Whenever I serve as a preceptor for a paramedic intern or as a field training officer for a new paramedic trainee, I always give them my list of EMS proverbs and make sure they demonstrate the concepts on the patients we treat and the families who call us.

I say “my” list, when actually it’s a list of best practices that I’ve assembled with the help of colleagues and mentors from years past. In fact, I think it’s important to say that I learned about one-third of these practices in 1976 during my first two weeks as an EMT trainee for Hartson Ambulance Company. I was blessed to have Thom Dick and Chris Olson “show me the way” as my EMT field trainers the year before they went to paramedic school.

At the time of this writing, Chris is still providing superior paramedic care in San Diego County, and Thom is a prolific writer and champion of quality field EMS care.

Below are 10 EMS proverbs I hope will help you improve the quality of your care.

1. Arrive at least 30 minutes early for your first shift back after several days off, and cross-reference your protocols with each medication and piece of medical equipment you inventory.

2. Remember that your most important skill is “assessment,” because it’s the gatekeeper for all treatment skills.

3. All medical patients should receive a complete assessment (an ALS level of assessment if a paramedic is on scene), even if they don’t appear to require an ALS level of intervention.

4. Complex life-saving motor skills — such as advanced airway management, chest decompression, intraosseous insertion, tourniquet application — should be embedded in your midbrain and confidently performed like a reflex.

  • Refresh and practice all complex motor skills that you haven’t performed in the past three months on a routine, scheduled basis;
  • If you can’t get to the best manikin or tissue trainer to review and practice your complex skills, practice finding landmarks on yourself or someone else, manipulate the tools of the trade and visualize doing the beginning, middle and end of each skill.   

5. Err in favor of the worst-case scenario.

  • DON’T base your treatment plan on a “gut instinct” that tells you that your patient’s actual condition isn’t as bad as the presenting symptoms.
  • DO fully investigate and consider acting on a “gut instinct” when you feel your patient is in denial or masking symptoms that would indicate a more serious condition.   

6. When an apparently stable patient asks if they really “need” to go to the hospital, don’t feel compelled to respond with a definitive “no.” There may, in fact, be a safe alternative. Be sure they remember you offered to transport them by ambulance and told them, “It’s always the safest choice to go to the hospital.” Remember the importance and value of getting signatures of patients and witnesses.

7. Treat all patients and their family members as if they’re (loved) members of your own family.

8. When moving patients, make them feel as if they’re gently “floating” with minimal or no effort required on their part during the move.

  • Support patients under each shoulder if you’re “assisting” them to the gurney;
  • Lift the gurney wheels so it “floats” over every bump;
  • Coach the driver to anticipate all driving maneuvers. Encourage non-ballistic acceleration, imperceptible stops, non-centrifugal turns.   

9. Be a total rescuer: Be the provider of the best basic and advanced care, reporter of neglect and abuse, a true crisis interventionist, and a conduit to community and social services resources. 

10. Follow up on all patients who don’t have an obvious diagnosis and/or prognosis after turnover at the hospital. Use each of these patients as a valuable learning experience.

EMS providers are not always perfect but should strive for excellence. Hopefully these EMS proverbs represent to you or those you mentor the best practices for EMS excellence. 

Michael M. Meoli, FF/EMT-P/TEMS, is a firefighter/paramedic and field training officer with the San Diego Fire-Rescue Department STAR Team. He also is a SEAL Operator Chief, and advanced tactical practitioner with USNR SEAL Team Seventeen.