EMS One-Stop

In this episode of EMS One-Stop, Dr. Linda Dykes joins Rob Lawrence from the UK for a wide-ranging, transatlantic conversation that starts with workplace culture and ends with a practical look at how health systems can keep patients safely at home.

In the first half, Linda breaks down her newly published (open-access) qualitative paper, provocatively titled “It’s not bullying if I do it to everyone,” drawn from UK NHS “Med Twitter” responses: a raw, heartbreaking window into the red flags of toxic workplace culture, how bullying is experienced in the eye of the beholder, and why incivility and silence are not just HR problems — they’re patient safety threats.

In the second half, Linda brings listeners into the UK’s evolving admission alternative world: frailty care at home, urgent community response models, and the increasingly important interface between EMS and community-based teams. She explains the UK’s SPOA (single point of access) concept, why she dislikes the term “admission avoidance,” and how ED crowding and access change the risk-benefit equation for hospital vs. home.

Rob connects the dots back to the U.S. reality — reimbursement, APOT/wall time, treatment-in-place policy — and why this work is becoming a shared challenge on both sides of the Atlantic.

Timeline
00:51 – Rob opens, recaps NAEMSP in Tampa and recent content.

02:25 – Rob introduces Linda as the “triple threat” (emergency medicine, primary care/GP, geriatrics) and tees up two-part discussion.

05:39 – Rob introduces Linda’s paper: “It’s not bullying if I do it to everyone.”

06:13 – Linda explains why toxic culture is increasingly visible and how the tweet prompt became a dataset.

07:33 – “Flash mob research group” forms; Linda explains social-media-to-qualitative methodology and limitations.

10:03 – Rob asks about bias; Linda clarifies purpose: insight, not representativeness.

16:39 – Linda defines gaslighting and why it’s so destabilizing.

18:21 – Reactions to publication; resonance, sharing and uncomfortable self-reflection on learned behaviors.

20:18 – The “16:55 Friday email” as a weapon — and as an accidental harm.

23:29 – Leadership as “the sponge” — absorbing pressure rather than passing it down.

25:27 – “One thing right now”: know the impact your words can have, especially on vulnerable staff.

26:41 – Rob on “pressure bubbles,” micro-movements and atmospherics: how leaders shift climate without realizing it.

30:53 – SPOA explained: single point of access and urgent community response behind it.

33:03 – EMS interface: calling before conveyance to find safe pathways to keep patients at home.

35:47 – Linda on mortality risk of access block/long waits and how that reframes risk decisions.

37:19 – Evolving models: primary care-led response vs. hospital at home approaches.

39:34 – Clinical myths challenged: oral antibiotics sometimes non-inferior to IV in conditions we assumed needed admission.

40:34 – Outcomes: hospital at home trial signals safety and fewer patients in institutional care by 6 months.

42:00 – Telemedicine/telehealth: underutilized but useful; when you still need a senior clinician in person.

44:50 – Closing takeaways: read the paper (with trigger warning); admission alternative work is deeply satisfying.

Enjoying the show? Email [email protected] to share feedback or suggest guests for a future episode.

In this episode of EMS One-Stop, host Rob Lawrence welcomes John Sammons, an advanced practice paramedic with Wake County EMS, a peer support team member and a key leader in the NAEMT Lighthouse Leadership Program. John sits at the intersection of system design and human performance, helping build the kind of operational and cultural scaffolding that keeps clinicians effective, healthy and coming back tomorrow.

In this episode of EMS One-Stop, host Rob Lawrence welcomes John Sammons, an advanced practice paramedic with Wake County EMS, a peer support team member and a key leader in the NAEMT Lighthouse Leadership Program. John sits at the intersection of system design and human performance, helping build the kind of operational and cultural scaffolding that keeps clinicians effective, healthy and coming back tomorrow.

| MORE: Peer support teams: How to build trust and maximize effectiveness

This week’s conversation goes beyond “be more resilient” and into the practical realities of burnout, moral injury, mentoring and culture, including the role of frontline and unofficial leaders in shaping what “normal” looks like inside an agency. John also shares the Wake County approach to peer support: presence first, then resources, plus the power of finding your people: your team, your tribe, your board of directors.

Memorable quotes from John Sammons

“We have folks that don’t stay in the profession. We have folks that leave. We have folks that unfortunately develop substantial mental health crises up to and including, unfortunately, suicide in our profession.”

“What an amazing privilege that we’re invited into somebody’s home to take care of them and to figure it out.”

“Every one of those people expects to call 911 and have an expert show up and solve the problem.”

“I work to live, I don’t live to work. And that’s a great philosophy to have.”

“Everybody goes home ... but there should be an addendum on the bottom of it that says, ‘but everybody comes back tomorrow.’”

“Nobody gets us like we get us.”

“Leadership is action, not a title.”

“Everybody has their bucket, and everybody’s bucket can only hold so much.”

“Nobody got into this because we wanted to be crusty and angry and miserable and difficult to be around.”

Episode timeline
00:40 – Rob opens the episode and introduces John Sammons and the theme: resilience and beyond

02:05 – John’s “Sammons 101” bio: Wake County APP, peer support, Lighthouse Leadership involvement

03:01 – Burnout data and why it matters for retention and wellbeing

04:16 – Wake County’s Advanced Practice Paramedic Program: the “three Rs”

05:03 – John’s post-COVID turning point: “I’m done ... I don’t want to do this anymore”

06:12 – What brings John back to work: purpose, people, privilege, challenge

09:16 – Prevention and balance: identity beyond the job, sleep, nutrition, purpose

12:15 – Peer support in practice: presence, triage, in-house clinician, canines, statewide resources

17:09 – Podcast/vodcast reminder and John’s slides supporting the discussion

18:14 – NAEMT Lighthouse Leadership: why relationships and peers are the real multiplier

20:39 – Mentorship as a resilience strategy: formal programs and informal investment

24:25 – Culture: administration vs frontline leaders vs unofficial leaders

28:06 – Closing reflections: remembering why we got into EMS

30:36 – Final takeaways

Enjoying the show? Email [email protected] to share feedback or suggest guests for future episodes.

In this episode of EMS One-Stop, Sophie Fuller — better known across social media as Paramedic Sophie — joins host Rob Lawrence for a candid, energizing conversation about what it really feels like to work in EMS right now: pride, the pressure, the burnout, and the culture issues that too many providers have been taught to silently absorb.

Sophie is a critical care ground paramedic, flight paramedic, educator and president of the Tennessee Association of EMS Providers (TAEMSP), and she brings a provider-first lens to everything from leadership visibility, to mental health and pay equity.

Together, Rob and Sophie dig into why Sophie started creating content in the first place (hint: burnout and the need to connect), how social media can be used as a force for good, and what “healthy” EMS culture should look like in practice. Sophie shares practical advice for crews and leaders alike:

Be human

Say the uncomfortable thing

Stop normalizing harm

Build systems that “care back” for the people doing the work

Memorable quotes

“We're just working in systems that haven't yet learned how to care back for the provider.” — Sophie Fuller

“Management by walking about. Don't be stuck in the office. Don't say my door is always open because that relies on people coming in to see you. Get out and go and see them.” — Rob Lawrence

“We love this job and that distracts us from the fact that it's also hurting us.” — Sophie Fuller

“Just because it's normal doesn't mean it's healthy.” — Sophie Fuller

“We confuse trauma with tradition.” — Sophie Fuller

Additional resources:

Follow Paramedic Sophie on:

YouTube

Tik Tok

“The Next Shift : A mentorship workbook for EMTs and Paramedics” | E-Book, by Sophie Fuller

“To Err is Human: Building a Safer Health System” - PubMed

Episode timeline
01:00 – Rob introduces Sophie Fuller (“Paramedic Sophie”) and frames the influencer vs. “effluencer” concept

02:14 – Sophie’s origin story: graphic design → hospital tech → EMT → volunteer fire → paramedic → critical care → flight

06:16 – TAEMSP: why Tennessee needed a provider-level association and the shift toward legislative advocacy

08:05 – Why she started with social media: two full-time 911 jobs, low pay, burnout and the need for an outlet/connection

09:32 – Defining EMS burnout: the “jar on the shelf” and cumulative strain that becomes chronic fatigue

13:26 – Sophie’s guidance to providers: vulnerability, telling the truth and not letting naysayers silence needed conversations

16:00 – Sophie’s message to leadership: don’t be the “Wizard of Oz” — show up, communicate and stay connected to crews

20:26 – EMS culture: self-sacrifice, silence, “earning your place through suffering,” and confusing trauma with tradition

23:10 – Sophie’s book “The Next Shift”: a field guide to “learn, lead and last” in EMS

26:03 – Mistakes and “just culture”: reporting, mentoring, anonymous reporting systems, and learning vs. blame

32:08 – Closing challenge: stop normalizing harm; speak up for culture and patient care

33:14 – Where to find Sophie online and how large her platform has become

Enjoying the show? Email [email protected] to share feedback or suggest guests for a future episode.

In this episode of EMS One-Stop, Rob Lawrence is joined by his own Medical Director, Dr. Maia Dorsett, to unpack the 2025 NEMSQA Measures Report — a deep dive into trauma-focused quality measures built largely from NEMSIS data.

Dr. Dorsett frames the discussion around the central aim of quality improvement:

Are we doing a good job?

Are we delivering the best possible care?

How do we get better?

From pediatric vital signs to traumatic brain injury (TBI) fundamentals, she walks listeners through what the report reveals, what it can’t reliably measure yet, and why some of the “sexy” procedures are too rare to serve as useful system-wide metrics.

The conversation highlights a recurring theme: fundamentals matter most. Dr. Dorsett explains how measures like complete vital signs and avoiding secondary brain injury in TBI (hypoxia, hypotension, hyperventilation) can drive meaningful outcomes — even during relatively short prehospital intervals.

She also points out where current measurement approaches unintentionally create documentation burden for clinicians, arguing that systems should do more of the “figuring out” (like trauma center designation and prenotification capture) without requiring extra clicks.

The episode closes with a call to action: anyone can join NEMSQA, contribute to the work, and help shape what EMS quality measurement becomes next.

Memorable quotes from Dr. Maia Dorsett

“I think the most fundamental question in quality improvement is, are we doing a good job?”

“I think part of the value of this report is specifically looking at those things and saying what should we be measuring using NEMSIS data or how should things be integrated into that database so that the answers are there rather than needing to be documented on each individual case?”

“If there's one thing that you're going to take away from this trauma report is that, the sexy stuff is important, but it happens rarely. And if you want to improve care in your system, it's about the fundamentals of good care.”

Additional resources

NEMSQA 2025 Report Release

EMS One-Stop: Leading through momentum: Dr. Douglas Kupas on steering NAEMSP

Episode timeline

00:31 – Rob welcomes listeners; introduces the 2025 NEMSQA measures discussion and notes prior episode with Dr. Jeff Jarvis

01:10 – Dr. Dorsett joins; holiday surge discussion and flu impact on EDs and admissions

03:08 – Dr. Dorsett explains her role as co-chair of NEMSQA’s Measure Analysis and Research Committee; trauma focus of the 2025 report; pain measures not included due to active research

05:00 – NEMSIS scale and opportunity: extracting meaningful measures from a massive national dataset

05:35 – Dr. Dorsett on what NEMSIS measures well vs. what it shouldn’t force clinicians to document (system should determine trauma center status)

07:46 – “HALO procedures” table: why rare interventions shouldn’t become national quality measures

10:17 – Trauma 08: complete vital signs; pediatric gap (adults ~93% vs pediatrics ~85% in discussion)

14:22 – TBI measures: preventing secondary brain injury; why fundamentals outperform “sexy” fixes; correction rates for hypotension/hypoxia discussed

21:39 – Trauma 04: trauma triage criteria and transport to trauma centers; why national measure looks low; documentation field limitations

24:17 – State collaboration comparison: using state trauma center designation data shifts performance dramatically (often 75–90%+ in examples)

26:55 – Trauma 14: hospital prenotification; importance and measurement challenges (multiple modalities, inconsistent capture)

30:01 – Rob raises operational/policy concerns about trauma alerts and incentives; Dr. Dorsett adds nuance about local criteria variation

33:22 – Closing: Dr. Dorsett’s “fundamentals matter” takeaway; impact at scale

34:44 – Dr. Dorsett plugs joining NEMSQA as an individual/agency; committees are open

35:31 – NAEMSP Tampa preview; Dr. Dorsett: “The people” are why she goes — leaves energized with new ideas

Enjoying the show? Email [email protected] to share feedback or suggest guests for a future episode.

Dr. Douglas Kupas joins Rob Lawrence to kick off EMS One-Stop in 2026, reflecting on his first year as President of NAEMSP — a year he describes as fast-moving, complex and occasionally “whack-a-mole,” with emerging issues demanding real-time leadership while long-term priorities still had to move forward.

He shares what he’s learned about the presidency, the value of NAEMSP’s leadership “bench strength,” and why advocacy and coalition-building across national EMS organizations has become more coordinated, more strategic and more essential.

The conversation then turns to what’s immediately ahead: the NAEMSP Annual Meeting in Tampa (late January), including pre-conference courses, the flagship Medical Director’s Course, and a packed scientific program. Kupas highlights a keynote focused on transforming battlefield trauma care; major research programming through oral abstracts and hundreds of posters; and high-impact sessions spanning clinical care, operations, legal issues, and international perspectives — reinforcing why the Tampa meeting remains a must-attend event for anyone serious about the science and future of EMS.

Episode timeline
00:00 – Rob tees up NAEMSP Annual Meeting growth as a “good problem to have”
00:50 – Welcome/Happy New Year 2026; Dr. Kupas introduced as first guest of the year
01:45 – Year one as NAEMSP president: what’s surprised Dr. Kupas, pace of work, governance “bench strength”
04:26 – NEMSAC termination: what happened, what NAEMSP hopes comes next
07:02 – Building the pipeline: medical student/resident interest group, travel support ideas
08:47 – “Hot off the press:” NAEMSP accepted into WHO Acute Care Action Network
10:08 – Advocacy “hunting as a pack:” overlapping national orgs, EMS on the Hill coordination
12:40 – Why Hill visits work: stories, staffers and why first-timers matter
16:48 – “White hat” advocacy and patient-centered priorities; ED wall time as a key issue
20:07 – Tampa preview: “It’s not just for docs,” NAEMSP membership structure
22:11 – Pre-cons overview: Medical Director’s Course, QI workshop, MIH, ventilation, blood, TECC
23:55 – Keynote: Dr. Frank Butler and special intro by Dr. Bob Mabry; Grand Rounds obstetric focus
27:45 – Major legal session format and why legal content draws a crowd
29:28 – Space constraints and future planning: small convention centers; San Diego “buyout” scale
31:49 – Research explosion: oral abstracts, posters, receptions; better ways to access abstracts
34:39 – “Meat of the conference:” operations, clinical topics, international speakers/learning
36:49 – Closing question: Bill details

Enjoying the show? Email [email protected] to share feedback or suggest guests for a future episode.