Rules (Or, Things My Patients Should Know)

Having worked three years on an ambulance, with almost a year now on my own as a medic, I've compiled a list of rules that are helpful for my patients and partners to know. Typically, patient's are only informed of the rules when they are close to violating them, but I like to give my partners the run down ahead of time. Here are my top three:

1. No vomiting. This is an absolute do not violate and may warrant banishment from my unit in future encounters. (Okay, maybe not banishment, but preemptive Zofran.) This rule has as much to do with maintaining your cleanliness, dignity, and comfort, as it does with my ability to keep down the breakfast and to continue to provide care. Also, my partner appreciates a puke free ambulance. If you get carsick, if you even think that you're nauseous, or have vomited on scene or even before we got there, you have just bought yourself an antiemetic. Enjoy. Take it home (or at least to the ER). It's yours to keep.
   
   
2. Don't stop breathing. Yes, this is rule number 2. Rule number 1 has absolute priority over all other rules, although a violation of rule number 1 is often times a bad omen of a near future violation of rule number 2. Now, it's not that I can't handle an apneic patient. On the contrary, they are often very easy to manage--drop an airway and bag 'em. But it can be inconvenient (for you and me), and telling the ER doc "well, he was breathing when we first got to him." Do your best to keep breathing and I'll do my best to help you stay that way.
   
   
3. No F*bombs. I will always speak to you in a civil tone and tongue, please have the courtesy to do the same. Now, I will allow the usage of the F*bomb as it relates to your level of pain or discomfort, your general dissatisfaction with a situation, or perhaps in describing the circumstances that we found you. The History of F* provides many educational examples. However, the moment you direct the F*bomb at me, my partner, the police, or firemen, then the fucking gloves come off. You have one warning. Do not be a repeat violator of this rule. Chemical sedation, tazing, and physical restrainment (among other things), have been brought down upon violators of rule number 3. Some people say that I'm too harsh about this rule, that I need to chill out. I cite physician precedence on rule number 3 though. An ER doctor in my county will chemically paralyze and intubate you for dropping the F*bomb three times in her ER. You have been warned.

There are many other rules of course: no country music, unless it's Carrie Underwood (she was America's Idol after all). No family in the unit while transporting code 3 (drive it like you stole it, as TJ liked to say). And no free evaluations--I'm an ambulance, I take people to the hospital, not check blood pressures and change dressings.

The list goes on, of course. But I'm curious to hear if any one else has developed their own set of rules or "unwritten" protocols. Leave a comment and let me know.