Preacher of Habit


Preacher of Habit

By Mike Rubin Jan 28, 2013

“Order breeds habit.”

—Historian Henry Adams, 1907

If Adams had said that 100 years later, I might have believed he was talking about me. Yes, that would have been absurdly presumptuous, but his words fit me so well. I’m the one whose picture should appear if you Google creature of habit.

I consider predictability a virtue. Valentine’s Day was the last time I was impulsive: Instead of roses, I bought carnations. Pretty crazy, eh?

I know what you’re thinking: What about spontaneity? Don’t you ever want to let loose, walk on the wild side, make it up as you go along? Good question. No.

I crave order. I find what works, then take comfort in trying to do those things the same way every time. I could blame my engineering background, but most of the engineers I know are less regimented than I am. Clearly, that makes them inferior.

I can’t claim my habits help me work more efficiently. In EMS, routines mostly keep me from making mistakes. Take documentation: I much prefer to scribble notes real-time than to navigate even the friendliest of electronic PCRs. I don’t want to be bound by menus, lists, check boxes, grammar, spelling and syntax while I’m monitoring a patient. I’ll catch up with formal record-keeping after the call.

Here are other not-quite-state-of-the-art practices I favor:

Radios without earpieces. The 10-code heard most often where I work is 10-9: Repeat. I mention that only because at Opryland, ambient noise is a major issue—sightseers, music and recreational beverages being the main culprits. I thought an earpiece would solve that problem until I wore one. It was so uncomfortable, I switched to a shoulder mic. That worked until I attached it to a non-weight-bearing part of my uniform. It’s hard to look respectable with only one epaulet. Now I just hold the radio up to my ear when the place gets noisy.

Manual field guides. Most of my colleagues use mobile apps for medical reference, but I still find my 3” x 5” field guide faster. The problem is my phone’s keypad; it won’t cooperate with my fingers. Yesterday I tried looking up the drug isoniazid and got insomnia because I typed isomia instead of isonia. If my phone were truly smart, it would have known what I meant.

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Tape on pants. I mentioned earlier I’d rather not write run reports en route. On scene is even worse; a clipboard is just something else to carry and leave behind. Reconstructing the narrative after the fact is not a problem, but remembering vitals and medical history might be. The solution: a piece of two-inch tape mid-thigh—on me, not my patient. It’s perfect for jotting hard-to-remember details like vitals and medical history. So what if it looks like a quick fix for a wardrobe malfunction?

Paddles instead of pads. When I have a choice between paddles and pads during an arrest, I prefer the tactile feedback of paddles. Besides, it’s hard to look cool rubbing two pads together.

Sharps without safety gizmos. Like many of you, I learned to start IVs with basic assemblies that consisted of catheters, needles, flashback chambers and not much else. I appreciate the efforts of angiocath manufacturers to protect us from ourselves (and each other), but I’m not a big fan of push-buttons or telescoping barrels. They still strike me as bulky works-in-progress. Now, if you figure out how to add stud-finder technology to sharps, I have seed money waiting for you.

Landlines instead of cell phones. We’ve come a long way since the days of lunch-box-size car phones, but I still hear you much better when there are wires involved. Plus we can interrupt each other without waiting for complete sentences.

I have routines away from the field, too; for example, as I edited this column, I printed a hard copy and reread the revised text aloud each time I made a change. (Just now I performed that ritual after making edit and print past tense.) I have to hear the words, and they must be read from paper. I’m not sure why; I only know it works better that way. Remember the column last year you didn’t like? That was the one I proofed from the screen. I promise to be more careful.

How about you? Any peculiar EMS preferences?

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at

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