Ariana (00:00:07) - Welcome to Secret Ops, the podcast uncovering the world of business operations. One episode at a time. I'm your host, Ariana Cofone. And today's guest is James Mazza, Chief of Emergency Medical Services for Montclair Ambulance Unit in Montclair, New Jersey. James, welcome to Secret Ops. When you reached out to say that you'd be willing to speak on this podcast, I was beyond thrilled. So thank you so much for being here.

James (00:00:33) - Thanks for having me. I actually reached out sort of almost as a joke. I was like, oh, yeah, let me know when you wanna do that, to hear about our world of operations. And you were like, okay, let's do it. I was like, all right, I guess we're doing this

Ariana (00:00:45) - I mean, if you open the door, I'm gonna step right in, because, I've always been fascinated with your interest in this. I mean, we've known each other for seven, eight years now. I think it's incredible the work that you do. I could personally never do it, and I am really excited to give others a peek into your world. Cause I don't think most people really know of somebody or do the work themselves. But let's start a little bit back. So, where you are today, how the heck did you get there? Where did you find your path to, to what you're doing today?

James (00:01:20) - It was a lot of trial and error. I have always worked two jobs from high school on, and when I hit 18, 19, I had no idea what I wanted to do in this world. I was like, all right, I got a scholarship to college to international relations and diplomacy. And I was like, oh, okay. I'll work for Homeland Security, or something like that, you know, that whole post-911 mindset. And, I saw EMS as a stepping stone to law enforcement because okay, it's something that, is related to public safety, gives you that touch of what they go through, but it's not law enforcement. So, at 19 I started volunteering with, the Nutley Volunteer Emergency and Rescue Squad, and worked other jobs in between. And then, you know, there was, there was a clip there for five years.

James (00:02:08) - I worked, full-time. At an ambulance transport company nights and weekends, but I'd pull myself out of EMS because it doesn't really pay the bills. Unfortunately, it doesn't get the funding it deserves. So I'd wound up working either, you know, at Baron Fig for over a year, as one of the first employees or an IT company, or even at a gun range. And I just kept getting drawn back into EMS because it was just something that really called to me. It made me go to nursing school, but healthcare just called, to me is particularly emergency healthcare

Ariana (00:02:49) - Now for me. I'm like, that would not call to me at all. That is scary to me. What do you think about it, calls to you? What do you think it is that the act of helping people in the intensity of an emergency sort of situation where the stakes are really high? A combination of those things?

James (00:03:05) - It, is definitely a combination of those things. And there's plenty of people out there who will tell you that they don't get the rush and excitement from going on call anymore because they're burnt out. But if we weren't as burnt out as we were, even still today, if I'm in a vehicle that I'm driving lights and sirens there's a small touch of excitement. There's a little adrenaline hit there. It's knowing that I can help people at their worst possible time. I always knew I was able to talk to anyone of any different type of educational background or anything else. And 90% of what we do in EMS is really talking to people and either convincing them to go to the hospital or talking through their ailment or trying to dissect what their situation is. And I say that EMS being basic life support, which is what I, I mean, I'm an EMT, there are, are advanced life support that's a little bit more diagnostic, right? They can do EKGs and interpret the EKGs and provide different medications, but when it comes to basic life support, it's a very rudimentary bandaging, medicine and package them up, take them to the hospital and kind of talk them through that.

Ariana (00:04:20) - Hmm. What, so when you started volunteering at 19, you said. What was that first instance like, or that first week just getting used to what this world is?

James (00:04:33) - The first week we picked up an old man who had fallen on the ground and was wearing no pants. And that was my very first call, my only call. So that was an interesting experience.

Ariana (00:04:43) - That was a welcome to the world. Yeah.

James (00:04:46) - That was a welcome to the world, right? And we took him to the hospital and then there was nothing. And then my second week, you know, we had a, it was mid forties cardiac arrest victim who we could not successfully resuscitate. And she wound up, being transported to the hospital and passing at the hospital. And that hit me, you know, it hit me a little bit. And then some people in the field use a little bit of what we called gallows or dark humor and made me realize we did everything we could. And you can't save 'em all. In fact, you only, for a cardiac arrest victim, even if it's witness, you're only saving about 10% in the field.

Ariana (00:05:26) - Wow.

James (00:05:27) - And that's witness

Ariana (00:05:28) - 10%. Wow. Yeah. Oh my gosh. That is, that is heavy. I will say, Joey, my husband always said that when you would come in and tell the stories that it was captivating, it was, I think because you just got a peak at life in a way that no one at 19 would ever get to see life for the most part, you know, unless you were served some unfortunate circumstances. Now, if we zoom into today, so you've been doing this work, over a decade? Oh, 15 years.?

James (00:05:58) - Yeah, this year. This year is like 15, 16, something like that. I started 2006, so yeah.

Ariana (00:06:04) - Wow. We've talked about how you got into this line of work, but I wanna talk about your day-to-day life. So what does that look like? What is James Mazza’s day when he wakes up and he gets to work?

James (00:06:16) - Well, it kind of starts when I first wake up. I go through my emails and my phone because, you know, 2022, you can't be not connected to everything that's going on all the time. That's assuming that somebody didn't call me in the middle of the night. So we have four supervisors, myself being one of them that our staff will call in case there's a situation like, Hey, I accidentally backed the truck into a pole. There's no real damage, but it happened. Or, Hey, can we go to this hospital? And some of those calls are legitimate. Some of them probably could have been an email but we'll get to work. And typically there's already a pot of coffee brewing cuz you can't do anything without coffee. And, and when we say coffee, it's a 12 pot, 12 cup pot with eight heaping scoops.

James (00:07:05) - This is hard, strong coffee. The one guy made tried to make coffee and was just like, this is tea. You can't, we can't drink this . And then the day kind of devolves from what, what emails came up or what I've got going on. So our Executive Director recently left. So now on top of scheduling and logistical planning and trying to find funding for a new ambulance, I'm now also doing payroll, payroll entry. All of our fundraising donations that come in, I have to catalog them into our program and make sure that they're deposited and we send a thank you note out. It's a little bit of everything. For us operations, my day is kind of chained to a desk as opposed to driving an ambulance. I drive a desk and I have 35 kids now that in all different way, shape or form come to me with their personal or professional problems or concerns or ideas. Or I have to discipline people because they're not completing charts in time…it runs the gambit of anything you could think of that might happen just with the added piece of what we do may affect somebody's life in a way that other companies don't do. Right.

Ariana (00:08:27) - Totally, totally. The stakes are just always at a higher level than in most situations because you're most of the time talking about somebody's life in some of the ways that you're operating. So I guess this is a question I like to ask everybody. I'm just really curious on the approach to operations within emergency medical services particularly. So I think there's two different ways where you can approach operations through a problem-first mindset. So, you know, shit hits the fan, you've gotta navigate it, and that's where you sort of pinpoint your operational strategy and go from there. Or there's the opportunity-mindset. So this allows you to kind of look for opportunities that you can do different things or be able to develop operations differently. Between, an opportunity-mindset and a problem-first mindset. My guess is that you're leaning more towards problem-first just because you have a lot thrown at you on a day-to-day basis that is emergencies. But is that true? Is it more problem-first or opportunity?

James (00:09:30) - At least for me, an organization, probably a 70 30 split problem first versus opportunity. We definitely try and seize whatever opportunity we can to work for us. And I say that we got a grant for the whole inside of our building to be refurbished. You know, we're in a fire, we're in an old firehouse that was built in 1906 and we, we moved in 20 ish years ago. I don't remember, I don't know the exact date. I know I wasn't there yet. So that's why I don't know the exact date. But it hadn't been painted since we moved in and it was well over 15 years ago. So Lowe's came in and did some funding and we were able to get the whole inside, you know, painted and new flooring, which is great, but we had to all move out of our office emergently one day cuz the project was like oh by the way we're gonna start here today. It's like we, you are? So we happen to have a trailer, which is to be used for large scale incidents. So we activate what we call our continuity of operations plan, which is we work out of the trailer. So we moved all of our office stuff into the trailer, hooked up phone lines in the trailer, had the generator running and worked out of the trailer for about three weeks.

Ariana (00:10:52) - Wow. Yeah. It's so funny cuz I've written up, you know, business continuity plans, emergency response plans. I've never had to use one. And I love that you had to use it in the case of a remodel, it's always how it goes.

James (00:11:06) - Yep, but it was a good exercise. And that's where I think the opportunity comes from. Okay, it was a crisis and we had to kind of just like deal with it in the moment, but we also saw the opportunity, we're not just dealing with it in the moment. We're gonna exercise the plan and see where, what works. And we've discovered that after three weeks of intensive use of the generator, it kind of needs to be serviced . Cause after the end of the third week, it just was like, all right, we're done.

Ariana (00:11:30) - That is, that's actually a very good point though. How often are you implementing these things and doing these trial runs, but how important could that be in an entirely different situation, 10 out of 10 important. So thank you lows for remodeling and cooking

Ariana (00:11:46) - So before I go into the next phase, I just have a question that's maybe a little kid Ariana question, but what is it like to drive an ambulance? Tell us.

James (00:11:56) - Mildly exciting, a little terrifying kind of lame in the sense that you're basically driving a box on wheels, right? It is not, it's not aerodynamic. It doesn't take turns great. It’'s a big beefy vehicle and then nobody stops for you. So you're going lights and sirens, you come to a red light, nobody stops. You've got family members trying to follow you to the hospital that we tell…Hey, don't follow us through a red light because they're not gonna stop for me. They are really not gonna stop for you.

Ariana (00:12:30) - Oh man.

James (00:12:31) - So what's interesting, and, and there's a lot of of data coming out. You're probably gonna see over the next five years, you're already starting to see a lot of this, among some agencies. You're not gonna see ambulances going lights and sirens as much anymore, at least in non-urban settings. The data is showing that the amount of time saved going to the hospital, lights & sirens is anywhere from 30 seconds to two minutes. And once they're in the ambulance already, that typically that's not, except in certain circumstances where it is, that's not gonna make life or death situation, but the odds of getting into a car accident go up dramatically because the drivers, if they're younger…inexperienced, their adrenaline goes up. Even the older drivers, their adrenaline goes up.

Ariana (00:13:23) - My god, I get sweaty every time I hear an ambulance. I'm like, pull over. I'm sweating.

James (00:13:28) - And I, and I don't even mean just the people on the road, I mean the person driving the ambulance too, right? Oh, we're trained. We're trained, but it does change the dynamic. So the data's coming out in New Jersey's, been rolling out, a lot of sterile cockpit, don't, you know, hands on the wheel, your, your passenger hits the siren, which we all are used to like one hand at, at the top of the wheel right hand down hitting the siren. And they're trying to move us away from that and really move us to an idea where you're only using lights and sirens to go to the hospital if it's a true life-threatening emergency.

Ariana (00:14:02) - Wow.

James (00:14:03) - The stuff that we do is, you know, medicine and science-driven. So as these studies come out, the field changes every couple years.

Ariana (00:14:12) - My god. That is, that is fascinating. And not what I expected from what is it like to drop an ambulance this literally gets into, I think–

James (00:14:23) - It's really cool though.

Ariana (00:14:25) - Okay. That's what I was expecting. But what I'm so glad that you sort of broke down for us. There is one part of your job that has so many different components that you're thinking about. You're thinking about, in this case, traffic vehicles, emotional responses when it comes to operations. The easiest way I've been able to dissect it across all different kinds of operations is it is made up of people, process and technology. So I would love to dive into each of those just to, I guess talk more about how you view that. So kicking off with, let's start with technology. What are some pieces of technology that you have to think about?

James (00:15:09) - The biggest piece obviously is ambulances, right? They are not just a box on wheels, even though that's why I described them as, they have different, systems inside them, different control systems for the lights, the sirens. They also now have to have, center mounts for the cots so that if the ambulance rolls over the cot doesn't break free and harm the people in the back or the patient. And those center mount cots, those are actually, what they call power loads. So the EMT doesn't have to hurt their back. You, hook it in, press a button and it kind of loads itself. It's saving the strain. But with, with stuff like that, you're looking at $50,000 an ambulance just for that whole setup.

Ariana (00:15:52) - Oh my gosh. When that came into being, because we're, we're thinking about like, this is a whole different kind of layer of technology. This is physical engineering. This is maybe in some cases robotics. What was it like using one of those for the first time?

James (00:16:09) - It's interesting because you're not used to it where you just press a button and it lifts up. Our agency doesn't even have that technology yet. We have electric stretchers, which is even still pretty easy, where you still have to hold the stretcher up and press, you can press a button and just lift the legs and you push. But the newer stuff is even more advanced where you just hook it in, press a button, and the legs come up and it loads…it’s just like all the weights on the system.

Ariana (00:16:36) - Wow. And that does change who then can work within this kind of line of work as well too. Cause I'm sure there's physical restrictions just based on what you're having to do on a daily basis.

James (00:16:49) - We come up with technological workarounds or stuff like that. So that's the ambulances technology piece. When I started it was all paper charts. You go out with a clipboard and a piece, you know, one of those, pieces of paper that you can–

Ariana (00:17:07) - Oh, the carbon copies.

James (00:17:08) - Carbon copies, yeah.

Ariana (00:17:09) - Yeah. Love those yellow carbon copies.

James (00:17:11) - Pink goes to the patient, yellow goes to the hospital, white goes with us . But now it's all computers. So now we have to have these tough-books, which are rated to not break under the rigors that we do, but are constantly running into issues where, okay, this part of the keyboard's broken. Is it under warranty? Do we have to buy a new keyboard? You've got radios, which, you go on eBay and you look up a Motorola radio, you can find an old radio for $1,200. Yeah. The brand new encrypted radios that the state of New Jersey has moved towards that allow the radio transmissions to remain private and access certain channels, well that's about $8,000 a pop. The technology we use just constantly is evolving. In certain cases, it is definitely, predicated on medicine.

James (00:18:08) - So when I started, we used something called a backboard. And what a backboard is, it’s literally a board or a spine board. There also could be called, it's a board you'd use to immobilize a person who's been in a traumatic injury, car accident or a fall or something. It's like, we wanna mobilize their spine and keep their spine rigid so nothing hurts. That's when I started 15 years ago. Now it's like, we don't use that anymore because we found that that actually causes more spinal injury. Because what would happen is they would go to the hospital, they'd be on this hard piece of plastic for four hours in the hospital, and now they're sitting there developing pressure ulcers or just new chronic back pain. So there was a study, I don't remember, this happened years ago, so I don't remember the specifics, but it was, someplace in Arizona and I think it was Singapore. And they felt they were comparable in EMS responses. Arizona used backboard, Singapore did not. And in Singapore, patients had better outcomes. So–

Ariana (00:19:07) - Wow.

James (00:19:08) - Next thing you know, we have to carry 'em because you might need them still for certain circumstances, but we don't use them anymore.

Ariana (00:19:15) - So when it comes to the technology, the tools that you have, you sort of have so much research that's going into these that's constantly evolving, constantly changing a lot of these, the pricing is incredibly high. The funding isn't necessarily where it needs to be. I'm sure that creates a really stressful situation where you're trying to figure out where do we put our resources? What makes most sense moving forward? Do you work with other people in different towns or organizations to sort of collectively say, Hey, this is the new standard of what we're doing. How does that work?

James (00:19:50) - So a lot of these directives come out from the State Department of Health. So I wanna call them unfunded mandates because that's what they are that the state says or this is how we have to do it and we just have to figure it out. At Montclair Ambulance, we're trying to be very proactive with our, our partners, in other neighboring communities and really looking at the whole situation to say, look, five years from now, if we all want to be in existence, we need to change the way we operate. We're a hundred percent paid pretty much in Montclair, but a lot of the agencies around us are almost all volunteer. They have a harder time getting trucks out the door during the day or on weekend hours. Whereas they may get donations and they have money in the bank, they don't have the people.

James (00:20:36) - Whereas we have a hard time raising funds and, but we have people, right? So we're trying to open those conversations up to those neighbors. And there's still resistance because it's New Jersey and everyone wants to kind of run their own little show. Nobody wants to discuss the idea of maybe we need to change the way we operate for the better. But I think we're making inroads and I think, long term we will be successful in changing some of the minds of our neighbors out there. But when it comes to the ambulance, like technology, there is no standardization whatsoever. The state says you have to make sure it does x and you'll have 10 different models of that thing that does x and every agency uses something different.

Ariana (00:21:28) - Wow. That's a lot to manage and think about, even just the maintenance. I'm like, oh my God no, thank you. So I guess touching more on the process and the people standpoint, cause a lot of it goes hand in hand, I guess people is, is intriguing me most next, because you've got people that you work with on your team. You've got people that you're working with, that you're supporting on call, when you know, when they're in a high emotional situation. I can guess that potentially the people side of your job is a lot of what you're managing on a day to day basis, potentially . But, is that true? Are you finding that that is a big part of it just because of what you're doing?

James (00:22:12) - Definitely is a big part of it. I wish sometimes I had more time to sit back and look at the process and see, you know, instead of putting out fires daily and not actual fires I don't mean that in negative context. Like, oh my God, there's a crisis. It's not that it's a crisis, but it's the people dynamics. You know, I'm working on the schedule for the month of December and how many phone calls do I have to make to different people. Hey, I know you put this availability in, but can you do this? Or, I mean, it's what, November 15th and I'm looking at the schedule I'm creating. I'm gonna push out hopefully today or tomorrow. I don't have anyone as of today working Christmas Eve, Christmas day, New Year's Eve, not all change cause people wanna pick up overtime and everything else, but it becomes almost like make a deal, right?

James (00:23:00) - And I've got a really good team. Like I said, I've got 35 people. I've got a deputy chief, who's been at the organization for about 20 years. And I've got two supervisors, one of whom has also been at the organization for well over 15. He was actually my mentor when I was volunteering at Nutley Rescue and taught me everything I know. We have a good core group that's my two supervisors and Deputy Chief and then the rest are just EMTs. Different levels of experience. Been doing this different amount of time. All of them across the board and each of them comes with their own set of great things. I set of issues to be managed that, you know, it's, everyone wants to work the same hours. It's like, okay, I can't do that. Somebody's gotta work the off hours or how are we gonna make this work?

Ariana (00:23:50) - Yeah. I feel as somebody who has worked the holidays, I get it that time and a half is amazing. But it is a negotiation, especially when I think about how many people are you working with? You said 30, was it 35?

James (00:24:02) - Around that? Yeah, which maybe 20 to 23 are consistently, actively working every week. You know, I have some people who either are on a leave for whatever reason or only are able to help out infrequently. And we make that work for historical reasons. But, it's definitely interesting to deal with people in this way that I'm doing it. I've done that in the past. I rose up to the rank of Assistant Chief and Nutley Rescue and I kind of had to do the same thing. I took over scheduling there when I was Assistant Chief. And that was a whole different dynamic there as well. Cuz you had volunteers and paid staff. One of the things that I think helps us on the people side, it hurts us, but helps us, is we're not a town entity. We're not a government entity. We're a 501c3 nonprofit. So we're accountable to our board of trustees. So it allows us to be a little bit, I don't wanna say leaner, but there's no, outside the Department of Health and federal rules surrounding nonprofits, there's less government interaction than you might expect.

Ariana (00:25:14) - The red tape is different and it allows you to kind of be more flexible with how you work and how you get the work done. I guess this dips into the process side of the operations, which is, you know, we were talking about your emergency action plan, right? We're gonna use this backup. How, I guess how often my…curiosity is if things are changing so frequently with how you need to respond to situations, how are you tracking those changes? How are you training people? That just seems like a lot to be able to kind of make sure that you're distilling.

James (00:25:53) - So part of it is easy, and I say that because the state of New Jersey for an EMT requires, in order to stay certified…every three years, you have to go through 24 elective credits and 24 required credits. I'm gonna call them court 13 cuz that's why I grew up with them. They've changed it to court A, B, and C, but it's a core 13 or your core of classes and every three years you take these classes and they tell you about any updates to the scope of practice for EMTs any, changes to the science or anything like that. So I don't have to worry about that piece of it because if everyone has taken a recertification, they're properly certified, they should be up to speed on the changes that have occurred in healthcare over the last three years.

Ariana (00:26:41) - Got it.

James (00:26:42) - That being said, we do like to pride ourselves on the fact that we are a proactive organization. So some agencies will have a medical director who comes out of, say, Robert Wood Johnson or Atlantic Health, or all these other different hospital systems that exist in New Jersey. We have a separate medical director who's been involved in EMS and is involved in different organizations, but he's very proactive to the point that the State Department of Health says, EMTs can do X, he's gonna write up a policy and a protocol and a procedure, and we will be doing X right away. Whereas some agencies are well, we want to evaluate and see if this is the right move. It's like, no, if, if the state is saying we can do it, we're gonna do it. So not every agency in New Jersey does this, but we can administer albuterol treatments, we can administer aspirin for chest pain. We can also do, what's called CPAP, which everyone thinks about for the people at night when they're snoring. But if somebody has COPD or, or, not COPD, but congestive heart failure, we can put this on them and it's going to push the fluid to the bottom of the lungs if they're filling up with fluid.

Ariana (00:27:53) - Oh, wow. Yeah. Which buys time right?

James (00:27:56) - Exactly. It buys a lot of time and we don't use it that often because we're five minutes from the hospital or we have advanced life support right there. And they're usually like, we'll pull up and say, all right, we're gonna put this on now. But we have it and we're trained on it and we're able to use it if necessary. And there's been times where we have successfully used it. But not every agency does that.. Their medical directory either doesn't let them or their leadership says, listen, we don't want to get involved in that. We're kind of cutting edge on that process and we do yearly recurrencies and yearly training to make sure that our staff are able to do that.

Ariana (00:28:39) - Yeah. All right. Now I wanna break down this, the next part is what I call the inside scoop. So this is the stuff that people want to know, but maybe we don't ask these questions. I'm gonna try and ask them for the audience here. And the first one is, what do you think people get wrong about operations and specifically within emergency services emergency services, contacts? What do you think people call entirely get wrong?

James (00:29:04) - Calling an ambulance gets you into the ER faster.

Ariana (00:29:07) - Oh, interesting.

James (00:29:09) - I cannot tell you how many times. Someone says I'll go with you guys because I'll get seen faster. It's not the case. We give a report to the triage nurse and the triage nurse will determine, is this patient gonna go into a bed right now and start treatment right now?

Ariana (00:29:30) - Wow. Yeah. So for us outsiders, I guess what should we make sure that we do? Should we just go?

James (00:29:40) - If something–

Ariana (00:29:41) - The situation is case by case right?

James (00:29:43) - Of course it is, but you know, at the same degree it isn't. If you think that something is off and worries you enough that you're thinking about going to the hospital, I would say it's always prudent to call 911. Somebody will say, oh, can you just evaluate me? Well, we don't really evaluate people. We take their blood pressure, we take their vital signs, we look through their medical history, listen to their complaints, and then we say, Hey, okay, what hospital do you wanna go to by, at least in New Jersey, legally, EMTs can't say, okay, no, you, you don't, you don't need to go to the hospital. It's always, you should go to the hospital. So if you're calling us, it means you're having a, what you feel to you is a life-threatening emergency and you want somebody to evaluate, treat, and transport.

Ariana (00:30:34) - Got it.

James (00:30:36) - If you're kind of hedging, and I gotta be careful how I say that too, because during covid we saw so many people not go to the hospital and then pass away cuz they were afraid of getting covid and they would have a heart attack or a stroke or something else. So what I always recommend is if you feel off, if you feel something's wrong, you don't feel right, call the professionals. We come right to your house, but don't think that you get seen faster. Cuz you came via ambulance. That's more of somebody who's like, oh, I know it's just the flu, but I need to go to the doc or the hospital to get some medication. The ambulance doesn't get you there faster.

Ariana (00:31:14) - You're not getting preferential treatment in the situation of oh, you're gonna go skip to the front of the line. But if it is something incredibly serious, you need to call and and get somebody there STAT.. Okay. That's just good to know. I think that our medical care system is very confusing, even for myself over three decades. So you're always trying to, I guess, hack the system, but that is not a way to hack the system. Folks do not go that route. You're just gonna cause headaches for these wonderful humans.

James (00:31:43) - To that point also something that I don't think people know, I don't have the exact states and I should pull it up. There are only 11 states in the United States of America that EMS is considered an essential service.

Ariana (00:32:00) - Oh, interesting.

James (00:32:01) - 39 of the 50 states do not recognize EMS is an essential service. That means it's harder to get tax funding, it's harder to get grant funding. It's harder to get any type of federal or state or local dollars because we're not essential.

Ariana (00:32:15) - Wow. What we take for granted, huh?

James (00:32:18) - I'll just leave, you know, for you listeners, John Oliver did a great skit about that about a year ago. Look up John Oliver EMS and he does a funny, you know, and his typical John Oliver fashion, great skit about how EMS is non-essential service in most states.

Ariana (00:32:34) - That's mind blowing to me because I think we all assume that it's just a part of what the resources that we have in our lives but we can't just assume that. Right. We have to make sure that we have that.

James (00:32:47) - You can't imagine calling 911 and them saying, oh, the ambulance isn't coming. Nobody would ever process that. You expect the ambulance to come and it will, but that ambulance might be a private contractor that might be a for-profit company that might be a hospital system. It's not necessarily getting any tax dollars. So after that ride, oh by the way, this is a $2,000 bill and you need to pay it. Oh, I can't afford it. Yeah, that, that's great. You're going into collections like that. That's the type of mindset that's out there. In a lot of circumstances, you know, we at Montclair, we don't put anyone in collections. We need the money, right. But we're not gonna put somebody in collections over a medical transport bill.

Ariana (00:33:29) - Yeah. Wow. I'm learning a lot today. I feel like I'm having a life education, talking to you. So, I guess this transitions into the next question nicely because the next question is, what do you think is the hardest part of operations within emergency services? Now, I would say that this is maybe tough to say. What's the hardest thing? So if you have a top three list, I'll roll with that too.

James (00:33:55) - Supply chain difficulties, definitely one of the hardest things. It got pretty bad during COVID and it stayed bad. So, for the defibrillator pads, we placed an order I think it was mid-summer and we finally got it in October. And just staying on top of that, knowing that there's these delays, making sure we're ordering with more than enough lead time to make sure it gets to us. You can just Google ambulance chassis delays and find out that there's a two year backlog to buy a new ambulance. Whereas before you'd go call a dealer and within that same year you'd have an ambulance. Now it's minimum two years if not longer because there's no vehicles to be had or no raw materials to build the box that's gonna sit on the chassis even if they have the chassis.

Ariana (00:34:47) - Well, I think we've all heard or experienced the supply chain pinch that's happened since 2020. But that is, that takes it to a different level, that really does.

James (00:34:59) - We've all heard of the staffing problems too, right? Like Yeah. My organization, I like to pride ourselves in the fact that we're not having the staffing problems. That we previously had. The previous Chief before myself and the previous Deputy Chief before my Deputy Chief, they were working 50, 60 hour weeks sometimes mostly on the ambulance. Cause there was no staff. They were able to hire about seven people and I hired an additional seven people and we got to a comfortable number where we for the most part are staffed comfortably. And I've got people actually fighting for more hours as opposed to begging them to work, which is good and nice to have. But EMS as a whole is in a staffing crisis. You have in rural America, agencies are shutting because they don't have enough staff, there's not enough volunteers, there's not enough paid staff, there's not enough anything and your trips to the hospital take longer because the hospitals have closed.

James (00:35:58) - So now you're going further for a hospital or when you get to the hospital because they're understaffed, you're sitting there waiting at the hospital longer. There's been some crazy absurd times out in the west I've seen that are four hours sitting at an ER waiting to transfer a patient. And now your service area has no ambulance and there's no backup. So just like we've all heard in every single business there is, right? Our staffing problem is kind of a critical mass. We were in this situation before COVID, it's been this way before COVID and it's just COVID took so many people out of our workforce that said, we're done. We're not doing this anymore. It's not worth risking our lives because people were like, oh wait, we're at risk. I mean, New Jersey lost more EMTs than died at nine 911.

Ariana (00:36:56) - Oh my gosh. That's a huge. I can only imagine the burnout too that it, it's like if it's at a tipping point, right? If you're putting yourself at risk by proxy, maybe your family at risk and then you also are just experiencing burnout simultaneously. It's the trifecta for that has gotta be…I don't even know how that could feel to be just straight up.

James (00:37:22) - Your listeners are about to find this out, right? But if the average American understood how crisis mode EMS is nationwide, I've seen sign-on bonuses in New Jersey for paramedics at $30,000.

Ariana (00:37:38) - Whoa.

James (00:37:39) - The desperation is real and they cannot fill these positions.

Ariana (00:37:44) - Wow. I'm trying to comprehend that number straight up.

Ariana (00:37:50) - Whoa.

James (00:37:52) - And that's from a hospital system, right? So they have, I don't wanna say unlimited money a burn. But they have resources to burn and they can't staff. I'd say those are the top two. I think, I don't know if there's really a third that really strikes me as one of the biggest challenges. Cuz there's all these different little crises that pop up and different challenges that pop up. But just knowing how crisis point everything is.

Ariana (00:38:16) - All right, if we haven't scared people off yet, if you're not scared yet or you're interested in that signing bonus, if somebody were wanting to become an EMT, where should they start? Like today you wanna support your fellow emergency service people, you wanna become a part of it. Where do they begin?

James (00:38:39) - So it depends on where you are in the country and I'm gonna speak specific to New Jersey. I'm gonna get some heat from some people for this probably, but I believe volunteerism has a place in our field and there's a lot of paid EMTs and paramedics who kind of crap on volunteers all the time. And I don't think that's a fair outlook, because there's many volunteer agencies that hold themselves accountable to the same standard as a paid employee. And I think that's the key. So if you're looking to start out, look and see if there's any volunteer agencies in your area, most of them will help get you the training and pay for the training to become an EMT. And their ask is give us two years volunteering after you get the training. And I don't think that's a horrible ask. And I think, you know, it, it provides needed help inside your own community or your neighboring community, right? I started in Nutley, I lived in Clifton, I lived in Clifton though. So, and they're neighbors for those who don't know the area, Clifton and Nutley. So I think that's your first step,

Ariana (00:39:46) - Truly. I know that I would not be able to do what you do. I know straight up that this is something that I would really struggle with . But it's interesting because it's, at the flip side, I know people that like yourself, they wake up for that thing, you know, that this is the thing that drives them and there's nothing else that really gets in that level of gratification I guess than doing this kind of work. So it amazes me and, and I, I bow down to all of you that are in this line of work. Seriously. I'm in awe. You all are the special ones.

James (00:40:24) - We tell that to ourselves all the time. And that's the problem.

Ariana (00:40:28) - I will say I think it's interesting too because that was your journey as well, right? You started out volunteering and then, you know, obviously you've made this a career for yourself and you've really invested yourself in this thing too. So I do think that is sound advice coming from somebody who's walked that path before. One thing to say, tip of advice, another thing to have done it.

James (00:40:50) - And hopefully people in the EMS community…cuz I'll wind up sharing this under my social media and next thing you know, they're gonna have people breaking down the door saying, what are you saying that for? I also want to point out to volunteers that may listen to this, right?Not all pain people are assholes.

James (00:41:14) - There is a lot of us out there that, you know, as long as we all do the same job, as long as we're all held to the same standard and do the same job, that there should be no animosity between paid and volunteer.

Ariana (00:41:24) - And they can live together. They can live together harmoniously. That's the goal.

James (00:41:28) - Right. Exactly.

Ariana (00:41:30) - Yep. Alright. I want to wrap up with some personal questions, rapid fire questions just to learn more about, you know, the man behind the scenes. Get to know more about you, as a human. So I'm just gonna shoot them at you and answer them as we go. And this is how we'll end this episode of Secret Ops. Okay. So to kick off drum roll, I always feel like I have to do a drum roll. What morning rituals do you start your day with? We've established that we need coffee of the most acidity, but what other things do you need to start your day?

James (00:42:05) - Random Spotify playlist while I'm driving to work?

Ariana (00:42:09) - Hmm. How do you wind down at the end of the day? And I think this question is extra important in your case because of the stakes that you're navigating. How do you unpack that?

James (00:42:19) - For me personally, it's either playing video games or if I'm not in the mood for video games, it's smoking a cigar, sitting on the porch with my dog, reading a book. Very relaxed things, going to a Jets game.

Ariana (00:42:36) - All of those good things. What book are you currently reading? That was the next one.

James (00:42:41) - I'm in between books. I have to decide what I'm reading next. It honestly is probably gonna be the Laws of Creativity just cuz I haven't had a chance to read it yet.

Ariana (00:42:51) - And for those who don't know, that's my husband's book that he just released. So it’s shameless plug.

James (00:42:59) - A shameless plug. But I'm currently refreshing and rereading GI Joe comics.

Ariana (00:43:06) - Ooh. What is your favorite quote? If there was a quote that stuck with you over the years, what would that be?

James (00:43:13) - General Patton once said, lead me, follow me, or get out of the way.

Ariana (00:43:19) - Mm.

James (00:43:20) - And that one sticks with me a lot cuz it's like, either tell me, lead me, show me what to do and tell me what we're gonna do. Or if you're not gonna do that, follow me cuz I'm gonna do it. And if you're not gonna follow me, you're not gonna lead me. Just move cuz I'm not stopping.

Ariana (00:43:37) - Yeah. I love that one. I'm gonna take that one too. That's a good one. Yeah. In your life so far, what do you think is the most important lesson that you've learned?

James (00:43:48) - It's been a lot. Trust my gut.

Ariana (00:43:52) - Last question. What do you wanna be when you grow up?

James (00:43:56) - I wanna be either on a beach, relaxing on a beach, or like one of those apartments that overlooks Bourbon Street, right on Bourbon Street and you're just on a veranda. I just wanna be there watching the party. I wanna be the chill, retired, relaxed, like smoking a cigar, wearing a Hawaiian shirt. I just need to be retired, I guess.

Ariana (00:44:26) - James, I think I've seen a preview of that a couple years ago, so I can see it happening. I can see you manifesting it. Yeah. Well, I cannot thank you enough for taking the time to talk to me. I really hope that the listeners have gained a lot of knowledge from this conversation. I know that I've learned a ton. If people wanted to find you, where can they find or follow you?

James (00:44:48) - So I'm gonna plug Montclair EMS here, montclairems.org. If you want to follow up what we're doing, it's also on Instagram as well. MontclairEMS and Twitter it’s the same handle. You can email me at chief@montclairems.org or check my LinkedIn. it's simple. James Maza. I'm willing to answer any questions you might have, you know, things that you may disagree with me on. Maybe you're in the field and you're gonna yell at me about, supporting volunteers or whatever. Right? You know, I can't say enough about Montclair EMS and how much good we do in the community, but also how important support is, right? We are a nonprofit 501c3. We do not get tax dollars. You know, we get a little bit of help from the town, but we don't get sustained tax dollars. So outside of billing people, it's all about donations. So, no. I will plug that and maybe somebody can keep me honest and keep me writing on my blog for whatifhistory.com. It's an alternative history blog. You know, stuff like, what if Japan had invaded Hawaii after the Pearl Harbor attack? Stuff like that I just don't have enough time to write it, so somebody keep me honest on that.

Ariana (00:46:12) - All right. You've, you've heard the request. Keep 'em honest. James, thank you so much for your time. Everybody, who's listening, who is in Emergency Medical Services, thank you so much for all that you do on a day-to-day basis that's not seen. I think in the last two years, the appreciation for you has just been tenfold. And last not least, thank you to the wonderful audience for listening to Secret Ops. Please follow us wherever you find your podcast and check us out at secret-ops.com. We'll see you next time.