in the field is no longer theoretical; it is operational, measurable and increasingly expected. In this EMS One-Stop episode, host Rob Lawrence brings together two of California’s leading medical directors — Drs. Clayton Kazan and Kevin Mackey — to compare and contrast their prehospital blood programs.

From concept to deployment, both systems demonstrate how data, relationships and persistence can translate innovation into lives saved.

This discussion goes beyond theory. It addresses real-world barriers — regulation, blood bank skepticism, funding gaps — and pairs them with practical solutions.

The result is a clear message: EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving. For agencies considering similar programs, this episode provides a roadmap grounded in experience, outcomes and operational reality.

Notable quotes

“When there's someone who wants to see your program, talk about your program.” — Kevin Mackey

“I kind of never believed it really possible to put it on a paramedic truck until I saw what the military was able to do.” — Clayton Kazan

“If the five minutes matter, why wouldn’t we want to do it 5, 10, 15, 20 minutes sooner?” — Clayton Kazan

“Never say ‘no,’ never say ‘die.’” — Kevin Mackey

“They’re never tired of trying to find new ways to save people’s lives.” — Clayton Kazan

Episode timeline
00:00 – Opening message. “Never say ‘no,’ never say ‘die’” sets the tone for program development and persistence

01:00 – Series introduction. Rob frames the episode as part of a broader national discussion on blood in EMS

02:00 – Guest introductions. Dr. Kazan and Dr. Mackey outline their EMS and medical backgrounds

03:20 – Program overviews. LA County: April 2025 launch, 11 squads, 58 transfusions; Sacramento: December 2025 launch after 15-month build

05:20 – Origins and catalysts. Influence from San Antonio and New Orleans programs; leadership support as a trigger

07:00 – Military influence. Translation of battlefield success into civilian EMS feasibility

08:50 – Building the business case. Data-driven forecasting using ePCR systems

11:00 – Overcoming resistance. Regulatory hurdles, skepticism and blood bank concerns

15:00 – Survivor stories. Real-world saves that validate the programs and influence policymakers

18:00 – Funding realities. Grant-based models, no current reimbursement, cost-benefit framed in life-years saved

21:45 – Equipment and logistics. Cold chain, monitoring systems, delivery devices and operational considerations

24:40 – Training and deployment. Targeted rollout using heat maps and trauma incidence data

27:45 – Early challenges. Blood recirculation, cold chain validation and system integration issues

31:50 – QA/QI and research. 100% case review and participation in multi-county data collaboratives

34:10 – Patient populations. Primarily trauma, with emerging medical indications

36:00 – Sustainability and scaling. Political engagement and expansion planning

38:15 – Rapid fire lessons learned. Transparency, persistence, relationships

42:50 – Myths and realities. Frontline providers embrace innovation; capability concerns disproven

44:00 – Final takeaways. Appreciation, relationships and system-wide collaboration as keys to success

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In this special EMS One-Stop update, Rob Lawrence is joined by returning guest Dr. Alex Isakov to break down the rapidly developing Andes Hantavirus outbreak linked to the expedition cruise ship MV Hondius. What began as a handful of unexplained respiratory illnesses aboard a South Atlantic voyage has evolved into an internationally monitored infectious disease event involving multiple countries, quarantine operations, public health investigations and the repatriation of exposed passengers to specialized containment facilities in the United States.

| MORE: Hantavirus outbreak aboard cruise ship sends Americans to biocontainment quarantine units

Dr. Isakov is professor of emergency medicine at Emory University School of Medicine and executive director of the Emory Office of Critical Event Preparedness and Response (CEPAR). He also serves as EMS lead for the National Emerging Special Pathogens Training and Education Center (NETEC), where he helps lead national preparedness efforts for high-consequence infectious diseases.

In the episode, he explains how Andes Hantavirus differs from other hantaviruses already present in North America because it is capable of person-to-person transmission in limited circumstances.

The discussion covers transmission dynamics, incubation periods, PPE recommendations, public health monitoring and why experts continue to assess the overall public risk as low. Listeners are also directed toward the excellent educational resource hub on preparedness and response available through NETEC Hantavirus Resources.

Episode timeline
00:00 – Introduction to the Special Edition. Rob Lawrence introduces the emergency update format and welcomes Dr. Alex Isakov to discuss the emerging Andes Hantavirus outbreak.

00:50 – Understanding hantaviruses. Dr. Isakov explains the difference between common North American hantaviruses and Andes Virus, emphasizing the rare person-to-person transmission capability.

03:13 – The cruise ship incident. Discussion of the outbreak aboard the MV Hondius, including onboard transmission concerns, severe illness development and international evacuation efforts.

05:16 – U.S. monitoring and quarantine. Review of quarantine operations in Nebraska and ongoing public health monitoring of exposed American passengers.

07:21 – Incubation and EMS risk assessment. Dr. Isakov outlines the prolonged incubation period and explains why frontline EMS encounters remain unlikely.

11:17 – PPE guidance for EMS personnel. Specific PPE recommendations are reviewed, including standard, contact and airborne precautions with eye protection.

13:17 – Looking ahead to World Cup 2026. The discussion turns to international travel, mass gatherings and why clinicians must maintain awareness of rare infectious diseases tied to travel history.

14:32 – EMS and public health resources. Dr. Isakov directs listeners to CDC, WHO and NETEC resources for ongoing guidance and EMS-specific updates.

In this episode of EMS One-Stop, Rob Lawrence sits down with Kevin Hazzard to explore No One’s Coming, a gripping account of the 2014 Ebola outbreak and the extraordinary effort to rescue infected American aid workers from West Africa.

|WATCH NOW: FDNY’s future: AI, BWCs and pay parity with Commissioner Lillian Bonsignore 

What begins as a seemingly impossible mission evolved into a high-stakes, time-critical operation led by Phoenix Air — a team known for taking on the missions no one else will.

Hazzard traces the origins of this unconventional organization, from transporting explosives and nuclear materials, to pioneering aeromedical evacuation of the world’s most dangerous infectious patients.

The conversation moves beyond storytelling into operational reality. With no established protocols, limited knowledge of Ebola and widespread public fear, crews were forced to improvise, adapt and execute under intense pressure.

The episode examines the intersection of EMS readiness, public health hesitation and leadership under uncertainty. At its core, this is a study in preparation, risk tolerance and professional duty — illustrating how a small group of individuals stepped forward when systems hesitated, reinforcing the enduring EMS principle: when the call comes, you answer.

Key quotes from Kevin Hazzard

“This is as scary as it gets.”

“It is the largest and deadliest Ebola outbreak in human history.”

“We’ve got to figure out how to transport highly contagious patients — nobody does that.”

“They risked their lives. They risked their families’ lives for strangers.”

“Preparation is the most important thing.”

“We are notoriously short-minded … we’re not long-range thinkers.”

“There are people out there who are willing to step into the breach when needed.”

Episode timeline

00:00 – Opening context: Ebola outbreak severity and mission stakes

01:00 – Introducing Kevin Hazzard, author background

03:30 – Origins and evolution of Phoenix Air

08:00 – High-risk missions (including Libya nuclear extraction)

14:30 – Transition to EMS and infectious disease transport

16:00 – Development of the biocontainment system

20:00 – Ebola mission planning and execution challenges

27:00 – U.S. reception, EMS transport and public reaction

31:00 – Leadership lessons and EMS preparedness gaps

35:00 – Reflections on readiness, resilience and future threats

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In this episode of EMS One-Stop, Rob Lawrence sits down with Dr. Maria Koeppel to explore a topic that has long existed in the shadows of EMS culture — alcohol use among providers.

| MORE: First responders and alcohol – how much is too much?

Drawing on NIH and FEMA supported research, Koeppel outlines how EMS clinicians may be engaging in higher-risk drinking behaviors than the general population, with patterns influenced by stress, exposure and workplace culture.

What emerges is not a story of individual weakness, but one of systemic pressure — where both major traumatic incidents and the accumulation of low-acuity, high-frequency calls contribute to a steady burden of stress that many providers attempt to manage off-duty.

The conversation moves beyond statistics into culture, leadership and generational change. Koeppel highlights how traditional “crew bonding” through alcohol — what one participant termed “hydraulic debriefing” — may be giving way to a new, more wellness-focused approach among younger clinicians.

At the same time, gaps in education, policy and peer support remain evident across EMS systems. For leaders, the message is clear: alcohol use is not a fringe issue, but a workforce health, safety and performance issue that requires thoughtful engagement, cultural awareness and proactive support structures.

Key quotes from Maria Koeppel

“Over 50% of firefighters surveyed had binge drank in the last 30 days — about twice the rate of the general population.”

“EMS providers tend to drink a little bit more frequently than the general population — and that’s tied directly to stress.”

“It’s not just the big trauma calls — it’s the micro-stressors that add up over time.”

“A third of clinicians in our sample engaged in high-risk drinking behaviors.”

“Younger clinicians are at higher risk — but that risk declines with age as coping mechanisms develop.”

“Paramedics are at higher risk than EMTs, likely due to increased responsibility and patient exposure.”

“Some described going out after shift as ‘hydraulic debriefing’ — using alcohol to process the day.”

“Gen Z is driving a more sober culture — they’re choosing connection without alcohol.”

“Leadership isn’t just policy — it’s culture, awareness and how you care for your people.”

“Alcohol and coping has to be part of the conversation if we care about workforce health and patient safety.”

Episode timeline

01:06 – Maria’s background: firefighter and researcher

02:24 – Overview of NIH/FEMA research and EMS focus

04:14 – Key findings: stress, frequency of drinking and EMS culture

05:08 – Micro-stressors vs. major trauma calls

06:54 – Risk factors: age, role, education, multiple jobs

10:11 – Culture and “hydraulic debriefing”

11:46 – Fire vs. private EMS cultural differences

14:38 – Generational shift: Gen Z and sober culture

19:24 – Alternative substances and coping trends

21:20 – Leadership roles: policy vs. culture

24:11 – Peer support gaps in EMS

26:41 – Workforce impact: sleep, stress, retention

27:14 – Education gap and need for EMS-specific training

29:11 – Conferences and future research dissemination

30:13 – Episode wrap-up

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In this episode of EMS One-Stop, Rob Lawrence travels to New York City to sit down with Lillian Bonsignore, the 37th Commissioner of the Fire Department of the City of New York (FDNY). A 30-plus year veteran who rose through the ranks of EMS — from EMT in the South Bronx to Chief of EMS and now Commissioner — Bonsignore brings a ground-up understanding of the largest fire-EMS system in the United States.

She reflects on stepping into the role as “walking onto a fast-moving train,” immediately confronted with major incidents, severe weather and system pressures, while simultaneously building her leadership team and setting direction for the future.

| MORE: ‘We have to right the ship’: FDNY commissioner doubles down on EMS pay parity

The conversation explores the unique structure of FDNY, where the Commissioner operates as the executive leader “almost like CEO of the company,” while operational command sits with the Chief of Department.

Bonsignore is clear-eyed about the scale and demands of the system: over 2.2 million runs annually, with 1.6 million EMS-related, reinforcing her long-held position that EMS must be treated as an essential service with appropriate funding and career pathways.

Drawing on her experience leading through the COVID-19 pandemic and responding on Sept. 11, 2001, she emphasizes resilience, communication and presence — being visible in stations, honest with staff and committed to supporting those who “leave their own families behind to go serve a stranger.”

Bonsignore also addresses criticism of her appointment directly and without hesitation, framing it as a misunderstanding of the Commissioner’s role and the realities of modern emergency response. She underscores that FDNY is both fire and EMS, and that her career — spanning 9/11 response, pandemic leadership and decades of frontline service — positions her to lead the entire enterprise.

Looking ahead, she speaks to the need for infrastructure investment, workforce stabilization, mental health support, and the thoughtful adoption of technologies such as AI and body-worn cameras. As FDNY approaches the 25th anniversary of 9/11 and the nation’s 250th year, her focus remains clear: support the workforce, strengthen the system, and prepare the department for the next generation of service.

Key quotes from Commissioner Bonsignore

“Walking into a position like this is like walking onto a fast-moving train.”

“I understand the ground level challenges that go on because I lived them.”

“The commissioner is the administrative level, almost like CEO of the company.”

“We’re responding to over 2.2 million runs a year … 1.6 million of those runs are EMS-related runs.”

“We have to stabilize our system … it’s time that EMS is finally treated as an essential service.”

“I will always tell you the truth. You may not like my truth, but I will give it to you.”

“The decision of a first responder is to leave their own families behind … to go serve a stranger.”

“They are literally your heroes … they will put their lives on the line for you.”

Episode timeline

01:10 – First 100 days as Commissioner — “fast-moving train”

02:30 – Career journey and EMS roots shaping leadership

04:30 – Workforce trust, credibility and lived experience

06:30 – Pay parity and EMS as an essential service

09:00 – Structure of FDNY — Commissioner vs. operational command

11:30 – Setting direction and stabilizing the organization

13:30 – Relationship with the Mayor and political leadership

17:30 – Addressing criticism and misconceptions

19:30 – Leading through COVID — scale, innovation, mutual aid

23:30 – Morale, resilience and leadership presence

26:30 – Recruitment and retention challenges

30:30 – AI and future innovation in EMS

32:30 – Behavioral health response and BeHeard program

36:30 – First responder mental health and support systems

38:30 – Violence against EMS and workforce protection

41:00 – Body-worn cameras and transparency

43:30 – 9/11 reflections and legacy

50:30 – Commemoration planning and future outlook

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