Administration and Leadership, Cardiac & Resuscitation, Columns, Operations, Training

A Guide to EMS Gridiron Infractions

Issue 9 and Volume 38.

Underfoot, a blanket of flaming gold crunches with each brisk step. The quaking branches continue to shed their once-treasured foliage, ever yielding to the crisp yet invigorating wind. The earthen soil once veiled by the crowning aspens is now shaded by a carpet of gilded leaves, so thick in places that one cannot help but playfully dislodge their brittle grasp on the vegetation below with a spirited kick. The savory aroma of fetid autumn leaves fills our childhood sense of smell with … with … Hey, who didn’t clean up after their #@&! dog?! 

The fall season is here, and for many of us it’s a time of beauty as well as sadness. It’s nature’s last hurrah before the cold winter begins to crystalize your nose hairs. It’s a time to celebrate the harvest and mourn the loss of warm weather, long summer days and chainless tires. It’s a time of reflection, change, wisdom, loss, reclusiveness, maturity, preparation, education, balance, spiritual transition and, most importantly, football. Hoooorah!

Not that I’m a football fanatic by any means (Go Broncos!), but like most Americans I can appreciate a staged combative duel between conflicting tribal forces that’s not quite as lethal as the carnage of war yet can still provide the simplistic need for competitive violence without personally getting physically involved other than the precise bodily act of spraying Cheez Whiz on a cracker while fully reclined on a La-Z-Boy.

To some degree, football portrays an amplified version of life that includes emotions of high drama, danger, exhilaration, loss, struggle, skill, conflict, perseverance, passion, anticipation, strategy, unpredictability, camaraderie and salary caps. I personally believe EMS embodies all of these principles (unless you don’t consider minimum wage a salary cap).

Despite the similarities, football has a huge advantage over EMS in how the game is played—a method we would greatly benefit from (retirement before the age of 85 excluded). Football has an arbitrator in the midst who is authorized to keep the game from spinning out of control. These neutral judges of the field are known as referees, and despite their funny vertical-striped uniforms, they make sure all the rules of the game are properly adhered to. Plus, if they’re physically scrutinized for making a bad call, they can easily escape by blending in with a herd of zebras without detection.

Wouldn’t it be great to have such a person of authority preside over EMS scenes in which the care of our PHUTBALL (Patients Having Undergone Teamwork By Ambulance Live Longer) is being unnecessarily compromised by the edematous egos of medical parties (teams) of different uniforms, patches or level of training?

The goal (no pun intended) is to get our PHUTBALL in the prehospital setting from point A (scene) to point B (hospital) … or point D (Detox) as quickly and safely as possible while providing compassionate care and comfort utilizing state-of-the-art emergency medical care. 

Some of the players may consider the PHUTBALL solely theirs—selfishly not sharing or passing the PHUTBALL in a professional manner. Sometimes they even compromise the PHUTBALL by wasting valuable time or inappropriately performing procedures not listed in the playbook.

American football has more than 100 penalties to keep the game from devolving into chaos. Due to limited time and my propensity for ADD (Ambulance Driver Daydreaming), I will limit the PHUTBALL infractions and penalties to just a few pertinent fouls I’ve experienced in the past, which sadly, deflated my PHUTBALLs before they reached the end zone.

Delay Of Game: Prolonged interruptions of chest compressions during CPR to perform non-evasive medical procedures.

Ineligible Receiver Down Field: Transporting a patient to a hospital facility incapable of meeting the patient’s needs. 

Unsportsmanlike Conduct: Negatively armchair quarterbacking another medic’s medical treatment in the presence of the actual patient. 

Illegal Motion: Any act of reckless or erratic driving that causes the patient to become nauseous. 

Equipment Violation: Launching a helicopter to transport a stable patient secondary to not wanting to drive a long distance in the middle of the night.

False Start: Responding lights and sirens to a known stable, non-life-threatening call.

Illegal Use of Hands: Performing CPR on a patient with known DNR documentation.

Incomplete Pass: Dropping the patient while transferring them from the ambulance cot to the ER bed. 

Illegal Formation: Rescue vehicles on scene park in such a manner that prohibits ambulance access to the patient.

Encroachment: Interjecting questions to a patient that interferes with the already pre-established line of questions asked by the team leader.

Holding: The ER triage nurse putting the attending medic on hold in the middle of their radio patch while enroute to the hospital.

Too Many Men (Woman): Too many chiefs and not enough Indians on the field.

Off Sides: Medics self-dispatch to a call outside their jurisdiction without being requested.

Personal Foul: An EMS provider who presents themselves hygienically unprofessional in appearance.

Face Mask: A patient’s non-rebreather mask is pulled abruptly off their face secondary to the failure of the tubing being DC’d from the onboard oxygen as they are being unloaded from the ambulance.

Spearing: The insistence of establishing an IV on a patient regardless of the multitude of unsuccessful attempts already made.

Horse Collar Tackle: The insistence that a patient be spinal immobilized despite having no complaints to their head, neck or back.

Tripping: Stumbling over equipment or a patient in a dislodgement of IVs, EKG cables or airway adjuncts.

Intentional Grounding: Having a patient tazed and/or restrained simply because the EMS provider is not in the mood to negotiate.

Ineligible Receiver Downfield: Transferring patient care to a lesser qualified EMS provider.

Roughing the Passer: A nurse or doctor rudely criticizes an EMS responder’s patient care before EMS is able to pass on pertinent patient information as to why they did or did not perform certain procedures. 

Just as in American football, a yellow flag will be thrown down by the referee when a transgression occurs to the PHUTBALL, but additional colored flags should also be made available for simultaneous triage considerations as the penalties are being assessed.

Green Flag: “Hey! The patient is very stable and doesn’t need to be transported by ambulance if they don’t want to. So stop scaring the bejeesus out of them by using the clichéd line, ‘You could die if you don’t go with us.’” 

Yellow Flag: “Hey! The patient isn’t immediately in danger of dying, but let’s stop the idle conversations with coworkers you haven’t seen in a while and move with some sense of urgency here. Ya savvy?”

Red Flag: “Hello?! Move your @#!& and stop wasting time on procedures that can be done enroute.”

Black Flag: “Hey Hey Hey! He’s dead. Stop with the CPR already.” 

Until next time, Are you ready for some PHUTBALL?! jems