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10 things we need to fix in EMS

Host Rob Lawrence addresses the elephants in the EMS room

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This episode of EMS One-Stop With Rob Lawrence is brought to you by Lexipol, the experts in policy, training, wellness support and grants assistance for first responders and government leaders. To learn more, visit

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Our EMS One-Stop Host Rob Lawrence was recently invited attend the keynote session at the North Carolina EMS Expo, and to deliver an after-dinner speech at the banquet. The title of Rob’s session was “Elephants in the EMS room,” in which he addressed 10 things we must acknowledge and fix in order to improve the health of our profession.

As soon as he left the keynote stage, Rob joined Bradley Dean and David Blevans from the EMS Handoff Podcast to discuss the key issues raised in Rob’s presentation.

The biggest elephant in the room currently is recruiting and retention, and in addition to discussing inside industry suggestions, Rob looked to the outside world and got his inspiration from Glass Door, and identified what stands EMS apart from the nation’s top 50 companies to work in.

The discussion also covers data and politics, cost collection and surprise billing, amongst the other elephants in the EMS room.


“I don’t talk about surprise billing, I talk about surprise payment, the surprise is what the insurance company actually gives you.” — Rob Lawrence

“A lot of local authorities will describe what they want to see in their EMS system when they bid them out and these are wholly unaffordable, in fact, they describe the cruise liner, when they can only afford a rowboat.” — Rob Lawrence

“We have to stop thinking that we are the UN and start to thinking like NATO, because NATO is an attack on one is an attack on all so, we have to start changing our mindset.” — Rob Lawrence

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00:53 – Introduction

01:15 – Bradley Dean and David Blevins

2:10 – Elephants in the room

2:58 – Recruiting and retention

4:00 – Looking for clues via Glassdoor

5:05 – Is EMS in a pickle?

6:00 – Surprise billing

6:22 – EMS costs

7:00 – The cost of readiness

7:30 – Ground Ambulance and Patient Billing Committee

9:46 – Four little words – all those in favor!

10:20 – We are all politicians

11:30 – Degree or no degree – that is the question

15:40 – If you are going to get a degree anyway, why not a paramedicine degree!

17:00 – Data and making use of it

20:00 – Wall time

24:00 – The importance of advocacy

28:00 – National organizations working together

37:00 – The Peter Principle and training our people for the next position

39:00 – Close

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.