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Two firefighters from a different ALS agency come out of Room X.

They congratulate each other with a fist bump.

“Strong code, bro.”

I roll my eyes. As do the charge nurse and my partner.

The code is quickly terminated after an airway check and an echo.

<Rewind 3 minutes>

We’re waiting for a bed. A cardiac arrest is being brought in, which means we’re delayed even more. So I step away from the patient to print the report in a different area.

I hear a commotion. Loud voices and footsteps.


I come back to the patient. The charge nurse is visibly annoyed with the firefighters.

“There’s no need to yell. Guy’s been down for 50 minutes. Nothing’s going to change. Act like you’ve worked a code before.”

I shrug.

“Looks like they’ve been watching too many movies and TVs, bursting through the door and screaming out their report, holding up the IV bag with their teeth.”

I’d like some sanity please

Around here, law enforcement officers are nearly always allowed to independently determine their mode of response to a call based on the details. They seldom drive with lights and sirens. And it’s very rare to hear that they chose incorrectly.

In fact, they hold calls and stack them all the time. I’ve seen sergeants cancel responses just based on how stupid it sounds.* I envy them.

Furthermore, many law enforcement agencies don’t even chase anyone in vehicles anymore unless there’s a really, really good reason to chase someone down.

Looking toward the East Coast, a few years ago, FDNY – not exactly a bastion of ultra-progressiveness – stopped responding to a significant portion of their calls with lights and sirens. If FDNY can figure it out, everyone else should be able to figure it out.

Since we all work within the same legal framework, and driving with lights and sirens is very dangerous no matter what type of vehicle is used, and I write often about MPDS and how overly conservative it and the predetermined local responses are, why is it that I can’t choose my mode of response to what often sounds like total bullshit? Trading a few seconds for a much more dangerous ride to stupid calls doesn’t seem sensible at all, yet it is our norm.

We can constantly remind crews to use an abundance of caution, but that doesn’t take into account the unbelievably bone-headed behavior of the driving public in general. This seriously cannot be the way to do our work.

*And there are some really stupid calls.

“Concern” is really code for NIMBY*

Code 3 for man down.

A woman in a nice neighborhood waves us down, in front of the bagel shop. She’s a little excited, bouncing up and down a bit, arms outstretched, pointing behind the building with one hand and pointing in the exact opposite direction with the other. It’s quite a sight. I wonder what the fuck she wants.

I poke my head out the window.

“He’s back there! He’s back there!”

“So why are you pointing the other way then?”

“Oh, you guys can park over there. There’s not enough room here.”

Typical rich people “do as I say” bullshit.

“You leave the parking to us. I only care where the patient is.”

I’ll block the whole Goddamned intersection if it’s operationally necessary. I think it may even be operationally necessary today to piss her off on purpose.

She eventually points in the only direction that matters – you know, where the supposed patient is. We drive closer. I get out. I already don’t want to bring any gear.

“So what’s the problem?”

“We’re concerned about this guy lying on the ground behind that fence. See where he’s got his tent set up?”

“So he’s… sleeping…”

I’m definitely not bringing any gear.

“Well, I didn’t want to go check.”

“So you really just want him out of there. Got it. Thanks.”

And so it goes. Eight people belonging to 3 services show up to politely ask this guy to go sleep somewhere else to keep the more privileged folks happy.

*Not In My Back Yard


We’re driving along the left lane – and sometimes the left shoulder – of the freeway to a wreck, following the fire engine. Traffic is backed up, and as usual, people are making it very difficult for us, generally not paying attention and not moving a wee bit to the right just out of our way just so we can pass until the very, very last second. Or not at all.

In addition to these morons, there are the drivers who tuck in behind us in the wake of our ambulance, tailgating us all the way.

“I really hope the wreck is on the left so these assholes get stuck behind us.”

The fire engine starts slowing down. I think it really is on the left… wait for it… wait for it…

It turns to the right, and then to the left, and blocks the left shoulder and 2 left lanes at an angle. We drive around them, stop ahead of the wreck, way over near the center divider, safely in the protected zone. All those fuckheads illegally following us – STUCK.


Suck it, asshole drivers.

Six times a shift

I know this is going to go nowhere because our bosses are scared of dipshit patients and scumbag lawyers, but as a thought exercise, why is it that fire crews can choose to not respond to repeat alarms and cops can choose to not respond to chronic calls and non-injury wrecks while we go to every single one of our frequent calls? And unlike them, we usually, stupidly, go lights and sirens too. Obviously the cops and the firefighters can decide at the field level what is and what isn’t an legitimate emergency, but we can’t?

We went to the same street corner 6 times in one shift because the resident homeless guy with a movement disorder likes to lie on the ground occasionally when he’s not being handed money, and motorists are apparently too fucking busy NOT paying attention to their driving and instead dialing 911.

I suppose I should just be glad that he leaves at night.

What are you doing here?

I’m with a young-looking medic in the back with a young woman in seizures. I know her because I’ve transported her many times. Too well. She has impressive* status epilepticus. My last report to the ED was maybe one sentence beyond, “You guys know [insert patient’s name]?” Six people in the room said yes before it turned into a benzodiazepine convention.

We’ve already given her intranasal Versed. The young guy is looking for IV access in her extremities. I know she has no veins but I don’t stop him. I’m easy that way. It doesn’t hurt to look for a bit. He doesn’t find anything, as expected, because she has nothing.

“You want this EJ?” I say to him, figuring a young guy would like the experience of doing one. I mean, it’s even more infrequent than an intubation. I’m sitting at her head, manipulating her head and her body to make things advantageous for me. EJs are easy and difficult both at once. If you’ve done an EJ, you know exactly what I mean.

I once worked with this guy who would start EJs unnecessarily, in my opinion. In his mind, it was practice. In mine, it was disrespectful, even to cardiac arrests, especially when there’s no need for “a second line” or there’s obvious extremity access.

I don’t start any IVs if I don’t need to. I don’t start them “as a precaution” or “just in case” or “because we may need it.” I start them because there is a legitimate complaint. Yes, nurses love medics for starting IVs so they don’t have to do it, but they also hate medics for starting IVs when they want to send someone to the waiting room instead.

Anyway, he hesitates, and makes no move indicating that he’s at all interested in this EJ. He apparently doesn’t want to do it for whatever reason.

That’s like saying a firefighter doesn’t want the nozzle.

So I do it.

And of course that means I can’t fail.

A couple of months later, we go to this patient’s house again. I’m riding with a different young-looking medic to the hospital. After I tell him she has no veins without stopping him, he looks and looks, as if staring at her arms would magically summon something.

I look at her neck again. The same EJ is staring right back at me. I tell him the story of the the last medic who didn’t want to do the EJ, and I wonder out loud why he didn’t want to do it.

“I wouldn’t want to do it either.”


Who are these new medics and what the FUCK are they doing here?

*For medics to be impressed, you know she’s fucked up.


Since law enforcement, fire and EMS have to work day in and day out with one another, it’s not uncommon to butt heads sometimes. I just want to remind all of us that in the vast majority of cases, the stuff we deal with is so stupid and so bullshit that it’s really not worth butting heads at all. Let things go. Remember our common “enemy,”* for lack of a better word. Remember our common goal of dealing quickly with these people, as painlessly as possible.

Save the disagreements for when it matters a little bit.

*In this context, the people who abuse emergency services. Don’t get all high and mighty.