Imagine this

Imagine if you will, an ambulance service decides to make every “patient contact” require either a refusal signature, or a transport. Imagine there is no more “false call,” or “no patient found,” or “no EMS needed” options for call disposition, only a patient refusal or a transport to an emergency room.

Imagine that the service ignored their definition of a patient, which used to be “a person who is ill or injured who requests, or would request, emergency medical attention.” Imagine if that new definition included:

  • People sleeping in cars
  • Accidental medical alarm activations
  • People in car crashes who didn’t request EMS
  • A guy changing a flat tire
  • Passengers on a school bus which struck a mailbox

Imagine being told by dispatch to chase down a guy in a grocery store who was sleeping in his car, waiting for the store to open.

Now, imagine if you will, the ambulance service issues “report cards” to their employees, and one of the categories in which they are evaluated is their “Transport/Refusal Rate.”

Imagine that your yearly raise is directly tied to your “Transport/Refusal Rate.”

Imagine how angry you might be.

Dispatching Wolf

“Med four, call radio please.”

Sigh. I hate when they want us to call on the radio.

We have radios. They are called ‘radio’ (or dispatch, depending where you are, whatever) for crying out loud. We have multiple channels that we can talk on, and they have the ability to contact us directly through our radios.

They can even send messages to us through our MDTs.

But they want us to call them on the phone. I hate talking on the phone.

And it’s never for anything important that couldn’t be handled some other way. It’s always crap like “hey, you guys have a call coming out soon,” or “do you have a phone number from that lady from that wreck six hours ago?” or “did you guys see a purse/license/keys/stuffed animal in the back of the truck? A patient from two days ago is missing it.”

  • I don’t care. Just dispatch me when it’s time to go.
  • What lady? No, I don’t have her number. It’s on the PCR.
  • Yes, I found it, and I sold it on eBay.

I cannot stand talking to radio on the phone. Well, frankly, I don’t like talking to them on the radio either. Shaq and I came up with a new strategy:

“Medic four, can you call radio?”

“No, ma’am, we can’t. Neither one of us have a cellphone. But we can switch over to private.”

Lame excuses

My employer runs a paramedic program. When I say that the company runs a paramedic program, what I want you to take away from that is that the company supplies a physical location for a paramedic program, and students to fill the chairs.

But, they attached the words “EMS Academy” to it, so maybe it is sorta-kinda-official.

Whatever. It’s a moot point.

My employer runs a paramedic program.

Being one of the company’s Field Training Officers, I get to see the aftermath of the paramedic program, when the newly graduated paramedics spend several shifts riding with me. Some of them aren’t prepared, but most are.

I was having a talk with another FTO, Tony, while at the hospital a few days ago. This must have been early in a shift, because I actually cared about the topic.

Tony mentioned that he rarely sees the same paramedic student more than twice, and that each student does at least twenty rides at our company. He thought it would be wise for a student in our paramedic program to be ‘assigned’ to an FTO for the duration of their preceptor rides.

While we’re on the subject…our program is putting paramedic students on ambulances for their preceptor rides after three months of school. They don’t know how to read a monitor, and they aren’t allowed to perform any ALS interventions. What the hell is the point of riding for twelve hours on an ambulance if you can’t do anything?


Tony made a good point. After ten rides or so, there should be a pretty good rapport between an FTO and a student. They should be able to communicate openly with each other, so the student can get the most out of their classroom time, and their ambulance time. After twenty rides, any bad habits should be corrected, and the FTO can feel confident in his evaluation of the student. Alongside the FTO’s confidence in his evaluation, the course director can feel confident in the evaluations he gets from the FTO.

But instead, the students just ride whenever, and wherever. Rarely more than once with the same paramedic, or even with an FTO.

So Tony and I brought it up to the director of the program.

“Assign each student to an individual FTO. We have twenty-five students, and eighteen FTOs. Surely we can come up with a list of seven competent medics to fill the roster of needed FTOs. Once a student is assigned to an FTO, that student does all of their rides with that FTO. It only makes sense.”

We got a reply:

“Well, that would just be too hard, and we don’t want to make it any harder on the students.”

This is why I don’t care.

Lame-ass excuses.

System dairymaid

I met a lady today. She’s in her late forties, and lives in a nice, government-subsidized apartment. Much nicer apartment than I could ever afford.

She has oversized, comfy leather furniture that looks new, arranged to face a large flat-screen television on her wall.

She drives a 2015 BMW.

She gets around in her apartment with a very fancy electric wheelchair.

She carries a Prada purse and has an iPhone 6.

She lives with her husband. Except she doesn’t live with her husband. They aren’t married. She proudly admitted that they never got married, because he has a good job, and she would lose her disability benefits if they got married.

We passed at least three very capable hospitals on the way to the one of her preference, because her “doctors are there.” and “they have all my records,” and “it’s close to my friend’s house, and she is going to pick me up after.”

We transported her because her knees hurt.

Of course she handed me a Medicaid card. It was underneath her EBT card.

“Ma’am, you look really healthy. Why are you on disability, and why do you use the electric chair?”

“I have fibromyalgia. Medicaid gave me the wheelchair.”


So I was served with a subpoena. Or should I say, I wasn’t served with a subpoena. I received an email from some lady I see for three minutes once a year. I don’t know what her job is, or why she works at our company.

Maybe her job is to send out emails about subpoenas.

The email is an obvious form email. How often could EMTs and Paramedics at our company get subpoenaed that we would need a form email to notify employees?

The email says that my supervisor has the original subpoena. You guys know what is going to happen next, right? You got it.

My supervisor has no idea what I’m talking about.

The email says if I am scheduled to work that day, I can use PTO. If I’m not scheduled to work that day, I don’t get paid. Of course, I wouldn’t expect my employer to pay me if I wasn’t on duty. But I expect my employer to pay me when they require me to wear my uniform. Which the email says I must.

I would prefer not to wear my uniform, especially since I have the perfect suit and tie to wear for a court appearance. If it was summer, there might be a Matlock appearance. But no seersucker yet.

I haven’t decided if I’ll be showing up for court yet, but I have decided I won’t be in uniform.

Unless someone wants to pay me.

Look here, Miss Bubbly

I get it. Your bubbly personality is part of your ‘shtick.’ Everyone understands, you were a housewife, but your husband was a meany-head, and you divorced him, and had to get a job, and for some reason chose EMS. Whatever.

And you like to make cute little jokes, thinking your personality will make up for your lack of experience or real-world knowledge. But they don’t.

Making jokes and trying to be all cutesy is just fine and dandy, at the appropriate times. But that time is not in the middle of a patient’s home while they are having a myocardial infarction. I needed a hand with vitals, IV, and meds, but you had to go pet Sadie instead.

Oh, you didn’t realize that’s what was happening?

Maybe you could shut your mouth and open your eyes. Pay attention. Look at the patient. Hell, I don’t know, maybe you could follow the cues of your paramedic partner, and the fire department medic. Our combined experience may not be exactly as many years as you are old, but we know what we are doing.

But at least the dog was happy, right?


“Hi, this is C with Local Ambulance, I have a patient report I’d like to call in.”

“We are on diversion.”

“Yeah, I know. I tried to tell my patient that, but she insisted on coming to your hospital.”

“But we are on diversion.”

“I understand, but my patient wants to be seen there, so we are bringing her in. Would you like a report?”

“I don’t think you heard me. We are on diversion. You can’t bring her here.”

“Okay then. No problem. I’ll just need the name of the physician refusing to accept my patient.”


(and later on…)

“We don’t have any beds. You’ll have to wait there by the wall.”

“Okay, sure thing.”

The ER is virtually empty. The tracking board says they have five patients and more than twenty available rooms. It’s 6:45 on a Sunday morning. I spot two nurses playing checkers and drinking coffee.

Seriously, checkers.

“Hey, C, the bed in 6 is empty.” Slimm tells me after about 15 minutes of waiting and being ignored.

“Sweet. Let’s do it.”

(and later on, after being ignored for a few more minutes, and moving the patient to the empty bed in the empty ER…)

“Excuse me, would you happen to know who the nurse is for room 6?”

“We don’t have a patient in room 6.”

“Yes, you do. If you’ll look right over my shoulder, you’ll see a patient in the bed in room 6.”

“Where did that patient come from?”

“My stretcher.”

“You can’t do that!”

“Sure I can.”

“I’m getting the charge nurse!”

(charge nurse appears, obviously upset that her game of checkers was interrupted…)

“I told you we were on diversion.”

“But you hung up on me before I could get the name of the doctor refusing to see the patient.”

“But we are on diversion. I’m not accepting your patient.”

“It’s a little late for that.”

“No, it isn’t. You had better put that patient back on your stretcher and leave!”

“I can’t do that.. That’s against the law. Sign here, please.”


“Okay. Thanks. Bye.”

My partner the bigot

Slimm and I are trying to take care of a gentleman who is a guest of the County in their local Adult Detention Facility. He’s been vomiting, has a little bit of a fever, and describes a very sharp pain that started over his right kidney, then has slowly started moving down lower in his abdomen.

So he has a kidney stone.

I’m feeling generous, so I’m planning on hooking him up with some Fentanyl and Zofran. I like giving people narcotics, especially if I think they might need some, they aren’t a jackass, and they don’t beg for narcs.

Slimm is getting an IV.

Owww, man! That hurts!” He of course yells this out just as Slimm gets flash, and jerks his arm back at the same time, blowing the IV attempt.

Come on, man, it doesn’t hurt that much, and now I have to do it again.”

He gets everything ready again after putting a 4×4 over the previous puncture.

Now don’t jerk this time, man. I need to get this IV so we can give you some pain meds.”

Whatever, man.”

Big stick on three. One, two, thr-”


Come on, man, it doesn’t hurt that bad.”

Shit, man, yeah it does.”


Man, you’re just trying to hurt me because I’m black.”


No narcs for this guy. Works for me. Less documentation, anyways.


A “person shaking and cold after having an ultrasound” according to the dispatcher and the MDT

We are going by ourselves, and a quick glance at the directions tells me it might be a 15-minute ride. Just enough time to set my fantasy lineup for the weekend.

How do we know which house it is, if we are having trouble locating? That’s right, it’s the one with all the cars in the driveway.

Four cars this time.

Sure enough, some lady is sitting on a couch, shaking. She complains of being cold, and thinks this is some sort of a reaction to the ultrasound she had earlier.

I have already checked out, but we load the nice lady up anyways, and do a full workup.

Her pressure is better than mine, 12-lead is a sinus rhythm in the sixties, blood sugar is around 100, she’s afebrile, blah, blah, blah.

So we head on over to the hospital with, you guessed it, a guy following us in his car. He’s playing it tight, too. Less than one car length behind us, and he even has his flashers on.

Instead of brood over how stupid people are, I try to decide between starting Antonio Brown or Dez Bryant in my flex spot.

Before we can get this lady out of the ambulance, the follower is all up in Slimm’s face.

“What took you so long to get to the hospital?!”

“Nothing? It took about ten minutes.”

“Why didn’t you go emergency? Use the lights and the siren?”

“Because it wasn’t necessary? Because your wife’s vital signs are all just fine.”

“Hell, I could have brought her here in less time!”


“Why the hell did I call an ambulance if I could have taken her to the hospital just the same?!”


Gotta love it when they answer their own questions.

My policy trumps your policy

Today we pick up where we left off with our previous call.

To recap; some chick doesn’t want to be at school, so she either a) is having a panic attack because she forgot her homework, or, b) just wants to go home. The fireputterouters have no idea that nothing is actually wrong with the patient, because instead of performing an assessment, they went straight for the IV attempt.

And blew up both of her ACs in the process. With 22 gauge catheters.

Seriously, a 22 in the AC? Knock it off, guys.

Slimm and I fixed the flag, and we are walking out of the classroom, ostensibly in a hurry to take care of our critical patient.

Some guy approaches. This guy looks official. He has grey hair and a lanyard, AND a whistle.

“This is Missus Whatsherface. She is going to ride with you.”

“She will have to follow us down to the hospital, we can’t take riders.”

“Well, it is the school policy that a staff member accompanies any student.”

“Okay. She can accompany the student at the hospital. Slimm and I will accompany her in the ambulance.”

Now, mind you, I’m not really against people riding in the ambulance with patients. Frankly, I don’t care. Except in cases like this. First, this guy is being a mega-douche, and second, we don’t take riders in the ambulance with fakers/anxiety attacks. We give them quiet rides, with vital signs monitored. And third, I don’t like the cut of this guy’s jib.

“Umm, one of our staff members has to ride in the ambulance with her. It is our policy.

“I am terribly sorry, but it is the policy of the ambulance service that will be transporting her that only immediate family members ride in the ambulance with any patient, and that is at the discretion of the ambulance crew.”

She followed in her car. With her flashers on the whole way. Later, I find out that Lanyardman called and complained. And lo and behold, my supervisor stood up for me.  “Yes, sir, I understand, but the paramedic made the right decision, and followed our company policy.”

Maybe the third time that has ever happened.