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10 EMS screw-ups that can get you in trouble

Here is the “never-do” list if you want to have a long and prosperous career in EMS


In EMS, doing what we’re told usually works for everyone.

Photo/Joe Thomas of Greenbox Photography

Remember this video of a Florida paramedic dumping a patient off a stretcher in 2015? It sparked an emotional debate about whether job-related dissatisfactions were justifiable causes of bad behavior by caregivers. While most of us were lamenting the shame of the recorded spectacle my friend Tom Bouthillet, a paramedic, teacher and EMS1 columnist, had a more constructive contribution: Make that incident part of a “never-do” list for EMS providers.

Tom’s pretty busy teaching 12-lead-EKG interpretation to, like, everyone, so I told him I’d take this on. My chief criteria for items on the list were:

1. The never do’s had to be EMS-related,

2. They had to apply to everyone in the field, regardless of certification, and

3. I had to know of at least one occurrence of each. That last rule allowed me to exclude such frivolous acts as hitting your partner with a tire iron. Hmm … could be the start of another list.

Here are my 10 never-do items in no particular order:

1. Knowingly responding to a call without essential supplies or equipment.

I had to add “knowingly” when I realized I’d otherwise broken this rule many times by relieving a crew that hadn’t refilled the oxygen or replaced the LifePak batteries during their shift. I’d get aggravated, then they’d get aggravated at me for being aggravated. Sometimes we’d lose sight of the main issue: not being able to deliver appropriate care.

2. Initiating unwanted physical contact with patients.

This isn’t just about inappropriate touching of patients; it also covers medical procedures conscious patients haven’t consented to. Let me just add that some of you are scaring me with talk of routine drilling for bone marrow instead of even attempting IVs. If I’m awake and you come at me with a power tool, I will aggressively seek safety.

3. Dropping patients from carrying devices.

This doesn’t have to be intentional to be alarming. In the days before powered stretchers, I came close to mismanaging heavy patients during two-person lifts more than once. The hardest part for me was putting my pride aside and admitting we needed more people. If the weight of a loaded scoop, stair chair or backboard divided by the number of lifters exceeds your personal limit, find another way or get help.

4. Delivering care not compliant with medical direction.

As much as I hate the “paragod” characterization of paramedics, I have to admit it applies to some of my colleagues — the ones who think medical school is an unnecessarily tedious route to independent practice. I would remind them that street experience, no matter how bold or intense, is not a substitute for medical direction.

5. Driving while distracted.

Since I was a kid, society has been reluctant to associate driving with death. We didn’t have seat belts in our ’62 Chevy Bel Air until my father installed them. When I started borrowing the car a few years later, blood alcohol was still an unfamiliar term. DWI and DUI were things criminals did — not parents or next-door neighbors. Now texting is another way to ruin many lives simultaneously while behind the wheel. Please stop.

6. Working while impaired.

The use of alcohol and other drugs during business hours isn’t a problem unique to EMS. Having a few drinks at lunch was a common practice when I was in the corporate world. I wish I could tell you executives started tempering their intake because of conscientiousness and a concern for others, but I don’t remember any change in midday libation until the IRS started limiting deductions for meals.

7. Failing to respond as dispatched.

There are two sides to this, both bad: going where you shouldn’t and not going where you should. In EMS, doing what we’re told usually works for everyone. The glamor of stubbornness and single-mindedness is a myth propagated by absurd, televised renditions of cowboy medics and their Hollywood-esque war stories.

8. Not possessing the required licenses or certifications.

It’s easier than it should be at some agencies to work without proper credentials. Even if you’re not a believer in earning whatever you claim to be, the prospect of unemployment plus penalties for impersonating medical providers should be reason enough to schedule refreshers with plenty of lead time.

9. Falsifying patient-care records.

If the obvious ethical issue isn’t enough to convince you, consider you’re an audit away from infamy if you document what you should have done.

10. Declaring a living patient dead.

Avoiding this mistake seems uncomplicated, given access to EKGs and physicians, yet we hear of new cases every year or so. Not a good way to make the six o’clock news. When death is not quite obvious in the absence of rigor mortis and dependent lividity, work your patient or you might have some ‘splainin’ to do.

That’s my list of never do’s. What should we add?

Mike Rubin is a paramedic in Nashville, Tennessee. A former faculty member at Stony Brook University, Mike has logged 28 years in EMS after 18 in the corporate world as an engineer, manager and consultant. He created the EMS version of Trivial Pursuit and produced Down Time, a collection of rescue-oriented rock and pop tunes. Contact him at