October 5, 2025 • 36 mins
Episode 304: Welcome back to Medic2Medic. After a break, the podcast is back to share the stories of EMS and more. This week on Medic2Medic, I sit down with Steve Tafoya, a critical care paramedic and healthcare operations leader with over 25 years of EMS experience. Steve has worked at every level of the profession, from the back of an ambulance to the executive suite, and even as Nevada’s State EMS Program Manager, overseeing licensure, investigations, and standards for more than 60 agencies.
https://www.spreaker.com/episode/episode-304-steve-tafoya--68024317
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
https://www.spreaker.com/episode/episode-304-steve-tafoya--68024317
Medic2Medic is back, bringing authentic voices, untold stories, and the human side of Emergency Medical Services and beyond.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome back to Megadematic Podcasts after three hundred plus episodes
and almost three years away. I'm bringing the podcasts out
of retirement. Why because the stories of EMS never retire.
The podcast is where we shine the light on the
people who make emergency medical services what it is today. Paramedics, EMTs, physicians, educators, leaders,
(00:20):
and innovators, just to name a few. We'll share their stories,
lessons and experiences from the field and beyond. Whether you're
in EMS or just curious about the people behind the sirens,
Magnematic is here for you. Matematic is probably sponsored by
Magical Destinations by Steve, where your next vacation is not
just a trip, it is a story waiting to be told.
Whether it's Disney, a cruise, or a dream getaway across
(00:43):
the globe. Let Magical Destinations by Steve turn your travel
dreams into lasting memories. You can reach out to Magical
Destinations by Steve at s Cohen at Curated Travel Collection
dot com. Now let's get started and welcome to Medidematic Podcasting.
Speaker 2 (01:06):
Getting attention all listeners on this frequency stand by for.
Speaker 3 (01:11):
An important announcement.
Speaker 2 (01:14):
Welcome to medic to Medical podcast, the weekly podcast for
EMS providers, EMS leaders, EMS, medical directors and others involved
in or those who have an interest in emergency medical services.
Speaker 3 (01:27):
Ladies and gentlemen, here's your host, Steve.
Speaker 1 (01:29):
Cohen, coming from the Ferndale Megnematic Podcast Studios. That's right,
Megamatic is back. It's Steve Cohen bringing back the Medical
Metic Podcast. And of course you know I am the
host and I'm so happy to be back. I'm excited
(01:53):
to bring back this exciting podcast after being on hiatus
for about three years. By the quest for me to
bring it back, I said no, no, no, but now
I'm bringing it back and I hope you continue to listen.
And of course you can reach the host at Magnematic
Podcasts at gmail dot com. You can listen to this
(02:14):
podcast on many platforms including Apple podbeing Spotify as well
as it'll be on my Facebook page as well. So again,
welcome back today. I've got a guest who's emas career
spans just about every angle you can think about, from
clinical administrator, from the government side, and even legal. Steve
(02:35):
Tafoya is a critical care paramedic and healthcare operations leader
with over twenty five.
Speaker 3 (02:41):
Years of experience.
Speaker 1 (02:42):
He's done it all from emergency response and inter facility
transports of managing EMAS, licensure and investigations, and a lot
lot more. He also is a college educator, which I
always like talking to people about how they educate our
upcoming EMS providers. Do you want to know what EMS
looks like? Well, we're going to talk about it today
(03:04):
from the streets all the way to the State House.
This is a guy you want to talk to and
get to know. So Steve, welcome to Medical Metic Podcast.
Speaker 3 (03:12):
Thank you for having me. I appreciate that intro. Well.
Speaker 1 (03:16):
I always like to start my podcast as tell us
a little bit about yourself.
Speaker 3 (03:20):
Yeah. So I'm Steve Dafoya. I'm a critical par paramedic
and then.
Speaker 4 (03:24):
In EMS about twenty five years I actually started in
the Coast Guard. The Coast Guard sent me through EMT
school when I was a non rate still.
Speaker 3 (03:34):
And then I went to become a corman.
Speaker 4 (03:37):
And as a corman, I was fortunate where the Coast
Guard actually co sponsored me to go through full paramedic
school and I joined a at the time a mixed
service of a paid in volunteer service out of North
Carolina and learned a lot there and then from there
moved to Nevada, and then in Nevada had a handful
(03:58):
of different stuff, whether it was a flight, fixed weed
and then well taught at the local college here, ran
in the MS program at the college teaching stuff and
back in the day, and we did one of the
first like West Coast hybrid EMS programs for paramedic in
online and in person. And then I took over an
(04:18):
MS agency in the middle of the data and then
from there I saw that the EMS at the state
was kind of struggling and needed some guidance, so I
took over the EMS for the state, at which point
I was the regulatory authority for about sixty plus agencies
ground and.
Speaker 3 (04:35):
Air and the military as well here.
Speaker 4 (04:37):
From there, when I left the state, I did a
whole bunch of other side of businesses as well. So
we helped raise capital for businesses with the focus in healthcare,
so I helped companies one do consulting, but then to grow.
Speaker 3 (04:49):
Their businesses and look at other ways to bring in revenue.
Speaker 4 (04:53):
And from that I also did disaster response at that
time with the Federal Response Team. So I as a
medic and go out to the z asks and then
throughout all that, I've always been a you know, per
game group of care.
Speaker 3 (05:05):
And parmatics, still helping agencies now.
Speaker 4 (05:08):
The company I've work for now we really specialize in
the facility transfers. We're not really truly animin one system,
but we do a lot of rural hospital pickups and
take them to bigger hospitals, and then we take from
bigger hospitals to you know, notorious healthcare centers type of stuff.
Speaker 1 (05:25):
I got two follow up questions for you, Steve. One
is what you do the coast Guard? My boss is
retired coast guard too, That's how he got his start
as well. He talks about his coast guard days with
big smile on his face. So what do you do
the coast guard? As well as what you're you to ems?
Speaker 3 (05:44):
Yeah, so say what led me to the coast Guard?
Speaker 4 (05:46):
Yeah?
Speaker 1 (05:46):
What drew you to the coast Guard?
Speaker 4 (05:49):
I was a kid from La bodyboard even surfing my
whole life, and always saw the helicopters play over in
the boats. And even as a kid in high school,
I day handful of people out of the water that
were stuck in you know, rip tides and that, And
I mean I actually joined the Coast Guard in that
station up in Fort Brye, California, doing search and rescue.
(06:12):
Learned a lot there and that really started my EMS career.
There was I lived through a local VMT program in Order,
California and just loved it. And the parts that I
love the similarities between the Coast Guard and EMS is
you know, you don't know what's happening called a call.
It's not like you know other branches where you're constantly
training for war. You know, in the Coast Guard, you
know you might go out and respond to a boat fire.
(06:34):
The next one might be a medical, but now the
one might just be a person that means toad in.
And then obviously you have coaching and a whole bunch
of other weird drug in addiction and stuff like that.
So it's really interesting with the Coast Guard because you
learn this swath of information and you have to be
proficient at doing all those things. And you know, when
I started taking AMT courses, it fell when very similar
(06:55):
to that love of not knowing what's coming next and
meeting them for you know when where it could be.
And you know, I always choked at EMS call. You
don't know if you're going to go for you know,
to save somebody's life, or you're.
Speaker 3 (07:07):
Going to go tie somebody's shoes.
Speaker 4 (07:09):
And you know, all of us that have not been
on both sides of those calls, and you know those
calls that you're tying somebody's shoes for that patient is
just as important as some of the other stuff. So
that's really how come I'm felling in love with this profession.
Speaker 1 (07:24):
Do you remember your first EMS call outside the coast Guard?
Speaker 4 (07:28):
You know, the first call actually went on was actually
I remember my first ride along call that I went
on me too, Yeah, and it was in Pedalima, California,
and partner kind of through Santa Rosa there as well,
and you know, went on to a call and it
turned out to be a full on cardiac arrest, and
it was a family reunion as well, so Grandpa passed
(07:51):
away to family reunion in the backyard. And you know,
you know, sometimes you feel like you're dating yourself, but
this is still when you started CEP, and you really
only wanted to do it the whole way to the
hospital and then somebody took over for you. You were,
you know, not doing your job. So as the ride
along I remember, you know, doing a CPR in the
whole way, and my EMT class this was through the military,
(08:14):
so it was actually a condensed DMT class that was
two weeks.
Speaker 3 (08:16):
I already had my MT certification, but we still.
Speaker 4 (08:18):
Had to go through it as part of our training
to be a health service technician. And then when I
went through that.
Speaker 3 (08:24):
Call, I you know, got done and we went to the.
Speaker 4 (08:26):
Hospital there and it was still one of the few
times I actually saw the physician. They'd opened up her
chest and did everything, and you know, it's not one
thing that you see.
Speaker 3 (08:35):
Very often, so that was great.
Speaker 4 (08:36):
And I got to do you know, corrupt a massage,
chronic massage and everything and learned a ton and I
remember getting back in the rig and I actually ran
the call with the person in charge of the station actually,
and we get back in after.
Speaker 3 (08:49):
The call and we we kind of don't clean up yet.
Speaker 4 (08:53):
We're kind of cleaning up, and I remember still eating
a subway sandwich and the guy just looks at me
and he's like, I've never seen somebody just be so
calm after call and you know, just.
Speaker 3 (09:01):
Go back to eating. That's the first call, and you're like,
he's like, I think you might be cut out for this.
About that, that's pretty good.
Speaker 1 (09:09):
Was there a particular patient that just sticks in your
mind after you know, twenty plus years, twenty five plus
years being in the business, you know, yeah.
Speaker 3 (09:16):
It was. It was kind of weird. In the military,
I had a patient that stood out. So in the military,
as I.
Speaker 4 (09:22):
Moved up, I took iran an urgent care, a lab,
and the EMS system, and so I worked with a
few patients. And I remember one patient in particularly in
the clinical setting. We were helping her become an organ
donor for her brother that lived in a different states.
So we did a lot of stuff back and forth
(09:42):
with the hospitals and the transport teams there. So I
was running a lot of labs. She had the transport
successfully gave.
Speaker 3 (09:50):
You know, a kidney to her.
Speaker 4 (09:51):
Brother, and then you know, she invited over her house
for dinner and everything, and then about three months later,
reapaged out to her house and you know, so it's
just kind of one of those visceral responses and you know,
you know somebody and it's always a.
Speaker 3 (10:04):
Little bit harder. It was great because it had a great.
Speaker 4 (10:06):
Outcome and we were able to you know, keep in
touch and making sure that she had everything. You know,
there's you know, unfortunately we could do this enough to
you know, blending hut calls.
Speaker 3 (10:15):
They kind of just blend into one.
Speaker 4 (10:18):
But sometimes we're having those one on one impacts where
you know, somebody was kind of nice to have the
follow up and you see all those other parts there.
But yeah, it was great because it also you know,
had a good outcome, So it was the.
Speaker 1 (10:29):
Other part before we move on, Like, so you've been
in the business for a while, how would you describe
the EMS world when you started versus what it is today?
What are some of the differences?
Speaker 3 (10:41):
You know, that's a great question.
Speaker 4 (10:42):
So what I do now is I help a lot
of other businesses and consulting with so I do a
lot of stuff on that side.
Speaker 3 (10:48):
But with that so I see a lot.
Speaker 4 (10:49):
Of agencies and when I go back to the early
two thousands to now, you know, it feels like protocols changed,
but the overall mission of nine to one hasn't.
Speaker 3 (10:59):
And that's really where I help clients now today is
looking beyond nine one one.
Speaker 4 (11:04):
What you know, So in the matter, for example, when
I ran the state, we passed community para medicine and
when PIV Para medicine first started, it was very heavily
grant driven.
Speaker 3 (11:15):
Hey can we reduce hospital emissions and this is going
to fund this whole program, And that never really.
Speaker 4 (11:20):
Made sense to me from a point of view because
it's not sustainable because if you got more missions down,
and what's going to happen next, Like, how are you
going to keep that going? So what I really help
companies is trying to grow their businesses, and we're using
community para medicine is potentially the backbar.
Speaker 3 (11:35):
Or mobile integrated health depending on which state.
Speaker 4 (11:38):
You live in, and then we start looking at other
ways for them to generate revenue. So kind of beyond
nine one one calls what else is out there for
agencies to you know, keep this stuff. We hear so
many stories of you know, rural ams is struggling to
you know.
Speaker 3 (11:53):
Keep the lands on.
Speaker 4 (11:54):
Well, is that because you're only looking at one angle
of how to get breach patients and how to do stuff?
You know, when you think of about most healthcare organizations,
they pretty much start with a physician.
Speaker 3 (12:05):
And you know that is one part any MS we had.
Speaker 4 (12:08):
We have a physician, and when you think about a
hospital they have a physicians, and then they have a
lot of physician extenders, whether that's nurses, texts, whether that's
you know, story text lab technicians. They have a lot
of those parts. So I come in and I start
working with agencies to show how to utilize that physition
in a role that's different because to me, EMS I
feel like has become stagnant over time. You know, you
(12:31):
see innovation, but it's not innovation to grow. It's innovation
out of necessity. And I think of agencies and I
come across a lot of agencies and they don't think
they're innovative. But you know, if you would have told
me when I first started back in two thousand that
we would have had, you know, medics writing with SWAT
teams and other places, that's innovation and innovation came out
of necessity. Though they came out of you know, unfortunately
(12:53):
horrible events and people realize, hey, we need people closer.
Speaker 3 (12:57):
Doesn't mean that it wasn't.
Speaker 4 (12:57):
Innovative and it wasn't there and it's a central revenue
JIT stream as well. But that's kind of where I
think EMS has this opportunity to become more innovative. And
then when you see, you know, the regardless of political views,
the you know, big beautiful build you know, and the
Rural Innovation Grant or you know that has fifty billion
(13:18):
dollars in your mark for states, EMS is physically listed
as one of the places.
Speaker 3 (13:22):
To innovate and to think of new ways to do stuff.
You know. So when I go around and.
Speaker 4 (13:27):
I talk and I lecture and I view other stuff,
I really show people that, you know, EMS is beyond
my l There's so many and more opportunities now that
are out there, and this is a way to expand
and also it gives other people within the industry career
guirld I felt like that was one of the biggest
issues when I was in charge of was you know,
when I was educational officer pretty young in my career.
(13:50):
At the company I worked at, there was only two
roles above me. It was the ops chief and then
the chief. Right that was the only two places to progress.
Speaker 3 (13:58):
And you know, and if you.
Speaker 4 (14:01):
Got into a system and you know, at the time
of a person that was in charge, they were probably
only about seven years older than me, and that person
is still probably at that role today. So like the
odds of me and we're progressing in that one service
was limited. I feel like with this this gives more opportunities,
different avenues for people as well to expand their expand
(14:23):
this profession, but also expand their professional.
Speaker 1 (14:25):
It takes me to a different thought here when you
talk about the positions and some of the things that
have changed as well. How do you balance being you know,
go from a street medic or being a street medic
with having that systems and operations in your mind?
Speaker 3 (14:41):
Right?
Speaker 1 (14:42):
Do those two words ever clash in your head?
Speaker 4 (14:44):
For me, they're very synonymous because you know, in the MS,
we are taught, you know, a way to go down
an algorithm. Uh, you know, we still got to practice
and we still got to use our minds. A lot
of this stuff is if then then this, And that's
kind of when you're looking at syste and structures. When
I help companies on the business side, it's very similar.
You know, when you think about hiring a person onto
(15:06):
a staff, it's still a decision tree at the end
of the day, right, you go through the process, Hey,
we need to hire somebody.
Speaker 3 (15:11):
Well, we need to do a job hosting.
Speaker 4 (15:13):
You do the job hosting, you need to do interviews,
so and then you get the candidates.
Speaker 3 (15:17):
It and you start chatting them through.
Speaker 4 (15:18):
So for me, you know, the operation side system structure
becomes very similar because it is a lot of the
verbs might change, but the action is still really the same.
Speaker 1 (15:30):
You mentioned your first leadership position. Let's talk about that
first leadership position. You just kind of you mentioned that
just a few seconds ago, and pretty much on how
young you were. But it's your first leadership position. And
if you had a chance to go back and tell
your younger self, what changes or what would you do differently,
and talk a little bit about that experience.
Speaker 4 (15:51):
I took over my first agency when I was probably
I don't go by men like twenty nine in Ish
somewhere before there, and when I was in charge of
the state, I would have a lot of new people
that were taking over an agency for the first time,
and they would come and ask me questions, and they
would ask me this question all the time, like, hey,
I feel like i'd come up.
Speaker 3 (16:12):
From this part.
Speaker 4 (16:14):
What would you have to tell me from the other side?
And I think the answer, surprise is people. Most of
the time. What I tell people is chances are you
came up if you were in that operations chair and
then you progressed up and then you took over the
department or agency. And I would tell people that the
first thing that they want to do is they want
to go hire a great operation sheet because that's where
(16:35):
they were. And I feel like when I tell people
the place that you probably need to look at to
hire the most is the place that you're the weakest.
And most of the people when they looked at it, but
they were very weak at building. That is its own
subspecialty in this industry. And you know, if you can't
get good rebursement and codes are being denied and you're
not being able to get that, you're not going to
have in the great revenue that you're looking for. So
(16:58):
I would always tell people, you know, if I wish
I knew one thing from.
Speaker 3 (17:01):
When I first went back to that, you know, first day.
Speaker 4 (17:03):
On the job, that the most important person I needed
in my corner was an excellent builder.
Speaker 3 (17:08):
I needed that biller that could get everything done.
Speaker 4 (17:10):
Understand, you know, the chaos of you know, at the time,
you know, some agencies were still doing paper charts. Paper
charts are you know, epc rs and how to really
leverage that into the other parts. Chances are I could
survive as a person in charge with a weaker operations chief.
Speaker 3 (17:32):
Because I had that mob before.
Speaker 4 (17:34):
If I had to, you know, help in and step in,
that was the place that I could. I couldn't really
help and step in with billing because it was it's
complex and there's a lot of denial, and you don't
see how much denial there is because of a submission
or you know, you forgot to attach a physician statement,
you know, sheet to the document. So there's a lot
of resubmissions. So when I go back and tell people
(17:56):
that's just starting, you want to find that place where
you're the weakest and then.
Speaker 3 (18:00):
Go from there. The second thing I tell them.
Speaker 4 (18:02):
Is reread your state regulations. Most people never render regulations.
They might have read it when they were in the
MP school or paramedic school, and then you know, so
some classes, that's one of the things that's top is
why you get through certifications. But when you reread that
as a person in charge, that legislation sounds different. That
wore those regulations and administrative codes sound different because.
Speaker 3 (18:24):
Now you're no longer worrying about your own.
Speaker 4 (18:27):
You know, certificate, certification or licensure, depending on the state,
you're not really concerned about that anymore, but now you're
concerned that you might have a staff of thirty people,
and that reads different, like what requirements do I have
to do as the person in charge of the agency
and making sure all these people are compliant? And then two,
what do I have to do to renew my agency permit?
You know, so all of those things that they probably
(18:48):
never had to do before starts becoming a bigger part,
and the regulations really start to become a almost every
day piece of your life as a person in charge.
Speaker 1 (18:59):
Well, you, sarve Ems, program manager for Nevada? What led
you do that role? Why did you choose that role?
Talk about that a little bit with our listeners.
Speaker 4 (19:09):
Yeah, so, you know, the taking over the stadiums, It
was a job that I looked at as potential growth
because again, already being in charge of an agency, there
wasn't much else for me to do other than go
take over other agencies. And you know, so for me,
I thought about it from a long point of view
and luckily having great life and that's very supportive.
Speaker 3 (19:31):
And I told her, hey, I think that I can
help shape this industry.
Speaker 4 (19:35):
I think that I can do a lot, and then
I think we all know in the MS there's not
this great national voice that pushes everything down. A lot
of the stuff when you see is created at the
state level, and then through the National Association of the
mess Officials starts to push stuff up. And then so
I'm like, how can I have the greatest impact. And
(19:55):
at the time, you know, managing a station with about
thirty thirty five employees and you know, having a call
boying about you know, thirty five hundred a year, I
could impact those.
Speaker 3 (20:04):
Thirty five hundred patients. And that was kind of a limitation.
Speaker 4 (20:08):
When I look at the state Nevada has about two
million people. I realized I could have an impact on
about two million people and helping them have better health.
Speaker 3 (20:15):
Care throughout the industry or throughout the state.
Speaker 4 (20:17):
And then picturists, obviously in Nevada we have massive events.
You know, you think of Vegas and it's probably one
of the largest special events places.
Speaker 3 (20:24):
In the world.
Speaker 4 (20:25):
And then up north we have massive events like learning It,
you know, so it's the very unique events that we
were regulatory in charge of. So that opportunity came across.
And again it's one of those jobs that doesn't always
pop open, and I'm like, man, I got to try
for this. So I took that job and then you know,
kind of.
Speaker 3 (20:43):
Jumped right into legislation.
Speaker 4 (20:45):
So then we started drafting new bills bounce sponsors.
Speaker 3 (20:50):
Luckily, at the time there was a handful of.
Speaker 4 (20:51):
Agencies within the state that really were progressive nationally, not
just in the state, and they wanted to change the
system as well. So it was nice because we had
a lot of allies come together from fire ems, hospital associations,
real hospital associations that wanted to you know, get better
care out there. So it was great timing at the
(21:13):
time to really progress stuff. So and then we had
a handful of Assembly Assembly women and senators that were
prior doctors. We had a couple that were actually prior paramedics,
nurses and r.
Speaker 3 (21:27):
Nurses to really be helpful.
Speaker 4 (21:29):
So it was great because we had a great team
of people that could.
Speaker 3 (21:31):
Go through there. And at the time the governor.
Speaker 4 (21:34):
Was also very supportive, so it made a lot of
great headway to get changes in there and really impact
patient care, public health.
Speaker 1 (21:44):
And emergency medical services.
Speaker 3 (21:46):
Should they be.
Speaker 1 (21:46):
Linked at well, my thought is they should be linked.
I think we do a lot of public health and EMS.
There's only a certain percentage of our calls are true emergencies.
So we're I think we're doing public health on a
pretty regular basis. EMS is not as public health, but
what do you thinks fits in public health?
Speaker 4 (22:06):
So again back to the state. This was one of
the challenges. Is it seemed like every legislation session it
was where do we put EMS? Is it going to
live under the fire marshal, Is it going to live
under public safety? Is it going to live under Health
and Human Services, which in the.
Speaker 3 (22:19):
Matter had public health.
Speaker 4 (22:20):
And then when you look at all the states, So
when I went to the state legislator and I had
to show this every time, Like I said, this was
an every year bill almost and then then I found
out there was no money that we were revenue generating.
Speaker 3 (22:32):
It kind of to stop the conversation.
Speaker 4 (22:34):
But the fascinating part about it is we had to
do an analysis at the time of every state and
where EMS lived. And I was surprised because I always
want to stay is Illinois or Indiana? I can't remember
off the top of my head, but they were under
homeland security in their state. They weren't even underneath their
own part and I do think that there is a
public element piece here of public health. And again, when
(22:56):
you think back to a lot of state regulations. You know,
a lot of amps and paramedics can do amusations.
Speaker 3 (23:05):
You know they can do blood dross. There's a lot
more in there that they can do that or beyond
just that nine to one one calling in.
Speaker 4 (23:12):
So I think there are a lot of expanding roles
out there that can look into ways that we tie
back to public health beyond them. And again, if you're
a rural county or you know you're struggling for revenue,
it's also a great.
Speaker 3 (23:24):
Tie in because.
Speaker 4 (23:27):
That could be the other place where you're looking at
to generate the calls. And I mean that calls generate
revenue for your industry, because there are other ways out there,
and that's when you start looking at public health, whether
it's helping for mental health, you know, whether it's peer
response there. I was actually at a conference in Seattle
a couple of weeks ago for a Health Lot conference,
(23:48):
and it focuses on you know, really what how they
how they work hand in hand because public health, you know,
when you're seeing studies done and you're seeing ways to
improve healthcare. You know, somebody at the backyard legal site
has to help draft those, you know, get those approved
from the college boards.
Speaker 3 (24:04):
And all of those.
Speaker 4 (24:05):
And when I told them about what EMS could do,
most of those attorneys and other public health people was like, yeah,
we tried to reach out to EMS. We didn't get
an answer back. They were too busy they had this
other part. So I think there is this link that
public health is looking for, you know, partners and agencies
that are willing to partner out there, I think are
going to have a good advantage.
Speaker 1 (24:25):
Was there a mentor in your career that shaped your
clinical and leadership style.
Speaker 3 (24:30):
That's a great question. There is. Yeah, there's been about
three or four.
Speaker 4 (24:36):
I had a great medical director when I worked out
at Lizabeth City, North Carolina. Her name was or it
is still obviously doctor Planning. She was phenomenal out there
and she was great. She was very hands on medical director.
She would come to all the training, she was pretty
much at every meeting we had. It was nice because
it was not attached to the hospital, but our ambulance
(25:00):
were attached on the hospital.
Speaker 3 (25:01):
Property, so we could go over there.
Speaker 4 (25:04):
You know, she would call us over when there was
you know, intubations and you know difficult any sticks or
if there was codes, she would call us over and
be like, hey, guys, we have something going on. So
she was just super involved, great person as well.
Speaker 3 (25:19):
And then you know, when.
Speaker 4 (25:21):
I moved to the West Coast, one of my first
managers out here of his name is Steve. There was
Steve Town. He was great at what he did. He
was very he listened to a lot of the ideas.
So him and I worked on a plan on how
to introduce critical care of paramedics to our system as
they leave anything.
Speaker 3 (25:41):
So we didn't have it at the time.
Speaker 4 (25:43):
We were about sixty miles away from the trauma center,
and we had a rural hospital that we were you know,
taking most of our patients from her and stabilize and
then our crew would pretty much hang around and then transport.
Speaker 3 (25:53):
That patient to the trauma center.
Speaker 4 (25:56):
And we were looking at it, and I was telling him,
I'm like, hey, I think there's a way for us
to pay for critical and paramedics and do reinbursements and
everything else. You know, we can pretty much be that
even after about three calls. You know, there was a
lot of stuff at the time we could charge a
little bit better, and again being rules with the transports
and the mileage and everything else, there was a lot
(26:18):
of other ways to add that to get that bill
to a place. So we designed a critical care and
paramedic program out of that and it was, you know huge.
It was one of the you know, there was at
the time not a lot of ground places there. But
he was very instrumental in that and helping foster ideas.
So when I was at the State, I really used
a lot of those lessons learned there from you know, hey,
(26:40):
how can we look at other avenues?
Speaker 3 (26:42):
Who else has great ideas?
Speaker 4 (26:44):
And you know, sometimes it was junior people that were
stepping up and saying, hey, I came from this other
industry and this is what we did. You know, I
remember one person in a Love to Mata place. They
were like a former electrical like engineer type of person,
and they came up with like some ways to uh
improve their call system in that county. And you know,
(27:05):
if you were to tell somebody that this person initially
had no really in best experience and they were redesigning
a system, I think there would have been pushed back.
But because we're going to work with them, they were
able to improve their system.
Speaker 3 (27:16):
So that was that was very helpful.
Speaker 1 (27:17):
Those two mentors and other people in your life that
help you in your career. What do you do to
pay that forward? Because I know you're probably paying it
forward by your teaching and leading teams, But can you
talk a little bit about that and why how important
is to pay that forward? And I'll give just a
quick example. When I took my EMT course and Community
(27:40):
College of Alleghany County and Pittsburgh, my EMT instructor said
to us on the first day, always passed on your knowledge.
And I've been doing that ever since, so that still
sticks in my mind after all these years. So I'm
just curious what your thoughts on that are.
Speaker 4 (27:55):
You know, I love that kind of quote there that
that's a great way to look at Yeah, it's it's
a weird mixture because I teach people one on one,
so I get still running halls and you know, somebody
is sitting next to me. And again, we do some
long transfers, so I mean there's times that we transport
for seven hours in the back of the ring to
(28:16):
take somebody to like Stanford. So there's a lot of
times where we're taking them from a very rural hospital
to Stanford and they're with us, and so I do
a lot of one on one, you know, kind of
showing people how to do that, because it comes back
to textbooks. I think when we moved first start and
there's not a lot in the EMS textbooks that shows
how to care for somebody for seven hours.
Speaker 3 (28:34):
You know.
Speaker 4 (28:35):
Most of the stuff is designed how to be short
term and how to do that. So the other part
I do when I work with managers and directors a
lot is I show them about other avenues of MS.
Speaker 3 (28:45):
And again it comes back to regulations.
Speaker 4 (28:47):
When you look at community paar of medicine, it gives
you the opportunity to expand out. So I really tried
to pass my knowledge on in the way laws were
written and drafted and show them that one is allowed
and what isn't allowed. And that's where again back to
the public health question, all this other stuff of adding
service lines to providers. A lot of these people don't
(29:09):
haven't thought about this outside of this typical.
Speaker 3 (29:11):
Square nine to one one box of you call and.
Speaker 4 (29:14):
We show up and we take you to the hospital
and you know, and then that's where we start to
show people it is different. And you go back to
even one of your earlier questions about what's changed from
you know, the early two thousands.
Speaker 3 (29:28):
You know, there's states now.
Speaker 4 (29:30):
Where you can transport to uh you know, a free
stand in er, you can transport to an urging care.
Those things didn't exist when I first started, and you
had to take them to a hospital. And you know, again,
it came out of necessity. This wasn't it was still innovation,
but it came out of necessity. And that's where I
want to show. And I get back to a lot
of the people when I talk to them, is think
(29:50):
about again that's different. Don't think about this is the
only way it has to be done. And again with
limited promotion and other stuff within the departments, a lot
of these people they don't see other agencies. You know,
you mentioned before that you were in North Carolina, Pittsburgh,
you know, Washington. You've seen a lot of different agencies.
There's a lot of people that I know, you know,
(30:11):
they don't want to move out of their zip code
and there might be one or two ambulances in that
region and they just worked in that system their whole life,
and they don't think about like.
Speaker 3 (30:19):
Other ways to innovate in other ways to go.
Speaker 4 (30:21):
So that's where I really try to get back because
I try to meet with clients and I try to
meet with agencies and try to show them ways to
grow their business.
Speaker 1 (30:30):
A couple closing questions for you before we wrap it up.
Besides the billing component, which I know you're an expert in,
if you could fix one thing in EMS tomorrow with
just a snap of your fingers, whether it could be
pay recognition or whatever, you think, what would it be?
And why?
Speaker 3 (30:49):
Oh man, But it's a phenomenal question. You know. This
probably goes back to my educational side.
Speaker 4 (30:54):
But I would say educational standards we are when I
meet with clients and legislators and other people that are.
Speaker 3 (31:03):
You know, cutting checks and that type of stuff. Is
EMS has been taught one way, you know, getting back
to the textbook.
Speaker 4 (31:09):
It's taught for how to respond to a nine one
one call. It's not taught how to do long business transfers.
It's not really taught how to do all this other
community pair of medicine options and mobile integrated health. So
I think that the programming, if I had to go
back and change one thing, was how to educate people
from the e MT level of differently that nine to
(31:31):
one one is just a component of being that role
as an EMT. You know, we see tons of providers
now working as you know, warehouse medics.
Speaker 3 (31:39):
I just use the love of medics. That's usually how
the title goes. But it could be EMTs, it could
be AMTS, it could be whatever.
Speaker 4 (31:45):
But we see these roles now where people are not
working on a rig. You see so many people working
at warehouses, special events, not attached to an ambulance company.
Speaker 3 (31:55):
And you know, there are tons of these positions throughout
the country.
Speaker 4 (31:59):
Where they're doing patrol, doing all these things that are
not tied to a rig.
Speaker 3 (32:03):
But yet everything we're todd is tied to a rig.
Speaker 4 (32:06):
So that was the one part where I would change
right now is getting where and I quit ems a
lot back to If you think back to nursing and
the nineteen hundreds, you only think of nurses working in
the hospital. You know, I literally I was at a
different conference last week and there was literally a place.
Speaker 3 (32:25):
That had in Chicago that had a sign that said.
Speaker 4 (32:31):
Ear piercing only done by nurses. You know, so this
this whole place was you know, I remember not myself.
I remember growing up and there was like that Clayre's
small place that they.
Speaker 3 (32:42):
Would pierce your ears.
Speaker 4 (32:43):
I'd hear like all these horror stories. This company said, hey,
we have nurses, we are good at sticking people with needles.
We're going to start a business and our main tagline
is going to be all of our staff has nurses.
Speaker 3 (32:54):
If you were to told that, if you were to tell.
Speaker 4 (32:56):
That nineteen hundreds nurse that down the road, you know,
health spas and all these other things are going to
exist for nursing opportunities.
Speaker 3 (33:04):
They would have laughed at you. And that's kind of
where I see EMS is.
Speaker 4 (33:08):
EMS is this place where we have this amazing skill
set of providers out there and we are forcing them
into one box. And again, if you go back to
physician extenders, we have a lot of options to do
other things, other ways to expand the industry. Still provide
the nine one one care, but also provide other revenue
streams for agencies.
Speaker 1 (33:28):
Steve, before we close out, tell us a little bit
more about what you do as a consultant and how
you do that and if people want to get in
touch with you, how would they be able to do that?
Speaker 3 (33:38):
Yeah, thank you for that.
Speaker 4 (33:39):
I have a company called battle Board Advising, and basically
with that I help ems companies look to add service lines.
That's really where I focus, and I look at a
lot of the regulations behind each state showing what you
can do.
Speaker 3 (33:53):
And again, the service line doesn't have to.
Speaker 4 (33:55):
Be something that produces when in some agencies it's again
it's bringing on that tactic.
Speaker 3 (33:58):
Holy MS side.
Speaker 4 (34:00):
What are the legalities of adding a tactical only INSS side.
I also have a Master's of Law degree from Arizona State,
so I really tie in a lot of the legal
side of it.
Speaker 3 (34:12):
I don't for my legal advice.
Speaker 4 (34:13):
I'm in a turn, but I really look at the
regulations and then I help agencies expand their service lines.
Speaker 3 (34:21):
I said to the other part is agencies need money.
Speaker 4 (34:24):
I also help agencies look at ways to use capital
and collateralize stuff for hard money lending, potentially grants, other places.
A lot of these agencies they have a generated income,
and when you're looking to go out and do private financing,
private equity, they're looking for a return revenue and be
a mester kind of already built in where you have
(34:44):
revenue pretty much guaranteed and might take time to get
paid for.
Speaker 3 (34:48):
Payers, but it's a model. It shows where you're.
Speaker 4 (34:51):
Going, it's where you're at, so it does have a
place to where that comes in. So I tie my
business degree side and start helping them grow avenues for
them to expand out their business. But you know, it
all starts, you know, with looking at somebody who wants
to find other ways to you know, keep the lights on.
Speaker 3 (35:10):
And then we have other agencies.
Speaker 4 (35:11):
They're massive and they want to grow and they want
to expand and take over other territories. So it's looking
at each agency and what they're objective is coming up
with the plan to support that and making sure that
the that the regulations.
Speaker 3 (35:26):
Allow for it.
Speaker 1 (35:27):
How can people reach you, they.
Speaker 4 (35:29):
Think, we're thinking my website at battle Born advising they
can look for me on LinkedIn at Steve Tafoya as well.
Speaker 3 (35:37):
And yeah, I appreciate everybody listening.
Speaker 1 (35:40):
Well, Steve, I want to thank you for joining me
back on my podcast. Glad to have you, Glad to
meet you.
Speaker 3 (35:47):
Yeah, I appreciate the time, and you know, I'm glad
that you restarted this. I always feel that, you know,
people want to listen and people want to learn people
want to see stuff, so I'm.
Speaker 4 (35:55):
Grateful for yourself to restart this and hopefully it makes
you energize jan supporting as well.
Speaker 1 (36:05):
Thanks for joining me on the podcast. Remember this podcast
was sponsored by Magical Destinations by Steve. You can reach
Magical Destinations by Steve Scohen at Creative travel Collection dot com.
Join me next time on Medical Metic podcast
Welcome back to Megadematic Podcasts after three hundred plus episodes
and almost three years away. I'm bringing the podcasts out
of retirement. Why because the stories of EMS never retire.
The podcast is where we shine the light on the
people who make emergency medical services what it is today. Paramedics, EMTs, physicians, educators, leaders,
(00:20):
and innovators, just to name a few. We'll share their stories,
lessons and experiences from the field and beyond. Whether you're
in EMS or just curious about the people behind the sirens,
Magnematic is here for you. Matematic is probably sponsored by
Magical Destinations by Steve, where your next vacation is not
just a trip, it is a story waiting to be told.
Whether it's Disney, a cruise, or a dream getaway across
(00:43):
the globe. Let Magical Destinations by Steve turn your travel
dreams into lasting memories. You can reach out to Magical
Destinations by Steve at s Cohen at Curated Travel Collection
dot com. Now let's get started and welcome to Medidematic Podcasting.
Speaker 2 (01:06):
Getting attention all listeners on this frequency stand by for.
Speaker 3 (01:11):
An important announcement.
Speaker 2 (01:14):
Welcome to medic to Medical podcast, the weekly podcast for
EMS providers, EMS leaders, EMS, medical directors and others involved
in or those who have an interest in emergency medical services.
Speaker 3 (01:27):
Ladies and gentlemen, here's your host, Steve.
Speaker 1 (01:29):
Cohen, coming from the Ferndale Megnematic Podcast Studios. That's right,
Megamatic is back. It's Steve Cohen bringing back the Medical
Metic Podcast. And of course you know I am the
host and I'm so happy to be back. I'm excited
(01:53):
to bring back this exciting podcast after being on hiatus
for about three years. By the quest for me to
bring it back, I said no, no, no, but now
I'm bringing it back and I hope you continue to listen.
And of course you can reach the host at Magnematic
Podcasts at gmail dot com. You can listen to this
(02:14):
podcast on many platforms including Apple podbeing Spotify as well
as it'll be on my Facebook page as well. So again,
welcome back today. I've got a guest who's emas career
spans just about every angle you can think about, from
clinical administrator, from the government side, and even legal. Steve
(02:35):
Tafoya is a critical care paramedic and healthcare operations leader
with over twenty five.
Speaker 3 (02:41):
Years of experience.
Speaker 1 (02:42):
He's done it all from emergency response and inter facility
transports of managing EMAS, licensure and investigations, and a lot
lot more. He also is a college educator, which I
always like talking to people about how they educate our
upcoming EMS providers. Do you want to know what EMS
looks like? Well, we're going to talk about it today
(03:04):
from the streets all the way to the State House.
This is a guy you want to talk to and
get to know. So Steve, welcome to Medical Metic Podcast.
Speaker 3 (03:12):
Thank you for having me. I appreciate that intro. Well.
Speaker 1 (03:16):
I always like to start my podcast as tell us
a little bit about yourself.
Speaker 3 (03:20):
Yeah. So I'm Steve Dafoya. I'm a critical par paramedic
and then.
Speaker 4 (03:24):
In EMS about twenty five years I actually started in
the Coast Guard. The Coast Guard sent me through EMT
school when I was a non rate still.
Speaker 3 (03:34):
And then I went to become a corman.
Speaker 4 (03:37):
And as a corman, I was fortunate where the Coast
Guard actually co sponsored me to go through full paramedic
school and I joined a at the time a mixed
service of a paid in volunteer service out of North
Carolina and learned a lot there and then from there
moved to Nevada, and then in Nevada had a handful
(03:58):
of different stuff, whether it was a flight, fixed weed
and then well taught at the local college here, ran
in the MS program at the college teaching stuff and
back in the day, and we did one of the
first like West Coast hybrid EMS programs for paramedic in
online and in person. And then I took over an
(04:18):
MS agency in the middle of the data and then
from there I saw that the EMS at the state
was kind of struggling and needed some guidance, so I
took over the EMS for the state, at which point
I was the regulatory authority for about sixty plus agencies
ground and.
Speaker 3 (04:35):
Air and the military as well here.
Speaker 4 (04:37):
From there, when I left the state, I did a
whole bunch of other side of businesses as well. So
we helped raise capital for businesses with the focus in healthcare,
so I helped companies one do consulting, but then to grow.
Speaker 3 (04:49):
Their businesses and look at other ways to bring in revenue.
Speaker 4 (04:53):
And from that I also did disaster response at that
time with the Federal Response Team. So I as a
medic and go out to the z asks and then
throughout all that, I've always been a you know, per
game group of care.
Speaker 3 (05:05):
And parmatics, still helping agencies now.
Speaker 4 (05:08):
The company I've work for now we really specialize in
the facility transfers. We're not really truly animin one system,
but we do a lot of rural hospital pickups and
take them to bigger hospitals, and then we take from
bigger hospitals to you know, notorious healthcare centers type of stuff.
Speaker 1 (05:25):
I got two follow up questions for you, Steve. One
is what you do the coast Guard? My boss is
retired coast guard too, That's how he got his start
as well. He talks about his coast guard days with
big smile on his face. So what do you do
the coast guard? As well as what you're you to ems?
Speaker 3 (05:44):
Yeah, so say what led me to the coast Guard?
Speaker 4 (05:46):
Yeah?
Speaker 1 (05:46):
What drew you to the coast Guard?
Speaker 4 (05:49):
I was a kid from La bodyboard even surfing my
whole life, and always saw the helicopters play over in
the boats. And even as a kid in high school,
I day handful of people out of the water that
were stuck in you know, rip tides and that, And
I mean I actually joined the Coast Guard in that
station up in Fort Brye, California, doing search and rescue.
(06:12):
Learned a lot there and that really started my EMS career.
There was I lived through a local VMT program in Order,
California and just loved it. And the parts that I
love the similarities between the Coast Guard and EMS is
you know, you don't know what's happening called a call.
It's not like you know other branches where you're constantly
training for war. You know, in the Coast Guard, you
know you might go out and respond to a boat fire.
(06:34):
The next one might be a medical, but now the
one might just be a person that means toad in.
And then obviously you have coaching and a whole bunch
of other weird drug in addiction and stuff like that.
So it's really interesting with the Coast Guard because you
learn this swath of information and you have to be
proficient at doing all those things. And you know, when
I started taking AMT courses, it fell when very similar
(06:55):
to that love of not knowing what's coming next and
meeting them for you know when where it could be.
And you know, I always choked at EMS call. You
don't know if you're going to go for you know,
to save somebody's life, or you're.
Speaker 3 (07:07):
Going to go tie somebody's shoes.
Speaker 4 (07:09):
And you know, all of us that have not been
on both sides of those calls, and you know those
calls that you're tying somebody's shoes for that patient is
just as important as some of the other stuff. So
that's really how come I'm felling in love with this profession.
Speaker 1 (07:24):
Do you remember your first EMS call outside the coast Guard?
Speaker 4 (07:28):
You know, the first call actually went on was actually
I remember my first ride along call that I went
on me too, Yeah, and it was in Pedalima, California,
and partner kind of through Santa Rosa there as well,
and you know, went on to a call and it
turned out to be a full on cardiac arrest, and
it was a family reunion as well, so Grandpa passed
(07:51):
away to family reunion in the backyard. And you know,
you know, sometimes you feel like you're dating yourself, but
this is still when you started CEP, and you really
only wanted to do it the whole way to the
hospital and then somebody took over for you. You were,
you know, not doing your job. So as the ride
along I remember, you know, doing a CPR in the
whole way, and my EMT class this was through the military,
(08:14):
so it was actually a condensed DMT class that was
two weeks.
Speaker 3 (08:16):
I already had my MT certification, but we still.
Speaker 4 (08:18):
Had to go through it as part of our training
to be a health service technician. And then when I
went through that.
Speaker 3 (08:24):
Call, I you know, got done and we went to the.
Speaker 4 (08:26):
Hospital there and it was still one of the few
times I actually saw the physician. They'd opened up her
chest and did everything, and you know, it's not one
thing that you see.
Speaker 3 (08:35):
Very often, so that was great.
Speaker 4 (08:36):
And I got to do you know, corrupt a massage,
chronic massage and everything and learned a ton and I
remember getting back in the rig and I actually ran
the call with the person in charge of the station actually,
and we get back in after.
Speaker 3 (08:49):
The call and we we kind of don't clean up yet.
Speaker 4 (08:53):
We're kind of cleaning up, and I remember still eating
a subway sandwich and the guy just looks at me
and he's like, I've never seen somebody just be so
calm after call and you know, just.
Speaker 3 (09:01):
Go back to eating. That's the first call, and you're like,
he's like, I think you might be cut out for this.
About that, that's pretty good.
Speaker 1 (09:09):
Was there a particular patient that just sticks in your
mind after you know, twenty plus years, twenty five plus
years being in the business, you know, yeah.
Speaker 3 (09:16):
It was. It was kind of weird. In the military,
I had a patient that stood out. So in the military,
as I.
Speaker 4 (09:22):
Moved up, I took iran an urgent care, a lab,
and the EMS system, and so I worked with a
few patients. And I remember one patient in particularly in
the clinical setting. We were helping her become an organ
donor for her brother that lived in a different states.
So we did a lot of stuff back and forth
(09:42):
with the hospitals and the transport teams there. So I
was running a lot of labs. She had the transport
successfully gave.
Speaker 3 (09:50):
You know, a kidney to her.
Speaker 4 (09:51):
Brother, and then you know, she invited over her house
for dinner and everything, and then about three months later,
reapaged out to her house and you know, so it's
just kind of one of those visceral responses and you know,
you know somebody and it's always a.
Speaker 3 (10:04):
Little bit harder. It was great because it had a great.
Speaker 4 (10:06):
Outcome and we were able to you know, keep in
touch and making sure that she had everything. You know,
there's you know, unfortunately we could do this enough to
you know, blending hut calls.
Speaker 3 (10:15):
They kind of just blend into one.
Speaker 4 (10:18):
But sometimes we're having those one on one impacts where
you know, somebody was kind of nice to have the
follow up and you see all those other parts there.
But yeah, it was great because it also you know,
had a good outcome, So it was the.
Speaker 1 (10:29):
Other part before we move on, Like, so you've been
in the business for a while, how would you describe
the EMS world when you started versus what it is today?
What are some of the differences?
Speaker 3 (10:41):
You know, that's a great question.
Speaker 4 (10:42):
So what I do now is I help a lot
of other businesses and consulting with so I do a
lot of stuff on that side.
Speaker 3 (10:48):
But with that so I see a lot.
Speaker 4 (10:49):
Of agencies and when I go back to the early
two thousands to now, you know, it feels like protocols changed,
but the overall mission of nine to one hasn't.
Speaker 3 (10:59):
And that's really where I help clients now today is
looking beyond nine one one.
Speaker 4 (11:04):
What you know, So in the matter, for example, when
I ran the state, we passed community para medicine and
when PIV Para medicine first started, it was very heavily
grant driven.
Speaker 3 (11:15):
Hey can we reduce hospital emissions and this is going
to fund this whole program, And that never really.
Speaker 4 (11:20):
Made sense to me from a point of view because
it's not sustainable because if you got more missions down,
and what's going to happen next, Like, how are you
going to keep that going? So what I really help
companies is trying to grow their businesses, and we're using
community para medicine is potentially the backbar.
Speaker 3 (11:35):
Or mobile integrated health depending on which state.
Speaker 4 (11:38):
You live in, and then we start looking at other
ways for them to generate revenue. So kind of beyond
nine one one calls what else is out there for
agencies to you know, keep this stuff. We hear so
many stories of you know, rural ams is struggling to
you know.
Speaker 3 (11:53):
Keep the lands on.
Speaker 4 (11:54):
Well, is that because you're only looking at one angle
of how to get breach patients and how to do stuff?
You know, when you think of about most healthcare organizations,
they pretty much start with a physician.
Speaker 3 (12:05):
And you know that is one part any MS we had.
Speaker 4 (12:08):
We have a physician, and when you think about a
hospital they have a physicians, and then they have a
lot of physician extenders, whether that's nurses, texts, whether that's
you know, story text lab technicians. They have a lot
of those parts. So I come in and I start
working with agencies to show how to utilize that physition
in a role that's different because to me, EMS I
feel like has become stagnant over time. You know, you
(12:31):
see innovation, but it's not innovation to grow. It's innovation
out of necessity. And I think of agencies and I
come across a lot of agencies and they don't think
they're innovative. But you know, if you would have told
me when I first started back in two thousand that
we would have had, you know, medics writing with SWAT
teams and other places, that's innovation and innovation came out
of necessity. Though they came out of you know, unfortunately
(12:53):
horrible events and people realize, hey, we need people closer.
Speaker 3 (12:57):
Doesn't mean that it wasn't.
Speaker 4 (12:57):
Innovative and it wasn't there and it's a central revenue
JIT stream as well. But that's kind of where I
think EMS has this opportunity to become more innovative. And
then when you see, you know, the regardless of political views,
the you know, big beautiful build you know, and the
Rural Innovation Grant or you know that has fifty billion
(13:18):
dollars in your mark for states, EMS is physically listed
as one of the places.
Speaker 3 (13:22):
To innovate and to think of new ways to do stuff.
You know. So when I go around and.
Speaker 4 (13:27):
I talk and I lecture and I view other stuff,
I really show people that, you know, EMS is beyond
my l There's so many and more opportunities now that
are out there, and this is a way to expand
and also it gives other people within the industry career
guirld I felt like that was one of the biggest
issues when I was in charge of was you know,
when I was educational officer pretty young in my career.
(13:50):
At the company I worked at, there was only two
roles above me. It was the ops chief and then
the chief. Right that was the only two places to progress.
Speaker 3 (13:58):
And you know, and if you.
Speaker 4 (14:01):
Got into a system and you know, at the time
of a person that was in charge, they were probably
only about seven years older than me, and that person
is still probably at that role today. So like the
odds of me and we're progressing in that one service
was limited. I feel like with this this gives more opportunities,
different avenues for people as well to expand their expand
(14:23):
this profession, but also expand their professional.
Speaker 1 (14:25):
It takes me to a different thought here when you
talk about the positions and some of the things that
have changed as well. How do you balance being you know,
go from a street medic or being a street medic
with having that systems and operations in your mind?
Speaker 3 (14:41):
Right?
Speaker 1 (14:42):
Do those two words ever clash in your head?
Speaker 4 (14:44):
For me, they're very synonymous because you know, in the MS,
we are taught, you know, a way to go down
an algorithm. Uh, you know, we still got to practice
and we still got to use our minds. A lot
of this stuff is if then then this, And that's
kind of when you're looking at syste and structures. When
I help companies on the business side, it's very similar.
You know, when you think about hiring a person onto
(15:06):
a staff, it's still a decision tree at the end
of the day, right, you go through the process, Hey,
we need to hire somebody.
Speaker 3 (15:11):
Well, we need to do a job hosting.
Speaker 4 (15:13):
You do the job hosting, you need to do interviews,
so and then you get the candidates.
Speaker 3 (15:17):
It and you start chatting them through.
Speaker 4 (15:18):
So for me, you know, the operation side system structure
becomes very similar because it is a lot of the
verbs might change, but the action is still really the same.
Speaker 1 (15:30):
You mentioned your first leadership position. Let's talk about that
first leadership position. You just kind of you mentioned that
just a few seconds ago, and pretty much on how
young you were. But it's your first leadership position. And
if you had a chance to go back and tell
your younger self, what changes or what would you do differently,
and talk a little bit about that experience.
Speaker 4 (15:51):
I took over my first agency when I was probably
I don't go by men like twenty nine in Ish
somewhere before there, and when I was in charge of
the state, I would have a lot of new people
that were taking over an agency for the first time,
and they would come and ask me questions, and they
would ask me this question all the time, like, hey,
I feel like i'd come up.
Speaker 3 (16:12):
From this part.
Speaker 4 (16:14):
What would you have to tell me from the other side?
And I think the answer, surprise is people. Most of
the time. What I tell people is chances are you
came up if you were in that operations chair and
then you progressed up and then you took over the
department or agency. And I would tell people that the
first thing that they want to do is they want
to go hire a great operation sheet because that's where
(16:35):
they were. And I feel like when I tell people
the place that you probably need to look at to
hire the most is the place that you're the weakest.
And most of the people when they looked at it, but
they were very weak at building. That is its own
subspecialty in this industry. And you know, if you can't
get good rebursement and codes are being denied and you're
not being able to get that, you're not going to
have in the great revenue that you're looking for. So
(16:58):
I would always tell people, you know, if I wish
I knew one thing from.
Speaker 3 (17:01):
When I first went back to that, you know, first day.
Speaker 4 (17:03):
On the job, that the most important person I needed
in my corner was an excellent builder.
Speaker 3 (17:08):
I needed that biller that could get everything done.
Speaker 4 (17:10):
Understand, you know, the chaos of you know, at the time,
you know, some agencies were still doing paper charts. Paper
charts are you know, epc rs and how to really
leverage that into the other parts. Chances are I could
survive as a person in charge with a weaker operations chief.
Speaker 3 (17:32):
Because I had that mob before.
Speaker 4 (17:34):
If I had to, you know, help in and step in,
that was the place that I could. I couldn't really
help and step in with billing because it was it's
complex and there's a lot of denial, and you don't
see how much denial there is because of a submission
or you know, you forgot to attach a physician statement,
you know, sheet to the document. So there's a lot
of resubmissions. So when I go back and tell people
(17:56):
that's just starting, you want to find that place where
you're the weakest and then.
Speaker 3 (18:00):
Go from there. The second thing I tell them.
Speaker 4 (18:02):
Is reread your state regulations. Most people never render regulations.
They might have read it when they were in the
MP school or paramedic school, and then you know, so
some classes, that's one of the things that's top is
why you get through certifications. But when you reread that
as a person in charge, that legislation sounds different. That
wore those regulations and administrative codes sound different because.
Speaker 3 (18:24):
Now you're no longer worrying about your own.
Speaker 4 (18:27):
You know, certificate, certification or licensure, depending on the state,
you're not really concerned about that anymore, but now you're
concerned that you might have a staff of thirty people,
and that reads different, like what requirements do I have
to do as the person in charge of the agency
and making sure all these people are compliant? And then two,
what do I have to do to renew my agency permit?
You know, so all of those things that they probably
(18:48):
never had to do before starts becoming a bigger part,
and the regulations really start to become a almost every
day piece of your life as a person in charge.
Speaker 1 (18:59):
Well, you, sarve Ems, program manager for Nevada? What led
you do that role? Why did you choose that role?
Talk about that a little bit with our listeners.
Speaker 4 (19:09):
Yeah, so, you know, the taking over the stadiums, It
was a job that I looked at as potential growth
because again, already being in charge of an agency, there
wasn't much else for me to do other than go
take over other agencies. And you know, so for me,
I thought about it from a long point of view
and luckily having great life and that's very supportive.
Speaker 3 (19:31):
And I told her, hey, I think that I can
help shape this industry.
Speaker 4 (19:35):
I think that I can do a lot, and then
I think we all know in the MS there's not
this great national voice that pushes everything down. A lot
of the stuff when you see is created at the
state level, and then through the National Association of the
mess Officials starts to push stuff up. And then so
I'm like, how can I have the greatest impact. And
(19:55):
at the time, you know, managing a station with about
thirty thirty five employees and you know, having a call
boying about you know, thirty five hundred a year, I
could impact those.
Speaker 3 (20:04):
Thirty five hundred patients. And that was kind of a limitation.
Speaker 4 (20:08):
When I look at the state Nevada has about two
million people. I realized I could have an impact on
about two million people and helping them have better health.
Speaker 3 (20:15):
Care throughout the industry or throughout the state.
Speaker 4 (20:17):
And then picturists, obviously in Nevada we have massive events.
You know, you think of Vegas and it's probably one
of the largest special events places.
Speaker 3 (20:24):
In the world.
Speaker 4 (20:25):
And then up north we have massive events like learning It,
you know, so it's the very unique events that we
were regulatory in charge of. So that opportunity came across.
And again it's one of those jobs that doesn't always
pop open, and I'm like, man, I got to try
for this. So I took that job and then you know,
kind of.
Speaker 3 (20:43):
Jumped right into legislation.
Speaker 4 (20:45):
So then we started drafting new bills bounce sponsors.
Speaker 3 (20:50):
Luckily, at the time there was a handful of.
Speaker 4 (20:51):
Agencies within the state that really were progressive nationally, not
just in the state, and they wanted to change the
system as well. So it was nice because we had
a lot of allies come together from fire ems, hospital associations,
real hospital associations that wanted to you know, get better
care out there. So it was great timing at the
(21:13):
time to really progress stuff. So and then we had
a handful of Assembly Assembly women and senators that were
prior doctors. We had a couple that were actually prior paramedics,
nurses and r.
Speaker 3 (21:27):
Nurses to really be helpful.
Speaker 4 (21:29):
So it was great because we had a great team
of people that could.
Speaker 3 (21:31):
Go through there. And at the time the governor.
Speaker 4 (21:34):
Was also very supportive, so it made a lot of
great headway to get changes in there and really impact
patient care, public health.
Speaker 1 (21:44):
And emergency medical services.
Speaker 3 (21:46):
Should they be.
Speaker 1 (21:46):
Linked at well, my thought is they should be linked.
I think we do a lot of public health and EMS.
There's only a certain percentage of our calls are true emergencies.
So we're I think we're doing public health on a
pretty regular basis. EMS is not as public health, but
what do you thinks fits in public health?
Speaker 4 (22:06):
So again back to the state. This was one of
the challenges. Is it seemed like every legislation session it
was where do we put EMS? Is it going to
live under the fire marshal, Is it going to live
under public safety? Is it going to live under Health
and Human Services, which in the.
Speaker 3 (22:19):
Matter had public health.
Speaker 4 (22:20):
And then when you look at all the states, So
when I went to the state legislator and I had
to show this every time, Like I said, this was
an every year bill almost and then then I found
out there was no money that we were revenue generating.
Speaker 3 (22:32):
It kind of to stop the conversation.
Speaker 4 (22:34):
But the fascinating part about it is we had to
do an analysis at the time of every state and
where EMS lived. And I was surprised because I always
want to stay is Illinois or Indiana? I can't remember
off the top of my head, but they were under
homeland security in their state. They weren't even underneath their
own part and I do think that there is a
public element piece here of public health. And again, when
(22:56):
you think back to a lot of state regulations. You know,
a lot of amps and paramedics can do amusations.
Speaker 3 (23:05):
You know they can do blood dross. There's a lot
more in there that they can do that or beyond
just that nine to one one calling in.
Speaker 4 (23:12):
So I think there are a lot of expanding roles
out there that can look into ways that we tie
back to public health beyond them. And again, if you're
a rural county or you know you're struggling for revenue,
it's also a great.
Speaker 3 (23:24):
Tie in because.
Speaker 4 (23:27):
That could be the other place where you're looking at
to generate the calls. And I mean that calls generate
revenue for your industry, because there are other ways out there,
and that's when you start looking at public health, whether
it's helping for mental health, you know, whether it's peer
response there. I was actually at a conference in Seattle
a couple of weeks ago for a Health Lot conference,
(23:48):
and it focuses on you know, really what how they
how they work hand in hand because public health, you know,
when you're seeing studies done and you're seeing ways to
improve healthcare. You know, somebody at the backyard legal site
has to help draft those, you know, get those approved
from the college boards.
Speaker 3 (24:04):
And all of those.
Speaker 4 (24:05):
And when I told them about what EMS could do,
most of those attorneys and other public health people was like, yeah,
we tried to reach out to EMS. We didn't get
an answer back. They were too busy they had this
other part. So I think there is this link that
public health is looking for, you know, partners and agencies
that are willing to partner out there, I think are
going to have a good advantage.
Speaker 1 (24:25):
Was there a mentor in your career that shaped your
clinical and leadership style.
Speaker 3 (24:30):
That's a great question. There is. Yeah, there's been about
three or four.
Speaker 4 (24:36):
I had a great medical director when I worked out
at Lizabeth City, North Carolina. Her name was or it
is still obviously doctor Planning. She was phenomenal out there
and she was great. She was very hands on medical director.
She would come to all the training, she was pretty
much at every meeting we had. It was nice because
it was not attached to the hospital, but our ambulance
(25:00):
were attached on the hospital.
Speaker 3 (25:01):
Property, so we could go over there.
Speaker 4 (25:04):
You know, she would call us over when there was
you know, intubations and you know difficult any sticks or
if there was codes, she would call us over and
be like, hey, guys, we have something going on. So
she was just super involved, great person as well.
Speaker 3 (25:19):
And then you know, when.
Speaker 4 (25:21):
I moved to the West Coast, one of my first
managers out here of his name is Steve. There was
Steve Town. He was great at what he did. He
was very he listened to a lot of the ideas.
So him and I worked on a plan on how
to introduce critical care of paramedics to our system as
they leave anything.
Speaker 3 (25:41):
So we didn't have it at the time.
Speaker 4 (25:43):
We were about sixty miles away from the trauma center,
and we had a rural hospital that we were you know,
taking most of our patients from her and stabilize and
then our crew would pretty much hang around and then transport.
Speaker 3 (25:53):
That patient to the trauma center.
Speaker 4 (25:56):
And we were looking at it, and I was telling him,
I'm like, hey, I think there's a way for us
to pay for critical and paramedics and do reinbursements and
everything else. You know, we can pretty much be that
even after about three calls. You know, there was a
lot of stuff at the time we could charge a
little bit better, and again being rules with the transports
and the mileage and everything else, there was a lot
(26:18):
of other ways to add that to get that bill
to a place. So we designed a critical care and
paramedic program out of that and it was, you know huge.
It was one of the you know, there was at
the time not a lot of ground places there. But
he was very instrumental in that and helping foster ideas.
So when I was at the State, I really used
a lot of those lessons learned there from you know, hey,
(26:40):
how can we look at other avenues?
Speaker 3 (26:42):
Who else has great ideas?
Speaker 4 (26:44):
And you know, sometimes it was junior people that were
stepping up and saying, hey, I came from this other
industry and this is what we did. You know, I
remember one person in a Love to Mata place. They
were like a former electrical like engineer type of person,
and they came up with like some ways to uh
improve their call system in that county. And you know,
(27:05):
if you were to tell somebody that this person initially
had no really in best experience and they were redesigning
a system, I think there would have been pushed back.
But because we're going to work with them, they were
able to improve their system.
Speaker 3 (27:16):
So that was that was very helpful.
Speaker 1 (27:17):
Those two mentors and other people in your life that
help you in your career. What do you do to
pay that forward? Because I know you're probably paying it
forward by your teaching and leading teams, But can you
talk a little bit about that and why how important
is to pay that forward? And I'll give just a
quick example. When I took my EMT course and Community
(27:40):
College of Alleghany County and Pittsburgh, my EMT instructor said
to us on the first day, always passed on your knowledge.
And I've been doing that ever since, so that still
sticks in my mind after all these years. So I'm
just curious what your thoughts on that are.
Speaker 4 (27:55):
You know, I love that kind of quote there that
that's a great way to look at Yeah, it's it's
a weird mixture because I teach people one on one,
so I get still running halls and you know, somebody
is sitting next to me. And again, we do some
long transfers, so I mean there's times that we transport
for seven hours in the back of the ring to
(28:16):
take somebody to like Stanford. So there's a lot of
times where we're taking them from a very rural hospital
to Stanford and they're with us, and so I do
a lot of one on one, you know, kind of
showing people how to do that, because it comes back
to textbooks. I think when we moved first start and
there's not a lot in the EMS textbooks that shows
how to care for somebody for seven hours.
Speaker 3 (28:34):
You know.
Speaker 4 (28:35):
Most of the stuff is designed how to be short
term and how to do that. So the other part
I do when I work with managers and directors a
lot is I show them about other avenues of MS.
Speaker 3 (28:45):
And again it comes back to regulations.
Speaker 4 (28:47):
When you look at community paar of medicine, it gives
you the opportunity to expand out. So I really tried
to pass my knowledge on in the way laws were
written and drafted and show them that one is allowed
and what isn't allowed. And that's where again back to
the public health question, all this other stuff of adding
service lines to providers. A lot of these people don't
(29:09):
haven't thought about this outside of this typical.
Speaker 3 (29:11):
Square nine to one one box of you call and.
Speaker 4 (29:14):
We show up and we take you to the hospital
and you know, and then that's where we start to
show people it is different. And you go back to
even one of your earlier questions about what's changed from
you know, the early two thousands.
Speaker 3 (29:28):
You know, there's states now.
Speaker 4 (29:30):
Where you can transport to uh you know, a free
stand in er, you can transport to an urging care.
Those things didn't exist when I first started, and you
had to take them to a hospital. And you know, again,
it came out of necessity. This wasn't it was still innovation,
but it came out of necessity. And that's where I
want to show. And I get back to a lot
of the people when I talk to them, is think
(29:50):
about again that's different. Don't think about this is the
only way it has to be done. And again with
limited promotion and other stuff within the departments, a lot
of these people they don't see other agencies. You know,
you mentioned before that you were in North Carolina, Pittsburgh,
you know, Washington. You've seen a lot of different agencies.
There's a lot of people that I know, you know,
(30:11):
they don't want to move out of their zip code
and there might be one or two ambulances in that
region and they just worked in that system their whole life,
and they don't think about like.
Speaker 3 (30:19):
Other ways to innovate in other ways to go.
Speaker 4 (30:21):
So that's where I really try to get back because
I try to meet with clients and I try to
meet with agencies and try to show them ways to
grow their business.
Speaker 1 (30:30):
A couple closing questions for you before we wrap it up.
Besides the billing component, which I know you're an expert in,
if you could fix one thing in EMS tomorrow with
just a snap of your fingers, whether it could be
pay recognition or whatever, you think, what would it be?
And why?
Speaker 3 (30:49):
Oh man, But it's a phenomenal question. You know. This
probably goes back to my educational side.
Speaker 4 (30:54):
But I would say educational standards we are when I
meet with clients and legislators and other people that are.
Speaker 3 (31:03):
You know, cutting checks and that type of stuff. Is
EMS has been taught one way, you know, getting back
to the textbook.
Speaker 4 (31:09):
It's taught for how to respond to a nine one
one call. It's not taught how to do long business transfers.
It's not really taught how to do all this other
community pair of medicine options and mobile integrated health. So
I think that the programming, if I had to go
back and change one thing, was how to educate people
from the e MT level of differently that nine to
(31:31):
one one is just a component of being that role
as an EMT. You know, we see tons of providers
now working as you know, warehouse medics.
Speaker 3 (31:39):
I just use the love of medics. That's usually how
the title goes. But it could be EMTs, it could
be AMTS, it could be whatever.
Speaker 4 (31:45):
But we see these roles now where people are not
working on a rig. You see so many people working
at warehouses, special events, not attached to an ambulance company.
Speaker 3 (31:55):
And you know, there are tons of these positions throughout
the country.
Speaker 4 (31:59):
Where they're doing patrol, doing all these things that are
not tied to a rig.
Speaker 3 (32:03):
But yet everything we're todd is tied to a rig.
Speaker 4 (32:06):
So that was the one part where I would change
right now is getting where and I quit ems a
lot back to If you think back to nursing and
the nineteen hundreds, you only think of nurses working in
the hospital. You know, I literally I was at a
different conference last week and there was literally a place.
Speaker 3 (32:25):
That had in Chicago that had a sign that said.
Speaker 4 (32:31):
Ear piercing only done by nurses. You know, so this
this whole place was you know, I remember not myself.
I remember growing up and there was like that Clayre's
small place that they.
Speaker 3 (32:42):
Would pierce your ears.
Speaker 4 (32:43):
I'd hear like all these horror stories. This company said, hey,
we have nurses, we are good at sticking people with needles.
We're going to start a business and our main tagline
is going to be all of our staff has nurses.
Speaker 3 (32:54):
If you were to told that, if you were to tell.
Speaker 4 (32:56):
That nineteen hundreds nurse that down the road, you know,
health spas and all these other things are going to
exist for nursing opportunities.
Speaker 3 (33:04):
They would have laughed at you. And that's kind of
where I see EMS is.
Speaker 4 (33:08):
EMS is this place where we have this amazing skill
set of providers out there and we are forcing them
into one box. And again, if you go back to
physician extenders, we have a lot of options to do
other things, other ways to expand the industry. Still provide
the nine one one care, but also provide other revenue
streams for agencies.
Speaker 1 (33:28):
Steve, before we close out, tell us a little bit
more about what you do as a consultant and how
you do that and if people want to get in
touch with you, how would they be able to do that?
Speaker 3 (33:38):
Yeah, thank you for that.
Speaker 4 (33:39):
I have a company called battle Board Advising, and basically
with that I help ems companies look to add service lines.
That's really where I focus, and I look at a
lot of the regulations behind each state showing what you
can do.
Speaker 3 (33:53):
And again, the service line doesn't have to.
Speaker 4 (33:55):
Be something that produces when in some agencies it's again
it's bringing on that tactic.
Speaker 3 (33:58):
Holy MS side.
Speaker 4 (34:00):
What are the legalities of adding a tactical only INSS side.
I also have a Master's of Law degree from Arizona State,
so I really tie in a lot of the legal
side of it.
Speaker 3 (34:12):
I don't for my legal advice.
Speaker 4 (34:13):
I'm in a turn, but I really look at the
regulations and then I help agencies expand their service lines.
Speaker 3 (34:21):
I said to the other part is agencies need money.
Speaker 4 (34:24):
I also help agencies look at ways to use capital
and collateralize stuff for hard money lending, potentially grants, other places.
A lot of these agencies they have a generated income,
and when you're looking to go out and do private financing,
private equity, they're looking for a return revenue and be
a mester kind of already built in where you have
(34:44):
revenue pretty much guaranteed and might take time to get
paid for.
Speaker 3 (34:48):
Payers, but it's a model. It shows where you're.
Speaker 4 (34:51):
Going, it's where you're at, so it does have a
place to where that comes in. So I tie my
business degree side and start helping them grow avenues for
them to expand out their business. But you know, it
all starts, you know, with looking at somebody who wants
to find other ways to you know, keep the lights on.
Speaker 3 (35:10):
And then we have other agencies.
Speaker 4 (35:11):
They're massive and they want to grow and they want
to expand and take over other territories. So it's looking
at each agency and what they're objective is coming up
with the plan to support that and making sure that
the that the regulations.
Speaker 3 (35:26):
Allow for it.
Speaker 1 (35:27):
How can people reach you, they.
Speaker 4 (35:29):
Think, we're thinking my website at battle Born advising they
can look for me on LinkedIn at Steve Tafoya as well.
Speaker 3 (35:37):
And yeah, I appreciate everybody listening.
Speaker 1 (35:40):
Well, Steve, I want to thank you for joining me
back on my podcast. Glad to have you, Glad to
meet you.
Speaker 3 (35:47):
Yeah, I appreciate the time, and you know, I'm glad
that you restarted this. I always feel that, you know,
people want to listen and people want to learn people
want to see stuff, so I'm.
Speaker 4 (35:55):
Grateful for yourself to restart this and hopefully it makes
you energize jan supporting as well.
Speaker 1 (36:05):
Thanks for joining me on the podcast. Remember this podcast
was sponsored by Magical Destinations by Steve. You can reach
Magical Destinations by Steve Scohen at Creative travel Collection dot com.
Join me next time on Medical Metic podcast
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