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In 2014, Andrew Hodgetts left a paramedic career in Victoria with a set of keys, an empty bank account and a mandate to start an ambulance service on Espiritu Santo, Vanuatu's largest island. There was no funding for equipment or vehicles. That came later through cold-calling ambulance commissioners, a chance conversation at a trade stall that filled his car boot with donated gear, and an unsolicited vehicle donation from Queensland Ambulance Service.

In this episode, Hamish McLean talks with Andrew about what it actually took to build ProMedical Santo from nothing: recruiting and training two Ni-Vanuatu nurses as the service's first paramedics, funding operations through business sponsorship and a subscription model, and the slower, harder job of teaching a community what an ambulance is and why they should call one rather than load a patient into the back of a ute.

The conversation moves from the practical (no street names, no central dispatch, directions given by mango tree) to the systemic: why Andrew now believes importing a high-income paramedic model into a low-resource setting was, in his own words, naive; how a near-mutiny over cutting CPR from a first-aid course taught him that "what works" and "what the community needs" aren't always the same question; and why his PhD research into community first responder programmes has led him to conclude that context - culture, infrastructure, geography, trust in the profession - has to shape the model, not the other way around.

The episode closes on a comparison that speaks directly to EMS Global's work in Mongolia: what happens when first-responder models designed for dense, road-connected populations meet nomadic, geographically dispersed communities — and why the answer isn't always more training, but a different question altogether.

In this episode

• How a volunteering trip turned into founding a new ambulance station on Santo
• Funding a charity ambulance service door-to-door: sponsorship tiers, raffles and a free fuel deal that kept the service running
• Training two Ni-Vanuatu nurses as the service's first paramedics
• Teaching a community what "call an ambulance" means and why visibility mattered as much as clinical capability
• The Village First Aid Responder (VIFA) programme, and the community pushback that changed Andrew's approach to CPR training
• Why he now questions transplanting a paramedic-level, high-income model into a low-resource context
• The gap between prehospital and hospital-level care, and what happens when an ambulance service outpaces the system it delivers into
• Aeromedical retrieval without air traffic control, on grass runways, at dusk
• What his PhD research into community first responder models is finding and why most existing programmes are taught in isolation from the wider health system
• Parallels with nomadic, dispersed communities in Mongolia

About the guest

Andrew Hodgetts is a Victorian-trained paramedic who founded ProMedical Santo, a charity ambulance service on Espiritu Santo, Vanuatu, in 2014, supported through the Australian Volunteers for International Development (AVID) programme. He is now a PhD candidate researching how community first responder programmes can be integrated into established health systems in low- and middle-income countries.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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Decades ago in the United States, if you called an ambulance, the vehicle most likely to arrive was a hearse.

For much of the 20th century, more than half of the country's ambulance service was run by funeral homes — not because it was profitable, but because they had the only vehicle in town built to carry someone lying down, and no one else stepped up.

In this episode, host Dr Hamish McLean talks with Police Chief (Ret.) Scott Reinbolt — 25 years in law enforcement, now an adjunct professor of law enforcement at Ohio University — about the era he documents in his book, Humble Heroes: The History of Funeral Home Operated Ambulance Service. We cover how the system actually worked, why it finally collapsed under a convergence of new labour law, a landmark federal report, and a reimbursement system that never covered the real cost of care — and why the funeral directors who built it were largely excluded, blamed and forgotten once it changed hands.

This isn't just American history. The same questions - who builds an EMS system when no one else will, and what happens to that knowledge when the system finally changes - are ones EMS Global Foundation works through today in Mongolia, Central Asia, and the Pacific.

In this episode:
• Why funeral homes ended up running American EMS, and how the model actually worked
• The regulatory and financial convergence that ended the era
• What happened when incumbent providers were excluded from EMS reform
• What today's EMS system-builders can take from this history

About Before the Hospital: a podcast from EMS Global Foundation examining the governance, financing, and workforce decisions that determine whether prehospital emergency care systems succeed — particularly in low- and middle-income settings.

Read the companion essay and subscribe: emsglobalfoundation.substack.com/
Learn more about our work: emsglobalfoundation.org

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/

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In this episode of the Before the Hospital Podcast, host Hamish McLean interviews Joe Acker, CEO of the EMS Global Foundation, who brings 35 years of experience in running emergency medical services across Australia and Canada. Joe discusses the critical need for EMS leadership to balance high professional standards with a "leading with love" approach. He explores the challenges of shifting EMS culture from traditional paramilitary structures toward a modern healthcare-focused model, emphasizing the importance of transparency, showing up for staff, and building strong collaborative partnerships rather than operating in isolation.

For video podcasts visit: https://www.youtube.com/@ems-global2048/podcasts

Our website: https://emsglobalfoundation.org/