Rules of EMS, Part One

  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.