I have spent hundreds, perhaps thousands of hours driving and riding with patients in the back of ambulances.

From 13 year-olds in active labor in housing projects and full-on cardiac arrests to repeat detox runs for frequent flyers and hours of endless paperwork, I’ve been on almost every sort of EMS 911 call you can think of, and some you wouldn’t believe if I told you.

In 3 years of driving and riding through the streets of Milwaukee, Madison and Middleton, Wisconsin, I think that there is some wisdom to be gained and passed along to new generations of medics and anyone who has ever been curious what goes on in the mind of an Emergency Medical Technician.

It isn’t all guts and glory, but it’s all there for the taking. Here are 25 “inevitable truths” I have found to be self-evident about emergency medical services. Enjoy.

(Note: This piece is a little bit of a departure from my normal piss and vinegar war stories from the courtroom. Working in EMS was a huge part of my life and has really helped shape my worldview. So I’ll leave it to the Internets to preserve it for posterity. -JG)

EMERGENCY MEDICAL SERVICES WISDOM

1. In a medical emergency, the larger the patient, the less the likelihood of an elevator, the higher the floor to walk to, and the worst designed house to get them out of for extrication.

2. You will never sleep well working overnight shifts.  I’ve never seen a medic after a 6pm-6am shift say “Boy, did I sleep well.  I feel like a million bucks.”  Doesn’t happen.

3. Right when you hit that blissful stage of pre-sleep during a nap or at night, expect your pager to go off.

4. Have a plan to keep your food good for those times you end up on a 4 hour call as you sit down for dinner.

5. Nobody has a GI bleed anytime before 1 am or after 5 am. And no, you will never get used to that kind of dispatch in the dead of night.

6. Everyone in medicine has a horror story about something awful found in a body cavity.  Trust me.

7. Always thought it would be cool to be one of those guys in the fire department pants and jackets working on a serious accident?  We did too at one point.  Then you almost get clipped by one car too many, or get drenched in freezing rain or throw out your back and you realize that the smart money is in staying inside.

8. Ambulance work is like a drug.  It’s addictive as hell, the highs are extremely high and the lows extremely low, and you crave it when you don’t have it.  There aren’t very many healthy things that come from your adrenaline levels going from 0 to 100, then back to 0 within 20 minutes.

9. If you want to drive an ambulance, you better be damn good at small talk.  Picture driving with your patient’s husband, wife or parent sitting in the passenger’s seat as you take their loved one to the hospital.  Not an easy task.

10. Nurses have it rough – Doctors get a lot of credit, and at times deservedly so.  But the nurses are the ones on the front lines, doing the things that need to be done to keep our healthcare system moving.  They are the first ones to see you and the people who really know what is going on with a patient’s condition.  They also do the unpleasant tasks that nobody else wants in medicine, and that’s saying a lot.  I don’t know a lot of people who could bring themselves to change a bedpan or catheter at 3am.  Thank your nurse the next time you are at your doctor’s office or the hospital.  They deserve it.

11. When you are in the hospital or ER, ask every question you can think of.  If the doctor seems irritated, don’t fret…he’ll survive. Hopefully so will a few of his patients you helped bring in. We can’t send doctors to every 911 call, but today’s ALS ambulances absolutely save lives with more and more interventions available in the field. So when a Doctor thanks a medic sincerely, take the compliment.

12. I did everything I could to get out of taking O.B. and labor calls.  Some people loved the thought of delivering a baby.  I hid in the men’s room until they dispatched another unit (when one was available and willing…don’t worry, I never skipped calls).

13. Delivering babies may be a miracle, but it’s messy.  Not to mention it’s mostly biology and physics doing the work.  You’re a glorified catcher.

14. You will never agree on a show to watch in the day room if you don’t have cable.  If you have cable, get a DVR/TIVO.  We couldn’t get a station of 30 people to each chip in $2.00 per month from their paychecks to get cable.  So instead, we argued constantly about which daytime talk show or soap we were going to watch on our 24 inch TV. Not great for morale…

“SOME THINGS DEFY EXPLANATION…DON’T RUIN THE MYSTERY BY TRYING TO FIGURE THEM OUT”

15. Some piece of equipment at every ambulance or fire station is cursed and might as well be thrown away, regardless of cost.

16. There is no substitue for humor.  Even in the worst of situations, if you can make a patient laugh, they have no choice but to feel better.

17. Don’t take it personally. Trust your training and your common sense and keep both sharp. That way when push comes to shove, you can be more than just a bundle of useless nerves getting in the way.

18. You will see a lot more terminally ill patients than patients in acute life-threatening emergencies.  Know that to them, you are their lifeline at that moment.  Embrace the opportunity to talk to patients who have lived far longer than you have.  You would be surprised how sharp many elderly people are.

19. Know how to “turn it off” when you are not on duty. The world will still spin and people will still get to the hospital safely when you are not the one working.

20. Don’t become a FARCAL. No explanation needed. It’s annoying, unbecoming and ultimately bad for your patient care skills.

21. Know when to ask for help. This is another skill that applies to everyday life, but is amplified in the chaos of an emergency. Advanced life support intercepts, medical control and helicopters are there for a reason. You are a better EMT for getting a patient into someone’s care who can perform life-saving interventions than driving 90mph on city streets to get to a hospital while the patient barely hangs-on.

22. Don’t mention the word “catheter” in the presence of any male patients (unless they already have one in).

23. You can’t always be there in time.  The world doesn’t care how far away the ambulance is or if the weather is nice enough for a helicopter.  Life, and death, goes on.  So must you.

24. Enjoy it! Working in emergency services allows you access to parts of the world and your city that most people will never get the opportunity to experience or see. A good ambulance call with a positive patient outcome will stay with you for months. It really doesn’t get much better than the feeling that you have made a difference in a patient’s survival.

25. Oh, and I suppose the obvious question needs answering – Yes, it is fun to drive through the city with the lights and sirens blaring…I can’t lie about that. And even after 3 years I still got an adrenaline rush when my pager went off.

If you can hack it, it’s a hell of a job. Love it.

-JSG

Jonathan S. Goldman worked as an Emergency Medical Technician for three years in Milwaukee and Madison, Wisconsin – responding to 911 calls as well as private transports. He taught CPR for the Red Cross as well. Mr. Goldman is the founding attorney at the Law Office of Jonathan S. Goldman in 2009 in Chicago, Illinois. His practice focuses on felony criminal trial defense. The office also is a leader in expungements and record sealing. Feel free to call us at 773-809-5529 with any questions or for a free consultation. You can also find us on the web at Goldmanlawchicago.com