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EMS Expressions That Should Stay in the Past
During the early 1970s, I was a New York-based hockey writer. I attended 10–20 NHL games a year, mostly at Madison Square Garden, and tried to collect meaningful quotes from players who were better at puck handling than public speaking.
After locker-room visits, I’d doctor tedious clichés from skaters who seemed less introspective whenever Manhattan night life beckoned. If you’ve followed any major sport, you’ve probably seen or heard these mindless postgame comments from indifferent athletes:
“We found a way to win.”
“That’s the kind of game you hate to lose.”
“It’s a long season.”
“Hard to say.”
If you can spin any of that drivel into something profound, you should be writing this instead of me.
EMS has its own overused sayings. They’re offered by senior practitioners to junior partners as evidence of hard-earned wisdom, but they lack substance and don’t age well—the words, not the medics.
Here are five EMS expressions masquerading as insight:
Paramedics Save Lives; EMTs Save Paramedics
I loved hearing that as a new EMT. I already knew lifesaving was a much smaller part of EMS than Hollywood portrayed, but I relished the notion of “saving” my smarter colleagues. I couldn’t wait to rescue a paragod.
That never happened. Sure, I helped fetch various supplies (“Not that box, the red one!”) from drug bags that may have included nuclear launch codes, for all I knew, but I don’t remember a medic ever telling me, “Thanks, Mike. I couldn’t have decompressed that tension pneumo without you.”
As a paramedic, I worked with many capable, conscientious EMTs who helped me a lot. The few times anyone was saved, it was our patient. We were all OK with that.
BLS Before ALS
This made more sense in our industry’s first millennium, when advanced practitioners were the only ones allowed to administer meds and attempt invasive procedures. That began to change in the ‘90s with inclusion of AEDs, autoinjectors, and extraglottic airways in BLS protocols, followed by oral and nebulized meds.
By 2000, basic and advanced life support were parts of a continuum more nuanced than an arbitrary line in the sand. Performing BLS and ALS sequentially, rather than cooperatively or even simultaneously, is a legacy practice favored by the less imaginative among us.
When You Hear Hoofbeats, Think Horses, Not Zebras
I was sure this guidance was golden because even doctors endorsed it. It’s not bad advice in many scenarios, but it opposes the application of critical thinking.
I’d like to see the hoofbeats rule replaced by three questions highlighted in Jerome Groopman’s engaging book about patient assessment, How Doctors Think:
Is there anything that doesn’t match?
Could it be more than one thing?
Could it be something else?
That’s a less folksy but more thorough way of balancing the ordinary and extraordinary.
Treat the Patient, Not the Monitor
If the purpose of this saying is to discourage tunnel vision, maybe we should preach that directly.
How much consideration we give EKGs depends on what we’re seeing. If the rhythm is, say, Vfib, a shock will follow except in rare instances of cable mismanagement. After defibrillation and CPR, we’ll again rely mostly on our monitors to determine next steps. When the waveform is lower priority—during a CVA, for example—we’ll pay greater attention to the patient and less to the machine.
It’s Not Your/My Emergency
A partner once said that when he felt I was overthinking what was best for our patient. Since then, I’ve seen the phrase at least a dozen times online. I like it even less now. It discourages empathy.
Sharing an emergency, or even owning one, doesn’t have to handicap prehospital providers. We’re talking about commitment—how far responders will go to offer the same service they’d want for their families. Some degree of professional detachment is prudent, but outright apathy won’t impress our employers or the public. Having a sense of urgency is part of caring.
EMS is a dynamic field. Surely our pet expressions will evolve with the rest of our industry, but which current issues will inspire tomorrow’s mottos? Community outreach? Fiscal constraints? Patients’ rights? Social unrest?
Hard to say.
Nashville paramedic Mike Rubin is the author of Life Support, a collection of EMS-oriented essays, and a member of the EMS World Editorial Advisory Board. Contact Mike at mgr22@prodigy.net.
Comments
You missed a classic expression that was so inappropriate: Should we stay and play or load and go. I have heard that on scene. I even received was criticized when I suggested to the leader of an EMS instructor class to change it to: Stay and stabilize or load and go.
—Russell Malone