The Rules Of EMS

In honor of the end of EMS Recognition & Appreciation Week here in the USA, I

couldn't find a better summation than that of my longtime friend, colleague, and EMS teacher/mentor, John Kirtley (2nd row, 4th from left in photo to the left).

John has been a part of EMS in the Richmond, Virginia area since...the Pope was an altar boy. (The photo is the first graduating class of paramedics in Richmond area who received their training at the Medical College of Virginia (MCV).  Without further ado, I yield the floor to the esteemed man from Tuckahoe Volunteer Rescue Squad, Chesterfield Fire and EMS, and J. Sargent Reynolds Community College!

This is, as I know, the most complete list of all the rules of EMS. The first 10 are from the original posting to miscellaneous emergency services back in 1993, I found the original posting with some help from the author Jay Friberg, Thanks Jay, that list was the original inspiration for this page. The rest are from additions to that list in the news group and various websites that have the list. Including 50 or so of my own creations If you see any mistakes or have any additions please Use our forums Also please check your submissions to see if they are already on the list Most of my now gone duplicates were from submissions, thank you.
Take me to the updates
1. Skin signs tell all
2. Sick people don't bitch
3. Air goes in and out, blood goes round and round, and any variation on this is a bad thing.
4. About 70% of the battery patients more than likely deserved it.
5. The more equipment you see on a EMT's belt, the newer they are.
6. There is no rule 6.
7. When dealing with patients, supervisors, or citizens, if it felt good saying it, it was the wrong thing to say.
8. All bleeding stops....eventually.
9. All people will eventually die, no matter what you do.
10. If the child is quiet, be scared.
11. EMS is extended periods of intense boredom, interrupted by occasional moments of sheer terror.
12. Always follow the rules but be wise enough to leave them sometimes.
13. If the patient vomits, try to hold the head to the side of the rig with the least difficult cleanable equipment.
14. If someone dies by chem. hazards, electrical shocks or other on-scene dangers it should be the patient, not you. (also known as rule 1313)
15. Any EMT, FF, LEO and/or scene chief who is drunker than the patient is the real problem.
16. There will be problems.
17. The severity of the injury(s) is directly proportional to the difficulty in accessing, as well as the weight, of the patient.
18. Hand grenades and turret mounted machine guns usually work better than lights and sirens.
19. Make sure the rookie EMT knows that a med patch is a radio term, and not a medicated bandage.
20. "Paramedics save lives; EMTs save Paramedics." (to quote a T-shirt or bumper sticker)
21. If the patient looks sick, then the patient is sick.
22. If the patient is sitting up and talking to you, then the patient is not in V-Fib, no matter what the monitor says.
23. It is that bad.
24. Full spinal precautions were custom made for obnoxious drunks. So were NPAs.
25. If you absolutely must vomit, than it is probably best to turn your head away from the patient.
26. It is generally bad to use the words "holy shit" on scene, in reference to the patient’s condition.
27. Patients that crash in separate vehicles should be transported in separate vehicles.
28. Just because someone's fully immobilized doesn't mean they can't be violent.
29. If I'm up, EVERYONE is up!
30. Better them (another unit) then me.
31. I saved the patient...from the fire department.
32. When responding to a call always remember that your ambulance was built by the lowest bidder
33. Never get into the front of the ambulance with someone that is braver than you are
34. When in doubt use industrial strength therapy
35. If it’s stupid, but it works, then it isn’t stupid
36. Algorithms never survive the first thirty seconds of patient contact
37. Always honor a threat
38. Always know when to get out of dodge
39. Always know HOW to get out of dodge
40. The important things are always simple
41. The simple things are always hard
42. If the patient is going to vomit (especially projectile) be sure to aim towards any bystanders that would NOT clear the scene. (This also works for OIC's)
43. Sometimes it's easier to beg forgiveness than get permission.
44. You can't please any of the people any of the time.
45. Don't go INTO Dodge without the Marshall.
46. They said, "Smile, things could be worse." So we smiled and sure enough, things got worse!!!
47. Always answer a newbie's questions. (Remember: you once asked them, too.)
48. Always Trust bad feelings (let's see if anyone notices I added in the missing #)
49. EMTs are taught - "the man with the gun, is the man in charge" (i.e.: the police) WRONG !!!!! Real life (when the fire dept. is on scene) "The man with the NOZZLE (charged hose line) is the man in charge!!" Trust me, it's true. I've been there. That charged hose will send you farther down the block & hurt more before the cop begins to think about shooting you.
50. The number of drugs a patient has on board is directly proportional to the number of knuckles tattooed.
51. If you respond to an MVA [motor vehicle accident] after midnight and you don't find a drunk, keep looking - you've missed a patient.
52. PVC's can be eliminated by sending a strip to the hospital.
53. The ultimate QA program in EMS is an autopsy.
54. Best time to work a code - overtime.
55. Pain never killed anyone.
56. All fevers eventually fall to room temperature.
56. A Pt.'s weight is directly proportional to the chances the elevator will be non-functioning.
57. Here is a simple ETOH [alcohol] test: Hold your hands about 6 inches apart with thumbs and forefingers touching and ask patient what color strings you are holding. If patient indicates a color it is a positive test.
58. A tourniquet around the neck solves all problems.
59. If you drop the baby, pick it up.
60. The dead never get better; on the other hand they never get worse.
61. O2 is good, blue is bad.
62. Never trust an E/R doc with anything sharper than a tongue depressor
63. Less than 8 [Glasgow Coma Scale score], intubate
64. Asystole is a very stable rhythm
65. A patient's weight is in direct proportion to their altitude in the building.
66. A patient's weight is directly related to the number of stair flights between him/her and the rig [ambulance].
67. "When in trouble, when in doubt, run in circles, scream and shout".
68. EMS RULE OF THREES (as it relates to codes) >300 pounds < 30 minutes to shift change > 3 stories up in the building.
69. Whoops: 1) the monitor just fell down the stairs, 2) the cold and flu patient just coded, 3) the wrong house. (hint: the one with the lab probably didn't call 911)
70. Rules: 1) Don't get dirty, 2) Don't run, you may violate rule #1, 3) If it looks like you might get dirty doing something let the new guy do it.
71. For every ALS [advanced life support] skill we learn, we forget a BLS [basic life support] one.
72. The fire tetrahedron consists of the following: heat, oxygen, fuel, chief officer. Take any of them away and the fire goes out.
73. "Compassion Kills", don't dive into incidents.
74. When a call comes in 2 min. before shift change you will always pass your relief 1 block from the station. He/she/ it will be laughing and waving at you.
75. If there is little to be gained, there is little to be lost. If there is a lot to gain, there is a lot to be lost.
76. If you lift an inch, crib an inch.
77. What do you call a medical student who finishes last in their class? Doctor.
78. If you think the cost of education is expensive, check out the cost of ignorance.
79. Universal Precautions - Is it wet? Is it yours? If it is, and it isn't then leave it alone.
80. Death is a stabilization of the patient's condition.
81. Every Emergency has three phases - PANIC, FEAR, and REMORSE.
89. You are bound to get a call either during dinner, while you are on the can, or at 02:00 in the middle of a great dream.
90. Training is learning the rules, experience is learning the exceptions.
91. Rocket scientists that get into stupid car crashes are the first ones to complain how bumpy the ambulance ride is.
92. "Poke & Hope" = blind sticking [trying to establish an IV line]
93. Why do fire chiefs where white helmets? So you know where the Preparation H goes.
94. Never trust your rig, drug box, or airway bag to be fully stocked. (In spite of the assurances of the off going crew.)
95. If you don't have it, don't give up. Adapt, improvise, overcome…then call for a second unit.
96. There is no such thing as a "textbook case".
97. Newbies always look for large things in the smallest compartments and vice versa.
98. There is no such thing as a bad call. Only calls that didn't go the way you planned.
99. Just because someone's EMT or Paramedic original license date is before yours does not mean they know what they are doing.
100. Truckies are people who are over 6 feet tall and their hands drag the ground while walking upright.
101. Newbies have their own way of doing things.
102. When it comes to needles, 'tis better to give than to receive.
103. Listening to some EMTs talk on the radio makes you wonder why they don't become professional auctioneers.
104. For every 25 calls you run, only 1 will be exciting.
105. Take comfort in the fact that most of your patients survive no matter what you do to them.
106. The old EMS constant: no matter how bad the politics get, the doors go up and the trucks go out.
107. ALS really stands for "absolute loss of sense".
108. Most of your patients are healthier than you are.
109. Being in emergency services means you get to celebrate your holidays with all your friends, while on-duty.
110. Being an EMT means you get to expose yourself to rare, exotic and exciting new diseases.
111. EMS does not save lives, EMS is to care for people. It is 95% of what we do.
112. You fall, you call, we haul, that's all.
113. There are two kinds of EMS calls: "Oh-Shit!" and "Bull-Shit!"
114. Call 1st, call fast, got to make that v-fib last, till we shock 'um, make 'um jump, get a rhythm, and a pump
115. When rate is slow, when BP is low, we give atropine, so we can go go go!
116. When you join the kidney club, you usually cannot go.
117. Common sense isn't.
118.The more reflective stripping there is on your jumpsuit, the easier it is for the only drunk driver going by the MVA to find you.
119. If you have a ride-along you want to show the real world, nothing will happen that shift.
120. EMS goes against the process of natural selection.
121. Just because you're paranoid doesn't mean your supervisor's not around the corner.
122. You can't cure stupid.
123. If it's wet and sticky and not yours, leave it alone!
124. If at all possible, avoid any edible item that firefighters prepare, especially the tuna casserole.
125. Heaven protects Fools and Drunks.
126. We are all slaves to the god "Motorola"
127. Only medical control option that can always be used # 48 "Drive Faster"
128. Murphy was an optimist.
129. The address is never clearly marked.
130. EMS doesn't save lives we only "postpone the inevitable."
131. Supervisors become that because they won't be missed in the field.
132. The god "Motorola" desires sacrifices of hot food at least once a shift.
133. Even sterile water tastes great on a hot day.
134. The stereo must always be louder than the siren.
135. At the beginning of your shift, your main O2 tank, fuel tank, and stomach will be empty...but the call volume will be full.
136. You know you are in trouble when the directions to a patient's house include... " turn off of the paved surface..."
137. Anyone with a "T" to "T" ratio of less than 5 to 1 is guaranteed to be drunk, on drugs, or both. ("T" to "T" means teeth to tattoos)
138. All arrhythmia's eventually straighten themselves out.
139. Dead is dead, leave it at that.
139. Your seriously ill pt. will miraculously get better when you roll them into the ER.
140. Your pt. will get new symptoms after radio report and pulling up to ER.
141. Don't get excited about blood unless its your own
142. The pain will go away when it stops hurting.
143.If nothing has gone wrong you obviously don't understand the situation.
144. You should always stop CPR after the second ouch!, from the PT.
145. People don't call an Ambulance because they did something right.

146. The quickest way to gather the relatives is to leave the primaries on while at the scene.

147. Every nurse is right as long as you are in THEIR E.D.

148. When in doubt, always take another set of vital signs.

149. If your patient is violent you can always use O2 therapy (an O2 bottle across the head usually calms them down).
150. The larger the house the furthest from a door the patient will be.
151. If the patient fell and was moved by the family, they will have moved them so that climbing stairs will be involved.
152. The furniture will always be arranged so that a stretcher or stairchair will never fit easily.
153. The problem won't be that bad until a major disaster strikes. (you have had chest pain for 3 days and wail till the middle of a blizzard to call?!?!?)
154. The Patient will all of a sudden develop a PMH as soon as the ED nurse asks for one.
155. The same (#154) applies for medications
156. Whenever you have NO lights or sirens on, everyone on the road will pull over for you, whether you want them to or not.
157. The probability of getting a code 3 call is directly proportional to how badly you need to go to the bathroom.
158. You've never been as sick as just before you stop breathing.
159.Dispatchers tell everyone where to go, inversely, everyone would like to tell the dispatcher where to go!
160. If you ever do tell the dispatcher where to go they will give you more places to go (or never piss off the nice dispatcher).
161. A patient's weight will always be inversely proportional to the size of the vehicle they choose to wreck. (in other words, the fatter they are, the smaller their car.)
162. It's not our emergency..........it's our patients! (For all you newbies who forget to take a chill pill!)
163. If someone is pointing a gun at you, 2 things 1. you should have waited for PD, 2. you wish you just hadn't made that wise ass comment.
164. Fellow paramedics always have a better story than yours.

165. Just when you say, "You know, I have never had a hanging....", you will get one.

165. The only time you go out on a limb (As a Dispatcher), and not provide coverage so a crew can eat, a serious call will come in that area.

166. The only time you need to fart is when you have your patient loaded in the elevator.

167. The only time your pant's split is when there are gorgeous Police Officers there to assist you.

168. You will get caught sleeping, eventually.
169. never say the kind of call you are in the mood for in the beginning of the shift, you will get it in the worst way (I.e mva in the pouring rain)
170. Make sure the newbie knows that the portable O2 is the one to bring to a code (not the main)
171. God made Paramedics and EMT's to give him a chance to change his mind!!!
172. Beware when a firefighter says "Check this out."
173. never let a rookie drive the truck when they drive a tiny car. bridges are scary as hell and curbs are ruff.
174. Your driver will never hit a pot hole or curb unless your patient has a bad fracture.
175. The worse your patient breath is the quitter they will talk. You will have to get closer to hear them
176. No matter how many times and ways you ask the patient questions, the story will always change once they get into the ER making you look like an ass.

177. If ever in doubt which house you were called to look for the stairs.

178. If there aren't nurses around when you get called to a nursing home go to the last room in the hallway that’s always where the sickest pts are

179. Never start putting your stuff away before you are told to go home because you have just given yourself another call

180. When in doubt let your partner handle it

181. When getting a TMJ call on Sunday never say it around your pt it sucks when you have to tell them what it means ( too much Jesus)

182. When giving a radio report never tell the er nurse that your pt is stable, by the time you get there you will be working a code!!
183. If the patient pukes, it is not unprofessional to puke along with them it is sympathetic puking. You have something in common with your patient and
can relate to how they feel. That is what they made the big step well by the side door.
184. If the patient only moans when you listen to lung sounds, they aren't as sick as they want to be.
185. If a p/t tells you he/she is going to die, believe them they are probably right.

186. When in doubt remember the p/t is sick, the ambulance has wheels, USE THEM!
187. 911 The government's answer to dial a prayer
188. The more addicted your patient is to valium, morphine, etc.... The more they are allergic to torodal.......
189. You can have circulation with no breathing-but you can NOT have breathing with no circulation
190. On trauma calls - survivability is inversely proportionate to social worth!
191. How you know an unconscious is a DOA 1) If it weighs over 300 pounds it's a DOA 2) if it lives more than three flights up in a walkup apartment it's a DOA 3) if its less than 30 minutes left in the shift it's a DOA
192. EMS providers know how to say "got shoes" in 7 different languages.
193. All fevers eventually reach room temperature
194. Cops make the best gas leak detectors in a Haz-Mat incident, they approach the scene and pass out
195. Message to Newbies: People are going to get sick, People are going to get hurt, and People are going to die. This is not a multiple choice job. You must be able to handle ALL OF THE ABOVE!
196. Never go past the first dead cop.

197. There will be no dying or multiplying in the back of my unit. (They die on scene or are pronounced at the hospital. Birth happens on scene or at the hospital.)
198. The worse you have to use the restroom, the farther the distance it will be from the location of the call to the hospital.
199. When entering a HazMat scene: "Never pass the first dead canary (cop)"
200. Some people can do this job some can't. Pray you are partners with one who can.
201. All rhythms will eventually degenerate into one you will recognize and can treat.

202. If God had intended you to have a rapid response to the call, you would have been parked in front of the location.

203. Upon arrival at a code, check your own pulse first, if it is still there everything else is easy.
204. As soon as you finish cleaning the rig up for a parade You'll have to drive ten miles down a road filled with mud puddles for a difficulty breathing.
205. IF you ever go to a call and find the cops laughing on the front lawn...worry!
206. Cops are wonderful assessment tools at a HazMat incident. Send them in with a lit road flare. If they don't pass out or blow up, it's safe.
207. Remember that it is the patient's emergency, not yours
208. Try to keep your pulse rate lower than your patient's
209. If you drop the baby-fake a seizure
210. Trauma is treated with diesel first

This list as noted above goes back to 1993. As EMS Week ends, I thought everyone would enjoy this.

John Kirtley has been a fixture in EMS in the Richmond, Virginia Area for many years as a paramedic with the Tuckahoe Volunteer Rescue Squad, EMS Instructor & ALS Program Coordinator for the Chesterfield County (VA) Fire and EMS Department, and now EMS Program Coordinator at J. Sargent Reynolds Community College in Richmond, VA.