COVID-19 Town Hall: The Effect of Hospital Overcrowding on EMS

September 8, 2021

Many US EMS systems are experiencing unprecedented challenges in providing ambulance availability. Some of this appears directly related to the lingering effects of the pandemic on staffing and, more recently, overwhelmed hospital systems have no place to put our patients leading to extended “wall times” for our crews. NAEMSP is convening a series a Town Halls to bring together a geographically diverse group of EMS leaders to discuss the current state of affairs and approaches they have taken to deal with the crisis. Join us in this timely discussion, bring questions and solutions as you visit with this seasoned group of colleague


  • Clayton Kazan – Dr. Kazan started in EMS as EMT while an undergraduate at UCLA in 1994. After completing his BS in Biology from UCLA, he received his MD and MS (Clinical Pathology) from Rosalind Franklin University of Medicine and Science in 2001 and completed a transitional internship at the University of Hawaii and his emergency medicine residency at UCLA/Olive View-UCLA in 2005. Dr. Kazan held a variety of EMS leadership positions, and he has spearheaded a number of innovative programs since being named as the Medical Director of the Los Angeles County Fire Department since 2015.  In addition, he served on the Clinical Faculty in Emergency Medicine at Harbor-UCLA Medical Center from 2005-2012, and he is currently an Assistant Clinical Professor of Emergency Medicine at the David Geffen School of Medicine at UCLA.

  • Joe Holley – Dr. Joe Holley is the Medical Director for the State of TN Department of Emergency Medical Services as well as the Memphis and Shelby County Fire Departments and several municipal and private ambulance services in West Tennessee. He also holds the position of Associate Professor in Emergency Medicine for the University of Tennessee Health Science Center. Dr. Holley received his Medical Degree from the University of Mississippi School of Medicine, followed by internship and residency at University Medical Center in Jackson. Dr. Holley has served on over 30 deployments, including Hurricane Katrina and the Pentagon on 9/11, as the Medical Director of the Tennessee Task Force 1, Urban Search & Rescue Team and serves on the national FEMA Incident Support Team. He is a member of the CAPCE Board of Directors, the National Association of EMS Physicians and a Fellow of the American College of Emergency Physicians. Dr. Holley is board certified in Emergency Medicine and was among the first group of physicians in the nation to earn the designation of Fellow of the Academy of Emergency Medical Services.

  • David Miramontes – Dr. David Miramontes started as a volunteer Firefighter-EMT while still in high school and went on to the level of EMT-II, Registered Nurse (he worked a total of ten years as a Registered Nurse in ER and ICU), Mobile Intensive Care Nurse, and then received his BS in Physiology at UC Davis. He attended the Medical College of Ohio and Emergency Medicine Residency at the St Vincent Mercy Medical Center in Toledo Ohio, where he also was a Lifeflight Physician. He served as the Pre-hospital EMS Director at St Vincent Mercy Medical Center and provided medical direction for the City of Toledo Fire Dept. and 18 rural and suburban EMS agencies. He was the Assistant Fire Chief and Medical Director for District of Columbia Fire Department (Wash. DC) from 2011-14 and currently serves at EMS Medical Director for the San Antonio Fire Department.

  • Anjni Joiner – Dr. Anjni Joiner is the System Medical Director for Durham County Emergency Medical Services in Durham, NC. She is also an Assistant Professor of Surgery/Emergency Medicine at Duke University. She completed her Emergency Medicine residency at Duke University and an EMS fellowship at Emory University. She is board certified in both Emergency Medicine and Emergency Medical Services and holds a Master of Public Health from the Rollins School of Public Health at Emory University in Global Epidemiology. Her research focuses primarily on emergency care and emergency medical services development in low- and middle-income countries and using artificial intelligence for emergency call center chief complaint categorization and triage.
  • Paul Pepe – For over four decades, Dr. Paul Pepe has continued to pioneer many of our patient care advances in resuscitation medicine, EMS systems design and public health emergencies. A critical care clinician-scientist, he brought vanguard clinical/research expertise to EMS in 1970s as an on-scene “street doctor” for the Seattle Fire Department. Later, as the first Physician Director of EMS for Houston, TX (1980s, early 90s), he helped to forge the EMS subspecialty within the house of medicine and also stewarded dramatically-increased survival rates for both cardiac arrest and critical trauma, all facilitated by many landmark research initiatives. After serving as Commonwealth Emergency Medical Director for Pennsylvania (late 1990s), he became the Chief Medical Director for Dallas County (TX) Public Safety when recruited, in 2000, to also become Professor and Chair of Emergency Medicine at the University of Texas Southwestern Medical School and Parkland Emergency-Trauma Center.

    Today, he not only continues to serve as Dallas County Medical Director, but also as Medical Director for Research, Education & Special Operations for numerous south Florida public safety agencies (Broward, Palm Beach and Polk counties). Among many dozens of notable accomplishments, Dr. Paul Pepe co-founded the National Association of EMS Physicians in 1984 and became its first President-Elect. He later organized the Metropolitan EMS Medical Directors Global Alliance (aka “Eagles”) and also helped to co-found and organize the NIH Resuscitation Outcomes Consortium. Still receiving numerous awards for multi-disciplinary scientific achievements over the past year, he also facilitated boots-on-the-ground accurate and rapid informational exchange across the globe through his unparalleled network of 9-1-1 system leaders. In turn, he was named the 2020 NAEMT EMS Medical Director of the Year.

  • Veer Vithalani – Veer Vithalani, MD, FACEP, FAEMS, is the System Medical Director for the Metropolitan Area EMS Authority and the Chief Medical Officer for MedStar Mobile Healthcare. He is also an Emergency Physician at John Peter Smith Hospital and Texas Health Resources Harris Methodist Fort Worth. Board Certified in both Emergency & EMS Medicine; he is a Fellow of the American College of Emergency Physicians and the National Association of EMS Physicians. He is active in organized medicine, as the President of the Texas Chapter of the National Association of EMS Physicians, Board Member for the Tarrant County Medical Society, and past Chair of the EMS & Trauma Committee for the Texas Medical Association.

  • James Augustine – James Augustine, MD, FACEP, is an emergency physician and a Clinical Professor in the Department of Emergency Medicine at Wright State University in Dayton, Ohio.  He is Chair Emeritus of the National Clinical Governance Board of US Acute Care Solutions, based in Canton, Ohio.   He is a proud member of NAEMSP.

    Dr. Augustine currently serves as the Medical Director role with Georgia fire services in the cities of Morrow, Forest Park, Hapeville, Riverdale, and South Fulton.  He is an Associate Medical Director for North Collier Fire Rescue in Naples, Florida.  He is also Medical Director for Washington Township Fire Rescue near Dayton, Ohio.  He served as Medical Director for Atlanta Fire Rescue, and later as Assistant Fire Chief and Medical Director for the District of Columbia Fire EMS Department.


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