Trending Topics
Sponsored Content

Leadership and labor: Saving California’s ambulance services

“If we don’t do something soon with our Medi-Cal rates, then our EMS system is going to implode”

Sponsored by

An ambulance leaves Harbor-UCLA Medical Center Wednesday, Feb. 24, 2021, in Torrance, Calif.

AP Photo/Ashley Landis

Enjoying the show? Please take a moment to rate and review us on Apple Podcasts. Contact the EMS One-Stop team at to share ideas, suggestions and feedback.

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

Like many other states across the U.S., California’s ambulance services are both understaffed and underfunded. In what has turned into a vicious circle, poor reimbursement levels hamper the employers’ ability to increase pay and compete with other sectors that offer better hourly rates for less risky or skilled employment. In fact, California has not had an increase in its Medi-Cal (Medicaid) rate in 20 years.

As part of the ongoing legislative campaign, California’s ambulance service owners and operators have created a coalition with all the labor unions that represent EMS in the state to campaign for increases.

In this episode of EMS One-Stop, both labor and leadership sit down with Rob Lawrence to discuss politics, funding and working as a team.

About our guests

Melissa Harris is president and CEO of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; and board member and treasurer of the California Ambulance Association.

Shelly Huddleson is the national labor representative for the International Association of EMTs and Paramedics.

Chad Druten is the COO of Emergency Ambulance Service based in Brea, California; president of the Los Angeles County Ambulance Association, and president of the Ambulance Association of Orange County.

Ryan Walters is a resident of IAEP Local 370 representing EMTs and paramedics working at Falck in Orange County and Los Angeles.

Jim Karras is vice president and chief operating officer of Ambuserve Ambulance, Medic1 Ambulance and Shoreline Ambulance; vice president, Los Angeles County Ambulance Association; and secretary of the Ambulance Association of Orange County.

Top quotes from this episode

“EMTs are one missed shift away from poverty. This is the industry I love. I’ve seen people leave, people that I wish we could hold on to, but they have to provide for their families.” — Ryan Walters

“Unlike the In and Outs, the Jack in the Boxes, the Del Tacos who can raise their prices to meet the escalating minimum wage and escalating inflationary pressures that they are feeling, we don’t have the ability to do that. Our rates are set for us by the government and by government payers and they are capped and in some cases, they are fixed, so we are beholden to the State of California to help us and give us some relief.” — Jim Karras

“If we don’t do something soon with our Medi-Cal rates, then our EMS system is going to implode, it’s going to implode because our ambulance companies are either going to stop taking these Medi-Cal patients because they can’t afford them and so who is going to take care of them or they are going to start shutting their doors. When they shut their doors, our members lose jobs.” — Shelly Huddleson

“The patient is the one that’s most important here, the medical recipient, they are the ones that stand to lose the most and they are the only reason we exist, they are the only reason any of us have jobs and we can’t lose sight of that, so we are not just advocating for our industry, we are advocating for the citizens of California.” — Chad Druten

Episode contents

0:30 Rob sets the scene

1:00 Meet the guests

2:05 The campaign to increase reimbursement

3:08 EMTs are one missed shift away from poverty

3:45 Management and labor alliance

6:30 How labor and management can work together on political campaigns

9:00 We share a common humanity

11:00 We as an industry are not good at going hat in hand

13:00 The politicians are astonished at what we pay and that we are losing people to fast-food chains

14:00 Medi-Cal is for the patient to have equal access to healthcare

17:00 This is an economic nightmare

18:30 If you were in an elevator with a politician, what would your pitch be?

21:45 Find your champions – those elected officials that will fight for you

23:00 Acting as a coalition

24:40 Ambulance companies with staffing issues

26:10 Workers deserve a long and dignified career

28:30 The patient is at the center

30:00 A call to action

Additional resources on this topic

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.