How to Tell a Good War Story

      Last July the National Association of State EMS Officials (NASEMSO) published a guide to help regional EMS systems compare local standards of care to national practices. After rereading the document, I realized there's a significant omission in the proposed curriculum: We don't teach our students how to tell war stories. As an aged but high-functioning member of the caregiving community, I consider it my duty to fill that void.

   War stories are lurid, frequently embellished accounts of allegedly dangerous and/or heroic exploits, with the teller as protagonist. Their purpose is to impress, to entertain and, most important, to elicit nods and grunts of affirmation from the crowd. According to a retrospective study of my memories--an emerging alternative to time-consuming research--the ratio of nods to grunts is highest among small, EMS-only audiences, especially when the narrative includes words like "large-bore" and "cric."

   Some would say war stories educate. Fair enough. Here's what I've learned from EMS war stories:

• Real medics can insert 14-gauge catheters into capillaries. In the dark. On horseback.
• If you knock on the wrong door and a deranged drug lord answers, your options are to hit him with your radio, fake a seizure or pose as a stethoscope salesman.
• Bad calls really are good calls.
• The American Heart Association must have overlooked hundreds of saves from precordial thumps.
• You can intubate from more positions than there are in the Kama Sutra.
• Sometimes you have to do what you have to do. Sometimes you need a lawyer when you're done doing it.

   Maybe war stories aren't all that illuminating. They have other uses, though. Suppose you're at a cocktail party (I know, EMS people at cocktail parties: scary thought) and the talk turns to, say, the trade gap with Ghana. You'd be doing everyone a favor by rehashing your latest encounter with impaled body parts. By the time you finish, guests will admire you, feel sorry for you or dread you.

   War stories also are offered by some EMS instructors as substitutes for boring didactic material. Take pharmacology, for example. It's a lot easier for teachers and students to skip all that pedantic text about epinephrine dosing. Besides, when's the last time you gave epi for an evisceration?

   The first thing you should know about reciting war stories is that what happened isn't as important as where. Suppose I tell you I bagged, intubated and resuscitated a patient; that's not nearly as impressive as claiming I bagged, intubated and resuscitated a patient while tethered to a fire escape!

   Next, war stories should convey a demure determination to do something dramatic, preferably against all odds. If the best you can do is describe how you helped an arthritic neighbor negotiate a child-resistant cap, you should probably keep that to yourself.

   If you'd like to spin your very own war story, try the template below. Simply select from the multiple choices, and you'll be the proud author of six sentences loaded with danger, decisiveness, perseverance and poignancy:

1. We responded to:
• A train into a Ferris wheel.
• A standoff between cops and killer clowns.
• An ice cream truck without exact change.
2. I could see:
   • Desolation, where newly condemned warehouses once stood.
   • A cloud shaped like a eucalyptus tree.
   • Clearly now, the rain is gone.
3. I sensed that:
   • All of my skills as an ACLS instructor would be needed.
   • All of my skills as a game warden would be needed.
   • I should have taken that post office job.
4. My first patient was:
   • Major General Hiram S. Dreedle of the Counter-MCI Task Force.
   • Skippy the Wonder Dog.
   • Gleck, from the planet Flurnoy.
5. I knew I had to act fast, so I:
   • Cranked open the O2, then checked my e-mail.
   • Said a little prayer to Azuza, goddess of the Transitional Layer.
   • Called for my tube kit, but it didn't answer.
6. It was touch and go, but I knew we'd made it when:
   • My relief arrived with fresh cravats.
   • I pushed the drug labeled "For really bad calls only."
   • My patient RMA'd.

   I've always been reluctant to tell war stories. Maybe that's because I've found my most challenging cases in nursing homes. Managing elderly patients with acute illnesses, multiple meds, altered mental status, fragile vasculature, limited history and concurrent debilitating conditions won't make the evening news. Besides, what self-respecting medic would start a war story with, "There I was at the senior center..."?

   I'm going to have to start hanging out downtown. With my tube kit.

   Mike Rubin, BS, NREMT-P, is an EMS educator and consultant based in Nashville, TN, and a member of EMS Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.