SAN DIEGO — I’ve spent a fair amount of time at FirstWatch’s “Collaborate Live” conference talking about the future — AI, technology, data, communications and the increasingly rapid pace of change. Then along comes a conversation that takes us back more than 50 years and, strangely enough, feels every bit as relevant.
Blair Sadler has quite a story. Together with his identical twin brother Fred, the Sadlers somehow managed to become involved in the formative years of not one, but three significant developments in American healthcare: organ donation and transplantation, the physician assistant profession and modern EMS.
Most of us would be quite satisfied getting one of those onto the CV.
Blair’s conversation with Mike Taigman wasn’t really about claiming credit for any of it. In fact, almost the opposite. It was about curiosity, relationships, finding people who know more than you do, occasionally taking a chance and, perhaps most importantly, simply getting started.
Which brings me to a tennis court covered in broken glass.
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Start where you are
Long before Blair Sadler was running Rady Children’s Hospital-San Diego, he was a college student with a summer job teaching tennis. One day, he found himself with about 19 youngsters, a fairly hopeless tennis court covered in broken glass, a questionable net and nowhere near enough equipment.
I suspect there are a few ambulance leaders reading this who recognize the operating environment.
The solution wasn’t particularly sophisticated. Find some brooms, clean up the court, divide everyone into teams and work with what you’ve got. What stuck with Blair wasn’t the tennis. It was the realization afterwards that he had thoroughly enjoyed walking into a problem, bringing people together and figuring out a solution.
Decades later, “begin where you are” became one of 15 principles Blair and Fred captured in their book, “Pluck: Lessons we learned for improving healthcare and the world.”
I rather like it because we in EMS can occasionally convince ourselves that change has to begin with the perfect plan, complete funding, universal agreement and all 37 stakeholders safely aboard the bus. Sometimes, you just need to find the broom and start sweeping up the glass.
Apparently, they built EMS as well
It’s easy to forget how young modern EMS actually is. Go back to the late 1960s and much of what we regard as normal simply wasn’t there — no nationwide 911 system, no paramedic profession as we know it today, emergency medicine itself still emerging, and wildly inconsistent ambulance care. At the same time, the experience of Vietnam was demonstrating what trained military medics and organized trauma care could achieve. Back home, the contrast could be extraordinary.
Into this environment wandered two young brothers — one a doctor and one a lawyer — who were quite prepared to admit they didn’t know much about EMS.
That may have been one of their greatest advantages.
Rather than arriving with the answer, they went looking for people who might have pieces of it. They travelled, met the pioneers, asked questions, gathered information and looked at what was actually happening on the ground. Their work in Connecticut eventually helped provide a blueprint for statewide EMS development.
There’s a lesson there that feels remarkably contemporary. We are once again redesigning EMS around workforce pressures, changing demand, alternative response, new care models, reimbursement and technology. We spend a great deal of time looking for the answer when the answer may actually be spread among 20 different people already doing interesting things. Go and find them.
Being the rookie is perfectly acceptable
Another phrase from Blair that went straight into my notes was “grow from rookie to expert.” The Sadler brothers seem to have spent a surprising amount of their early careers walking into subjects they knew very little about. Organ transplantation was one. EMS another. The emerging physician assistant profession another. They didn’t regard being the rookie as a problem. They read. They travelled. They found mentors. They asked lots of questions and gradually became useful.
That feels worth remembering in 2026, particularly as AI lands squarely in the middle of our profession. There is enormous pressure on leaders to sound as though they understand everything. We don’t. Nobody does. “I don’t know enough about this yet” is a perfectly respectable starting position, provided the next sentence is “so I’m going to find out.”
Finding your voice — and apparently mine
This part of the conversation became slightly dangerous when the subject turned to developing your voice. Blair’s point was that communicating well doesn’t just happen. He worked at public speaking, including Toastmasters, and he and Fred would go through draft after draft of their writing trying to make complicated ideas understandable.
At this point Taigman decided to point at me and use my various podcasts, radio shows, articles and other EMS ramblings as an example of someone who has spent years developing a voice.
Check’s in the post, Mike!
But there was a serious point behind it. Mike uses AI every day and is an enthusiastic advocate for what it can do. His observation was that as AI makes it increasingly easy for all of us to produce things, the old-fashioned human skills may actually become more important. Can you communicate? Can you stand in front of a room? Can you build relationships? Can you explain an idea in a way that makes somebody want to do something with it?
AI can help us enormously. It can’t outsource our credibility.
Look for the green lights
Perhaps my favorite story involved Earl Warren, former Governor of California and Chief Justice of the United States. A young Blair Sadler found himself in the same orbit as one of the most significant figures in American public life. He could have done what most people would do: spotted him, perhaps told his brother afterwards and carried on with his day.
Instead, he went and introduced himself. That simple decision eventually led to Blair and Fred spending time with Warren, talking about their work and hearing about some of his experiences on the Supreme Court. Blair describes opportunities like these as green lights.
I think we probably drive past far more of them than we realize. Conferences are particularly full of them. The person sitting beside you at breakfast. Someone you’ve wanted to meet standing alone with a coffee. The speaker you could email afterwards. We have a remarkable ability to persuade ourselves not to do these things. Sometimes, just say “hello.”
Never worry alone
There was another Blair phrase I particularly liked: “Never worry alone.” Look underneath the Sadlers’ achievements and there always seems to be somebody else in the picture — a mentor, collaborator, expert, policymaker, physician, lawyer or person they simply decided they needed to meet.
EMS leadership can occasionally be a lonely occupation. We take a problem back to the office and assume that because it has landed on our desk, we are somehow supposed to solve it ourselves. We aren’t.
Someone, somewhere, has probably dealt with something remarkably similar. Ring them. Buy them a coffee. Ask what went wrong as well as what went right. That isn’t weakness. It’s environmental scanning with caffeine.
You don’t fix culture with a memo
An audience question about the loss of camaraderie in the workplace also stayed with me. We hear it frequently in EMS: people arrive, do the shift and go home. How do you rebuild the sense of team? The answer wasn’t a strategic culture transformation initiative. Thankfully.
Start with something small that people can do together. Give them a project, an event or a problem they can collectively solve. Make it achievable and allow them to experience a win. That makes sense to me because real organizational culture doesn’t live in a PowerPoint deck. It lives in the station, the ambulance, the communications center and the emergency department at two in the morning.
You don’t change culture by sending an email announcing that everyone will collaborate more effectively from Monday. You give people reasons to.
Dwell in possibility
Blair’s final principle was “dwell in possibility.” That’s probably where this particular Rob on the Road should end. We spend a lot of time talking about what’s wrong with EMS — workforce, reimbursement, demand, hospital handover delays, rural coverage, burnout and a healthcare system that doesn’t always seem entirely sure what it wants us to be.
More than 50 years ago, another generation was staring at an emergency care system with enormous problems and no obvious roadmap. They didn’t wait until everything was lined up perfectly. They started where they were, became comfortable being rookies, found good people, asked questions, knocked on doors and changed direction when necessary.
Modern EMS didn’t simply appear. People built it.
The next version won’t simply appear either.
So perhaps the best thing I brought away from Blair Sadler in San Diego wasn’t a history lesson at all. It was a reminder to look for the green lights, never worry alone and, when faced with the inevitable broken glass, find a broom and get started.
