Confessions Of An EMS Newbie Podcast

1. You fall, you call, we haul, that’s all.
2. There are two kinds of EMS calls: “Oh, shit!” and “Bullshit!”
3. When you join the kidney club, you usually cannot go.
4. Common sense isn’t.
5. The more reflective striping there is on your jumpsuit, the easier it is for the only drunk driver going by the MVA to find you.
6. If you have a ride-along you want to show the real world, nothing will happen that shift.
7. 95% of the time, EMS is simply thwarting the process of natural selection.
8. Just because you’re paranoid doesn’t mean your supervisor is not around the corner.
9. You can’t cure stupid.
10. If at all possible, avoid any edible item that firefighters prepare, especially the tuna casserole.
11. Heaven protects fools and drunks.
12. We are all slaves to the god “Motorola.” And that god requires sacrifices of hot food at least once a shift.
13. The address is never clearly marked.
14. Avoid bringing your patients to teaching hospitals in July.
15. EMS doesn’t save lives. We only postpone the inevitable.
16. Even sterile water tastes great on a hot day.
17. The stereo must always be louder than the siren.
18. At the beginning of your shift, your main O2 tank, fuel tank, and stomach will be empty…but the call volume will be full.
19. You know you are in trouble when the directions to a patient’s house include, “Turn off of the paved surface…”
20. Anyone with a tooth: tattoo ratio of less than 5:1 is guaranteed to be drunk, on drugs, or both.
21. Anyone with more than five listed drug allergies is automatically a psych diagnosis.
22. Avoid hospitals with Saint, Mercy, or Memorial in their names. And St. Mary of Mercy Memorial Medical Center is a definite no-no.
23. All arrhythmias eventually straighten themselves out.
24. Dead is dead, leave it at that.
25. Your seriously ill patient will miraculously get better after five minutes in the ER. We call this “fluorescent light therapy.”
26. Periodically, aliens will abduct your patient and replace him with an exact duplicate with a totally different chief complaint and set of symptoms. This usually happens right after you call report.
27. Don’t get excited about blood unless it’s your own.
28. The pain will go away when it stops hurting.
29. If nothing has gone wrong, you obviously don’t understand the situation.
30. You should always stop CPR after the second “ouch!” from the pt.
31. People don’t call an ambulance because they did something right.
32. The quickest way to gather the relatives is to leave the primaries on while at the scene.
33. Every nurse is right, as long as you are in their E.D.
34. When in doubt, always take another set of vital signs.
35. If your patient is violent, you can always use topical oxygen therapy. The green paint usually wears off in about a week.
36. The larger the house, the furthest from a door the patient will be, and the sickest patients are always in the back bedroom.
37. If the patient fell and was moved by the family, they will have moved them so that climbing stairs will be involved.
38. The furniture will always be arranged so that a stretcher or stair chair will never fit easily.
39. The problem won’t be that bad until a major disaster strikes: “You’ve had chest pain for three days and you waited until the middle of a blizzard to call?”
40. History never repeats itself. This is never more apparent than in the E.D., when the nurse asks the patient the same questions you did five minutes ago.
41. You’ve never been as sick as just before you stop breathing.
42. If someone is pointing a gun at you, two things become apparent: 1) You should have waited for law enforcement; 2) You wish you just hadn’t made that wise-assed comment.
43. Fellow medics always have a better story than yours.
44. Just when you say, “You know, I have never had a hanging….” you will get one.
45. The only time you go out on a limb (as a dispatcher), and not provide coverage so a crew can eat, a serious call will come in that area.
46. The only time you need to fart is when you have your patient loaded in the elevator.
47. The only time your pants split is when there are gorgeous police officers there to assist you.
48. You will get caught sleeping, eventually.
49. Never say the kind of call you are in the mood for in the beginning of the shift, because you will get it in the worst way, i.e. an MVC in the pouring rain.
50. God made Paramedics and EMTs to give him a chance to change his mind.
51. Beware when a firefighter says, “Y’all check this out.”
52. Your driver will never hit a pot hole or curb unless your patient has a bad fracture.
53. The worse your patient’s breath, the more quietly they will talk, forcing you to lean very close to hear them.
54. If ever in doubt of which house you were called to, look for the stairs.
55. If there aren’t nurses around when you get called to a nursing home, go to the last room in the hallway. That’s always where the sickest patients are.
56. Never start putting your stuff away before you are told to go home, because you have just given yourself another call.
57. When in doubt, let your partner handle it.
58. When getting a TMJ (too much Jesus) call on a Sunday, never say it around your patient. It sucks when you have to tell them what it means.
59. If the patient pukes, it is not unprofessional to puke along with them, it is sympathetic puking. You have something in common with your patient and can relate to how they feel. This is why they made the big step well by the side door.
60. If the patient only moans when you listen to lung sounds, they aren’t as sick as they want to be.
61. If a patient calmly tells you they are going to die, you had better believe them.
62. When the patient is really sick, remember that the ambulance has wheels for a reason.
63. 911: The government’s answer to Dial-A-Prayer.
64. The more addicted your patient is to morphine, Demerol, Fentanyl, etc…. the more allergic they are to Toradal.
65. You can have circulation with no breathing, but you can not have breathing with no circulation.
66. On trauma calls, survivability is inversely proportionate to social worth.
67. How you know an unconscious is a DOA: 1) If it weighs over 300 pounds… DOA; 2) if it lives more than three flights up in a walkup apartment… DOA; 3) if it’s less than 30 minutes left in the shift… DOA.
68. EMS providers know how to say “got shoes?” in 7 different languages.
69. At haz-mat scenes, remember to use the Copological Indicators: If the stripe on the officer’s trouser leg is vertical, it’s safe to go in. If the stripe is horizontal, wait for the haz-mat team. At a gas leak, send the cop in with a lit road flare. If the cop passes out and the flare goes out, it’s an asphyxiant. If the cop explodes, it’s a flammable.
70. Never go past the first dead cop.
71. There will be no dying or multiplying in the back of my unit.
72. The worse you have to use the restroom, the farther the distance it will be from the location of the call to the hospital.
73. If you haven’t yet had to use a patient’s bathroom… you haven’t been in EMS very long.
74. Some people can do this job, some can’t. Pray your partner is one who can.
75. All rhythms will eventually degenerate into one you will recognize and can treat.
76. If God had intended you to have a rapid response to the call, you would have been parked in front of the location.
77. Upon arrival at a code, check your own pulse first. If it is still there, everything else is easy.
78. As soon as you finish cleaning the rig up for a parade, you’ll have to drive ten miles down a muddy, unpaved road for a difficulty breathing.
79. If you ever go to a call and find the cops laughing on the front lawn…worry!
80. Remember, it’s the patient’s emergency, not yours. Try to keep your pulse rate lower than theirs.
81. If you drop the baby, fake a seizure.
82. The most effective prehospital fluid for trauma patients is a diesel bolus.
83. Sometimes people will die despite our best efforts.
84. Dead people very seldom get any better, but they never get worse.
85. “Can you walk? Have you tried?”
86. If EMS workers never eat, sleep, or go to the bathroom, nobody would ever get sick or injured.
87. Better to be looking at it than looking for it.
88. Go to work expecting to get screwed. You will occasionally be pleasantly surprised, but you will never be disappointed.
89. The size of the IV needle and the number of attempts is directly proportionate to the patient’s attitude.
90. All people eventually die.
91. If there is a God, you are not him. This even applies to paramedics.
92. The patient’s need of medical attention is inversely proportional to the amount of noise he/she is making.
93. If the patient says she’s in labor, it’s a UTI. If the doctor said it was a UTI, break out the OB kit.
94. If she says the baby is coming, believe her.
95. If a patient presents you with a problem you don’t know how to treat, change it into something you do.
96. All bystanders, and the majority of your patients, have more medical training, experience and knowledge than you. And they’re never shy about offering advice.
97. The best way to make a bystander go away is to ask for help.
98. The amount of vomit produced always exceeds the size of the container by at least a factor of 2.
99. The seriousness of an injury is inversely proportional to the number of escorts wanting to accompany the patient to hospital.
100. When your patient says, “I’ve called my doctor, and he’ll be meeting us at the hospital,” this actually means, “I am a hypochondriac and my doctor doesn’t have caller ID.”

1. Skin signs tell all.
2. Sick people don’t bitch.
3. Air goes in and out, blood goes round and round, any variation on this is a bad thing.
4. About 70% of the battery patients more than likely deserved it.
5. The more equipment you see on a EMT’s belt, the newer they are.
6. When dealing with patients, supervisors, or citizens, if it felt good saying it, it was the wrong thing to say.
7. All bleeding stops… eventually.
8. If the child is quiet, be scared.
9. EMS is extended periods of intense boredom, interrupted by occasional moments of sheer terror.
10. Always follow the rules, but be wise enough to leave them sometimes.
11. If the patient vomits, try to hold the head to the side of the bus with the least difficult-to-clean equipment.
12. If someone dies by chemical hazards, electrical shocks or other on-scene dangers it should be the patient, not you. (Also known as rule 1313)
13. Any EMT, FF, LEO and/or scene chief who is more drunk than the patient is the real problem.
14. There will be problems.
15. The severity of the injury(s) is directly proportional to the difficulty in accessing, as well as the weight, of the patient.
16. Make sure the rookie EMT knows that a med patch is a radio term, and not a medicated bandage.
17. Paramedics save lives; EMTs save Paramedics.
18. If the patient looks sick, than the patient is sick.
19. If the patient is sitting up and talking to you, then the patient is not in V-Fib, no matter what the monitor says.
20. It is that bad.
21. Full spinal precautions were custom made for obnoxious drunks. So were NPAs.
22. If you absolutely must vomit, than it is probably best to turn your head away from the patient.
23. It is generally bad to use the words “holy s***” on scene, in reference to the patient’s condition.
24. Patients that crash in separate vehicles should be transported in separate vehicles.
25. Just because someone is fully immobilized doesn’t mean they can’t be violent.
26. If I’m up, EVERYONE is up!
27. Better them (another unit) than me.
28. I saved the patient… from the fire department.
29. When responding to a call, always remember that your ambulance was built by the lowest bidder.
30. Never get into the front of the ambulance with someone that is braver than you are.
31. When in doubt, use industrial strength therapy.
32. If it’s stupid, but it works… then it ain’t stupid.
33. Algorithms never survive the first thirty seconds of patient contact.
34. Always honor a threat.
35. Always know WHEN to get out of Dodge.  Always know HOW to get out of Dodge. Don’t go INTO Dodge without the marshal.
36. The important things are always simple.
37. The simple things are always hard.
38. If the patient is going to vomit (especially projectile) be sure to aim towards any bystanders that would NOT clear the scene. (This also works for OIC’s)
39. Sometimes it’s easier to beg forgiveness than get permission.
40. You can’t please any of the people any of the time.
41. They said, “Smile, things could be worse.” So we smiled and sure enough, things got worse!
42. Always answer a newbie’s questions. You once asked them, too.
43. Always trust bad feelings
44. Touch no one’s genitalia but your own.
45. The number of drugs a patient has on board is directly proportional to the number of knuckles tattooed. If the patient has every knuckle tattooed, the drug screen will simply say, “YES.”
46. PVC’s can be eliminated by sending a strip to the hospital.
47. The likelihood of a lethal arrhythmia increases with the distance of the paramedic from the “SHOCK” button on the monitor.
48. The ultimate QA program in EMS is an autopsy.
49. Best time to work a code: overtime.
50. Pain never killed anyone.
51. All fevers eventually fall to room temperature.
52. A patient’s weight is directly proportional to the chances the elevator will be non-functioning.
53. Here is a simple ETOH test: Hold your hands about 6 inches apart with thumbs and forefingers touching and ask the patient what color string you are holding. If he indicates a color, it is a positive test.
54. A tourniquet around the neck solves all problems.
55. If you drop the baby, pick it up.
56. Oxygen is good, blue is bad.
57. Never trust an ER doc with anything sharper than a tongue depressor.
58. GCS less than 8, intubate.
59. Asystole is a very stable rhythm.
60. A patient’s weight is in direct proportion to their altitude in the building.
61. A patient’s weight is directly related to the number of stair flights between him/her and the bus.
62. “When in trouble, when in doubt, run in circles, scream and shout”.
63. EMS RULE OF THREES (as it relates to codes) 300 pounds; <30 minutes to shift change; 3 stories up in the building.
64. Whoops: 1) the monitor just fell down the stairs, 2) the cold and flu patient just coded; 3) the wrong house. (Hint: the one with the Lab probably didn’t call 911)
65. Rules: 1) Don’t get dirty, 2) Don’t run, you may violate rule #1, 3) If it looks like you might get dirty doing something, let the new guy do it.
66. For every ALS skill we learn, we forget a BLS one.
67. The fire tetrahedron consists of the following: heat, oxygen, fuel, chief officer. Take any of them away and the fire goes out.
68. “Compassion kills.” Don’t dive into incidents.
69. If there is little to be gained, there is little to be lost. If there is a lot to gain, there is a lot to be lost.
70. If you lift an inch, crib an inch.
71. What do you call a medical student who finishes last in their class? Doctor.
72. If you think the cost of education is expensive, check out the cost of ignorance.
73. If it’s wet and sticky and not yours, leave it alone.
74. Death is a stabilization of the patient’s condition.
75. Every emergency has three phases; PANIC, FEAR, REMORSE.
76. You are bound to get a call either during dinner, while you are on the can, or at 02:00 in the middle of a great dream.
77. Training is learning the rules, experience is learning the exceptions.
78. Good judgment comes from experience, and experience comes from bad judgment.
79. Rocket scientists that get into stupid car crashes are the first ones to complain how bumpy the ambulance ride is.
80. “Poke & Hope” = blind sticking
81. Why do fire chiefs where white helmets? So you know where the Preparation H goes.
82. Never trust your bus, drug box, or airway bag to be fully stocked, in spite of the assurances of the off going crew.
83. If you don’t have it, don’t give up. Adapt, improvise, overcome. And if that doesn’t work, call for a second unit.
84. There is no such thing as a “textbook case.” Patients don’t read the textbook.
85. Newbies always look for large things in the smallest compartments, and vice versa.
86. There is no such thing as a bad call, only calls that didn’t go the way you planned.
87. Just because someone’s EMT or Paramedic original license date is before yours, does not mean they know what they are doing.
88. There are very few paramedics with 20 years of experience. There are thousands of paramedics with 1 year of experience, repeated 20 times.
89. Truckies are people who are over 6 feet tall and their hands drag the ground while walking upright.
90. Newbies have their own way of doing things.
91. When it comes to needles, ’tis better to give than to receive.
92. Listening to some EMTs talk on the radio makes you wonder why they don’t become professional auctioneers.
93. For every 25 calls you run, only 1 will be exciting.
94. Take comfort in the fact that most of your patients survive, no matter what you do to them.
95. The old EMS constant; no matter how bad the politics get, the doors go up and the trucks go out.
96. ALS really stands for “absolute loss of sense.”
97. Many of your patients will be healthier than you are.
98. Being in emergency services means you get to celebrate your holidays with all your friends, while on-duty.
99. Being an EMT means you get to expose yourself to rare, exotic and exciting new diseases.
100. EMS does not save lives; EMS is to care for people. It is 95% of what we do.

Last night I almost failed EMT-B class because I did my traction splint incorrectly. Twice. I’ll talk more about it on the podcast next week, but I thought I’d do a post now about the traction splint. After I tweeted last night that I’d failed it the first time, Greg Friese replied

I’ve heard this before. The traction splint is so rarely used that medics forget how to use it when they do need it.

So here’s my request of you – Tell us about a time you did use the traction splint.

Either in the comments, or via trackback to your own blog.

Since I obviously don’t have such a story, I’ll tell you one one of our paramedic lab instructors told.

Man was working on the roof of his house. Near the edge. And took one step too far. Falls and lands so his thigh hits a rock, causing an isolated femur fracture. The guy is alone at home and ends up dragging himself into the house, across the living room into the kitchen to the phone and calls 911. When the medics arrive they just follow the trail of blood to the patient, who is sitting up in the kitchen. Other than minor cuts and abrasions, the only injury is the femur. So they use a traction splint.*

What’s your story?

* I don’t believe the fracture was open, and I realize MOI says you need to do more (C-collar, spinal immobilization etc), but that’s the story I was told by the paramedic.

Before being accepted into the paramedic program at my school you have to write an essay. You have to hand write it, but come on, I’m doing an essay in one hand written draft? Not likely. So I typed it up. I thought I’d share it here.

It is short, I think it had to be between 200-300 words.

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What are the traits and characteristics that all great paramedics share?

A great paramedic knows their stuff. They are the people other paramedics what to show up when they dial 911. Knowing your stuff isn’t about finishing first in your class, or acing the National Registry, it is about wanting to know everything you can. You aren’t learning from your teachers to pass the test, you are learning to know the material. A great paramedic is a lifelong learner. They are constantly reading and studying the latest in EMS and emergency medicine in general. They are networking with the best in the field and learning from them.

Knowing your stuff is a given, but it won’t make you great. A great paramedic is compassionate, and sympathetic. When a paramedic is called to a scene, this is probably one of the worst days of the patient’s lives. They need someone who shows compassion for their situation. They need to know you understand they are in pain and want to do something about it. That you are concerned not just with fixing the problem, but making them feel better both physically and emotionally. A good paramedic helps their patient calm down and feel it is going to be OK.

Lastly, a great paramedic is likeable. Likeability is hard to define but you know it when you see it. These are people you just like when you interact with them. It isn’t a personality type because there are introverted people who are just as likeable as the life of the party extroverts. A big part of being likeable is the ability to communicate the compassion, sympathy and knowledge I’ve mentioned previously. If you can make people feel good, even when they are in crisis and pain, they are going to like you.

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Must not have sounded too full of it because they let me in. I’d be interested to hear what our listeners think the answer to that question is. Both the experienced ones and the other newbies. I don’t think there are any wrong answers here.

From Chronicles of EMS. Check out the details on the Happy Medic website. The official site is on The Chronicles Of EMS Scholarship page.

Interestingly I told the Mrs the other day if I died during my clinicals to create a scholarship in my name for Paramedic students. I guess I don’t have to die now.