“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.

Keep it simple

Look, y’all. I’m interested in your reports and everything, but let’s try to keep it simple, okay?

I don’t care that the patient had her gallbladder removed in 2004. It has nothing to do with the tibia sticking out of her skin.*

I sure as hell don’t care that the patient got bitten by a spider eighteen weeks ago.*

I don’t care that the patient stopped taking Lisinopril three years ago when his doctor switched him to Cozaar. And I don’t care why the doctor made the switch, because it probably had something to do with the cough the Lisinopril gave him.*

I don’t care that the patient speaks Spanish, because we are communicating just fine with her in English. Also, working in the Southeast United States, I’m pretty good at spotting Hispanic people.*

Just tell me what hospital they want to go to.

And don’t bother with the vitals. Because we both know you need them only to write them on your report, and I am going to take my own.


*all things I have actually been told by first responders

Are all FTOs ignored?

A few days ago, I had a new-hire employee riding along with me, for her evaluation rides. My company seems to think that 3 rides with a Field Training Officer is enough to prepare new EMTs for the field, and this was her third ride. So, ostensibly, it was also her last. Her two previous rides were with a different FTO, on the other shift

In the morning, I got an email from Topper, the other FTO that she rode with the previous day. His email was purely objective, and simply stated that the employee drove only for a short while, but was proficient with radios, the MDT, the computer, and checking the truck off.

Essentially, she was going to spend the day with me, driving, and she would occasionally ride in the back with me to the hospital. I like to have a game plan with new employees. We don’t get a lot of time with them, so I try to focus on the things they need the most.

When she introduced herself to me, I noticed something was ‘off’ about her personality. I couldn’t tell exactly what it was, but she was pleasant, and that’s always a good start. She needed some prompting to check the truck off, and to log into the MDT, which I thought was strange, remembering she was with Topper just the previous day, and she did all of this stuff.

Then the day just spiraled downhill.

Her driving was terrible. Not in the rough sense, but in the sense that she was scared to drive. She consistently drove 10 miles an hour under the speed limit. On every road. She was driving on the interstate, complaining that the tractor trailer in front of her was going 45 miles per hour. For several miles. Yet she never tried passing, even though there was virtually no traffic on the interstate. She stopped completely at a green light while we were traveling to an emergency, because “I thought that car was going to turn in front of us.”

She wasn’t interested in patient care, at all. While at an accident scene, with two patients quite some distance apart, I looked for her. I needed some extra hands, and she was standing at the back door of the ambulance, looking around, with her hands in her pockets. After loading a patient from the scene into the ambulance, she had to be told that Newguy needed vital signs taken, and then had to be told to take them when she failed to act.

Typing all this out makes me feel like I am lamenting my position as an FTO. I really don’t want that to be the case. But what we had here was a person who obviously was not Local Ambulance Company material, and maybe was not cut out for EMS at all.

Newguy and I tried talking with her several times throughout the day, but she was either not interested or couldn’t comprehend what we were saying. Neither Newguy nor I are rude, but this girl simply didn’t get it.

So I wrote as much in my evaluation of her. I have never had to give a negative evaluation on an employee since I have been an FTO at this company, and I suppose my naivete’ got the best of me. In my review, I explained what I explained here, and in further depth. I suggested the new employee receive some more FTO-monitored third rides, and perhaps not be hired full-time.

I guess I expected the Training department to call me or email me and want to discuss my concerns. I think most of my readers will know that I wasn’t contacted at all. Of course not. My review was essentially ignored, and the employee was scheduled to ride on her own the next day.

Which lead me to ask the questions: if FTOs aren’t listened to, what is the point of having us out there? Is it like this at every service? Is the joke really on me, because I expected more out of my management team?

Is this just another straw on the camel’s back, causing more burn out, or do I feel slighted because I’m burned out?

These people got lights and siren responses

These are calls I have heard dispatched over the radio, or ran myself in the past few weeks or so since the implementation of the new policy that requires an “emergent response to all requests for services generated through the 911 system.”

  • A male with CHF who just got out of the hospital and wants to know how to take his meds.
  • A female with a swollen knuckle who can’t get her ring off (the ring isn’t stuck, her knuckle is just swollen.
  • A female who is depressed and ‘wants to talk to someone.’
  • A male in the waiting room of the emergency room who has been waiting too long and wants to go to another hospital.
  • A female who ‘has anxiety and witnessed an accident and is now having a panic attack.’
  • A male who ran out of gas on the interstate and is demanding PD drive him 40 miles home, but now PD wants EMS there.
  • A  very elderly male who is dead in bed, cold to the touch and stiff, with family refusing CPR instructions.*
  • A female who wants her blood pressure checked.
  • A school bus with 14 children on it was struck by the arm of an apartment complex gate. There are no injuries on the bus.
  • A male who was in a fight last week, and now has a swollen hand.
  • A male sitting behind a strip mall, dirty, and talking to himself.

There were others, but these are just the highlights.

But we want people to take us seriously.

*I sort of understand this one, but in reality, this family just needs a coroner.


“Person choking” is what the dispatcher says. A young person, too.

We skedaddle on over there, to find the nice fire crew already on scene. From what the friend says, the unconscious guy on the floor took a bite of a chicken sandwich then passed out and turned blue.

Somebody is bagging this guy, but “his sat is good with the bag, so I didn’t tube him.”

His vitals are okay, except for the unconscious part. He is breathing on his own, about 10 times a minute. Sugar’s normal. Heart rate is normal. Pressure is better than mine. Something about pinpoint pupils, but whatever. Everything is going smoothly so far.

While I’m thinking of the logistics of how to get this unconscious fellow up two flights of stairs, I hear some wonderkid say “Narcan.”

My ears immediately perk up, and my head turns as I say “dowhatnow?” But they don’t hear me. They are too busy talking amongst themselves.

“Yeah, we might as well.”

“It ain’t gonna hurt nuthin.”

“Yeah, it can’t hurt.”

“How much you want me to give?”*

“Give half of it.”**


I interject. “Uh, if we’re gonna give naloxone, how about we go with point-four milligrams instead of one?”

“So you want me to give a fourth of the vial?”***


The other guy speaks up: “Just eyeball half of it, it’ll be alright.”****

Before I can begin to process the shit show of patient care that just occurred right in front of my eyes and ears, someone gives ‘about half the vial’ of naloxone.

You know what happens next, don’t you?

Homey promptly awakens, retches, and coughs up a humongous piece of a chicken sandwich, which was obviously lodged somewhere north of his vocal cords.***** (It was just too big to go past the cords. Imagine you took a huge bite of a sandwich, and decided to inhale it without chewing. Yeah.)

My head is literally about to explode at this point.


* Personally, I don’t want you to give any, but the question wasn’t being asked of me.

** ”Half?” Is your partner not intelligent enough to read the numbers on the side of the little cute glass tube?

*** Okay, now we know you can’t read, and you suck at math. For the record, zero-point-four is one-fifth of 2 milligrams. Or twenty percent.

**** Seriously, I heard a paramedic say this. In the company of 4 other paramedics. Have you no shame, mustachioed dude?

***** Seriously, what the hell is going on here? The call was for “choking” and you arrived on scene to find an unconscious guy lying on the floor with a fucking chicken sandwich in his hand missing a bite. Did nobody think to look in his airway? A blade and a set of forceps would have done fixed this problem a long time ago, but now this guy’s going to have to sit in a hospital for a few hours.


Newguy and I are left to try to pick up what remains of our jaws from the floors. We literally can’t believe the serious shit-show we just saw happen. And meanwhile, these yahoos are patting themselves on the back.

What the hell is wrong with people?

The Pepsi Challenge, New Coke, and Fire Department Tiered Response to EMS Calls

(I began thinking about writing this post a long time ago while reading Malcolm Gladwell’s book blink. Being from the South, I am intimately familiar with the Pepsi Challenge, and ‘New Coke’ and the ensuing disaster for Coca-Cola. I got tired of thinking about writing this post, and decided to do something about it.)


First, a little bit about the system in which I work: My county sends the closest fire engine to virtually every EMS-related call received in the 911 system (92% of EMS responses included an engine in 2012). That engine may be ALS or BLS, but it is always the closest engine no matter what, so ALS engines are frequently sent to BLS-level requests. The county also requires that an ALS ambulance is sent to every response, with response time requirements that don’t really matter for this discussion. For those of you familiar with ProQA, an additional ALS component is sent to every Charlie response and above, regardless of the level of care of the initial engine response.

So a 4 year old with croup in the middle of the night very well may receive three different pieces of apparatus, and between 8 and 12 responders, all because the patient is “under 15 years old” and is having “difficulty breathing” and is “making noises when he breathes.”

The citizens absolutely love this. They are just the most important thing in the world, and it only takes 3 pushes of buttons on a phone, 30 seconds with someone on the other end, and a dozen people will drop everything and rush as fast as they can to the citizen’s house.

But is it necessary?

Of course not.

I have my own issues with ProQA, or MPDS, or whatever it may be called in your area, but the bigger issue is with the tiered response.

One paramedic will do just fine, yet we find it necessary to send 3, 4, 5, and sometimes more to virtually every call.

So what does this have to do with the Pepsi Challenge? I’ll get there. But first, a little background.

In the 1970s, Coca-Cola had an almost 5-1 market share over Pepsi, and Pepsi wanted more. Like any business would. In the early 80s, the two products were virtually tied, with Coke having a 12 percent market share, and Pepsi having 11 percent. This is in spite of Coke’s wider availability and advertising spending.

Pepsi decides (brilliantly, I might add) to introduce the Pepsi Challenge, in which self-described dedicated Coke drinkers were asked to take a sip of two different beverages, in two different, unmarked cups, one containing Pepsi and the other Coke. The majority of the tasters preferred Pepsi, and the results were confirmed by Coke executives doing their own market research. Coke executives blindly ignored the inherent problem of the blind taste test, much to their later chagrin.

But why did Pepsi continue to win the Pepsi Challenge?

Because Pepsi is much, much sweeter. And the test was a sip test, or a central location test (CLT). Tasters didn’t drink and entire can, and they certainly didn’t take home an entire case to enjoy in front of the television.

So Coke decided to change. They changed their formula, after continued alterations and their own taste tests, and finally came up with a product that rivaled Pepsi. They marketed their product as New Coke.

And it was horrible. An absolute disaster.

I remember New Coke vividly. I remember people who refused to buy another Coke product until Coca-Cola Classic was brought back. People wrote letters, and executives got fired. People literally picketed in front of Coke’s headquarters. Coke was forced to tuck their tails between their legs, apologize profusely, and reinstate Coca-Cola Classic.

Only 79 days elapsed between the introduction of New Coke and the return of Coca-Cola Classic, but it was quite the time.

So what does this have to do with tiered response?

When I first started in this business, we only saw the fire department on fire-related calls. Occasionally, they were requested for extrication of victims from a motor vehicle crash, but that was not often. People called 911, asked for an ambulance, and they got an ambulance.

But now it is different. Fire departments are no longer “Fire Departments,” they are “Fire-Rescue” departments, or “Fire and EMS” departments. EMS has been taken over, and now ambulance standards are being written by NFPA.

The citizens seem to love the tiered response. As mentioned earlier, three button pushes and thirty seconds on the phone, and a dozen people will stop whatever they are doing and drive as fast as they can to get to you. All in an effort to mitigate liability, but that’s another post.

The citizens, the taxpayers, are the taste testers. They are taking a sip of this drink that is tiered response, but they aren’t being offered the alternative. This is just the way it is.

Somehow, this is going to have to change. The response that I outlined above is not just common, it is the norm. And it is a waste of money.

But money is the answer, isn’t it?

If the fire department doesn’t send their vehicles and their people to these calls, then the fire department runs a lot fewer calls. When the fire department all of a sudden runs 80 percent fewer calls, then local government wants to know why there are so many firefighters and so many pieces of apparatus for so few calls.

This tired response may not have begun to justify a larger budget, but that is certainly where it is now.

Everyone deserves better.

Resume’ tips for EMS

Everybody needs a resume’. Even in EMS. They aren’t complicated to make, and keep updated.

Make one:

There are plenty of templates on Microsoft Word, and plenty of places on the internet to download templates.

Heck, a resume’ could be done in Notepad. We won’t judge you.

Get a real email address:

There are many, many places to get free email addresses. Use one that actually uses your name. Try to be grown-up and adult about email addresses. Frankly, when I see an application with an email address of something like “”; I’m not going to bother sending you an email, much less letting your paperwork clog my desk.

Make it look nice:

Look, colors and fonts are creative and can make your resume’ stand out. But too much is just too much.

I’m not giving a resume’ with pink or purple text or fancy fonts more than one glance.

Know yourself and how people view you:

Employers can, and do, call previous employers to verify references and work history. But previous employers don’t verify anything past dates employed, job titles, and eligibility for rehire.

Make one:

Again, just make a resume’. I would much rather have a stack of one-page resume’s to look at, as opposed to a stack of 8-page computer-generated applications.


And please, one page only. Two pages max if you publish or write articles, or if you are a committee member at a national or state organization.