Jana Williams, president and CEO of the Association of Air Medical Services (AAMS), joins Mike Brown to discuss the evolving role of air medical and critical care transport. They cover AAMS’ three pillars—advocacy, collaboration, and education—highlighting current priorities: Medicare reimbursement that reflects modern clinical and aviation investments, the mental health and aviation bill, and a cost study showing underpayment. Jana explains how air medical teams act as mobile critical-access beds for rural communities, the expansion of point-of-care diagnostics, ECMO and whole blood transport, and the operational realities driving higher costs. She outlines workforce initiatives: the Flight Ready Institute (formerly the Critical Care Transport Academy), leadership schools (MTI, SMT, LIFT), and the annual Air Medical Transport Conference (MTC).

Matt Zavadsky from PWW Advisory Group (PWW|AG) joins the podcast to discuss the economics of EMS. We discuss the current economic landscape of EMS and how it has strained some services to the point of closure. We also discuss the Medicare Ground Ambulance Data Collection Surveys conducted over the past few years and how some of the data collected were not included in the final results published. We wrap up with a brief discussion on what could be seen in EMS economics and reimbursement in the future.

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Dr. Tim Nutbeam, a consultant and professor of emergency and prehospital medicine at a major trauma center in Plymouth, UK, explains evidence that should change how teams manage vehicle entrapment. Key takeaways from the EXIT research program: self extrication often produces less spinal movement than complex “slow and steady” techniques; minimize entrapment time because clinical observations poorly predict rapid deterioration; pelvic binders mainly help rare open book fractures and may be unhelpful or contraindicated for the common lateral compression patterns; long spine boards are for extrication/transfer only; cervical collars can be removed or loosened once a conscious patient is ready to self move, but use briefly for rapid extrication of unconscious patients. Dr. Nutbeam also stresses the human side: assign an extrication buddy, explain noisy steps, hold a hand, and prioritize analgesia and oxygen.

Mike Brown sits down with Dr. Sarah Fabiano and Mike Ellis as they distill pediatric diabetic ketoacidosis into a clear prehospital approach. Using a “sour blood stew” recipe metaphor, they explain how zero units of insulin produces ketones, osmotic diuresis, dehydration, and electrolyte shifts.

Key takeaways for EMS: prioritize perfusion with IV fluids (lactated Ringer’s preferred), monitor rhythm, obtain potassium before giving insulin, use a two bag insulin/dextrose strategy to close the anion gap safely, and avoid intubation unless absolutely necessary as spontaneous ventilation supports the physiologic need for higher alveolar tidal volumes.

This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Paramedic Brad Lawson joins Just a Little Salt to talk about founding the PIERCE Foundation and PIERCE Provisions, running mental wellness summits and a new Responder Fest. Brad explains why cumulative trauma drives PTSD and emotional numbness, how healing looks, and why peer led, story driven summits cut through the usual PowerPoint culture. He announces upcoming events: Responder Fest (Greenville, SC — Sept 10–11), Nashville summit (Oct 5–6) and Asheville (Oct 28–30, couples workshop + themed events).

This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Melody Mesmer tells the story behind Foundation 1023, a peer driven nonprofit born after a string of 2015 line of duty tragedies.

Melody explains how 1023 (Kristen McLean’s badge number) connects first responders, dispatchers, medical crews, tow operators and families in Texas and Colorado to culturally competent, trauma informed counselors, peer support training, and outdoor resiliency programs like paddle boarding and movement-based therapies.

She covers what early intervention looks like, how peer support reduces isolation, confidentiality protections for peer teams, and practical steps to access help. Melody emphasizes rural volunteer gaps, the importance of community outside the workplace, and why asking for help is a hero’s act.

This podcast is brought to you by Medical Shipment: https://medicalshipment.com/

Mark Flauter sits down with registered nurse Tammy Scott to share her powerful and deeply personal story of survival and advocacy. In April 2022, Tammy was stabbed and critically injured by a patient while working in a St. Louis–area emergency department. She recounts what she remembers from that traumatic day and opens up about her long and challenging journey toward physical and emotional recovery.

Tammy also discusses her experiences navigating the workers’ compensation system and shares her perspective on where hospital administration, and the healthcare system more broadly, can do more to protect frontline professionals from violence. The conversation expands to explore the alarming prevalence of assaults against healthcare workers, both in prehospital settings and inside hospitals, and the troubling normalization of these incidents within the profession.

The episode concludes with a look at Tammy’s ongoing advocacy work, including her foundation, The Nightingale Front, her memoir Frontline Survivor, and her upcoming appearance in the documentary Suck It Up, Buttercup, soon to be available on streaming platforms.

This episode is brought to you by Medical Shipment: https://medicalshipment.com/

On EMS Remembrance Day, we speak with Jana Williams, Tony O’Brien, and James Robinson of the National EMS Memorial Foundation about honoring fallen EMS providers, the annual National EMS Memorial Service, and the drive to build a permanent memorial in Washington, D.C. Learn about Moving Honors (a traveling Tree of Life memorial that visits communities June 1–July 2), the Weekend of Honor (July 17–19, Alexandria, VA), MIT’s pro bono conceptual designs, and how volunteers power this effort. Hear firsthand why memorials matter to families and colleagues and how remembering supports safety and healing. Want to help? Attend or volunteer for events, donate to the three memorial organizations, or contact your senator to support reauthorization in Congress (S.2546). Share this episode to spread the word and help build a permanent home for EMS remembrance and honor our colleagues' service.