EMS One-Stop

FDNY Chief of Department John Esposito recounts FDNY’s devastating losses, the decisions that saved thousands of lives and why honoring 9/11 means preparing the next generation to meet the moment

Twenty-five years after Sept. 11, 2001, FDNY Chief of Department John Esposito joins podcast hosts Jim Dudley, Rob Lawrence and Aaron Zamzow of Police1’s Policing Matters, EMS1's EMS One-Stop and FireRescue1’s Better Every Shift for a deeply personal conversation about 9/11, its enduring impact and the lessons that continue to shape fire, EMS and law enforcement. Esposito was a newly promoted FDNY lieutenant on Sept. 11, 2001. He recalls returning to the city after the towers fell, the collapse of command and communications, the desperate effort to account for missing members, and the realization that FDNY had suffered unimaginable losses.

The discussion moves beyond remembrance to examine what emergency services learned: stronger accountability, controlling self-deployment, incident management teams, interoperable communications, interagency cooperation, intelligence sharing and peer support. Esposito also reflects on the continuing toll of World Trade Center-related illness and explains why “never forget” must mean more than remembering 343 names. For him, it means remembering the decisions responders made, the conditions they faced and the thousands of lives their actions helped save. His challenge to today’s generation is simple: know your job, keep learning, take care of your people and ask whether you are prepared to “measure up” to those who came before.

Key quotes from FDNY Chief of Department John Esposito

“Never forget is not just their names and who they were, how they lived their lives, and most importantly, the decisions that they made that day and the actions that they took.”

“They're like, ‘No, we think we lost everybody.’ And that was when it started to sink in that no, this is gonna be as bad as it could be.”

“If we never showed up and we had no losses that day, the loss of civilians is in the tens of thousands.”

“This is your legacy. This is our legacy, this is what we do, and these are the people that did this before us.”

“I believe that some of them knew that they were not going to make it home that night. And they still did their job.”

“September twelfth came, the doors of the firehouse went up, people got on fire trucks, and they went out and did their job.”

“It was like an all-star team that we lost. Some of the best people to ever do this job we lost that day.”

“I see my job here and our job in this building and headquarters is to take care of the people that take care of the city.”

“We have no idea. We're in a firehouse or an ambulance one second and in five minutes we could be in the worst situation we've ever been in.”

“It's our job to make sure that the people in the field are prepared and when they need something, it's our job to get it for them.”

Episode timeline

00:27 – Introduction: EMS1, FireRescue1 and Police1 come together to reflect on 25 years since September 11

02:28 – Introduction: FDNY Chief of Department John Esposito

03:23 – Chief Esposito recalls Sept. 11, 2001 as a newly promoted lieutenant with a day off and plans to study for the captain’s exam

04:28 – Chief Esposito details arriving in lower Manhattan and finding command structures and communications devastated

05:04 – The desperate process of identifying who was alive, missing or lost

07:00 – Chief Esposito describes his initial response and why he never imagined the towers could collapse

09:00 – “We think we lost everybody.” When the magnitude of FDNY's losses began to become clear

09:30 – Accountability and self-deployment emerge as major lessons from 9/11

10:00 – How FDNY now wants off-duty members to report to firehouses and EMS stations rather than directly to an incident

10:30 – Modern digital accountability, riding lists and identifiable radio transmissions compared with 2001's paper systems

12:00 – The human factor: firefighters desperate to get aboard apparatus headed toward the World Trade Center

12:30 – Leadership decisions that removed extra firefighters from overloaded apparatus ultimately saved lives

14:00 – The continuing human toll: FDNY's memorial walls and deaths from World Trade Center-related illness

16:30 – How FDNY will commemorate the 25th anniversary

17:30 – Why September 11 remembrance is intensely personal for individual firefighters and families

21:00 – Chief Esposito discusses the emotional effect September 11 continues to have on him

22:00 – “Never forget” means remembering actions and decisions, not merely names

24:00 – The actions of responders helped prevent civilian deaths potentially reaching into the tens of thousands

25:00 – Managing the overwhelming desire of responders to help during catastrophic incidents

27:30 – How outside incident management teams helped FDNY solve problems after 9/11

28:30 – FDNY repaying the assistance it received through deployments around the United States

30:00 – How today's incident command and dispatch systems control resources and prevent uncontrolled response

31:42 – Sponsor message

32:30 – Improved interagency collaboration between FDNY, NYPD and other agencies

36:00 – Peer support, firehouse culture and challenging the stereotype that firefighters do not talk about emotional distress

38:30 – How FDNY's peer-support system works after difficult incidents

42:30 – September 11 demonstrated why the fire service needs to be part of the intelligence community

44:00 – FDNY members are trained to recognize suspicious activity during routine fire and EMS responses

46:00 – How information spotted by firefighters may become the missing piece in a larger investigation

48:30 – What Chief Esposito wants responders who were not alive on 9/11 to understand

49:00 – “This is our legacy.” Measuring today's performance against those who came before

52:00 – Know your job and do your job — while recognizing that not every emergency fits an SOP

52:30 – A recent Bronx explosion illustrates the need to adapt principles to situations for which no exact procedure exists

53:30 – Applying the overarching principles of life safety and rescue when the situation is unprecedented

54:30 – What does “never forget” mean 25 years later?

55:30 – September 12: despite catastrophic losses, FDNY opened its firehouses and continued protecting New York City

56:30 – Chief Esposito describes those killed as “an all-star team” and some of the best ever to do the job

58:00 – Aaron Zamzow reflects on the responsibility to “measure up”

59:30 – The nationwide impact of 9/11 and seeing FDNY remembered on apparatus thousands of miles from New York

1:01:30 – Jim Dudley reflects on intelligence, prevention and acting on warning signs

1:03:30 – Chief Esposito discusses the difficulty of measuring successful prevention

1:05:00 – Warning signs, intelligence and lessons shared with other historic disasters

1:06:00 – Rob Lawrence reflects on September 12 and the emergency services reality that tomorrow brings another shift

1:07:00 – “At the going down of the sun and in the morning, we will remember.”

1:08:00 – Esposito discusses how 9/11 affected his career and leadership journey

1:09:00 – Leadership, doing the right thing and measuring decisions against the memory of colleagues lost

1:10:00 – “Take care of the people that take care of the city.”

1:11:30 – Emergency responders never know when the next call will become the worst situation they have ever faced

1:12:00 – The responsibility to ensure frontline personnel are prepared and supported

1:12:30 – Closing message: “Keep learning and keep moving forward.”

About our sponsor

This crossover episode of the Policing Matters, Better Every Shift and EMS One-Stop podcasts is sponsored by FirstNet — the only wireless network built with and for first responders.

Twenty-five years ago, first responders faced an emergency unlike any other. They stepped forward to protect and care for others, demonstrating extraordinary courage and resolve. This September 11th, we remember and honor those who answered the call. The example they set endures through the values that continue to inspire the profession today.

Learn more about FirstNet, Built with AT&T, at www.firstnet.com.

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AI may feel like the newest revolution in EMS, but the industry's relationship with data has been evolving for decades. In this episode of EMS One-Stop, Rob Lawrence sits down with FirstWatch founder Todd Stout, whose 28 years working with EMS data gives him a particularly long view of where the industry has been and where it is heading.

Todd traces the journey from an era when monthly reports printed on green-bar paper were considered normal, to today's world of real-time dashboards, cloud-based systems and enormous volumes of operational and clinical information. The challenge has changed: EMS no longer suffers primarily from a lack of data; leaders now need technology that can identify what matters, separate signal from noise and turn information into decisions.

That makes AI extraordinarily promising — and potentially dangerous. Todd explains why he is more excited about the next 3-5 years than at any point in his career, while simultaneously being more concerned about the next 8-10 months. Rob and Todd discuss unreliable AI outputs, data security, HIPAA and privacy, the risks associated with startups and what EMS leaders should ask before entrusting vendors with organizational or patient data. They also examine the urgent need for EMS agencies to establish AI policies and train their workforce on responsible use.

Todd concludes with a preview of FirstWatch's next generation of AI-enabled tools and a broader message for EMS leaders: the organizations that thrive through this technology shift will not necessarily be those with the newest technology, but those capable of adapting, learning and using it responsibly.

Additional resources:

EMS1 Leadership Institute: 2026 Spotlight on AI in EMS: On-demand: Smart tools, strategic choices: EMS puts AI into action

Why EMS must measure the human side of care: What patients remember

No rulebook is coming: EMS must take control of AI now: Why EMS must govern AI locally as adoption accelerates

Hyper-turbulent times: EMS economics and AI guardrails with Matt Zavadsky and Dr. Shannon Gollnick: Why EMS needs AI guardrails and Medicare reform today

Memorable quotes

"I'm more excited about the next 3-5 years than I've ever been, I am also more scared about the next 8-10 months for our industry than I've ever been because it's so messy." — Todd Stout

"Nobody gets into EMS to be excellent data enterers." — Todd Stout

"AI well formed — with the proper bumpers, guidelines, rules around it — is astonishingly good at processing through lots of data." — Todd Stout

"If you're not paying for the thing that you're using, you are the product." — Todd Stout

"AI to many people seems like magic. And it's the opposite of magic almost. It's a lot of work and plumbing to get it right." — Todd Stout

Episode timeline

00:27 – Rob introduces the episode and the evolution of EMS data, information and AI

01:54 – Twenty-eight years of FirstWatch: from Stout Solutions to today's real-time data environment

03:57 – Looking back at EMS's early adoption of real-time operational data

05:18 – Why immediate data can improve individual performance and expose problems with systems and protocols

06:24 – The "ah, buts:" gut instinct versus what the data actually shows

07:19 – Dirty data, disconnected systems and why organizations sometimes don't believe their own numbers

09:45 – EMS has moved from too little information to information overload

10:31 – How AI can sift through enormous amounts of data and identify what leaders actually need to know

11:22 – The accuracy problem: AI can produce impressive outputs while struggling with surprisingly basic tasks

12:39 – Todd explains why he is simultaneously excited and concerned about the immediate future of AI in EMS

14:35 – How EMS leaders can become better, more discerning customers of AI technology

15:10 – Established technology partners versus innovative AI startups

17:00 – What happens to your organization's data if an AI vendor fails or goes out of business?

17:41 – HIPAA, privacy, cybersecurity and employee data obligations

18:11 – Sponsor break

19:26 – Part two: protecting patient and organizational information when using AI

20:18 – AI training models, data sharing and why leaders need to understand vendors' default settings

22:44 – The pace of change: today's AI expertise can become outdated within weeks

23:08 – Preparing for the wave of "AI everything" appearing in EMS exhibit halls

23:45 – Questions EMS leaders should ask prospective AI vendors

25:20 – Why AI isn't magic — and why implementation requires significant work behind the scenes

27:08 – The case for every EMS organization having an AI policy now

27:41 – Todd warns that employees are almost certainly already using AI, sometimes without understanding the privacy implications

28:21 – Why AI education should resemble cybersecurity education: policy, training, suspicion and continual reinforcement

30:13 – Preview of FirstWatch Collaborate and the company's next generation of technology

31:02 – FirstWatch 2.0, AI-enabled mobile tools and workload management

31:55 – Reflect: incorporating patient satisfaction alongside operational and clinical performance

33:34 – Why rapid patient feedback can be more meaningful to crews than retrospective monthly scores

35:19 – Todd's closing message: EMS is good at adapting and improvising, and technology can make the job easier

36:22 – Rob's takeaway: adapt, innovate, become a discerning AI customer and establish an organizational AI policy

Enjoying the show? Email editor@ems1.com to share feedback.

This week on EMS One-Stop, I sit down with Liz Harney, almost a year after I first walked into a classroom at EMS World Expo looking for another session to report on and found what I later described as “the keynote I didn’t know I needed.”

Liz’s presentation was built around a part of EMS education we routinely acknowledge but rarely give equal billing: the affective domain — empathy, communication, professionalism, self-awareness and the ability to connect with another human being in what may be the worst moment of their life.

But the real power came from Liz herself. Before she was a paramedic, educator and EMS leader, she was the patient. At the lowest point of a decade-long struggle with addiction, one paramedic looked beyond the overdose, the circumstances and the judgement, and treated her as a person who still mattered.

Liz credits that interaction not simply with helping save her clinically, but with changing the trajectory of her life. She recovered, entered EMS and ultimately became the kind of paramedic she had encountered that day.

It is a remarkable journey from patient to paramedic, and in this conversation, Liz explains why that experience now sits at the heart of everything she teaches about the human side of EMS.

| MORE: Liz Harney — the affective domain is the heart of EMS, so why aren’t we teaching it?

Our discussion also catches up with where Liz’s thinking has evolved since. In her recent EMS1 article, “Shiny Happy People,” she takes that same belief in people and applies it to EMS leadership, challenging professionals that is exceptionally good at identifying everything that might go wrong not to let that instinct extinguish every new idea before it gets moving.

Together, we connect those themes: the provider who changed one patient’s life, the importance of deliberately teaching the affective domain, turning cynics into champions, recognizing burnout through QA and QI, and creating leadership teams with enough optimism and emotional intelligence (EI) to make change happen.

At a time when EMS is increasingly consumed by another form of intelligence (AI), the conversation comes back to a proposition I think matters more and more: if we are going to get good at AI, we first need to get much better at EI.

Additional resources:

Liz Harney: Shiny happy people. The leadership power of optimism

Rob Lawrence: The affective domain is the heart of EMS — so why aren’t we teaching it?

Inside EMS: Tactical empathy: The leadership tool you’re not using enough

Colby Davis: Can emotional intelligence be taught?

Shannon L. Gollnick: The paradox of progress — emotional intelligence as the differentiator in an AI-augmented workforce

Key quotes

“It truly was a paramedic that not only saved me in a clinical sense, but she saved me in a human sense.” — Liz Harney

“Everybody has a story and they’re all a little the same, but they’re all very different at the same time.” — Liz Harney

“It’s our role as educators and program directors to be able to ensure that we are instilling, improving the affective domain, just as we are the cognitive and the psychomotor.” — Liz Harney

“You created from the cynic, turned them into the champion, and then the champion then took that back to their own service.” — Rob Lawrence

“I am the dreamer, probably because I have forged myself out of the depths of hell.” — Liz Harney

“Look at me, anything is possible. Like there is never a ‘no’ in my language.” — Liz Harney

“In order to build, in order to make change, in order to move the needle, you have to have folks that are strong in EI to make that happen.” — Liz Harney

“There’s always room for improvement.” — Liz Harney

“I may not be able to teach everyone to care, but I absolutely think you can teach people what caring looks like in practice.” — Liz Harney

“No one’s ever complained about the gauge of needle that we used, but they’ve certainly complained that the medic was mean.” — Rob Lawrence

“People underestimate the power of storytelling, but I’m here to tell you that is what creates the change into someone, that changes their perspective.” — Liz Harney

Episode timeline

00:00 — Harney on surviving addiction, being written off and the potential EMS providers have to influence another person’s future

01:02 — Rob welcomes listeners to EMS One-Stop and introduces Liz Harney

02:14 — How Rob first encountered Harney at EMS World Expo and why he describes her presentation as “the keynote I didn’t know I needed”

02:40 — Liz Harney 101: critical care paramedicine, organizational leadership, Baptist Health, Kentucky EMS workforce initiatives and Paramedic Pathways

04:10 — Harney reflects on the rapid growth of her speaking platform and why sharing her story remains difficult but necessary

05:32 — The human side of EMS: affect, emotional intelligence and why clinical competence alone is not enough

08:10 — AI versus EI: why Lawrence argues that increasingly intelligent technology makes human emotional intelligence even more important

09:00 — From patient to paramedic: Harney recounts the interaction with the paramedic who changed the direction of her life

18:33 — Revealing her past to colleagues and students, and how that story changes attitudes toward people experiencing addiction

22:08 — Why simply telling EMS students to care does not work — and how Harney began using clinical rotations and direct patient interaction to build the affective domain

23:18 — “Everybody has a story:” students hear directly from people in addiction recovery

25:23 — The cynic-to-champion story: a student’s dismissive attitude toward patients with addiction is transformed through one clinical rotation

31:00 — Educating not simply for cognitive and psychomotor competence, but for the clinician the student is becoming

32:15 — Harney moves from education into leadership and begins seeing the same issues around decision-making tables

33:19 — The case for optimism: Harney describes herself as a dreamer and explains how persistent negativity can kill innovation

34:04 — Lawrence’s rule: “If we do what we always did, we’ll get what we always got”

36:27 — Why potential barriers matter — but introducing every possible objection too early can destroy an idea before it develops

38:02 — “Shiny, happy people:” the discussion turns to Harney’s article on optimism, innovation and assembling teams capable of making change

39:02 — Harney describes Kentucky’s EMS workforce committee and what happened when a group of optimistic problem-solvers started building ideas without immediately saying “no”

41:00 — Choosing the right people for decision-making groups: why names, titles and tenure should not outweigh emotional intelligence

41:59 — Harney defines EI: self-awareness, self-regulation, communication and empathy

45:00 — “You can teach people what caring looks like in practice.”

45:15 — Lawrence asks whether EMS can genuinely change the affect and attitudes of a generation of clinicians

46:39 — Protecting the workforce: recognizing behavioral changes, cumulative exposure and the early warning signs of burnout

47:41 — QA/QI as more than clinical oversight: documentation can expose frustration and changes in provider behavior

48:07 — The leadership question: “What can I do for you?”

49:27 — The power of storytelling to challenge judgment and change perspectives

49:49 — Harney returns to her own experience: addiction, being cast off and ultimately demonstrating that recovery and transformation are possible

51:10 — Harney’s closing message: “You don’t have to understand someone’s life to understand your responsibility to them.”

52:41 — Turning QA/QI from a fault-finding function into a mechanism for recognizing providers, celebrating success and checking on people carrying heavy cognitive and emotional loads

54:10 — Lawrence recommends seeing Harney speak: “You will come away emotional but enlightened.”

Enjoying the show? Email editor@ems1.com to share feedback.

EMS research has grown rapidly, but finding the studies that truly matter to everyday clinical practice remains a challenge. In this edition of EMS One-Stop, Rob Lawrence is joined by Dr. Christopher Richards, EMS and emergency physician at the University of Cincinnati; and Dr. Christian Martin-Gill, chief of the Division of EMS at the University of Pittsburgh and former president of the Prehospital Guidelines Consortium, to discuss the recently published EMS research reading list and the effort to identify the most important evidence EMS clinicians and medical directors should know about.

The discussion explores how the reading list was created; why a significant gap remains between publication and implementation; and how EMS can better translate research into education, protocols and patient care.

Richards and Martin-Gill explain the mix of evidence-based guidelines, position statements, systematic reviews and original research included in the project, while highlighting major gaps in behavioral emergencies, pediatrics, obstetrics, workforce wellness and EMS operations.

The message is clear: EMS practitioners should not wait for new research to appear in their protocols. They should read it, discuss it, question current practice and, where evidence is lacking, consider contributing to research that closes the gap.

Additional resources:

Richards CT, Cash RE, Crowe RP, et al. 2026. “Developing an emergency medical services research reading list for emergency medical services practitioners.” Prehospital Emergency Care, 1-6. https://doi.org/10.1080/10903127.2026.2693158

EMS1 Research Center. A central access point for critical research that can help drive operational and policy changes

Understanding research and its impact on patient care. David Page, MS; Hezedean Smith, DM; and Ayanna Walker, MD, share best practices for evaluating and interpreting prehospital research 

Key quotes

“With EMS research, there's always something missing. There's always more that we can do.” — Dr. Christian Martin-Gill

“What we're seeing here, particularly over the last decade, is these organizations working less as silos and moving more towards working together when it makes sense to do that.” — Dr. Christian Martin-Gill

“We didn't go in actually feeling like we needed to identify 10 primary research or professional statements that complemented the guidelines that were already identified through the systematic review. But there was just a natural break point there.” — Dr. Christopher Richards

“There are a number of position statements that are published by national and international organizations that are key scientific literature out there that people need to be paying attention to.” — Dr. Christian Martin-Gill

“Still there is research lacking in what the EMS clinicians themselves experience as part of the workforce — safety on scene, wellness, these sort of questions.” — Dr. Christopher Richards

“The behavioral emergency space I think is really important right now.” — Dr. Christian Martin-Gill

Episode timeline

01:09 – Rob introduces the episode and welcomes Drs. Christopher Richards and Christian Martin-Gill

02:16 – Dr. Richards introduces his EMS, emergency medicine and research background

03:18 – Dr. Martin-Gill discusses his role at the University of Pittsburgh, UPMC and the Prehospital Guidelines Consortium

04:15 – Why does EMS need a dedicated research reading list?

07:11 – Where can EMS practitioners currently go to identify the research that really matters?

09:13 – Moving research into protocols, practice and clinical care

11:15 – Can the Prehospital Guidelines Consortium help align the many organizations producing EMS clinical guidance?

13:41 – Breaking down the different categories of publications on the reading list

14:47 – Evidence-based guidelines included in the broader reading list

15:49 – Position statements covering hemorrhage, restraint, air medical utilization and workforce issues

16:26 – Systematic reviews addressing airway management and prehospital evidence-based guidelines

16:51 – Four original research papers, including refractory VF, pain disparities, evidence integration and midazolam use

18:58 – How the research reading list was actually developed

19:32 – The open call for EMS research submissions

20:10 – The project is ongoing, with submissions continuing for the next iteration

20:42 – Expert panel review, scoring and the natural cutoff that produced the final 10

23:18 – What important EMS research is still missing?

24:37 – Gaps in airway, pediatric and behavioral emergency evidence

26:08 – Dr. Richards highlights workforce, safety, wellness and operational research gaps

28:18 – Which areas should future EMS researchers investigate?

28:31 – Martin-Gill highlights behavioral, obstetric and pediatric emergencies as priorities

30:12 – Richards explains how everyday frustrations in EMS can become important research questions

32:12 – Final thoughts on the paper and the breadth of the reading list

33:37 – Martin-Gill discusses access to research and why highlighting important publications matters

35:05 – Turning reading into discussion, protocol review and further research

35:58 – Rob closes with a challenge to read, question, discuss and contribute to EMS research

Enjoying the show? Email editor@ems1.com to share feedback.

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

Key quotes

“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

Episode timeline
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

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