Show Notes
EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving Whole blood in the field is no longer theoretical; it is operational, measurable and increasingly expected. In this EMS One-Stop episode, host Rob Lawrence brings together two of California’s leading medical directors — Drs. Clayton Kazan and Kevin Mackey — to compare and contrast their prehospital blood programs. From concept to deployment, both systems demonstrate how data, relationships and persistence can translate innovation into lives saved. This discussion goes beyond theory. It addresses real-world barriers — regulation, blood bank skepticism, funding gaps — and pairs them with practical solutions. The result is a clear message: EMS systems can safely deliver blood in the field, and when they do, patients who would otherwise die are surviving. For agencies considering similar programs, this episode provides a roadmap grounded in experience, outcomes and operational reality. Notable quotes
“When there's someone who wants to see your program, talk about your program.” — Kevin Mackey
“I kind of never believed it really possible to put it on a paramedic truck until I saw what the military was able to do.” — Clayton Kazan
“If the five minutes matter, why wouldn’t we want to do it 5, 10, 15, 20 minutes sooner?” — Clayton Kazan
“Never say ‘no,’ never say ‘die.’” — Kevin Mackey
“They’re never tired of trying to find new ways to save people’s lives.” — Clayton Kazan
Episode timeline 00:00 – Opening message. “Never say ‘no,’ never say ‘die’” sets the tone for program development and persistence 01:00 – Series introduction. Rob frames the episode as part of a broader national discussion on blood in EMS 02:00 – Guest introductions. Dr. Kazan and Dr. Mackey outline their EMS and medical backgrounds 03:20 – Program overviews. LA County: April 2025 launch, 11 squads, 58 transfusions; Sacramento: December 2025 launch after 15-month build 05:20 – Origins and catalysts. Influence from San Antonio and New Orleans programs; leadership support as a trigger 07:00 – Military influence. Translation of battlefield success into civilian EMS feasibility 08:50 – Building the business case. Data-driven forecasting using ePCR systems 11:00 – Overcoming resistance. Regulatory hurdles, skepticism and blood bank concerns 15:00 – Survivor stories. Real-world saves that validate the programs and influence policymakers 18:00 – Funding realities. Grant-based models, no current reimbursement, cost-benefit framed in life-years saved 21:45 – Equipment and logistics. Cold chain, monitoring systems, delivery devices and operational considerations 24:40 – Training and deployment. Targeted rollout using heat maps and trauma incidence data 27:45 – Early challenges. Blood recirculation, cold chain validation and system integration issues 31:50 – QA/QI and research. 100% case review and participation in multi-county data collaboratives 34:10 – Patient populations. Primarily trauma, with emerging medical indications 36:00 – Sustainability and scaling. Political engagement and expansion planning 38:15 – Rapid fire lessons learned. Transparency, persistence, relationships 42:50 – Myths and realities. Frontline providers embrace innovation; capability concerns disproven 44:00 – Final takeaways. Appreciation, relationships and system-wide collaboration as keys to success Enjoying the show? Email [email protected] to share feedback.
More from EMS One-Stop
In the first part of the Hyde County story, EMS One-Stop explored how a small rural North Carolina EMS system became the first in the nation to deploy an eVTOL aircraft as part of a 911 response. In this episode, host Rob Lawrence talks to the people who actually took the concept into the air. Quinn Reece, a North Carolina paramedic with a background in emergency management, austere medicine and technical rescue, became the first pilot-paramedic to fly the Pivotal BlackFly on a 911 response in Hyde County. On both of the operational calls she flew, Reese arrived and began providing ALS care approximately 20 minutes before the responding ground ambulance. Joining Quinn is James Robinson, an experienced North Carolina paramedic who served as ground support and supporting pilot for the project. Together, they take Rob behind the scenes of the proof of concept: intensive simulator training, emergency procedures, actually flying a single-seat eVTOL, operational control, weather and range calculations, landing close to patients, carrying a 38-pound ALS package, and using a Cybertruck as a mobile charging platform. They also tackle the inevitable criticism around new technology and explain why the project was never about replacing the ambulance. It was about finding another way to put a skilled clinician beside a patient sooner when geography, water, distance and limited resources make conventional response difficult. Memorable quotes
Weather is no longer simply something EMS and public safety agencies can react to when it arrives. In this episode of EMS One-Stop, Rob Lawrence is joined by meteorologist and emergency management specialist Sunny Wescott to examine what she describes as “weather whiplash” — rapidly changing conditions, stronger storms, heavier rainfall, coastal erosion, flooding, drought and infrastructure failures occurring with increasing intensity and sometimes in places where responders have not traditionally expected them. | WEBINAR: Ready before the call — Building a stronger fire and EMS preparedness strategy Sunny explains why understanding global weather patterns matters locally, and why storms developing thousands of miles away can provide valuable early warning for emergency managers in the United States. The discussion moves from the global weather picture to the West Coast, El Niño, coastal erosion, Lake Mead and the Colorado River, before looking east toward the remainder of hurricane season. More importantly, Sunny translates the science into practical advice for first responders:
North Carolina has always been proud of being first in flight. More than 120 years after the Wright brothers took to the air at Kitty Hawk, a small rural EMS system in the eastern part of the state is once again asking what flight might mean for the future. In this episode of EMS One-Stop, Rob Lawrence heads to Hyde County, North Carolina, where EMS leaders have become the first in the nation to operationally deploy an electric vertical takeoff and landing — eVTOL — aircraft to get a paramedic rapidly to a 911 call. Rob is joined by Hyde County EMS Chief Brooke Cox; Todd Baker, director of education and clinical services with Code Blue Resources and a captain with Hyde County EMS; and Carla Baker, owner of Code Blue Resources. They explain how a geographically challenging rural county moved from an ambitious idea to an operational proof of concept; working through state EMS regulation, the FAA, aviation safety, clinical requirements, pilot training and more than 1,000 training missions. They also describe the moment a paramedic reached a remote patient about 20 minutes ahead of the responding ambulance, what the project has taught them, and why this is not about replacing ambulances or helicopters. It is about finding another tool to overcome the challenge of time and distance — and proving that even a small rural EMS system can do very big things. | MORE: N.C. county EMS is first in nation to deploy eVTOL aircraft on 911 calls Key quotes
In this episode of EMS One-Stop, host Rob Lawrence sits down with Oscar Monterrosa, the 2026 NAEMT Paramedic of the Year, whose career has taken him from Army combat medic to street paramedic, medical student and now an emergency medicine-internal medicine resident at Hennepin County Medical Center. Yet despite the white coat and demands of residency, Monterrosa continues to work on the ambulance, including in rural Minnesota, and remains closely connected to the profession that shaped his approach to medicine. The conversation also returns to one of the defining moments of Monterrosa’s career: the Oct. 1, 2017, mass shooting in Las Vegas. Working an overtime special-event shift, Monterrosa was already inside the medical tent when gunfire began and casualties started arriving. He describes slipping into “work mode,” drawing on his experience as an Army combat medic in Iraq as he and others triaged and treated patients while the shooting was still underway. Beyond that extraordinary night, the discussion explores rural EMS, critical care and ECMO, education, mentorship and the long road from paramedic to physician. Monterrosa’s message to other EMS clinicians considering further education is straightforward: the road may be difficult and it may take longer than expected, but it is possible. Key quotes from Oscar Monterrosa
FDNY Chief of Department John Esposito recounts FDNY’s devastating losses, the decisions that saved thousands of lives and why honoring 9/11 means preparing the next generation to meet the moment Twenty-five years after Sept. 11, 2001, FDNY Chief of Department John Esposito joins podcast hosts Jim Dudley, Rob Lawrence and Aaron Zamzow of Police1’s Policing Matters, EMS1's EMS One-Stop and FireRescue1’s Better Every Shift for a deeply personal conversation about 9/11, its enduring impact and the lessons that continue to shape fire, EMS and law enforcement. Esposito was a newly promoted FDNY lieutenant on Sept. 11, 2001. He recalls returning to the city after the towers fell, the collapse of command and communications, the desperate effort to account for missing members, and the realization that FDNY had suffered unimaginable losses. The discussion moves beyond remembrance to examine what emergency services learned: stronger accountability, controlling self-deployment, incident management teams, interoperable communications, interagency cooperation, intelligence sharing and peer support. Esposito also reflects on the continuing toll of World Trade Center-related illness and explains why “never forget” must mean more than remembering 343 names. For him, it means remembering the decisions responders made, the conditions they faced and the thousands of lives their actions helped save. His challenge to today’s generation is simple: know your job, keep learning, take care of your people and ask whether you are prepared to “measure up” to those who came before. Key quotes from FDNY Chief of Department John Esposito “Never forget is not just their names and who they were, how they lived their lives, and most importantly, the decisions that they made that day and the actions that they took.” “They're like, ‘No, we think we lost everybody.’ And that was when it started to sink in that no, this is gonna be as bad as it could be.” “If we never showed up and we had no losses that day, the loss of civilians is in the tens of thousands.” “This is your legacy. This is our legacy, this is what we do, and these are the people that did this before us.” “I believe that some of them knew that they were not going to make it home that night. And they still did their job.” “September twelfth came, the doors of the firehouse went up, people got on fire trucks, and they went out and did their job.” “It was like an all-star team that we lost. Some of the best people to ever do this job we lost that day.” “I see my job here and our job in this building and headquarters is to take care of the people that take care of the city.” “We have no idea. We're in a firehouse or an ambulance one second and in five minutes we could be in the worst situation we've ever been in.” “It's our job to make sure that the people in the field are prepared and when they need something, it's our job to get it for them.” Episode timeline 00:27 – Introduction: EMS1, FireRescue1 and Police1 come together to reflect on 25 years since September 11 02:28 – Introduction: FDNY Chief of Department John Esposito 03:23 – Chief Esposito recalls Sept. 11, 2001 as a newly promoted lieutenant with a day off and plans to study for the captain’s exam 04:28 – Chief Esposito details arriving in lower Manhattan and finding command structures and communications devastated 05:04 – The desperate process of identifying who was alive, missing or lost 07:00 – Chief Esposito describes his initial response and why he never imagined the towers could collapse 09:00 – “We think we lost everybody.” When the magnitude of FDNY's losses began to become clear 09:30 – Accountability and self-deployment emerge as major lessons from 9/11 10:00 – How FDNY now wants off-duty members to report to firehouses and EMS stations rather than directly to an incident 10:30 – Modern digital accountability, riding lists and identifiable radio transmissions compared with 2001's paper systems 12:00 – The human factor: f