EMS One-Stop

What does the future of EMS look like, and are we ready for it? This week on EMS One-Stop, host Rob Lawrence welcomes Donnie Woodyard Jr., executive director of the EMS Compact, aviator and EMS futurist, for a wide-ranging conversation about the technologies and policies shaping the next generation of emergency medical services.

Fresh from qualifying to fly Pivotal's electric vertical takeoff and landing (eVTOL) aircraft, Woodyard shares his firsthand experience and explains why emerging aviation technology could transform emergency response. The discussion moves from autonomous helicopters and AI-powered patient assessments, to body-worn cameras, clinical documentation, and the opportunities and responsibilities that come with collecting more patient data. Woodyard challenges EMS leaders to look beyond today's technology and consider how the profession will fit into the wider healthcare system over the next decade.

The conversation then turns to the EMS Compact and its expanding role in workforce mobility, professional regulation and public protection. With 28 states having enacted the Compact and more than 500,000 EMS clinicians expected to be covered as data integration progresses, Woodyard explains how interstate license recognition can help agencies recruit, allow clinicians to work across state lines, and strengthen regulatory oversight. He also discusses Alaska's recent entry, legislative activity in other states, and the connection between Compact participation and federal rural healthcare transformation funding.

The episode closes with a look back at the origins of EMS certification and licensure, alongside a call for EMS professionals to engage with newly elected lawmakers, tell their stories, and help shape the policies that will determine the profession's future.

Key quotes

"What we are seeing is small aircraft that can I think solve a real-world problem when it comes to access, time, traffic, etc." — Donnie Woodyard, Jr.

"EMS is going to be very uniquely positioned to gather huge amounts of data and information from where the patient's at, the home, the environment, the situation." — Donnie Woodyard, Jr.

"I want to make sure that our EMS colleagues have the same opportunities for mobility and licensure recognition as our other colleagues in healthcare." — Donnie Woodyard, Jr.

"Speak to them from the heart because they want to know about your stories and then give their chief of staff the data." — Donnie Woodyard, Jr.

"We have to be performative now because everyone is recording us, and if we say nothing, it kind of infers that we're thinking nothing and doing nothing." — Rob Lawrence

"It's a shame to see organizations saying that they’re either underfunded in one way, they're living in an ambulance desert, or they can't recruit, yet they're not taking the steps to actually help themselves." — Rob Lawrence

Additional resources

Paramedic Quinn Reece and her flying machine. Reece and James Robinson describe flying a single-seat eVTOL on 911 calls in rural North Carolina, from simulator drills to landing beside patients

First in flight, first on scene. Hyde County EMS is the first in the nation to deploy an eVTOL aircraft, putting a paramedic in the air to overcome the time and distance challenges of rural response

Inside the EMS Compact: How REPLICA transforms disaster response, licensing and leadership

The United States EMS Compact

Episode timeline

00:38 – Introduction and welcome to Donnie Woodyard, Jr.

02:13 – Flying Pivotal's eVTOL aircraft — training and first impressions

06:16 – The future of aviation, autonomous helicopters and EMS transportation

10:04 – AI, data integration and EMS's place in healthcare

12:57 – Body-worn cameras, clinical documentation and recording patient care

17:24 – EMS Compact explained — 28 states and workforce mobility

20:44 – Online Compact credentials and interstate practice privileges

21:40 – Non-Compact states, recruitment opportunities and legislative expansion

23:38 – Alaska, Connecticut and emerging Compact legislation

25:01 – Rural healthcare transformation funding and infrastructure investment

27:00 – The history of EMS certification and licensure

29:11 – Engaging lawmakers and advocating for EMS

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The votes have been cast, congressional and statehouse leadership is changing, and EMS organizations across the country are beginning to work out what the 2026 midterm elections mean for them. In this special edition of EMS One-Stop, host Rob Lawrence is joined by longtime EMS leader and policy analyst Matt Zavadsky to look beyond the red-versus-blue election narrative and focus instead on what EMS leaders should be doing next.

Their message is straightforward: election results do not automatically change policy, reimbursement rules or the economic realities facing ambulance services. What they do create is a new group of elected officials, committee members and political leaders who must quickly be educated about EMS, its value and, crucially, what it actually costs to maintain a 24/7 emergency medical response system.

Rob and Matt examine what remains unchanged after the midterms, including existing federal law and regulatory changes already moving through CMS, before turning to some of the more significant state and local results. They discuss property-tax reform, EMS levy votes, commercial payer reimbursement, the cost of readiness, and the growing tension between public expectations for rapid ambulance response and the willingness of communities to fund that level of service.

The episode concludes with a practical five-point action plan for EMS leaders:

Calculate the true cost of readiness

Demonstrate value beyond response time

Reconsider system design

Model financial exposure

Immediately begin educating newly elected officials

The election may have changed some of the people at the table, but EMS still has to make its case.

Key quotes

“We’re not here to talk about red or blue, we’re not here to talk about Democrats or Republicans. We’re here to talk about us.” — Rob Lawrence

“Election results don’t automatically translate into policy changes … a change in congressional leadership and state house leadership and local leadership creates, if nothing else, a new opportunity for us to advocate for reform, but it’s not a guarantee of that reform.” — Matt Zavadsky

“We have a lot of freshmen to influence now and educate and have them understand before anybody else gets to them.” — Rob Lawrence

“Everybody wants lower taxes and everybody wants an ambulance in five minutes. But somebody needs to explain how those two expectations fit into the same spreadsheet.” — Matt Zavadsky

“We can’t control who wins and who loses elections, but we can control the quality of the information that we provide, the relationships that we build and our willingness to rethink how we deliver care.” — Matt Zavadsky

“For me to be there for that one unit hour that I am dealing with you as my patient, I need to be there for the other 23 hours to be ready for that one unit hour.” — Rob Lawrence

“Instead of asking taxpayers to give you more money, we need to explain what we’re doing with the money.” — Matt Zavadsky

“We don’t care who won, but we now have to talk to the winners in order to affect change or continue the good work that many associations, many organizations, and many individuals have been doing for some considerable time now.” — Rob Lawrence

Additional resources

2026 Ambulance Ride-Along Toolkit - American Ambulance Association

AAA & AIMHI EMS Media Log

The economics of saving lives (and explaining it to your finance director)

Episode timeline

01:00 – Rob introduces the midterms special: this is not a discussion about Democrats versus Republicans, but about what the election results mean for EMS.

02:51 – Matt’s first takeaway: elections create opportunities for reform, but election victories do not automatically translate into policy change.

04:19 – Rob’s immediate post-election task: identify new legislators, departing allies, freshmen members and the people EMS now needs to influence.

07:14 – Matt discusses treatment-in-place legislation, HR1 and why existing federal law remains in place unless Congress changes it.

08:39 – EMS organizations should continue financial contingency planning rather than assume the election will reverse current reimbursement pressures.

11:12 – Florida property-tax reform and the potential impact of reduced municipal and county revenue on public safety.

13:00 – Matt discusses alternative EMS financing, regional collaboration, consolidation and more efficient deployment.

13:26 – Fundamental system-design questions: Does every call require an ambulance? Does every call require a paramedic? Does every patient require an 11-minute response?

17:04 – Rob’s “political meteorite” theory: could financial pressure finally extinguish outdated EMS operating models?

18:48 – Not every tax measure failed: Matt examines communities where voters supported additional EMS funding.

19:21 – EMS levy campaigns: why successful funding measures require genuine campaigning and community education.

22:39 – Matt argues that EMS must become better stewards of resources and acknowledge that many low-acuity calls do not require rapid emergency response.

23:07 – Examples of high-performance systems adopting 45-, 60- and 90-minute response targets for some low-acuity calls.

25:25 – Matt argues that the changed political environment could create another opportunity to address commercial insurer underpayment of EMS.

26:22 – Revisiting the Ground Ambulance and Patient Billing Advisory Committee recommendations.

28:50 – Rob asks Matt for his post-midterm EMS leadership “top five.”

29:27 – No. 1: Calculate the true cost of readiness. Understand what it actually costs to maintain 24/7 ambulance availability.

29:44 – No. 2: Measure and communicate value beyond response time. Include clinical outcomes, patient experience, unit-hour costs, response costs and transport costs.

30:35 – No. 3: Reevaluate system design. Consider regional partnerships, consolidation, deployment changes and different service models.

31:02 – No. 4: Model financial exposure. Understand how Medicare, Medicaid, GEMT and local tax changes could affect the organization under different scenarios.

31:59 – No. 5: Educate newly elected officials now. Do not wait for the next crisis or budget cycle. Begin building relationships and teaching newly elected officials about EMS immediately.

33:06 – The objective: make sure EMS remains “at the table and not on the menu.”

In this episode of EMS One-Stop, host Rob Lawrence welcomes back FDNY Chief of Department John Esposito for a candid conversation about the challenges and opportunities facing emergency medical services in New York City.

Following a recent city council hearing examining ambulance response times, staffing shortages and EMS compensation, Esposito discusses the realities of operating one of the world's busiest emergency response systems.

With approximately 4,500 EMS calls each weekday, a nearly 10% staffing vacancy rate and mounting pressure to improve response times, he explains why the challenge is not a shortage of ambulances, but a shortage of people to staff them. Central to his vision is making FDNY EMS a career destination, rather than a steppingstone to other public safety professions.

The conversation also highlights Esposito's commitment to strengthening the relationship between fire and EMS within one unified department. From assigning rescue paramedics to FDNY rescue companies and deploying non-transport paramedic response units, to improving hospital turnaround times, Esposito outlines practical initiatives to increase operational efficiency and patient care.

He also discusses the importance of public education, alternative care pathways and FDNY's planned next-generation EMS computer-aided dispatch system, expected in November 2027. The episode concludes with a reflection on leadership, the professionalism of FDNY personnel, and the lasting impact EMTs and paramedics make on the patients and families they serve.

Key quotes

"We have a budgeted headcount in FDNY EMS of 4,500 people, and we have slightly over 4,000 —  almost a 10% vacancy." — Chief John Esposito

"And that results in in less ambulances. We have plenty of physical ambulances in service ... we just don't have the people to put in them." — Chief John Esposito

"One of our goals — one of my goals — is to make EMS here a career, make EMS the destination that you get people that come here for that." — Chief John Esposito

"But the people that they had those interactions with — those people's houses and apartments and homes that they went into to save somebody's life to make a difference — they will remember them probably forever." — Chief John Esposito

Episode timeline

00:49 – Welcome and reflections on the 9/11 remembrance

03:47 – Building a unified fire and EMS department

05:34 – Rescue paramedics embedded with rescue companies

07:35 – Making EMS a career destination

12:10 – Compensation, resources and response times

13:39 – Non-transport paramedic response units

15:41 – The unique challenges of responding in New York City

17:42 – Bystander CPR and the role of hospital ambulance partners

20:42 – City Council oversight and public accountability

23:24 – Staffing vacancies and rising ambulance response times

27:07 – Improving field staffing and response classification

30:00 – Daily call volume and alternative care pathways

33:52 – Hospital turnaround times and ambulance availability

36:38 – FDNY's operational priorities

38:11 – New EMS CAD, predictive technology and AI

39:30 – Leadership, professionalism and the lasting impact of EMS

41:31 – Closing reflections

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In the first part of the Hyde County story, EMS One-Stop explored how a small rural North Carolina EMS system became the first in the nation to deploy an eVTOL aircraft as part of a 911 response. In this episode, host Rob Lawrence talks to the people who actually took the concept into the air.

Quinn Reece, a North Carolina paramedic with a background in emergency management, austere medicine and technical rescue, became the first pilot-paramedic to fly the Pivotal BlackFly on a 911 response in Hyde County. On both of the operational calls she flew, Reese arrived and began providing ALS care approximately 20 minutes before the responding ground ambulance.

Joining Quinn is James Robinson, an experienced North Carolina paramedic who served as ground support and supporting pilot for the project. Together, they take Rob behind the scenes of the proof of concept: intensive simulator training, emergency procedures, actually flying a single-seat eVTOL, operational control, weather and range calculations, landing close to patients, carrying a 38-pound ALS package, and using a Cybertruck as a mobile charging platform.

They also tackle the inevitable criticism around new technology and explain why the project was never about replacing the ambulance. It was about finding another way to put a skilled clinician beside a patient sooner when geography, water, distance and limited resources make conventional response difficult.

Memorable quotes

“The pilot is 100% flying the aircraft.” — James Robinson

“I did run the first two calls to provide ALS care on scene 20 minutes before an ambulance on both times.” — Quinn Reece

“For you to first time sit back in it, you feel like almost an astronaut being projected up.” — Quinn Reece

“That patient had no idea how I got there. They weren’t looking outside to see what I arrived in. They were just happy that care was there in an appropriate amount of time to help them for what they needed.” — Quinn Reece

“To have them [my sons] actually see the aircraft for the first time and watch their mom fly was actually really inspirational for me.” — Quinn Reece

“You don’t have a copilot sitting there that can bail you out.” — James Robinson

“This is just another tool in the toolbox that allows you to pop straight up in the air, fly over the top of all that water that would otherwise be an obstacle.” — James Robinson

Episode timeline

00:26 ­– Rob introduces the second chapter of the Hyde County story and reflects on the leadership, determination and regulatory work required to move the concept from idea to actual flight.

02:04 – Meet Quinn Reese and James Robinson.

02:32 – Quinn explains her background in paramedicine, emergency management, technical rescue and austere environments, and why that experience helped prepare her to operate as a sole provider ahead of the ambulance.

03:27 – James introduces himself and describes almost 30 years in emergency services and his role providing ground support for the Hyde County project.

04:41 – Quinn recalls receiving the initial phone call in December 2025 asking whether she would consider joining the project.

06:13 – Quinn admits to some nerves as a North Carolina paramedic suddenly surrounded by engineers and PhD students — before telling them she was there to fly the aircraft operationally.

07:22 – Inside the simulator: VR goggles, moving seat, sound, wind and realistic flight environments.

08:30 – Two days of intensive simulator work including check rides, GPS and radar failures, parachute deployment, wind management, and transitioning between hover and cruise modes.

09:16 – James explains why simulator training and muscle memory are so critical in a single-seat aircraft where there is no copilot sitting beside you.

10:53 – Who is actually flying? James makes it clear: the pilot is controlling the aircraft, while built-in systems help prevent unsafe maneuvers.

12:43 – Quinn explains what happens when the controls are released in cruise and hover modes.

13:09 – The ballistic parachute: how an emergency parachute can lower the entire aircraft.

14:31 – Quinn remembers her first real flight over Monterey Bay.

15:06 – “You feel like almost an astronaut being projected up.” Quinn describes the sensation and power of the aircraft on initial vertical takeoff.

17:02 – Navigating the operational missions using both the aircraft display and SARTopo/CalTopo to plot call locations.

18:00 – James emphasizes that this was a prototype and a proof of concept designed in part to identify exactly these operational issues.

19:34 – Moving the aircraft: the BlackFly breaks into three major sections and fits into a 16-foot trailer.

20:08 – Range and weather: Quinn explains the roughly 20-nautical-mile operating capability and how wind changed the practical mission radius.

21:29 – The unusual support vehicle: a Cybertruck capable of charging the BlackFly repeatedly in the field.

25:34 – The first 911 call arrives while Quinn is already conducting a proficiency flight. She hears the dispatch over the radio, lands, plots the call, checks the weather and operational parameters, and launches toward the patient.

27:42 – Quinn arrives at the patient — and nobody initially understands how the paramedic got there.

28:43 – One of the less glamorous first-flight lessons: getting the medical bag out of the aircraft proves harder than expected, leading to changes before the second mission.

29:12 – Quinn begins patient care and explains that, from the patient’s perspective, the method of arrival was irrelevant: they were simply pleased that help had arrived.

29:40 – Meanwhile James and the ground team arrive, recharge the aircraft and prepare it for departure while neighbors slowly realize there is an aircraft sitting in the yard.

31:07 – From pilot Quinn to paramedic Quinn: what medical equipment did she carry?

32:48 – Public reaction evolves from skepticism and raised eyebrows to families bringing their children to see the aircraft and learn about the program.

33:23 – Rob addresses the skeptics: Is this just an expensive gimmick with limited range?

33:53 – James makes the clinical case: in rural areas where conventional 10-minute response simply is not realistic, an eVTOL is another way to overcome geography and put ALS care beside the patient sooner.

36:34 – What happens next? Quinn and James describe taking the aircraft to emergency management and aviation events to demonstrate the concept and educate other agencies.

38:15 – Other possible missions: moving critical medications across flooded areas, search and rescue, disaster assessment and other emergency-management applications.

39:07 – Quinn discusses the evolution from the BlackFly toward Pivotal’s newer Helix platform, with greater range, payload and capability.

40:13 – Will Quinn fly operational EMS missions again? She hopes so, with growing interest from other agencies exploring the concept.

44:35 – A personal moment: Quinn describes bringing her two young sons to Hyde County and watching them see their mother fly the aircraft.

44:53 – Rob closes the two-part Hyde County story, reflecting on the enthusiasm, belief and determination of everyone involved.

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Weather is no longer simply something EMS and public safety agencies can react to when it arrives. In this episode of EMS One-Stop, Rob Lawrence is joined by meteorologist and emergency management specialist Sunny Wescott to examine what she describes as “weather whiplash” — rapidly changing conditions, stronger storms, heavier rainfall, coastal erosion, flooding, drought and infrastructure failures occurring with increasing intensity and sometimes in places where responders have not traditionally expected them.

| WEBINAR: Ready before the call — Building a stronger fire and EMS preparedness strategy

Sunny explains why understanding global weather patterns matters locally, and why storms developing thousands of miles away can provide valuable early warning for emergency managers in the United States.

The discussion moves from the global weather picture to the West Coast, El Niño, coastal erosion, Lake Mead and the Colorado River, before looking east toward the remainder of hurricane season. More importantly, Sunny translates the science into practical advice for first responders:

Study international disasters

Anticipate public behavior

Identify critical infrastructure before it fails

Use recent after-action reviews to improve the next response

Plan not only for the emergency itself, but for the much longer recovery period that follows

Along the way, there is also the extraordinary example of a flooded snake farm in China that released 900 king cobras into floodwaters — a reminder that disasters frequently create secondary hazards no emergency plan anticipated.

Key quotes

“None of these weather events are new, but they’re entering into areas where they don’t typically go or haven’t gone before.” — Sunny Wescott

“If you look out of your windows, you can see there’s this thing called weather going on.” — Rob Lawrence

“If we’re not paying attention to Russia, Asia, India, then we’re going to be surprised when these weather events get into the Pacific and approach our coastline.” — Sunny Wescott

“I’m a Brit. I’m professionally trained to talk and moan about the weather, so I might as well do it on One-Stop.” — Rob Lawrence

“The problem is we weren’t prepared for the intensity of the last decade, and that’s led us into a place of complacency, kicking the can down the road.” — Sunny Wescott

“If you just did your after-action review from the last weather system, you have a real opportunity to make those corrections and to get it right even as soon as next week.” — Rob Lawrence

About our guest
Sunny Wescott is a federal emergency response official chief meteorologist with the Department of Homeland Security (DHS) specializing in national extreme weather hazards and climatological studies for impacts to public and private sector key resources; and deputy project manager for the National Hurricane Program (FEMA).

Episode timeline

00:31 — Rob introduces the episode and welcomes Sunny Wescott back to EMS One-Stop.

01:42 — Sunny’s background: from U.S. Air Force meteorology to critical infrastructure, homeland security, FEMA’s National Hurricane Program and geospatial intelligence.

03:26 — The global weather picture and why traditional weather patterns are becoming less reliable.

05:53 — Why U.S. emergency managers should pay attention to weather in Russia, Asia and Europe.

06:10 — The jet stream, wildfire smoke and the “carousel of weather” moving systems around the globe.

07:24 — How overseas weather events can offer advance warning of the intensity of systems later approaching North America.

09:29 — Sunny explains Kelvin waves, warmer coastal water, king tides and why California’s coastal flooding risk continues to increase.

11:25 — Emergency managers are being forced into a cycle of continually trying to catch up with increasingly damaging events.

13:03 — Sunny predicts continued worsening of coastal erosion and discusses wider infrastructure impacts — sinkholes, water mains and groundwater depletion: how underground infrastructure may become another increasingly important response issue.

15:00 — Why heavy rain does not necessarily solve the water crisis affecting Lake Mead and the Colorado River.

15:09 — Intense rainfall can fall too rapidly for soil, vegetation and drainage systems to absorb it effectively.

16:20 — Evaporation, human water use and warming water further complicate reservoir forecasts.

17:07 — The coming political and resource challenge: deciding who gets scarce Colorado River water.

18:41 — Rob and Sunny return and shift attention to the Atlantic and the remainder of hurricane season.

19:28 — Sunny explains Saharan dust, wildfire smoke and the environmental factors that influence tropical cyclone development.

20:22 — Late-season concern turns toward the Caribbean and Gulf.

21:44 — Sunny’s first recommendation: follow international disasters and learn how both responders and the public behaved.

22:12 — Preparing for public distrust, misinformation and hostility during emergencies.

22:45 — Using overseas infrastructure failures as scenario planning: bridges, roads, supply routes and rescue access.

23:07 — The 900 king cobras example and the importance of anticipating unexpected secondary hazards.

24:36 — A near-real-time look at the forecast for the following week. Sunny warns that a significant West Coast system may catch people off guard
because it lacks a dramatic label such as “hurricane” or “atmospheric river.”

25:14 — A developing system is expected to track down the West Coast, bringing waves of wind and precipitation.

26:03 — “Now’s your time to shine.” Agencies that have just completed after-action reviews have an immediate opportunity to make improvements.

26:20 — Rob reinforces the value of turning recent lessons learned into operational changes before the next event.

27:35 — Rob’s closing takeaway: first responders should think beyond immediate response and plan equally seriously for recovery.

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