EMS Revisited: 39 Lines To Live By

Lt. Dan’s Rules of EMS offers everything from ideas to insights, advice to admonitions, philosophies to points to ponder

EMS Revisited is an exclusive column that offers reprints of various columns and articles from our archives that are not currently available in electronic format. In the July 2001 issue of EMS Magazine (now EMS World Magazine), Beyond the Books columnist Mike Smith told us about Lt/ Dan's rules of EMS.

In the April 2001 issue, I ran a piece titled “Fatal Phrases” that focused on comments made by providers relative to their attitude about patient care and about EMS in general.

After the column ran, I received a number of phone calls, e-mails, etc., about the piece. A few weeks later, another e-mail showed up, with a short letter and a very interesting list, courtesy of Lt. Dan Hughes from the Prince George County Fire Department.

Dan had compiled the items over a period of 25 years in EMS. It now serves as sort of a mentoring handout that Dan uses for trainees/newcomers. As I read through it, I found everything from ideas to insights, advice to admonitions, philosophies to points to ponder. Please take a few minutes to read through Lt. Dan’s Rules of EMS.


1. You are there to solve a problem, not cause one.
2. The ABCs will save you every time.
3. The scene is not the venue for retraining.
4. Interview the patient, not the clipboard.
5. The patient should not be the recipient of your problems.
6. Treat the patient to the best of your ability.
7. We are guests in their domain.
8. Look for reasons to transport, not turf.
9. Do not base treatments on lifestyles.
10. Expect no more from others than you can provide.
11. Handle the call you are on, not the one that might happen.
12. The acuity of the situation is due to the patient’s condition, not your anxiety.
13. We do not interrogate over the radio.
14. We do not yell at the family or patient; we explain the problem.
15. Being nice never hurt anyone or cost money.
16. Do not judge lifestyles.
17. A clean ambulance is a happy ambulance.
18. Obey your gut instinct.
19. Being nice does not indicate that you are weak or naïve.
20. Leave tunnel vision for the Amtrak folks.
21. 35 mph is good for patient care.
22. The closest hospital is not always true.
23. Document truthfully; you never know.
24. Know your equipment.
25. Continue to study; dormant minds make Jell-O look smart.
26. Show me what you know, don’t tell me.
27. Level of certification does not guarantee respect.
28. Talk to the patient first, then everyone else—when possible.
29. If nothing else, do the ABCs, treat the problem, use TLC, keep the patient warm, transport.
30. Trouble breathing equals lung sounds.
31. Regardless of whether you are a career or volunteer provider, you are there to do the “JOB.”
32. It takes less energy to be pleasant; anger festers for the whole shift.
33. Each call is a new one.
34. If they can take a tube, they needed one.
35. Be nice to yourself; you have to start somewhere.
36. Scene survey, ABCs, pick a game plan, make a decision.
37. Have people doing things.
38. Ten-minute scene times are a good thing.
39. Certification cards x patches = ????

Dan concluded his list with the following comment: “After 25 years in this business, these are just some thoughts. If you like them or they help, that’s great. If not, oh well…”

Quite a list indeed. I wonder how many calls, how many classes, how many textbooks and how many run reviews it would take each of us to produce a similar list. These are the very things I think we need to make certain are passed on from our senior field providers to the up-and-comers in prehospital medicine. In doing so, both the art and science of EMS are not only preserved, but are transmitted to the next generation of field providers. Hopefully, this information will help as they establish the foundation of their practice and serve to improve the care they deliver to those we serve.

Until next month…

Mike Smith, BS, MICP, is director of clinical education and lead instructor for the Emergency Medical & Health Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.

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