The stupid EMS cliché usage guide

Using phrases like ‘We cheat death’ is so much easier than actually thinking


It started as one of those ordinary, everyday squad room bitch sessions that are so common in EMS; wages, respect, frequent fliers, supervisors, coworkers – you name it. The oncoming crew hadn’t gotten a post assignment yet, the other rig based at that station was still there, as well as a third crew that dispatch had apparently forgotten to assign to a new post.

My shift had ended, with another one due to begin in eight hours, so I had planned to crash in one of the station bedrooms until my next shift. So I sat there and listened in amusement as six guys with a grand total of 14 years of experience in EMS held forth on everything that was wrong with the profession.

And then one of them said it: “Paramedics save lives, EMTs save paramedics.”

Predictably, it was one of our EMTs who said it, speaking of another medic and former partner who has an ugly reputation for treating her partner as little more than a pack mule with a chauffeur’s license.

“Well, I just want to give it my best shot,” I interjected, “and the good Lord willing, things will work out.”

“Yeah, Kelly, but not every medic thinks like you. I mean, some of them —“

“You gotta play ‘em one day at a time, though.”

“Yeah, I get that, but… wait, what are you talking about?”

“I’m just happy to be here. Hope I can help the ball club.”

“Um, dude. Are you OK? You checked your blood sugar lately?”

“You're gonna have to learn your clichés, “I told them. “You're gonna have to study them, you're gonna have to know them. They're your friends.”

From the blank stares I got from all assembled, I realized that none of them had ever seen Bull Durham. So while I educated them in the Tao of Crash Davis, I started thinking about the clichés we spout in EMS. Every cliché has at its root a central truth; that’s how they get to be clichés in the first place.

But nothing is so good as a well-placed cliché as a substitute for real wisdom and knowledge. Just insert one of these babies into a social media comment thread and watch the “Likes” pile up!

You know, because it’s so much easier than actually thinking.

10. “Paramedics save lives, EMTs save paramedics.” This one fits in any social media thread where an EMT has complained about his paramedic partner being unappreciative or belittling. They post it seeking validation from the audience that they are a good EMT, and their partner is, in fact, a big fat poopyhead, and it’s your job to provide that validation. If you’re a paramedic, you get bonus points for saying it, thereby validating your street cred and proving that you haven’t forgotten your roots. Whatever you do, don’t point out that there are two sides to every story, or that something as complex as interpersonal dynamics between crewmembers isn’t best addressed in a Facebook post. That’s just crazy talk.

9. “Here to save your ass, not kiss it.” Use this one whenever someone complains about system abuse, or demanding patients and family members. Insert it in any conversation where someone seeks validation that attitude and patient rapport is less important than clinical skills. You’re a maverick, an iconoclast. You’re the EMS version of Hawkeye Pierce, thumbing your nose at the system and getting away with it, because you’re just that good. You’re a stellar medic... if the patient is unconscious… or dying… or physically attractive… or anyone deemed worthy of your awesomeness. It’s those other 99 percent of your patients that have the problem, not you.

8. “We cheat death.” Because most of our patients are cardiac arrests, right? We rarely do dialysis transfers, or psychiatric calls, or rides to detox, or garden variety aches and sprains, or any of that mundane stuff. We. Cheat. Death.

For 1 percent of our patients…

… and only about 50 percent of the time...

… and then only if we work in Seattle...

… and we only count the witnessed VF arrests with CPR in progress upon our arrival.

But yeah, within those parameters, we’re lifesavers, baby!

7. “Seconds count.” This one works wherever any wild-eyed heretic suggests that perhaps we’d be a lot safer if we slowed down, followed all traffic laws, and turned off the lights and siren for most of our calls. After all, why the heck did we get into EMS if not to drive a huge truck at breakneck speeds, weaving in and out of traffic, and blowing through intersections without stopping? Who cares if it’s 3 a.m. in a residential neighborhood and we’re the only vehicle on the road? If they wanted someone who drove safely and took their time, they should have called a cable installer!

6. “I don’t have X-ray eyes.” Use this one when someone suggests that mechanism isn’t a reliable predictor of actual injury, or that we shouldn’t strap patients to long spine boards if they have no physical findings of spinal injury. Whenever someone says that you treat patients and not car bumpers, and suggests you actually assess your patients and treat accordingly instead of just memorizing a list of criteria from the trauma chapter in an EMT textbook, this is the perfect retort. Besides, if they wanted to use clinical judgment rather than a one-size-fits-all protocol…

5. “They should have gone to medical school if they wanted to be a doctor.” This is the ultimate “know your place” admonition for those radical, dangerous, cowboy types who dare suggest that blind adherence to a protocol is unwise and potentially harmful. They’re the doctors, we’re the medics. We do what they tell us to do, and we don’t question it, and if it isn’t spelled out there in black and white, then we by-gosh ought to call them up and ask, “Mother, may I?” Anyone who says otherwise is just a paragod who wasn’t smart enough to get into med school.

4. “Zero to hero.” Everyone knows that all that fancy book learning you get in EMT school is pointless. No, the real learning occurs on the streets.

Outside the classroom.

Away from the teacher.

With no feedback.

And a guy critiquing you with one year of experience, repeated 20 times.

Experience is the best teacher, after all. That’s why all the medical schools require you to be a physician’s assistant first, and the nursing schools require you to be a CNA before they’ll even let you in the door. And if someone made it all the way to paramedic with poor clinical skills and bad judgment, it couldn’t possibly be the fault of the teacher or the program.

It’s because he didn’t have enough experience. You know, with a non-educator correcting all his mistakes.

3. “If it saves one life, it’s worth it.” Use this one to prove that you’re all about the patient. Pesky things like capital expenditures and amortization, cost / benefit analysis, and number needed to treat vs. number needed to harm be damned. This is especially true if you don’t have any idea what those things mean, or what they have to do with EMS systems.

2. “I save lives for a living.” Because really, who wants to know that you really get paid to sit on the couch and eat Cheetos until you get a call? Or that you spend your shift shuttling from one street corner post to another, or that 75 percent of your patients could have walked to the ED under their own power? None of that sounds heroic, and everyone knows that sounding heroic gets you laid.

1. “Treat the patient, not the monitor.” We work in an austere environment, without much of the diagnostic gadgetry available to our hospital colleagues. Often, we’re working in teams of only two, and during transport it’s just you and the patient. And let’s face it, machines fail. They break, they give false readings, and the batteries die just when you needed them the most. We have to rely on strong clinical assessment skills, and not become dependent upon technology.

All of that is true.

It’s especially true if you don’t know what the hell to call that strip Tom Bouthillet just posted.

If you learn to use these simple EMS clichés, I guarantee that you will develop a reputation as a paramedic sage in no time. Especially to people who don’t know better.

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