EMS One-Stop

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.

As the year wraps, Rob Lawrence welcomes back the “EMS Avenger” Jimmy Apple for a fast-moving, end-of-year pulse check on the EMS universe — through the lens of social media, research and what frontline clinicians are actually saying when the mic is on and the comments are open.

Building on last week’s data-and-trends conversation , this episode pivots into “the world according to Jimmy Apple” and his alter ego, the EMS Avenger, exploring what’s made providers lean in, push back or flat-out declare “enough is enough.”

| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond 

From burnout and workforce conditions to AI-assisted ECG interpretation and the rise of microlearning, the conversation lands on a central theme: the future of EMS isn’t just protocols — it’s people, technology and how we choose to learn, adapt and debate. Jimmy also names his “paper of the year” on spinal immobilization, explains how he handles disagreement without falling into “quicksand arguments,” and previews a packed 2026 speaking calendar — plus a relaunch of his podcast.

Memorable quotes

“If we can just verify that you’re retaining the information, that’s much more important than the veracity of how long it took you to get that information.” — Jimmy Apple

“You can catch more flies with honey than you can with vinegar.” — Jimmy Apple

“That’s the future; is that literally, we’re going to swipe it, absorb it and swipe away again.” — Rob Lawrence

“My paper of the year is the paper that was published on spinal mobilization … It does not support the use of backboards as anything other than an extrication tool.” — Jimmy Apple

“I think that a big push that I’m making this year is to really start talking about the EMS provider as the person.” — Jimmy Apple

Episode timeline

00:56 — Rob welcomes listeners, references year-in-review data and notes ambulance thefts continue to trend.

01:38 — Rob brings Jimmy back and asks for a quick summary of Jimmy’s year and growing reach, and the top themes Jimmy has seen.

04:12 — Jimmy identifies provider conditions and mindset as the dominant theme and describes discussion of collapse/collapsing systems.

06:12 — Jimmy explains social media as the pulse point and highlights burnout, anger and provider frustration.

06:52 — Jimmy pivots to technology’s growing role and EMS resistance to tech encroachment in practice.

07:23 — Rob connects the tech thread to conference observations (Axon, AI). Jimmy gives examples (AI 12-lead, apps) and argues tech advancement shouldn’t be rejected due to “skill deterioration” fears.

09:34 — Rob asks Jimmy’s “how do you explain complex concepts quickly?” Jimmy uses the Michelangelo anecdote to describe stripping concepts to essentials; critiques padded, time-gated education.

12:29 — Jimmy argues for education credit models that recognize microlearning and self-directed learning if retention can be verified.

14:04 — Rob asks for standout research; Jimmy discusses RSI/induction agent considerations, pressors debate and prehospital antibiotics.

16:47 — Rob and Jimmy preview NAEMSP’s annual meeting (“research Disney”), value of posters, networking and clinical depth.

18:26 — Jimmy names spinal immobilization evidence review as his “paper of the year” and explains its conclusions.

21:36 — Rob asks how Jimmy handles disagreement/detractors with a larger platform — Jimmy describes disagreement as healthy, focuses on respectful pushback and staying anchored in data.

29:00 — Final question: Jimmy emphasizes “provider as person,” healing the clinician and a sponsored podcast relaunch in January.

Additional resources

Meet the EMS Avenger: Saving lives with kindness and content. TikTok sensation and pediatric critical care paramedic Jimmy Apple shares his rise in EMS education, battling misinformation with heart and hustle

Jimmy Apple’s “paper of the year:” Millin MG, Innes JC, King GD, Abo BN, et al. “Prehospital Trauma Compendium: Prehospital Management of Spinal Cord Injuries — A NAEMSP Comprehensive Review and Analysis of the Literature.” Prehosp Emerg Care. 2025 Aug.

Connect with Jimmy Apple, better known as The EMS Avenger:

TikTok — Jimmy offers short-form, evidence-based EMS content here: @emsavenger

Instagram — Engage with in-depth reels, visuals, and professional updates: @emsavenger

X (formerly Twitter) — Follow EMS commentary, conversation, and boosts: @EMSAvenger

Facebook — Join the group for discussions and shared insights: EMS Avenger community

Apple Podcasts — Listen to “EMS Avenger: 20 Minutes to Save the World”: Weekly podcast series

AAA & AIMHI EMS Media Log: EMS Intel

Enjoying the show? Contact the EMS One-Stop team at [email protected] to share ideas, suggestions and feedback.

As EMS closes out 2025, host Rob Lawrence is joined by Matt Zavadsky (PWWAG) and Rodney Dyche (Patient Care EMS Solutions) for their second annual EMSIntel.org “year in review” conversation — a fast-moving tour through the biggest stories shaping the EMS profession.

Drawing from the EMSIntel news log (now 3,849 stories as of the morning of recording), the trio connects what’s making headlines to what EMS leaders are experiencing on the ground: unstable economics, governance pressure, system redesign and rising operational risk.

The discussion lands on several recurring themes: economic sustainability as the dominant issue; the real-world politics of tax levies and “essential service” designations; the ongoing obsession with response times (and what they cost); preventable ambulance thefts escalating in severity; and the importance of measuring and publishing clinical outcomes and meaningful performance metrics. The through-line: communities are being forced into more honest conversations about what they can afford — and what EMS should look like going into 2026.

| SHARE YOUR STORY: A call for real stories from the EMS field, station and beyond

Memorable quotes

“Having a thoughtful conversation about what your system needs to look like on the go forward is paramount.” — Rodney Dyche

“If you don’t talk about yourself, somebody else will, and then you don’t control the narrative.” — Rob Lawrence

“Our No. 1 focus really needs to be on the economic sustainability of these systems because we are past the breaking point.” — Matt Zavadsky

“Response times equals speed; speed equals crashes.” — Rob Lawrence

“These theft incidents are … in almost all cases, 100% preventable by an aftermarket device … probably for 100 or $150.” — Rodney Dyche

“Response times are expensive. The shorter that you want your response times, the more money it’s going to take.” — Matt Zavadsky

“Across every provider type … the fee-for-service revenue is 50% to 60% below the cost of providing service. So when somebody says to you, ‘I can do this for free,’ ask more questions.” — Matt Zavadsky

“Response times are used as a cudgel.” — Rodney Dyche

Episode timeline

01:11 – Rob introduces the end of 2025 reflection and 2026 look-ahead; welcomes Matt Zavadsky and Rodney Dyche for the second annual EMSIntel year-in-review.

02:26 – Rodney reports the EMSIntel log count (“3,849 as of this morning”); Rob explains EMSIntel’s purpose: curating national EMS stories to identify themes and brief stakeholders.

04:13 – Matt names the year’s biggest issue: economic sustainability; the fiscal model is broken and impacts everything else.
06:32 – Matt walks through the “AnyTown EMS” trajectory: communities can’t sustain old models, must define service levels, use system intelligence, and redesign for a modern “2028 model.”

09:06 – Matt cites the Medicare/RAND cost collection findings and warns that fee-for-service revenue sits far below actual costs; “ask more questions” when someone promises “free.”

10:12 – The group discusses communities pursuing tax levies and essential-service framing; Rodney contrasts places that pass funding measures with places that don’t, and highlights local politics and competing priorities.

11:52 – Matt clarifies that “essential service” means different things to the public versus statute; agencies need trust, transparency and real community education to succeed at the ballot box.

13:50 – Rodney describes the “cost of readiness” misunderstanding (public sees mileage, not readiness); Matt pushes proactive reporting (monthly/quarterly/annual) to build credibility.

15:35 – Matt pivots to response times: they’re expensive, clinically relevant in a small fraction of cases, and should be approached with evidence-based expectations and better triage/EMD practices.

18:14 – Rodney connects hot responses to preventable intersection crashes and modern driver realities; the discussion frames safety risk as a growing operational storyline.

20:21 – Matt adds an editorial caution that crashes are not confined to any one sector; points to recent examples including serious injuries during responses.

22:37 – Rob returns to ambulance thefts; Rodney calls most thefts preventable; Matt argues the basic lock discipline exists already and presses for stronger accountability and accreditation-style best practice.

26:11 – Rob flags downstream legal and regulatory risk (litigation exposure after stolen-unit crashes; DEA-controlled substances security implications).

26:52 – Rodney raises staffing; notes fewer staffing stories than 2024 but questions whether the situation is truly better; mentions earn-to-learn pipeline concerns.

28:13 – Matt describes the shift toward tiered deployment and greater EMT utilization, reducing pressure to staff large numbers of paramedics for calls that don’t require that level.

30:17 – Matt emphasizes outcomes and meaningful performance metrics; argues many systems still report the wrong measures and should lead with clinical metrics, patient experience, and quality indicators.

31:08 – Rodney reinforces that response times get weaponized in governance decisions; notes boards can be swayed by “advanced skills” narratives rather than outcome data.

33:25 – Forward-looking wrap: Matt highlights daily calls from communities that “can’t afford this anymore” and urges leaders to seize the redesign opportunity; Rodney echoes the need for planning and honest community conversations.

Additional resources:

AAA & AIMHI EMS Media Log: EMS Intel

Fast & spurious: America keeps losing ambulances and the fix is cheap

Callouts, chaos and career killers: The biggest EMS stories of the year

Enjoying EMS One-Stop? Email [email protected] to share feedback or suggest guests for future episodes.