What if EMS could prevent the call with Dr. Miramontes

EMS Medical Director Dr. Miramontes reveals how San Antonio's Mobile Integrated Healthcare program is saving $2 million a year — by NOT sending ambulances. In this conversation with host Matt Nealand, Dr. Miramontes breaks down the nine service lines his team runs to keep high-utilizers out of the ER, support hospice families at home, manage psychiatric patients in crisis, and deliver care inside a 14-acre homeless shelter — all without a 911 call. From flying Life Flight as a first-year resident with no physician's license, to running EMS for Washington DC during the Obama administration, to building one of the most forward-thinking MIH programs in the country — Dr. Miramontes brings 30+ years of EMS, nursing, and emergency medicine experience to every decision. In this episode: 0:00 – Cold open: "The bean counters love it" 0:47 – Dr. Miramontes' background: EMT at 16, nurse, flight physician, DC EMS chief 9:42 – Why Texas delegated practice changes everything 13:06 – What is Mobile Integrated Healthcare (MIH)? 22:03 – High-volume utilizers: how to identify and fix the real problem 27:58 – The hospice program that keeps patients comfortable and out of the ER 33:12 – PIC: Psychiatric Intensive Care Coordination ($7 saved per $1 invested) 39:17 – Haven for Hope: a clinic inside a homeless shelter 43:55 – Molina Healthcare partnership: insurance-funded MIH 47:10 – How any agency can start MIH today Subscribe for more conversations on the future of EMS, prehospital medicine, and the people redefining what it means to show up.