Richmond, Virginia’s EMS system is one of America’s most clinically-advanced and operationally-innovative systems. However, several decades ago, failure was of this system was imminent: Competing ambulance services, medical politics, fights with fire agencies, new state legislation, and lawsuits were all part of its history. Richmond’s story helped define the evolution of EMS. Come interact with three industry icons as they share how political waters were navigated and gain their insight about key factors that continue to move the system forward. Joe Ornato, MD has served as the system’s medical director for over 30 years. Dr. Ed Rach was an early medical leader in the Richmond system, and consultant Jay Fitch has provided guidance at several key points in the development of the Richmond system’s development.