Six EMS Phrases That Should Be Banished

There are a bunch of phrases we commonly throw around in EMS. With the popularity of social media, some of them seem to get carried far and wide. Some are helpful. Some…not so much. And some are downright useless, perhaps even damaging.

Here’s a quick list of six phrases I think we either could stand to use less or even do without entirely. There are a few phrases on this list that I would be happy to never hear again in my career.

With that, I offer, in no particular order, six EMS phrases that I would banish if I were king.

“Busting ours, saving yours.”

I get sick to my stomach every time I hear someone say this. This phrase permeates EMS blogs, chat rooms, forums, and comment strings. I’ve seen it on twitter and in individuals “about me” descriptions and auto-signatures. I’m sure you can even find it on a t-shirt somewhere.

This phrase bugs me on a bunch of levels. Mostly it bugs me because it’s false. Some folks in EMS work hard. Every once in a while we work real hard. Few of us ever “bust our…you know.”

There are people in this work who truly bust-ass for a living. When I worked in Bakersfield, California, there were migrant farm workers who came through during harvest and worked all day in the 104 degree heat picking fruit and tossing it down a line for packaging. Those people busted their asses for less money each day than I made before breakfast. When I think of hard work, I think of those workers. Think of people who work the night shift scrubbing toilets and cleaning bathrooms in 14 story corporate offices. I don’t think of us.

I also don’t really like the “saving yours” part either. It plays on the whole life-saver image of EMS that draws the wrong folks in and then burns them out. Rarely do we make life saving interventions. We serve others. I’d prefer to hear the phrase, “Working hard, serving others” instead of the “busting ours…” mantra.

“We can do this the easy way or the hard way.”

This one comes up when people refuse to go with us to the hospital. We want them to go. We need them to go. And often times, they just don’t have a choice in the matter. Every so often we end up with a stale-mate. The patient digs in their heels and refuses transport but they don’t have the right to refuse our care. When this happens, it seems inevitable that someone will eventually step in, cross their arms and say, “Look sir, we can do this the easy way, or we can do this the hard way.”

There are two reasons I dislike this tough-guy approach to patient transport. While the statement is true, it rarely convinces people to go the easy way. Something in our human DNA makes us want to rise to a challenge and this phrase is often interpreted as a challenge.

The phrase also does nothing to emphasize the point that we would really like the patient to go the easy way. What I’d prefer to hear people say is something more like, “Look sir, I’m sorry that you don’t have a choice in this matter but you don’t and neither do we. The last thing I’d ever want to do is physically force you to go along with me to the hospital. So I’m going to ask you to please not force me into that situation. Come along under your own power and let us preserve your dignity in from of your family and friends.”

Saying something like that communicates all the same information, but it emphasizes the positive outcome that we are trying to create.

“Based on the mechanism of injury…”

I don’t subscribe to the idea that mechanism of injury has no value in clinical care. There is a reason to take a good look at the mechanism, if only for the reason that we are the only providers that can truly evaluate it and communicate it to the rest of the medical team. However, as this video accentuates, we use mechanism of injury too much in EMS.

Mechanism of injury should raise our index of suspicion. It should alert us to the possibility of injury. It should not dictate our clinical care. Immobilize, assess and even make transport decisions based on mechanism of injury. But don’t let it direct your clinical care. Provide care based on your clinical findings, not the MOI.

“Passerby reported…”

I feel like there should be some rule that says that if you’re concerned enough to call 911, you also need to be willing to stand by in the area, just in case we need to speak to you. Perhaps you don’t need to stop right there on the scene. Wait around the corner or down the road. But 911 callers should have to do more than just dial 911 and report an emergency while going on their way.

Perhaps I’m a little sensitive to the idea of “passerby reported” because I work next to several busy freeways and frequently run to the freeway multiple times a day for all manner of roadside incidents. When the dispatch information begins with, “Single caller. Passerby reported…” the call just never seems to turn out to be an emergency. If there is a true emergency, two things tend to occur. First off, the caller tends to stop and remain on scene. Second, multiple people tend to call.

Today, it seems like everyone has a cell phone. At heavy traffic hours, if only one person calls and they don’t bother to stop, the information is highly suspect. I don’t know a good solution to this problem. At least during daylight hours, if the caller is a passerby and they are the only reporting party, I’d like to see us respond non-emergent. I think that would be a good start.

“Paramedics save lives. EMT’s save paramedics.”

I’ve never really understood the idea behind this phrase. It is one of the most long standing and frequently used phrases on this list. I hear it used in a lot of different contexts and scenarios. I don’t always think the people who say it understand what it means.

Let me list a few of my issues with this phrase and hopefully shed some light on why it’s so nonsensical to me.

  • Paramedics rarely “save” lives. We serve people. We practice medicine. Sometimes we even prolong people’s lives.
  • When we do “save” lives, we tend to do it using our BLS skills.
  • EMT’s work together with paramedics as a team.
  • Good paramedics are often “saved” by their good EMT skills.
  • If a bad paramedic has a good EMT partner, perhaps they could be “saved” by their good EMT partner, but someone also needs to get up front and drive eventually.

I’d like to see us adopt some phrase that still emphasizes  the importance of strong BLS skills whether you are an EMT or a paramedic without suggesting  that some EMS provider is necessary to bail out their counterparts or that “life-saving” skills are the purview of one certification level and not another. Perhaps something like, “Good EMTs make good EMTs and good EMTs make good paramedics.”

OK, that one’s pretty rough too but I haven’t had two decades to refine it. I’ll still take it over the phrase above.

“Pain never killed anyone.”

I hate the guts out of this phrase. And I’m embarrassed to say that it recently came out of the mouth of one of my EMS mentors. I get the truth in the statement and it’s worth considering when we talk about the prioritization of care. When a patient with a crushing chest injury also has their foot stuck under the brake pedal, we need to remember that pain control may fall farther down the care priority scale than we’d like.  But, too often, we use this phrase as an excuse to disregard vital but inconvenient patient care needs.

Pain control is one of the most important patient care interventions that we have to offer our patients. It’s also one of our biggest patient care failures in EMS. We have consistently and pervasively neglected pain control for too many years in prehospital EMS care. While were getting better, we are still far from where we need to be. Pain is endemic to the type of medicine that we practice and we, as EMS providers, should champion aggressive pain control.

Occasionally we need to rapidly transport someone with multiple painful injuries. In those moments, pain control might take a back seat to other patient care needs. On those days, know that people don’t die from pain. Now that you understand that fact, don’t ever, ever, ever use this phrase to neglect proper pain control.

So there they are. Six phrases I’d like to throw out of the EMS vernacular. What about you. Do you think these phrases deserve to be banished? What phrases would you throw out the window? Let us all know below in the comments section. I look forward to your response.

Comments

  1. A-Freaking-Men!

    As far as phrases that should be abolished, how about “You call, we haul, next call, that’s all?” Transport is only a portion of what EMS does, not the end all, be all. If we were that, we may as well be cabbies.

  2. BLS saves lives. ALS helps.

    All levels ostensibly do BLS so trying to refine it further is tough. I like your version, but there are probably exceptions; some EMTs don’t make great medics. However all good paramedics should be good EMTs, so I suppose you could invert it…

  3. Spot-on, again Steve. I hope that at some point in my career we will be able to look back and say “remember when people said those stupid things?” I am more optomistic about this now than ever before.

  4. Two of my least favorite are “Load and Go” or “Stay and Play” These seem to be especially common in EMS education and scenario training and are used as a catch all for a number of assessment and treatment procedures.

  5. I really don’t like “pain never killed anyone”, although that probably has more to do with the fact that it was one of my dad’s favorite phrases when I was growing up. He was kind of a hardass and crazy about running; I actually went on a four mile run with him a mere six hours after breaking my toe, and what I remember the most is him using that phrase repeatedly, so I have a severe hatred for it.

  6. I, too, hate “Load and Go” or “Stay and Play” but they do help me make that transport decision sooner. Those two seem to minimize the assessment process. Also dislike the question “Any good calls lately?” Steve, you addressed this in your column “What’s the worst thing you’ve ever seen?”. It implies that good calls are the ones in which we used our skills to their max, but someone had to be hurting badly. To me, a good call has a good outcome.

  7. I would like to see “at this time” go away

    As a former dispatcher we used to have some fun with it and when someone would give a report starting with “ATT” we would wait until they finished and ask…”what are you doing now? you just gave a report of what you did some time ago” what are you doing now?

  8. In my neck of the woods “Load and go” has been replaced by L.A.T.E.R – “Load and treat en route” and “Stay and play” by “Stabilize and prioritise”.

    L.A.T.E.R is well ensconsed in the vocabulary now with “stabilise and prioritise” getting there. I think they both better describe what we should be doing in each of those two approaches.

  9. We can do this the easy way or the hard way says:

    Hi Steve,
    Got here by accident! :-)
    I was threatened with the “we can do this the easy way or the hard way” talk when I had a syncopal episode in class. The ambulance people told me if I didn’t go with them, they’d involve the police and university security. No kidding.
    I went (like I had a choice) and when I got to the hospital, the doctor said I didn’t need to be there since I had clearly recovered fully. So I ended up sitting in the ER waiting room for some 5-6 hours till the wee hours of the morning before they looked at me, and by then, I was ill from fatigue and hunger.
    I was later told it was in my right to sign a treatment refusal.
    Wish I knew that earlier.

    p.s., AWESOME blog!

  10. This is stupid. The phrases are just dumb. I hate stupid fisty EMS stuff. Although easy way hard way has been stated from time to time. It’s basically me telling the patient. I’m done with your BS. I hate absolutely hate all this empathy crap. Guess what it’s not a touchy feely field. It’s not a were here to go the extra mile and spend an hour on scene dealing with your crap field. All patients I have ever encountered are greeted with a smile and kindness till they screw it up. I’m not talking a 10 second fuse here. I’m saying you called a professional because you think this is an emergency which could end your life shortly or someone else’s shortly. I’m not here to pussyfoot on scene. I’m here to get you to higher level care because you feel you cannot do this on your own.

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