(Transcript is automatically generated)

Erik: [00:00:00] Anybody who has ever treated a patient in a nursing home has been there to hear that nurse say she was fine one minute ago.

Matt: I was gonna say every paramedic EMT pre-hospital provider we have, they were fine just a few minutes ago. Probably got up and applauded in that moment. 

Narrator: You are listening to EMS with your hosts, Erik Axene and Matt Ball.

Erik: Welcome to the EMS show. 

Matt: Yes, 

Erik: Matt Ball. 

Matt: We're excited today. We're always excited, but today we're super excited. Before we get started, don't forget to like, share and subscribe to our channel. Helps us out and I think you guys are gonna be really excited too when you find out who we got on the podcast today.

We have the author of the movie Code 3 

Erik: Creator really. 

Matt: Creator yeah, exactly. The creator, the author, the brains, so to speak. Mm-hmm. Behind the movie Code 3, Patrick Pianezza. Patrick, how are you? We're so happy to [00:01:00] have you on here today. 

Patrick: I'm so excited to be here. Thanks. And just point of clarification, I'm, I am the creator, but I'm the co-writer. Chris Leone is, is shares credit with the writing. 

Erik: That's right. 

Matt: Credit to him as well. Yes. 

Patrick: Yeah. 

Erik: Yeah. It's interesting. Short story. I was at EMS World and I ran into some friends, uh, of, I didn't know this at the time, Patrick's friends. Yeah. But you had told me a couple days earlier, Hey, we got a response from our social media blast.

Yeah. From the co-writer of Code 3. And we're all excited about it. And I mentioned that to a group of guys I was talking to, and this guy named Chris Holden says, hold on a second, I think that's my roommate. And he called up Patrick, put him on FaceTime and stuck his phone in my face. And I was, do you remember that, Patrick?

Of course. Yeah. 

Patrick: Yeah. That's, that's definitely Chris in a nutshell. Yeah. Uh, we, we were coworkers and, uh, well, not coworkers. We worked for different counties, but we, uh, we were roommates in college. 

Erik: Oh, that's pretty cool. Nice. So you're [00:02:00] originally from Illinois? 

Patrick: I am. I'm from a small town Illinois, uh, called Sherman.

Uh, Springfield was the big city about 10 minutes away, but I grew up in Sherman, uh, got my associate's degree in biology. I got my, back then it was a certificate in non-degree program, uh, in paramedic. I was a fireman at Sherman. Uh, that's where that, and those two things come from. Uh, and then transferred to the University of South Carolina and did my bachelor's and my master's at USC, uh, and then did my externship at Johns Hopkins.

And, because I, they were paying us like interns there. I was also on their critical care transport team and eventually moved to California and have been doing healthcare administration, large projects for health systems for about the last 10 years, and then got to make a movie. So it's been, it's been a lot of fun.

Erik: Nice. I'm gonna back you up a little bit. I was reading and researching you. We both were and, and one of the things you'd [00:03:00] mentioned, one of the bios I read was how stories shaped your imagination growing up. Yeah, I was wondering if you could share a couple of those stories that were impactful to you. 

Patrick: I, I mean, not word for word, but my dad, uh, both my parents have passed, but my dad used to always, when we were kids, he would just make up stories on the fly to the point where, you know, as you start to develop these critical thinking skills, we would look at our mom and be like, that, that can't be real.

And she would be like, well, you know, let's think it through. But yeah, I mean, he would make up stories. Like, just on the fly. Like he would hold a pen and it would say something like, Batman, and then all of a sudden, like Batman would be, he saw Batman on the, the ceiling of the bakery. And, you know, he thwarted crime.

Like, it was like just, just the perfect improv, the way that he would do that. Or if we were at an airport stories about people watching and it was, it was hilarious. So that kind of stuff. And then you mix in some of the, the, the old timer [00:04:00] stories from, uh. Uh, the village where my family's from in Italy, there's not a lot going on.

It's a very small village, and so everybody's telling stories about like witches and, and things that happened like 20, 30 years ago, and it's just these old guys retelling stories and I was always just the kid sitting on the stoop just kind of absorbing all of it. It was great. It was really entertaining.

Erik: That's cool. That's cool. One thing I, I know code 3 is really what we want to talk about. But I have to mention one other thing I learned about you. You know, where I work within, uh, a hospital system, I was the patient experience expert. Uh, I would do some travel to help coach people up on patient experience.

It sounds like you had that same role. 

Patrick: That was my job. Yeah. I was, I was a patient experience expert for large lot, lots of hard, excuse me, lots of large health systems. So, uh, the running joke is I would tell people like you, I'd be like, I'm the guy you don't like, I'm the one always telling you to be nicer.

Uh, but would hopefully have some tools and tactics to help people [00:05:00] along the way. But yeah, the analysis and the process improvement for, uh, things like H caps and ED caps and, you know, other experiential measures in healthcare was kind of what I was, was my specialty. I still consult in that from time to time.

Yep. Um, I worked for a company called Studer Group that quite literally wrote the book on, uh, 

Erik: we worked with them too Yeah. Yeah. So, uh, you, our viewers can join us for the most boring podcast in history when we're going to elaborate more on patient experience. I'm just kidding. 

Patrick: Let's get into it.

Let's talk about NCIS and all the things. Yeah, 

Matt: well, I just recently made the transition from operations to admin, so I'm, uh, transitioning my mindset a little bit over to the admin thing. And one thing, you know, I worked closely with admin in my last department, but one thing that I didn't really the two and two that I didn't put together was that everybody, no, not everybody in ops has worked in admin, but everybody in admin has been in ops.

So everybody that's worked in administration at least for a short period of time has worked in operations at some [00:06:00] level. Yep. Um, and it is looking at life through a different lens. It for sure, it's looking at things very much through a different lens. 

Erik: And, and I kind of, I, I was being a little sarcastic, but I actually really enjoyed that patient experience piece because I really do think it's important, but unfortunately a lot of doctors hated it.

Matt: Oh, I'm sure. 

Erik: Me, I'm trying 

Matt: to, don't tell me how to do my job, 

Erik: because the only people that were there were the ones that somebody told 'em they sucked, and so I had to go help him. 

Matt: I'm here because you suck. When Erik walks in or Patrick walks in, we're here because you suck. 

Patrick: I'm here to fix you. 

Matt: Yes. 

Patrick: That's really kind of. Well, and and to your point, to your point, Erik, the thing that I would always tell people is like, it's, it I and, and I too have been having some fun, or, and I don't mean to dismiss my entire previous profession. Um, there are meaningful clinical impacts to people who believe in the care that they're receiving.

They're less likely to have, uh, reactions or less likely to bounce back to the ER. Um, there's, there's tons of, if nothing else, the really dumb medic in my brain goes. [00:07:00] Feel better, lower cortisol levels, we win. Like, yeah, that's, it's that simple. Um, but oftentimes it just, no one is ever saying that the clinician usually, that the clinician neither did something wrong or is terrible.

It's just like the communication mishaps there. And there's lots of strategies around like, how do we ensure that the patient receives the message that they need to hear the right way, the right time, just like any other drug, right route, right dose, right time, right everything. Um, and I think my, you know, my decade plus career as a clinician allowed me to have those conversations with a little bit more authority and authenticity than some of the consultants that are in the field. And so, yes, I, I do believe that I'm not dismissing it. Yep. I do think that patient experience has a place 

Erik: Yep. 

Patrick: And is necessary, especially, uh, in a world that's in insanely confusing and confounding that is healthcare.

Um, and I would tell people all the time, back when I was on the street, I would much rather talk you down than tie you down. Like there's, yeah, there's, there's exact corollaries between that. [00:08:00]

Erik: You know, it's funny you mention that because I think it actually came through in the movie Code 3 a little bit with some of the context.

There were people out there coaching patient experience who had no idea. What the real world, you know, experience was like in the emergency room, like with Rob Riggle's character, Dr. Serrano I mean, there was a scene there by the vending machine when he talked about how it really was in the ER. And I think the movie showed you a side of the ambulance, the prehospital environment where it's tough in that environment to be positive sometimes.

And when people would come in and coach patient experience without that context or without that credibility, like you said. They lost all the wind outta their sails and nobody listens to them. Yeah. But when you get somebody who understands the context and has been there in the trenches, they get it. Uh, which I think you did a brilliant job in writing it and co-writing it, sorry, and, and the movie hit the nail on the head. Uh, I thought so. It was really good. [00:09:00] And 

Patrick: thanks. And, and I do feel like, I do feel like I need to defend the film for a moment, like. Uh, the number one comment I get or the multiple comments I get are like, you know, the, I've never worked with a doctor that's that big of a jerk.

And it's like, look, some of my good friends are ER docs, i'm not. The movie never set out to say that ER docs are bad, but to your point, I'm really glad you keyed in on that scene as like we, we do our best to show like, yeah, they're both burned out. They're just burnt out from different things and it's like we, this is a struggle.

So yeah, 

Erik: I watched the movie with a nonclinical person, Jason, who my team knows, he's our COO here. We watched it in a hotel room together and he asked me, he said, are ER doctors really like that? And I said, absolutely not. But we all think those things and we don't say it. It, it, it was, I mean, I think those things, 

Matt: yeah, they're not that rude.

They're not quite as rude as, as, uh, Riggle's character was. But I have had some doctors, you know, be rude. And I think the biggest thing is that pre-hospital environment doesn't understand ER, and in hospital and [00:10:00] in hospital doesn't understand pre-hospital. And I kind of learned that when I got my RN and started working in the hospital again, it's kinda like going from ops to admin.

You see things through a different lens. And I think that as a whole, people that are watching this, if we have nurses or paramedics, like. We have to understand that we kind of have different roles and especially the in-hospital people need to understand and have a little bit more respect for the pre-hospital provider.

And I think that's gotten a lot better over the years. Yep. I've been doing this 20 plus years and it was way worse long ago. You'd have those old crotchety nurses that would yell at you for every little thing. It's gotten a lot better, but we need to understand the environments are a little bit different and have a little bit of grace for each other, um, for what we have to deal with in our respective environments.

Erik: Well, 

Patrick: yeah, I would tell people all the time, or not all the time, I, I've been in other interviews and I've said like, look, I'm the guy you want if you're dying in the next 30 minutes. Yep. I'm not the guy you want managing your diabetes. Right? Like that's exactly that my skillset is here and I know that, and you know that physicians or, or nursing is, [00:11:00] is over here.

Erik: Well, I think what we're talking about is part of the reason why I picked the clip that, that we, we picked. Uh, we'd like to show that right now, uh, you know, before we really get into the movie. And one of the reasons I think we picked this clip is that this scene I think is gonna really resonate with our viewers.

Yes. 

Movie Audio: What's going on here? 

Your patient is assuming room temperature. I declared her dead. The coroner is coming and we are going to leave. 

How do you know she's dead? What are her vitals? 

You wanna know her vitals? Well, if you must know. Zero Pulse, zero over. Zero Blood pressure, zero respirations, like all zeros. Would you like to know her blood sugar? 

She was just fine when I checked on her a few minutes ago. 

A few minutes ago, really? Shake her hand. Go over and shake her hand. Do [00:12:00] it. 

I'm good. 

Mike.

Look, look! Hi, I'm dead. 

Erik: Anybody who has ever treated a patient in a nursing home has been there to hear that nurse say she was fine one minute ago. 

Matt: I was gonna say every paramedic, EMT, pre-hospital provider, we have, they were fine just a few minutes ago. Probably got up and applauded in that moment.

Absolutely brilliant writing, Patrick. That was great. 

Erik: And I think, and if you see the movie, if you haven't seen it yet, there are a hundred scenes like that. Yes. Where it's like, yes, that's it. That's what we see. Awesome. 

Matt: Patrick, I told you this, this the other day, but I just wanted to share the, uh, the other day I was at work, 'cause at the station I walked over to one of our stations to go talk to one of the guys.

And as I'm walking into this station, I can hear this like this loud and I'm like. What are they having a rave in the day room? What [00:13:00] is going on? And I walk into the day room and they're all in there laughing and cracking up, and they're watching Code 3 and they're like, have you ever seen this movie? It's so funny. I said, as a matter of fact. So, yes, uh, it was very, very well received from the people that I've talked to. 

Patrick: I'm really glad to hear that. That's, that's kind of the funny thing is, you know, you make this thing. Then two years, two and a half, three years later, it comes out to the real world and you're like, I wrote that joke.

I hope it's still funny. 

Matt: Still applicable. Yeah. Right. 

Erik: Take us through the process. I mean, how did you get to the point where you decided to write a a screenplay? 

Patrick: It's, uh, it's an interesting question and, and the reason I say it's interesting is this entire film was a homework assignment and I, I, I can't stress that enough.

So, as part of my undergraduate program, I had to take a creative, my, my undergrad's in public relations. So it's not in creative writing, but it journalism adjacent and advertising adjacent. And one of the pre-reqs, or one of the courses I had to take, I'm sorry, was was a [00:14:00] creative writing class. I didn't really wanna take it.

It was kind of like the university made me do it. So I was like, all right, fine. And early on in the semester, I, I got off a shift that was like 14 hours that was supposed to be 12. Barely got myself because I worked night shift, so I was in class. Obviously classes are from like, you know, 10 to four or whatever.

Um. I barely get myself dressed and into class after this shift. And this professor just kind of kicks his feet up on the desk and he just goes, you know, if you want to tell a compelling story, write what you know. And it's very cliche saying, but it's the first time I had ever heard it. And I just remember going, you want a story?

I'll tell you a story. Uh, and I went home and just like screaming into the void. I was burnt out and just like smashing the keyboard, and it was a 36 page short story about EMS. It, it's, it's different than the movie, but the bones are there, and that was it. I turned it in. I got an A minus. I was happy with it.

There was no dream of it becoming a movie. It was, it was literally a homework assignment. As a laugh I sent it to my [00:15:00] family and I said, you guys keep asking me for stories. You wanna know what this is like, here's the story. So that was it. Flash forward to like four or five years later, I've graduated and I'm visiting my brother in LA and my brother just, he's working in the industry.

My brother came up as a VFX producer, uh, and he said, why don't you do what everybody does, which is write a script? And I just deadpan. I was like, I don't know anything about writing a script, like my degrees are in business or in like. Uh, telling, uh, trying to get your attention. And he's like, well, here's the computer program.

Uh, write it anyway. You have that short story. Write that into a script. And so over a week, I did. And the first draft is trash. It's always garbage, but hey, it was a first draft. I kept rewriting it. And then what I've said on every interview is you have to be good and then you gotta get lucky. And, uh, I know I'm a good writer.

I mean, I've written for like EMS World and, and the Joint Commission and some other, uh, commercial A places. [00:16:00] So I, I have, I've got a, a talent for writing, but there are thousands of writers that are more talented than I am. I just got really lucky and the way I got lucky was that my brother and the director, Chris Leone, were coworkers.

And so my brother approaches Chris and he is like, Hey Chris, do you wanna read a script? And Chris is like, absolutely not. Uh, which is the right answer in LA because you're never more than 20 feet away from an unsolicited script in this town. Um. Yeah, but my brother is nothing if not determined. And, and finally wore Chris down and said, you know, it's about being a paramedic.

Uh, and Chris is like, well, what's he know about that? And he's like, well, he was one for 12 years. Uh, so anyway, Chris read the first draft and he liked it enough to get involved. Um, obviously that first draft is not what we shot, but then we had a meeting. And he, he'd never, uh, gracely gracefully, graciously, I'm sorry. Uh, at the beginning he never asked me what was the worst thing I'd ever seen, but he said, you know, the script is really [00:17:00] interesting. Tell me something that I wouldn't know from an outsider. And I just started laughing and I said, well, I know what brains smell like and he almost fell out of his chair.

And that was kind of like the, the starting gun of us working together. And then we worked on it part-time. Nobody got paid. This was a passion project, um, for 12 years. And then we finally got it to a point that it was worthy of, of what you saw on screen. And so Chris is, like I said, he's a director and a writer and he had representation.

So his reps started throwing it around town and it landed in the Rainn, it landed in Rainn's lap, Rainn read it and loved it. And he says this too, the first script was 180 pages long. And for context, most movie scripts are anywhere from 90 to 120. So there was a lot in this script. Uh, and so we ended up over another year we cut and cut and cut and cut. Um. And then we, once we got, once, Rainn was happy with it and we, or all three of us [00:18:00] were happy with it, he took it to Wayfair, which was the studio behind it, and they got financing. And so like nothing happened for 15 years, 12 to 15 years. And then we were off. Uh, and then we shot for 28 days and then that's it.

So it's like this big. Fireworks and then like nothing. And then now we came out in, on 9/11 is when we premiered this year. So we had like this really cool thing and now it's kind of like it's, it's out and living in the world.

Erik: Awesome. 

Matt: That's so cool. What it's kinda like being in EMS, right? You sit around 90% of the time, followed by 10% of pure adrenaline.

Kinda, 

Patrick: yeah. I tell everybody EMS is, uh, 90, 80% boredom with 20 mixed 20 percent sheer terror. 

Matt: That's exactly right. That's exactly right. 

Erik: In the ER, I, I say 95% boredom and 5% sheer terror. Sheer terror. Yeah. Yeah, I got it. Same thing. 

Matt: Yeah, no, it was a great movie. Lots of different things. Even some small things that, like you said, people that aren't in EMS or aren't in the [00:19:00] medical field that wouldn't know that the EMS, the first responders, even nurses, ER staff, are gonna see those little things, those little, uh, pearls that you put in there, or what do you call it?

Easter eggs. Little Easter eggs. Easter eggs, Easter eggs. You put in the script, and they'll pick up on those things. Genius. Uh, I love the quote, uh, Randy's quote, the best healthcare that minimum wage can provide, 

Patrick: My favorite Easter egg about this, no one has seemed to have seen the sign and I, to me it's blatantly obvious 'cause we hung it the very beginning when he signs for his narcotics, when they're having the conversation about, you know, the can, when are we gonna get a raise? Yeah. If you look over that lady's shoulder, there is a blue sign that literally says EMS the best healthcare minimum wage can provide. And no one, no one has caught it yet.

Erik: Oh man. Watch it again. 

Matt: Yeah, we're gonna have to watch it again and look out for that. 

Patrick: Uh, but, uh, to that point, like the, the one thing I'm always incredibly grateful for is the absolute, uh, engagement of the actors and the crew, um, and their investment. Because one, [00:20:00] about day three, I didn't expect everybody read the full.

I mean, obviously I expect the cast to, but like the people that are doing hair and makeup. Yeah. About day three, the majority of them had read the entire script and they were very invested in telling the story. And Chris and I aligned. And Chris Leoni, the director and co-writer, aligned very early on that we were all, we were gonna be medically accurate.

'cause almost all of the TV shows and movies that are made in our image and likeness are usually terrible on the clinical side.

Erik: They're terrible.

Patrick: Um, and that we would never make fun of the patient. So everything could be funny. The setups can be funny, scenes can be zany. But if you're in crisis, we never made fun of the person calling 9 1 1.

Um, because, you know, I, I'm famous for saying I don't get to pick your emergency. Like whether it's a hangnail or you can't breathe, like my job is to help you call me. I show up, I'm here to help. Amen. Um, but uh, those were the two things and I had a very unusual. Situation in, in Hollywood, because I was on set every day and we were training the [00:21:00]actors on how to look, right.

Like, like you're saying, the little things, the non rebreathers are filled. There's, there's oxygen in the non rebreathers, the bags are, the IV fluids are running. The monitor is accurate, like 

Matt: the ET tube is actually hooked up to something.

Patrick: Yeah, yeah, yeah. The, the little things were, were, were hard to get right. And the, the thing that the actors would always. Uh, would always remember is like, I was famous for running around a set yelling gloves because they'd take their gloves off between takes and it's like you're still taking care of a patient. Put your gloves back on. Yeah. 

Erik: Oh, that's good.

Matt: That's funny.

Erik: You know, in our home, uh, we can't watch any movie about a dog because my daughter is afraid the dog will die and she won't enjoy it. And we also can't watch anything medically related because dad ruins the movie. Yeah. Because it's all, yeah. 

Patrick: My wife says the same thing, shut up and enjoy the film. 

Erik: Right.

That's, that's, that's it. That's it. 

Matt: I loved, um, the, all the like, uh, Mike and Randy's character. Oh yeah. Like the comradery on the ambulance going back and forth. What [00:22:00] was, what was it that Mike said about like. You ride, I drive or something like that? Yeah. 

Patrick: I wheel, you heel. 

Matt: That's what it was. I wheel, you heel.

That's what it was. Yeah. I thought that was a great, I hadn't heard that before. That was a great quote. 

Erik: But isn't it true though? 

Patrick: We had, we had a longer storyline where we were gonna do a montage of Randy driving and it's just terrible because there's, there's really no such thing as an ambulance driver.

That's there's, I mean, obviously I don't need to tell your audience that right. The, the whole idea is like, we wanted to have, we wanted to pay that joke off where it's like, just Randy just like basically almost getting into a wreck every time he is driving Code 3. But, uh, that's funny. It didn't make it, but that was, that was the, the, the running joke behind that.

Erik: Well, one thing that, that did come through, I think was the team. The, the team, I mean, they respected one another in their different roles. Uh, they're always together, working together. Um, and I think, uh, you, you didn't make fun of the patients. You didn't make, you know, everything was respectful that way, but I loved how you made fun of the, the citizens.

Yeah. 

Matt: Or even the homeless guy with his shirt was a [00:23:00] little too short at the beginning of the movie. 

Patrick: Yeah. That guy. Yeah. 

Matt: That was pretty. Now I heard, or I read that like, did all of the actors in the movie, like I know Rainn rode out with LAFD or somebody, didn't he do a ride out with some EMS people? 

Patrick: Yeah, so we did, we did some pretty hefty training to the, to them, to the, to the three leads, Amy, Rainn and Rel.

Matt: Okay. 

Patrick: Uh, Amy and, and Chris Leone too. So Chris was, Chris had no experience in EMS, so um, Rainn, Amy and Chris got ride time with LA County Fire Station 14, which is South Central. Um. So they were busy. And that came about through some connections that I had. Uh, I, I asked around and I was like, look, I only have one day tell me the busiest house in all of LA because I need, I'm, I'm only gonna get them for like maybe eight hours, so I need them crushing calls.

That's, that's all I care about. Uh, and they just told me, uh, they were like, you gotta talk to, to station 14, which again is South Central. So I drove over to South Central, made friends with the captain who [00:24:00] never met me before. And I was, I threw on my old fire department t-shirt. I'm like, look, I'm one of you.

And I have, I was like, look, I have the weirdest request you're ever gonna hear. That totally fits LA. I go, I got three actors and a director that need to hang out with you guys. And after he kinda looked at me cross-eyed, we talked for a little bit, he is like, okay, like these are the days. And so we got them to come in and they ran.

I mean, they were observing. They weren't running, but they were observing real 911 calls in South Central. And then we also had them, uh, for another couple of days where we had them at just the ambulance company. So Lifeline's a real ambulance company in LA uh, and they were absolutely fabulous partners.

I couldn't have asked for better partners from equipment to all the stuff, their training, their, their training room, all of it. Um, and the first day that they showed up for training. I said, you know, they start gravitating, gravitating towards all the toys, right? The monitor, the laryngoscopes, all the dummies and the moulage and stuff that's happening.

I go, no, no, no, no, no. Get in the [00:25:00] back of the truck. And they were like, what are we doing? So I threw 'em in the back of the truck. I said, don't put your seatbelt on. I go, there's the bar. I go, this is all you get. And we drove 'em around downtown LA for kind of threw 'em around and they're like, how do you guys do this?

And I was like cool. So now when you, because obviously for anybody who doesn't know Hollywood movie magic, when they're actually treating people in, in the back, we're obviously not driving. It's a sound stage. I was like, but this is the stuff. This is what you gotta feel like this, the, the truck is moving down the street.

And then we got them all healthcare provider, CPR certified, they all got cards. So they had to learn how to BVM, they had to learn how to do CPR 'cause my my cross to bear is like CPR is gonna be done right in this movie. Like, I hate bad CPR. Yeah. Um, because people will do what? Yeah. The exact or they're on the bed.

Yeah. It's just terrible. Um, 'cause people will imitate what they see on, on TV or on screen. And so if, if, if anybody watches this movie and has to do CPR and they saw it done right once. I'm happy and hopefully, hopefully [00:26:00] we can make an impact somewhere down the line, 

Matt: not Rainn Wilson in The Office doing CPR, Rainn Wilson doing CPR. Just, just to set the standard here. 

Patrick: But yeah, we did that and then we, we trained, I mean obviously we weren't gonna take 'em through the entire paramedic curricula, but basically the stuff that was tailored to the set or to the, to the script. Uh, so we taught them how to, how to intubate. Uh, we taught them how to do CPR.

We taught them how to splint. We taught 'em how to backboard. Um, the stretcher operations was really kind of the funnier bit, because to them it was like trying to wrestle raccoon. Like they just looked, they couldn't figure it out. They, like, we were like, anything that's colored red can move. And they're like, what?

And they're pushing the buttons. So That's funny. Uh, that was a lot of fun. And, uh, you know, the monitor, but, but they were all invested. They all wanted to make it look right. And the funniest part. Uh, the thing that I, that, that, the biggest realization for me having done the clinical work is like, if you ever read a script, I'm sure lots of people have seen it, like the dialogue's always down the middle and then to the left [00:27:00] are what's called the actions.

So, you know, you tell the actor like, you're gonna hold a bottle in your hand, or you're gonna walk to this room, whatever. My, and those are usually like three to four sentences. Mine were like a page long. 'cause I was writing them like a clinician. I was like, you're gonna, you're gonna intubate and then you're gonna listen for lung sounds.

You're gonna do the, and like we had to trim all of that out. That's why this first script was like 180 pages. Oh. And they were telling me like we're not trying to be paramedics. Write it down like a dance. And so the scene, the baseball scene, uh, Amy's writing on a notepad. Well, if, if you could see the notepad, it literally says, okay, when this happens, put your right hand here. Put your left hand. 

Erik: That's awesome. 

Matt: Notes for the script. 

Patrick: So it was way more choreography. But they were, they were very interested. They were very invested. And you, I couldn't have asked for, for better partners. I thought they, they were, they were fantastic to work with. 

Erik: Matt, Patrick, do you guys have a favorite scene?

I, I guess maybe we should end with you, Patrick, 'cause you're the star of the show here. Um, [00:28:00] my favorite scene was the vomiting scene in the ambulance. Uh, I couldn't stop laughing out loud after the Narcan and vomiting on the new guy. That was hilarious. That was my favorite scene. Matt, what's your favorite scene? 

Matt: As a, as an FTO and as a guy that leads our FTO program, my, my department, I really appreciated how you tied in uh, Rainn's character and uh, uh, Jessica Jessica's character and how he was teaching her as a student, how they would go on calls and he was in the moment teaching her, Hey, how do you do a proper assessment and all, and it was all very accurate. The way that he was doing it, the verbiage he was using, it was all very accurate on how an FTO trains a new EMT or a new paramedic in the field. I really appreciated. As you stated earlier, most of the times these shows are. Wildly inaccurate on what happens in the real world. And I thought that part of it, even though it was Hollywood dramatized, it was still pretty accurate on, Hey, how do you do a proper [00:29:00] assessment?

Here's a patient, this is what you're here to do, is to learn, so let's practice some things. So I really liked that interaction between the two of them, and I love. And I don't wanna spoil it for those who are watching or listening that have not seen the movie, go see the movie. I'm not gonna spoil it, but I love the little twist at the end.

Erik: Yeah, the twist is great. 

Matt: Yeah, it was a great little twist at the end, so make sure you go see it. 

Patrick: The twist was a lot of fun to write. 

Matt: That was great. Great. Very great writing. 

Patrick: Um, and just to take it in reverse, so the Narcan scene. Um, we intentionally show the, them, them hitting a pothole and everybody kept asking, well, why, why is that the important thing?

And I was like, if you want the vomit payoff, you have to do it this way. Yeah. And they're like, well, why wouldn't you just give it fast anyway? And I'm like, 'cause that's like, I don't have the time, or you don't care about the pathophysiology about this. Yeah, yeah, yeah. Just trust me when I tell you like, we have to, you have to show this, you have to show him really slamming it and he can't be doing it on purpose or else he's just an asshole and that's not what you do.

Um. And then, uh, [00:30:00] to, to your part about the, the, the motorcycle scene. That aha moment was something that was, that was born from a conversation I had with Chris 'cause that was a call I ran um back in the day. And, and he asked the same question. He goes, why would, why both eyes? And it's like that whole explanation is why that scene exists.

Um, but for me, my favorite scene is the really quiet one at the end or towards the end when you are inside the truck and the lights are, they turn the lights on and you're watching it bounce off the city as if Yeah. You are in the cab. Yeah. And you watch it bounce off of them. Like to me, that's the scene that I always that, that I always get attached to. I, uh, that that's the one that I love the most from a visual perspective. But, um, yeah. 

Erik: You know, one of my themes, one of the themes from the movie that I resonated with the most, because I'm like you, I'm a nocturnists for a decade of my life, I worked nights in the ER and I got pretty burned out.

And during COVID it [00:31:00] got bad and I really, really appreciated the way you wrote Rainn's character, I guess Randy's character, where he was so burned out and so wanting out, but there's no way out, it seemed, and he was so cynical and negative, but he was a dynamic character and he changed. And at the end, uh, when he, I don't, again, don't wanna give too many things away, but he was his.

The way his character changed and the way he saw his job for what it really was. And he kind of experienced that other stuff and came back full circle. To me as an ER doc, uh, who's kind of gone through a little bit of a process like that really resonated with me. And I think that, you know, there's a lot of funny stuff in the movie.

But as an ER doctor who felt like Dr. Serrano many times, you know, saying things under my mask, I wouldn't want my patients [00:32:00] to hear. Uh, I really, uh, the movie almost seemed cathartic to me. It was really special. Very, very cool. 

Matt: Well, and I thought it was,

Patrick: I'm honored to hear that that was, that's part of it.

Like, again, like the original starting point, I was, I was really burnt out and I had the. Uh, the fortune, I guess, to, to get out at the right time. I mean, after grad school I started being able to do stuff outside of EMS, which was the right path, but I've been very open about it. Like I got, the only way I got back to normal was through therapy and, uh, therapy's a great thing kids like I never struggled drug addiction or alcoholism or, or suicidality, very lucky. Doesn't make me better, stronger than anybody else. I just was fortunate, but like I had people that were like, we don't like being around you 'cause you're just a lot right now. And so I, I think that, I, I think, I think therapy should be mandatory to be frank, uh, to anybody who's done the job for more than five years.

And not in the, like, you're a broken human, but like. [00:33:00] Especially at night, it gets very insular because mm-hmm. Normal humans are up during the daylight and like, especially after a year of night shift, like the, the only people that you can hang out with really are other night shifters because you are wide awake at 2:00 AM and you know, your neighbor is snoring, like they're not gonna want to chill out or go to a barbecue.

Matt: Yeah. 

Patrick: Um. And so it's like, it's one of those things where I, I tell some of the, the new people that I've met, I'm like, I love night shift. I loved EMS, I loved every minute of it, but you've gotta make friends outside of medicine so that way you can still say normal. 

Erik: Yep. You, you've said it well, and, and you said it well in the movie.

Yeah. Uh, really profound to me because I'm with you, struggled mightily with, with, uh, uh, my own struggle with, uh, demons. Demons. I don't know. It just, yeah, like you, I've never had a drug addiction. I, all these things. Uh, it was really the, I think something changed in my personality working [00:34:00] night shift for a decade and my wife noticed it. My family noticed it. And when I got out of emergency medicine, I'm. I'm still PRN. I still have my hand in it, but I'm not night guy anymore. My mom said something to me that was profound this year. She said, Erik's back. And I, I was like, oh gosh. You know, I've, I've heard that from multiple people now.

Uh, I really, 

Patrick: yeah. I mean, the demons are real. Like anybody who's done this job for a significant period of time, like, I, I always talk, or I don't always talk, but I, you always run into the people that think they're the Marlboro man, right? Like, oh, I, it doesn't affect me like it does by you telling me it doesn't affect me, tells me that you're closed off.

Like, yeah. I mean, uh. It's one of those things where I remember just, I'll just share this, like I used to say like, well, I don't have emotions. And my, the therapist I was seeing at the time was like, you know, that's not normal. I was just like, what? 

Matt: You're not a sociopath. You, you have emotions. Yeah, right.

Erik: You know, it's, [00:35:00] I'm sorry. I just have to say that I've never heard anybody say that, and I said the exact same thing to my therapist. Her name's Natalie, and I told her that it is, like I said, I almost feel like a giant callous and I can't feel these emotions. I, I like, I should be crying right now and I'm not.

It's, yeah, it was, uh, it's, uh, something I'm gonna live with the rest of my life, I guess. Uh, but it's, it's nice to hear somebody else say that. 

Matt: We have a therapist that comes our fire. 

Patrick: Yeah. I remember somebody in the family died and I was just like, well that sucks. I'm hungry. And they were like, what? 

Erik: I know. 

Matt: Yeah, 

Erik: I know.

Matt: Only first responders will do that. 

Erik: This kid 

Matt: eat after death. 

Erik: No, it's true. Like I'll be resuscitating a nine day old kid in the middle of the night and it is like, I guys, I gotta get a Diet Coke. I'll be back. You know, it's like these aren't normal responses to life's tragedies. This is not normal. 

Matt: Well, that's a protection mechanism that we put up, right?

To do the job because we have to kind of have that to be able to operate in these [00:36:00] conditions. But I was gonna say, Dr. T, our good friend who's a therapist and runs a huge organization here in, uh, the Dallas area. She first came to our fire department. We talked about this in our mental health podcast.

And one of the things that she said that just resonated with me was that the average person sees about three to four traumatic events in their lifetime. And she said the average first responder sees like 900 to a thousand in their lifetime. And so, and, and there's a lot of other things about how long, you know, how many hours it takes to get over once you see a traumatic event.

And based on our schedules, we didn't have enough recovery time. Before we were right back at it, experienced another traumatic event. And then you start to build that up and it has a cumulative effect over an 18 year career like Randy had. And all of a sudden you hate everybody on the planet. Mm-hmm. And you just, you know, don't wanna talk to anybody.

And, uh, 

Erik: that one scene when Rainn was like f you. Yeah. I mean, just like, yeah, it was, [00:37:00] I, I'm not gonna swear on our podcast, but, but those are the things you think about sometimes. Yeah. When you're just, you've met your limit, you're fed up and we don't talk about it enough. And I think that 

Patrick: that was the most cathartic scene to write.

Erik: I bet. 

Matt: I bet. Yeah. Something you wanted to say for 12 years. You finally got to say it publicly. 

Patrick: It's like you reached that moment and you're just like, that's it. 

Erik: Yeah. Well see that's what it is too. What the movie did for me, and I think for anybody who sees it, who's been any involved in, in the pre-hospital environment somehow, is that, uh, this created an environment where you're saying things that we feel and think that we've never said before.

Yeah. And it's almost like therapy a little bit to me. It was so fun and it did something. You, when you finish watching the movie, it's like, it's like a big, deep breath. Yeah, yeah. It was, it was good. 

Matt: Well, and it, and it, it shows the EMS, the private EMS provider. We were talking about this right before we started today, that, you know.

Most police officers working for a city or working for a [00:38:00] state agency or something, they get compensated fairly well. Firefighters working for a city or a county or something like that, they get compensated fairly well. Private EMS workers, it is criminal what they get paid for, the amount of responsibility they have, it is 

Patrick: The most I ever got paid was $17.32 an hour.

Erik: Wow. 

Matt: Yeah. And it's, that's, that's crazy. And that's why a lot of guys go to the fire side because they wanna make more money. You know, even though they love EMS, they wanna make more money. And, and I think your, your script, your movie did an excellent job of showing, I think, kind of the unsung heroes, heroes of first responders.

'cause the cops and the firemen get all the glory stuff right. But that $17 an hour paramedic is saving lives every day on the streets of LA and nobody's putting his face on the news. So I think you're, you're, I think the movie did an excellent job, uh, kind of praising the, the private EMS worker specifically on the job that they do.

Erik: Patrick, you were about to say something. [00:39:00] We interrupted you. What were you gonna say? 

Patrick: Oh, uh, just going back to what, what you guys were talking about before, I, I've said this before, is I think that the dark humor that's proliferated in, in public safety is necessary. Yeah. I think in small doses it is not just appropriate as it, it's, it's necessary.

With the giant caveat being, when it becomes your only personality trait, you have a problem. Yeah. Like. I, I, we, the story I've told before is when, back when I was on the fire department, I was, I wasn't quite a paramedic yet. It was an EMT, I think it was an intermediate back in the day. Um, but somebody got smashed by a train.

And so we got there, there was obviously nothing we're gonna do. We had to wait till, till, you know, the coroner came up. And anyway, we get back to the firehouse and there's five guys on that truck. And as soon as the garage doors were closing, uh a buddy of mine just ran over to me, just kind of tagged me.

He goes, tag you're it. And [00:40:00] like these five grown adult ass men are running around the fire department playing tag. And from anybody else's perspective, it was like, it would be like, this is the what weird, backwards world are we in? And it was like. I'll never forget that because it helped, you know? Yeah.

We, we saw something really bad and we played tag afterwards and it's like, I don't know why, but it was kinda like the spoonful of sugar kind of thing. Yeah. Like, yeah. It, it helped. 

Erik: I could, I got a story like that. Uh, in the ER, we, uh, had just seen a horrific trauma level, one trauma type of thing, and we're getting cleaned up, house cleaning.

Uh, the, the, the housekeeper folks, environmental services, I think they call it mm-hmm. Are in that trauma bay mopping up the blood. We decided to have wheelchair races. So we pulled out the wheelchairs and my night crew and I, uh, made the like a little, like a mini Olympics. A track. Oh yeah. And then there we had patients in the ER, but we said, we got, you kinda of have to do that though.

You kinda have to not take yourself too [00:41:00] seriously and you gotta be ready 'cause another trauma could be right there on its way. So, you know. Yeah. I think there's, there's something, you know, actually right now, Patrick. I, I'd love to tell you more about it. Maybe this isn't the right time, but we're preparing a storyline for a documentary we're involved in, and the purpose of this documentary is to celebrate first responders.

And a lot of 

Patrick: That's awesome. I think we need to do more of that. 

Erik: Well see a lot of what I wanna say you said in the movie, but it's not appropriate to really talk about it there, but you're able to bring that out. Yeah. Like this is really what we think and this is what it's like. And uh, I think it was a different kind of a celebration that you guys built it with this movie, um, elevating their, their, the, the heroism and what they do for minimal money and the impact they have on society. 

Matt: Calling out nursing home nurses. I'm sorry, it just came. I'm sorry. It's true. Just kidding [00:42:00] nursing home nurses, we love you. 

Erik: Even, even the citizens who complain about them parking bad.

Saying stupid stuff. Yeah. It's nice to hear somebody tell 'em off, you know? Yes. That's funny. 

Patrick: Yeah. I mean, part of that is I, I've talked to some leaders, uh, in, in different, in fact, I'm going to Colorado tomorrow, and I'm gonna say this to them too. It's like if you're a leader in any EMS service and you walk out amongst your employee parking lot and you see more than 20% cars have Uber and Lyft stickers on them, you're not paying enough.

Yeah. Um, now there are. There are significant issues with reimbursement that your audience may or may not care about, that we talked about the CMS legislation and everything else, but the short answer is we gotta fix it. I don't pretend to know all the nuances around it, but if your employees are working two or three jobs and they still, they went to paramedic school and they got all of the credentials that everybody on this podcast know you have to have and keep current, and then on the side they're driving Uber or Lyft.

There's something functionally [00:43:00] broken. Yeah. Uh, uh, there, and, and I, I, I, I was at USC uh, last week talking to students and I just said like, no one with a straight face can tell me that the US healthcare system is good. Like it's, it's broken. Uh, and I've worked on both sides of it. I've done some policy work, I've even worked for the state.

Um. We've got a chicken wire and duct tape system that I believe needs to be remade. Uh, now how we do that, I don't claim to have all the brain power to, to be able to do that, but there are, there are significant gaps in the way that US healthcare is delivered and reimbursed. 

Erik: Well, I can, uh, I've spoken on this multiple times and I can talk about this, this will be our second most boring podcast, but 

Matt: I'll let you two, we'll have you back and I'll have you two nerd out on, uh, patient satisfaction scores.

Erik: No, but I will say this though, and, and actually at EMS World last year I spoke on this. Is that the pre-hospital providers that, that we're talking about right now, us, the, the first responders. [00:44:00] I believe wholeheartedly is the answer to fix some of the biggest things that are broken in our healthcare system.

We are overutilizing the healthcare system, but we have a pre-hospital system that's underappreciated, that's only incentivized to transport to the ER. ET three almost solves some of that, but by differentiating the care that we can deliver and by really maximizing the care potential that a first responder could have, we could do the healthcare system 

Patrick: Let 'em work top of scope. 

Erik: Say it again. 

Patrick: Let 'em work top of scope. 

Erik: Yes, exactly. 

Patrick: You can start a community paramedicine program and partner with a hospital to do ongoing care of your patients that you know are high risk, high utilize, high utilization. Yep, yep, yep. There are, there are paths forward. It's just you, number one I out the reimbursement.

Um, yeah. You'd have to partner with a hospital that somehow creates a reimbursement structure for that to decrease uh, ER runs. Like, and, and again, I don't wanna bore your audience to tears, but to your point doc, like there are, there are [00:45:00] ways to, to at least make meaningful inroads in, but part of that is also like, the thing I always hated the most is anytime you run into a mother may I system.

Like if you're trained at this level, let me work at this level. Like, 

Erik: yeah, 

Patrick: give me the drugs, give me the permission. Like when I worked at, when I worked at Johns Hopkins critical care team, like that was a light year above what I thought I could do. And I mean, some of the most significant, most interesting clinically bizarre, uh, scenes and, uh, not scenes, I'm sorry, but complex medical cases I've ever dealt with in my life. But talk about working the top of scope. Like I was with a CCT nurse and we were just, she'd hand, she'd ask for something and it was like, okay, like I guess we're doing this. 

Erik: Yeah. There's a lot of, there's a lot of care potential that we have not maximized, we, we haven't utilized our first responders like we could, and I actually think it would decrease stress if we recognize their capabilities and train them properly 

Matt: and [00:46:00] compensated them appropriately 

Erik: compensated.

Patrick: Yeah, 

Erik: I really believe that wholeheartedly. I think that's a lot of what we, that's actually why we built this business was really to train people appropriately. There's so much we could talk about with that. But you know, as a question to you, Patrick, actually, so we've, we do a lot of things that are very creative to be able to tailor education to first responders.

You seem like you're a pretty creative guy, writing scripts and stories. Uh, I, I don't know. What other creative things do you do outside of writing. 

Patrick: I, I'm, I'm an educator at heart, and it took me, it took me a long time to realize that, like I've done, I've loved all of my careers, but one of the things I really enjoy doing is kind of the training and education piece and making, um, when I was doing the, the, the patient experience stuff, I'd always say, my job is to make data tell a story.

Uh, and there was some foreshadowing there. Yeah, I guess with the movie. But yeah, making complex stuff easier to understand, easier to digest, and making sure that [00:47:00] there is um, a comprehension at the end is something that yeah, that, that I'm personally passionate about. I mean, I'm still, uh, if you're asking like on the Hollywood side, I've got some other stuff written.

We're, we're pitching, um, some other stuff that we're hoping to get up, up, up and off the ground. Some of it's EMS related, some of it's not. Um, but I would love to live and make believe for the rest of my life and, uh, or, or do something meaningful on the, in the training uh, an education space. In fact, I was just recently looking at, like, trying to see if I could become an adjunct professor with, with a master's degree.

So that's the kind of stuff that I, that I really like. 

Erik: Oh, very cool. Well, sounds like you're the kind of guy we need to hire here. 

Matt: Well, and I also think we need to start Code 3, the series. And that we need to have, 

Patrick: uh, you know, hey, if enough, if enough people get interested in it, uh, that would be I, I would love nothing more than to fill your TV with, uh, funny stories and, uh, continuing storylines.

Matt: Come on Netflix, Peacock, somebody. Sign this guy up and start a series. 

Erik: I actually started writing a [00:48:00] book, uh, a book that it's long story short, uh, a book, uh, basically it's got ER stories in it, ER. Yeah, from the ER of course, my perspective and some of the craziest situations that patients get themselves into.

And I've married each story with, uh, kind of a, a quick lesson on the physiology of that part of the body that was injured and how amazing a human machine is, it's uh, it's really phenomenal to think about how our bodies have been engineered in such amazing ways. Uh, I call it the human machine.

And to parlay that into some crazy ER story where a guy gets bit in the eye with a albino Burmese python. I mean, it's a, it's a fun, uh, a fun interplay. 

Patrick: Yeah, that's an interesting, yeah you should totally write that book. Yeah. Um, I don't know, I'm assuming you guys know who Rob Lawrence is, right? Uh, the, the Cal Director, the director of the California Analyst Association.

I thought he was at Expo. Anyway, Rob is a, is a British man. He's brilliant. He's been a buddy of mine for a long [00:49:00] time, but he's famous for saying, you know, it's either carpentry, plumbing, electricity, or electricity. Like, those are the three big things. 

Matt: That's true. That's so true. That's, so, that's, 

Erik: well that's what we said in our cardiovascular lecture.

It's really about pumping hoses. 

Matt: Yeah. We relate, we, we teach a lot of firefighters, uh, and so we relate a lot of stuff. So when we did our cardiovascular lecture, we were out with a firetruck talking about the pumps, the hoses, same. Same idea. Next, next time we're gonna have to, we did, we got tased. So 

Erik: we got tased for our EKG lecture. 50,000 volts. I intubate myself. 

Matt: Yeah. 

Erik: Wrestled alligators, 

Matt: hot chip challenge. 

Erik: Swam with the great white sharks to talk about hemorrhage. We, that's the way we teach, so 

Patrick: that's, that sounds incredible. I'm not gonna get tased. Sorry. I don't care how many likes you get, and I'm not eating that hot chip. 

Matt: That was better than the hot chip challenge.

I'll tell you that. 

Erik: It was

Matt: shorter. 

Patrick: I will not do that. I promise you that. I'm not that man. Um, but, uh, I'll go scuba diving with you any day. Let's go. Uh, 

Erik: well, I think I told you about, uh, Dr. Lowe out there at Long Beach, where you live. [00:50:00] Uh, he, uh, he joined us on our show and it was a, a ton of fun to work with him on our hemorrhage, uh, show we do cce. Patrick, but it's really more of a show. People actually watch our stuff. They don't just click play and walk away. They really actually watch it. And that's, that's what, that's why we have, we're like a bunch of junior hires here playing around and making learning fun.

It sounds like you, 

Patrick: I mean, that's what it's all about. Like anytime you drone on, no one pays attention, right? Like, let's talk about the T wave and re and you know, no, like, let's talk about depolarization. Why, salt's on the potato tastes like french fries. There's your chemistry lesson, like, let's go. 

Erik: Yeah, there you go.

Matt: Exactly. Exactly. 

Erik: Well do you, uh, Patrick, do you have any closing thoughts? Anything you'd like to tell our viewers or share, um, as we close out? 

Patrick: Yes, I, I've said this in every single interview I've done for this film. Uh, and, and anytime I can because I think it's too important, uh, for anybody who's watching.

Thank you for what [00:51:00] you do, especially if you're still doing the job right now. I don't, um, I still have my credential, but I don't use it. But, uh, what you do matters and it's important, and I know it's hard and sometimes it's very unfulfilling. So if you haven't heard it today, uh, you're gonna hear it from me today.

Thank you for what you do. I think it's incredibly important. I'm grateful. I don't care where you work, I don't care what it is that you do. Uh, if you're touching a patient, uh, it matters and it's gonna make a difference, uh, in their life and hopefully yours too. So thank you for what you do. 

Erik: That's great.

Matt: Well, thank you, Patrick for writing the movie. Uh, co-authoring, creating, having the brain behind the story, the movie, uh, it was a great movie, entertaining, educational, absolutely all those things, and thank you for being on our podcast. Really enjoyed it. 

Erik: Cathartic. 

Patrick: I love it. I'd come back as many times as you'll have me.

Matt: Well, don't say that 'cause we'll have you back. 

Erik: We would love to have you back. Thank you, Patrick. You've been great. What a pleasure it is to have you on our show. 

Matt: Thank you guys for watching, and Patrick, we kind of have [00:52:00] a little close out thing that we do. We'll see you on the next one. 

Erik: Be safe out there.

Patrick: Be safe.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.