The JEMS Report: Inside EMS Medical Direction and Rehab Strategies at Large-Scale Fire Incidents Dr. Jeremy Cushman shares his journey from EMT to full-time EMS physician and regional medical director covering over 100 agencies in New York’s Finger Lakes and western regions. He talks about the evolving EMS physician role and the relationship between medical directors and first responders. The discussion dives deep into EMS response and rehab protocols for large-scale fires, highlighting lessons from a recent five-alarm fire in Rochester, NY. Dr. Cushman explains the importance of preplanning, hydration, acclimatization and post-incident recovery while stressing rehab as a command responsibility, not solely EMS’s. He explores how automatic scaling of EMS resources during growing incidents supports both firefighter safety and system capacity.