In our last episode, we launched a special series featuring chapters from Donnie Woodyard's book, The Dark Ages of Emergency Medical Services. The opening installment covered the Prologue, Chapter 1: Is EMS Essential?, and Chapter 2: The Illumination — spanning from 1869 Bellevue Hospital to a 2026 South Dakota hearing room where legislators proposed letting people trained only in CPR staff ambulances.

In this companion episode, two colleagues sit down to talk through what they just heard — and what hit hardest.

The conversation starts where most listeners probably did a double take: the realization that American cities had physician-staffed, telegraph-dispatched, hospital-integrated ambulance systems before the twentieth century even began. Cities competing to build the best ambulance services. A military surgeon hand-delivering the American model to London. Edinburgh physicians writing that their American counterparts were decades ahead. If that history is real — and it's meticulously sourced — then everything the profession has been told about starting from nothing in 1966 needs reexamination.

They dig into the South Dakota testimony and what it reveals about a profession that everyone calls essential but no one will fund. They talk about the emotional weight of hearing 1889 clinical capabilities compared side by side with 2026 legislative proposals — and what it means that the distance between those two moments isn't progress. It's regression.

And they explore the question the opening chapters leave you with: if America built all of this once before, how did it disappear so completely that the people who rebuilt it didn't even know it had existed?

This is the first in a series of discussion episodes released between chapter installments — a chance to slow down, react, and think critically about what the book is asking the profession to confront.

Why is EMS the only major emergency service in America that bills the people it rescues? In this episode of EMS Evolution, we continue our series featuring chapters from Donnie Woodyard's book, The Dark Ages of Emergency Medical Services: How America Created, then Forgot, Its Early Emergency Medical Legacy.

Chapter 6 tackles what may be the most uncomfortable question in the profession: Is EMS fighting the wrong fight?

For decades, the profession has campaigned for higher reimbursement from CMS — and the grievance is real. But what if the reimbursement rate isn't the actual problem? What if Medicare is already paying close to what an insurance payer should pay for a clinical encounter — and the real crisis is that no one is funding the 85% of EMS costs that exist before the first call of the day is ever dispatched?

Police departments don't bill crime victims. Fire departments don't invoice homeowners. Yet EMS loads the full cost of 24/7 readiness onto the patients who happen to need help on any given day — disproportionately the elderly, the uninsured, and the chronically ill — and then wonders why the model is broken.

This episode traces how we got here: a jurisdictional contest between federal agencies in the 1960s, a self-sufficiency mandate in the 1973 EMS Systems Act, and the collapse of federal EMS funding in 1981. It compares how hospitals fund readiness — Hill-Burton grants, tax-exempt bonds, facility fees, philanthropy, and tax exemptions — against the zero equivalent mechanisms available to EMS. And it asks whether the profession has spent decades sending its lobbyists to the wrong address.

Some of what you hear may challenge long-held assumptions. Good. That's the point.

📖 Get your copy of The Dark Ages of Emergency Medical Services on Amazon for $9.99 🔗 Learn more: ems-history.com

In this special episode, we're thrilled to announce the release of Leadership in Action: The Wisdom and Stories of EMS Innovators! Edited and compiled by Donnie Woodyard, Jr., this groundbreaking book brings together the real-life experiences and leadership lessons of some of the most influential figures in Emergency Medical Services.

Join us as we dive into the inspiration behind the book, explore its powerful themes, and discuss why these stories matter for current and aspiring EMS leaders. You'll hear about the challenges, triumphs, and defining moments that have shaped EMS leadership—and how you can apply these lessons to your own career. Whether you're a veteran leader or just starting your journey, this episode is packed with insights that will inspire and empower you.

Learn more about the book:

https://www.ems-history.com/leadership-in-action

• Library of Congress Control Number: 2025901515

• ISBN: 979-8-9885254-5-5 (pbk. book)

• ISBN: 979-8-9885254-7-9 (hardback)

Contributing Authors: Zach Alvey; Alan Arguello; Jeanne-Marie Bakehouse; John Barrett; John Becknell; Maria Beermann-Foat; William J. Bullock, Daniel Burke; Sean Caffrey; Brandon Chambers; Gayan Chaturanga; Fred Claridge; John Clark; Bruce Evans; Leroy M. Garcia, Daniel Gerard; Shannon Gollnick; Kraig Kinney; Skip Kirkwood; Jon Krohmer; Douglas Kupas; Randy Lesher; Alex MacQuarrie; Gregg Margolis; Deb McDonald; Mike McEvoy; Asbel Montes; John Moon, Nitin Natarajan; Tad Rhodes; Justin Romanello; John Sammons; Joseph Schmider; Jay M. Scott; Randy Stair; Walt Stoy; Ryan Thorne; Joshua Tromp; Keith Wages; Moriah Washington; Roger White; Kenneth Williams; Doug Wolfberg; Dominique Wong; Donnie Woodyard, Jr.