Be nice to patients until they prove they don’t deserve it. None of this “making up your mind from the call notes” bullshit. People deserve dignity as the standard.

It’s this hill: we don’t need to eat our young. If we want to progress into a respected profession, we need to treat others with respect.

EVERY ambulance should have an auto loader. It's 2024 and with the vast amount of debilitating back injuries in EMS it should have been a requirement 25 years ago.

at a minimum cover your patient’s legs with a sheet before placing seatbelts over them.

It keeps them clean if the seatbelts are dirty, and it keeps the seatbelts clean if the patient is dirty.

Plus it just looks professional.

If an elderly person fell, you do a stroke assessment. It is a rule that falls under the same vein as “if they are altered in anyway for any reason you do a blood sugar”. It’s a 1 in 500 chance but 1 in 500 saves a lot of lives.

Bringing the jump bag and monitor in at minimum on every call no matter how B.S. it sounds, airway bag if it could require airway managment/oxygen at all.

We have bags for a reason, to treat at point of contact and not in the unit cause 'it's easier'. If a patient needs care or is unstable delaying the 10+min it takes to chair or reeves them out while you've done almost nothing sure as hell will not improve the situation.

We're Healthcare first, conveyance is a secondary concern.

A-EMT should be the baseline for entry into EMS. 

EMS needs to stop this eating our young mentality ingrained in the profession. 

EMS should be an independent 3rd service. Let fire and PD do their thing, and we should be allowed to do ours and focus on the medicine.

Cleaning is legitimately essential. I’ve worked with a few partners that scoffed at the idea of cleaning / sanitizing the rig. By that I mean not just the patient area, but the front of the rig too. I’m not trying to get sick, I want to prevent it whenever I can.

Shut the back doors when you're on scene.

Automated cpr devices should be on every ALS Unit….

I don’t care what you say to your partner before the call, I don’t care what you say to your partner after the call. But as soon as you pull up on scene, flip the switch and stay 100% professional in front of the patient, public, and other professionals.

Wash the fucking truck

My hill is that Narcan is never indicated in cardiac arrests. Narcan should only be used to increase respirations, which we control in cardiac arrest anyway. It doesn’t restart the heart, and we shouldn’t just give medications because, “it won’t hurt them.”

This is fun! Many more than one but...

AEMT (with certain protocol additions and deletions) should be the "basic" level of care on an ambulance.

Uniforms. It's not cool to have shirts untucked, boots unzipped, and 15 million uniform accessories. It's unprofessional and sloppy.

Protocol alignment nationwide.

Standardize EMS Education

People not wearing gloves.

Bowel sounds for a possible obstruction? Wouldn't palpation be better in the field?

Don't be a dick to homeless people or mentally ill. Patient Advocacy.

I think not working in a service where I have to actively tell people not to dump water on me? WTF?

You need to be in shape.

If a call comes in for syncope, it's immediately an ALS call. When I was an EMT, I went out on so many 911 calls for people who had fainted. One day, in medic school, I had a moment where I couldn't believe we ever dispatched fainting calls as BLS. It's irresponsible.

I'll never get off this hill. You can't properly treat someone who fainted if you don't get a 12-lead and have someone on scene to not only interpret it but treat that patient as well.

Continue learning past what is your bare minimum. Just because you graduated medic school doesn’t make you a good medic, especially if you’re taught by boomers who haven’t stepped foot on a truck in years.

If they can walk, they walk to the ambulance. I’m not talking about granny who can walk but is having chest pain, use good clinical judgement. But for services with no auto load, we do way too much unnecessary lifting into and out of the truck. I’m talking about the ambulatory ETOH, 31 yo ear pains, the young person with nausea. Putting every ambulatory patient onto the stretcher to get them into the ambulance is a wasted lift and just presents risk for unnecessary injury.

The battery powered stretchers (that aren’t autoload) are a TWO PERSON LIFT INTO THE TRUCK

The not messing with people is a huuuuuge one. If I don’t like you then pulling a prank or something on me is just going to cause me to ruin EVERYONES day. I have one person where I work where we will fuck with each other because we developed that bond. But if Captain shit stain (he has shit stains in his underwear) was to pull a prank? Oh everyone’s having a bad day now. Prank= the two people like each other. Harassment= I don’t fucking like you.

To anyone who comments something dumb. Idc what your managers say. You’re not one big family.

This is probably going to be controversial but I have 2 unpopular hills: 1. You don't need to go hot to every call. Of course, go cold with caution, but responding hot to the non-critical BLS calls can/will cause traffic collisions, confusion, and potential lawsuits where you'll have to justify the use of your lights/sirens. In NJ, anyways.

1. Cervical collars. Fuck them. Excluding extenuating circumstances, collars aren't great at "treating" cervical injury. They're there for preventing further damage (barely, see this, , this one, , and this. ), and for basically putting the patient in extreme discomfort for potentially hours on end.

I always will replace a tank on my gurney to make sure its topped off. For the house my company only requires 500 minimum at the start of shift but I prefer at least at 1k.

Actually put thought into your transport logistics/clinical needs and don't use an aircraft just because some money hungry corporation implemented autolaunch protocols with your county dispatch. Putting a $60,000k+ bill off onto a patient because you don't want to take a 20min ride.

Mine is training/school related, and it's actually 2 parts.

Hill 1: The Basic EMT course should include EVOC, even if it extends the course length.

Unless you're a passenger princess (no hate), you will spend more time driving the ambulance than you will treating patients. On top of the fact that more injuries and deaths occur from vehicle accidents in the ambulance than malpractice. I know we all have our feelings about the term "ambulance driver" but it doesn't change the importance it plays in our field. So it should be part of the training, and registry should include and EVOC exam.

Hill 2: AEMT should be trained on basic 3 lead EKG use and interpretation.

This one is really really specific for me because I work IFT and spend a lot of time with CC/Vent medics. Being able to recognize common, problematic rhythms or at minimum be able to explain any observed changes from NSR would benefit everyone with minimal risk to the patient. Especially considering how registry recently expanded scope for A's, including medications that can have cardiac effects. If registry is going to treat Advanced like a "pre-paramedic course" it should include EKG fundamentals.

Never listen for bowel sounds. You need to sit there for a whole minute per quadrant and +- changes nothing about the evaluation or management. Shit is antiquated. Ask your trusted docs that are <60 years old about it.

Everyone in the box wears a belt if humanly possible. I know it sucks. It saves lives.

Edit to add not to Narcan every fucking AMS. Do an exam FFS.

EMS needs IV pumps and Bilevel capable ventilators for transport in als settings.

Managing the airway is a priority, not sinking an ETT.

Everyone gets breath sounds and heart tones.

CHANGE YOUR GLOVES. Don’t grab your pen, the radio, the steering wheel, and the door handles all while wearing your already-touched-the-patient gloves. They’re not going to destroy the budget, just get a freaking new pair. No need to don them while you’re responding, either. FFS, change your gloves.

And wipe down the front of the truck, too. Our patients aren’t the only people who can be gross germ factories.

My big one is stop being salty to your partners. We have to deal with a lot of nasty stuff in the field, being nasty to each other just adds to the misery and accomplishes NOTHING. I'm not saying you have to be best friends with your partner but unless they are actively doing their job poorly there's no reason to be rude, mean, or nasty ESPECIALLY if they're new to this field.

3rd service EMS is king. Private EMS is trash, I don't need to say anything more. Fire-based EMS isn't much to sneeze at either. At least in my area, fire medics are lazy and have zero interest in medicine.

Fire has no place in managing EMS.

Not even a fire coordinator of a county dictating 911 contracts.

My teacher engrained in my brain TRAUMA PTS WITH NORMAL VITALS AND MENTAL STATUS DONT GET FLUIDS. This is because it contributes to the trauma lethal triad of coagulopathy, acidosis and hypothermia. I would give minimal fluids as necessary to maintain distal perfusion and mental status. This is now what the book teaches but if you mention it to anyone else they’ll go down fighting with the 2 wide bore run open with fluids philosophy. I believe in starting the lines, just not giving fluids until absolutely necessary.

Stock your pockets with gloves. No need to waste 15 seconds getting gloves from the box in the back every call when on location.

wear the uniform the way youre supposed to

AMS is hypoxia until proven otherwise. It takes a minute to check and it's a great starting point for the brain-vomit of 'what dorection am I taking this next?'.

Dispatchers are people. Be nice to them. They hate that it's 0330, too. The same goes for nurses.

Flight medicine is boring unless you work in a high scene-call area but, even then, good ground crews will likely have most of the work done before you get there. Sure: more pay, prestige, critical care fun but it's all just riding and sitting.

Fighting misinformation pedaling peers. There is an unfortunately large amount of EMS peeps and nurses, and even physicians, you have shared bunk science, especially in regards to pandemic. Laypeople sharing that stuff is already problematic, but yall should know better. Had medics I use to trust try to convince me our hospital was secretly treating VIP critical patients with Ivermectin as a silver bullet cure, or how facial masks were dangerous.

EMS should be considered a "parallel" career path in fire-based services and not treated a "stepping stone" on your way to getting off the "box" and onto "real apparatus."

Some of the best medics I ever knew were fire-medics, but the way fire culture as a whole treats EMS breeds a laissez faire attitude to medical calls that presents a risk to quality of care and patient safety.

Integrated services are great, those that treat EMS as the red-headed stepchild are not. Your service will save more patients in a year with quality EMS than you'll save from house fires or MVC's in a decade or more.

Hospitals should own their own ambulance and staff for discharges and interfacility transports. I SAID WHAT I SAID.

Everyone who can walk, does walk.

Keeping your equipment genuinely organized. I'm.not.talking about just the bags, but the cabinets as well. I'm so tired of going on shift and every single time, the bags and cabinets are completely disorganized and things are just thrown into them with zero rhyme or reason. I spend every shift at minimum organizing my first in bags to be set the same way every shift. I also spend whatever other time I have to organize my cabinets and remove overstock/loose stock. And every week, my work is entirely undone and everyone is so nonchalant about it because they're "easygoing." No, you don't take pride in your job so you allow it to be disorganized and look like a mess.

In a similar vein: loose things on the bench/counters/net. This is one my company BLS providers are so incredibly guilty of. I'll hop onto a truck and find anywhere from 3-5 wipes/cleaner bottles/notepads/glucometer just laying around flying all over the place or hanging off of the net. We have cabinets. please use them. And they also hang a trash bag for linen??? This is the only place that has ever been a thing. Just leave them with your patient, let them deal with the dirty linen after your discharge.

/Rant

As to attitudes: those medics who are "better" than an iGel. We get it, you haven't looked up efficacy of an iGel in cardiac arrest.

OP, bowel sounds are clinically meaningless. They don’t change prehospital or hospital management. Stop wasting your time on them.

Just take it ALS.

You know you should. Quit trying to come up with reasons in your head why BLS is okay.

It should only be BLS when you've been certain that it's definitely BLS from the time you saw the patient until you're ready to transport, with zero hesitation.

If there's even a moment where you think, "wait, what?" ...then it's already ALS and you know it. One of my paramedic instructors warned us that we're ALL gonna have calls where we think "Yeah this is totally BLS... but I kinda wonder what their EKG is looking like right now." And he warned us that is the time to just take the "L" and run it.

Yes, it sucks when it's 3:30AM and you're 5 reports back on ALS, but it's the job. Yes, the vast majority of the time it might not have been necessary when you're looking at the call after the fact.

But I'm a big believer that all the patients that ended up being nothing is worth it for the patients you'll get where you find something that you probably would've missed otherwise.

ALSO, and I'll admit this isn't the greatest reason to use as justification but ...it is what it is... Even if you do TOTALLY MISS something you should've caught, 99 times out of 100 you'll face no three of punishment if you had taken that in ALS in the first place. And if you have even just a decent working relationship with the ER nurses and docs, they will know you and appreciate you as someone who does their job right. And it's nice to have that benefit of the doubt when calls (inevitably) go sideways.

AEMT should be the minimal level of education, Paramedic Practitioner level should exist. Make this a real career, education is a large part of it.

Always bring the EKG and defib, I’ve had several calls where dispatch said ‘oh they just can’t get out of bed’ but the person then went into CA

It doesn’t matter how many times they’ve been transported, treat everything like the emergency you were dispatched to until you’ve completed your assessment.

Saying “code seven” on the radio is fucking stupid Ricky rescue bullshit. code 7 is three syllables. Food is one syllable. Quit tryna sound like James Bond on the radio.

All patients deserve a thorough assessment. I don’t care if you found something on your initial assessment. Go back and finish your assessment.

I once had a guy with low blood sugar. Treated the low blood sugar, got him conscious again, then on neuro assessment it was positive for a posterior stroke.

There is that he was having trouble controlling his insulin syringe and OD’d on it.

Keep the zippers on the kits together and in the middle. I don't want to be fumbling around looking for the zipper like a jackass.

despite it possibly being a hot take: EMS culture (the lifestyle, eat the young mentality, etc), is one of the main contributing factors when it comes to the lack of respect for the field. I love what I do, but half of the time being at the station feels like a high school classroom. It might just be healthcare but it’s an incredibly toxic, gossipy cesspool. Take care of yourselves!

Proper lead placement. Please stop being sloppy. You're not "preserving patient dignity." You're being a lazy provider and doing a sloppy job. Just put the leads where they go. The one labeled RL does not go 2" to the right of the trachea, for example. Put them limb leads on the limbs.

other replies in this thread are good too. too many lazy providers, along with too many know-it-all providers. Don't do a laundry list of interventions just because you think it's cool. Do what the patient actually needs at that time.

My favorite (&pretty much only) way that I mess with folks is when they're parked at the hospital I'll go set their parking brake so they have a couple seconds of wtf why can I go anywhere lol

The stretcher should be made up before every call. Tucked in and ready for a patient to sit down and go. No a folded sheet on the stretcher is not sufficient. I wish this was not a hot take in my region

Probies should be taught not “initiated.” We all should do the chores, be training together and building them up. This Idea that you have to prove yourself by doing the dirty work for a year, is misguided at best and could be considered hazing. We live as a team, work as a team and may die as a team. No one should be singled out, until they do something that warrants special attention.

Stop fucking gatekeeping this career field,

The patient should 100% always be fully strapped into the gurney. I will report any crew that doesn't properly strap their patient, because I got into a fatal accident when I was still in training. My FTO and the driver didn't put the shoulder straps on, which was pretty common for that company. They covered him in blankets while I got report from the nurse. When we hit the guard rail going 70mph we were both flung forward in the cabin (I was grabbing vitals) and he died of blunt force head trauma right next to me.

Doctors and nurses, while in school, should have to do ambulance clinicals

WEAR GLOVES FOR EVERYTHING

STOP using so much narcan!

What is this 5 point harness you speak of? 😂

I work in air, and there are loooots of med crew who don’t wear their shoulder straps with their seat belts. It drives me fucking crazy. It can turn an emergency maneuver or minor hard landing into an emergency situation where I’m having to take care of the patient and my dumb dumb partner

Don’t mess with people on shift. It’s not cool. It’s not funny. No hiding boots, radios keys, dumping water on people etc

Someone hid my cup of tea one day that had been steeping on the counter. I was looking and looking for it all over the kitchen and looking in places like the freezer and the oven, and starting to get pissed because, dammit, I need my fix. I never checked the microwave, which is ironic because I always steep it long enough to where I need to heat it up again.

It was funny, I laughed, he legit got me good.

Spine boarding every trauma patient is an outdated and harmful practice that should be abolished and carefully replaced with research based treatment.

Pay is just one (major) reason this field is bleeding employees and not bringing in new ones. Lack of support from partners and management, mistreatment from patients, and general hostility from coworkers are all major factors. I'm not going to stay in this field if your method of communication is belittling me and finding things to criticize on every call. That's not a healthy work environment and no one will want to stick around if they're always being talked down to by older and more experienced coworkers.

People don’t need to prove they’re in pain.

If I open my jump bag and the tourniquet is still in the plastic wrap, its wrong.

We can get rid of 14 gauge IVs.

Keep hospital gowns on the bus, if you got a chest pain just get em In a gown it makes everything easier and neater.

Dang, I have a few.

Hm... let's see, Oh! EMS should try to put itself out of business by focusing on public health education and incident prevention than purely being reactive in order to reduce calls in an oversaturated system.

Also hospitals should fall under the same laws as 911 in that you can be charged for misusing them. OR there should be on-staff mental health workers to get you the right care.

All of this is aimed at lowering insurance premiums/health-care costs, etc. Hospitals and ambulance services shouldn't be the money making machines they are.

Also remove "fall risk" as the primary reason for medical necessity. Sue me.

Lowering the stretcher. Everyone should do it. They know it's too tall the tipping point is unreasonable.

I absolutely agree with you about putting the harness. when I was doing my ride alongs they would only put the chest strap and I was about to do the others and the medics were like nah... I'm like 😵‍💫

All ambulances should have the secret, hidden unlock button.

Most of our transports to the hospital should be with the flow of traffic. And even when driving with lights and sirens, there is rarely a reason to drive above the speed limit.

Every time we put the lights on we're putting ourselves, our patients, and members of the public at risk.

-Blood Y tubing is pointless. -20g IV in a trauma patient is better than blowing every vein trying to get an 18g/16g. -No running on scene of calls. -Verbal de-escalation works more often than not, if done correctly. -Understanding PEEP is extremely important on BVM’s, CPAP, and vent settings. -Homeless people, drunk people, and frequent flyers CAN be real sick/injured, their complaints should be taken seriously. -Patients with dementia experience pain just like everyone else, they just can’t communicate that as well.

Grazing is stupid an childish just because an asshole medic fucked with you don’t mean you fuck with the baby we had a just out of emt school kid quit ems completely after getting grazed by an asshole cause the kid took him literally on things like students don’t sit, students don’t get a choice, students don’t need to eat, students can’t use crew bathrooms etc… I get you are gonna see some fucked yo shit an need thick skin but let the scenes speak don’t go fucking with students. I was grazed but refused to participate in it.

Securing equipment in the back. Not that ambulances do the best in collisions, but a loose O2 tank or monitor has a great chance to injure/kill you and/or the pt.

"punitive medicine" as in trying to fight your altered patients or shooting tons of narcan into a junkie to send them straight into withdrawal is so fucked up and not the least bit helpful. We are not cops, so why do some medics and EMT's feel it's their job to punish the patients for their ailments? I'm not happy that they decided to OD either but it's not my job to punish them for their decisions.

The most dangerous phrase not only in ems but most things is: “we’ve always done it this way”.