Don’t Call it a Bus

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With apologies to my new found buddy Gertrude over at “Ridin’ the Bus” we don’t call them buses in my system. If you do, your either a new guy trying (and failing) to sound call cool or someone from somewhere else trying (and failing) to sound cool. Although I have had two cops in the past year refer to the ambulance as “a bus”. One of which was exceptionally funny because he was an officer on the local transit system PD. Which set off one of my fellow paramedics who was so loud and obnoxious about it that I thought for a moment that the officer was going to arrest him for Disorderly Conduct. Ruffled feathers were smoothed and we all went on our way.

That would be Rule 4 or 5 of EMS. Don’t get in a pissing contest with the local PD. We need them on our side. Some people don’t ever learn that and they have unpleasant, and usually short, careers.

So, you can call it a truck, a rig, a wagon, a bumbulance, a cabulance, a bambalance, or even an ambulance. Just don’t call it a bus.

27 COMMENTS

  1. There are so many important things that we as pre-hospital care providers should be worrying about, such as rising gas prices, the outsourcing of pharmaceutical manufacturing to other countries, and the dwindling Medicare/Medicaid reimbursement that will either put non-tax funded services out of business or raise our taxes in an otherwise dwindling economy.What popular regional slang term is being used for an ambulance is not one of them. It’s similar to worrying about why you don’t proof read your posts.If you do, your either a new guy trying (and failing) to sound callIt really isn’t going to affect the outcome one way or the other.

  2. Thanks for spotting the typo. Other than that, you’re just full of good cheer, huh? The economy isn’t dwindling, it’s just not expanding as fast as it was. Big difference. Remember, free trade with other countries is good for the economy. Ask the Democrats, since they pushed it during the 1990s.

  3. Learning to interact with police, fire, and other responders is a big part of the job. So far the police have only threatened to shoot me once, that I know of. Arrest me? Too much paperwork. 🙂

  4. HAHAHAHA! I love it. The transit guy has watched too much TV. I don’t call it a bus. I call it the box or the medic. My blog name was a snarky nod at all the TV shows where the police office is yelling into their portable radio “I need back up and a bus to…”Getting along with PD is crucial. I have had my moments with them mostly on scene safety issues but really they know I’ll look after them and so they repay the favor. Whats up with NYCW? He has his cranky pants on today.

  5. I have a friend that calls the ambulance a “bone box”He’s also been known to refer to it as a “band-aid box”I think I’ve used all of the above slang terms at one point or another :)–Jim

  6. The gut-bucket, waaambulance, ambalamps, transportation unit, taxi cab, the truck. Those are the most recent I have heard.

  7. Now if I was full of cheer I’d be too busy vomiting on your shoes. If I was formerly full of cheer, I’d be spending the day with bi-lateral 14g pipes pumping in juice from the banana bags.Thankfully I’m independent in more ways than one.@Gertrude, those aren’t my cranky pants, those are my big girl panties that I put on because I find it extremely irritating to continually see this same topic that has no affect on the industry what so ever.And yes, they are pink with white polka dots if you must know.

  8. NYCW, I’d think if you are the watchdog of a really big city you’d be really, really busy. Unless you’re part of a task force or something. First, other than Medicaid and Medicare reimbursement, you don’t seem to concerned with anything directly involving EMS. Actually, I thought the reimbursement rates had increased, but I don’t follow billing issues, so I might be wrong. Second, most of us think of EMS as a profession, not an industry. Well, JEMS, the self proclaimed, slighty pretentioius, “Conscience of EMS” and for profit ambulance services do, but most of the rest of us don’t. Since you identify your insdustry as “Transportation” it tells me a bit about your mind set. So, I guess it’s a question of mind over matter. We don’t mind, you don’t matter.

  9. Dear Too Old To Work Too Young To Retire,First, allow me to assure you that while I have been a member of a few task forces, I am not currently. Furthermore my online moniker is an geographic evolution of my radio call sign. While this may not be as befitting today as it was ten years ago, it has evolved into my online identity which I proudly maintain.You pointed out my concerns regarding Medicare/Medicaid reimbursement as if to say that those are not EMS issues. As I stated in my original comment, those rates are dwindling and will therefore place non-tax funded services out of business or cause an increase in taxes. Admittedly, what I left out was the inevitable budget cuts because raising taxes for EMS related issues is not necessary popular with the political mindset.I did however also raise the concerns of the outsourcing of pharmaceutical manufacturing to countries outside of the United States and rising gas prices. Both of these are also related to the reimbursement issue. Not surprisingly, some other issues that are reimbursement related are recruitment and retention (increased prices everywhere else results in stagnant salaries), training (increased prices everywhere else results in budget cuts), and of course the fact that most of the new recruits are barely able to recite their ABCs (again, stagnant and low wages results in barely qualified candidates) much less string letters together to form coherent words and thoughts.Are all EMS issues resolved with money? Absolutely not! Another issue in EMS is this holier than thou attitude these supposed “senior” people exemplify. This post is a prime example of that elitist attitude. I would never be so presumptive as to go to other regions of the country where an ambulance is called a “rig”, a “truck”, a “rescue”, or an “ambo” and criticize them for doing so! That is exactly what David S. Becker did in his JEMS column a few months ago, and exactly what you have done here.On your second issue about thinking of EMS as a profession and not an industry, you clearly do not understand the definitions of them. A profession is a specifically trained group working within an industry. For example, to be a Paramedic is a profession that works in the industry of EMS. The fact that “most of the rest of us do not” highlights the tunnel vision that afflicts the majority of “professionals” in this industry.Which leads me to your final point about my “mindset”. I am a realist, plain and simple. I look at small pictures and expand them to see the big picture. It is by this that I can make things happen, because nothing is impossible, impossible just takes a little longer. All of it, is in an attempt to make someone’s life better, even if it is just for a minute. This is why I do what I do. This is why I listed my industry as Transportation. The purpose of transporting the sick and injured was the genesis of this field. It is after all the nucleus of what I do. I am a proponent of never forgetting where you came from, which you apparently already have.Peace and Love,NYCWDP.S.For your reference:David S. Becker’s original columnhttp://www.jems.com/news_and_articles/columns/Becker/An_Ambulance_Is_Not_a_Bus.htmlMy original retorthttp://www.apileofdogbones.com/index.php/site/i_prefer_to_be_a_cowboy/Of course they both happened before you even started blogging, but it doesn’t really make a difference because like you said, mind over matter. You don’t have the mind to make it matter.

  10. Iunno, as long as people know what you’re referring to, I don’t really mind what you call it.Usually, I use the term “truck” because it applies to both my ammalance, and the “fly-cars” we run.No reason to get wrapped around the axle (or the wheels on the bus).Then again, when I put on my helmet and pants with suspenders they want me to call it a “Rescue”, because the “Truck” has a big ladder on it. Semantics.It doesn’t just change from region to region. It changes from shift to shift, job to job, company to company, and so forth. So, in closing, I refer to my first sentence.

  11. I read his column, I read your rant. I frankly wasn’t impressed by either. The genesis of this field was treatment of people for their injuries and illnesses where they were found, not mere transport to the hospital as you seem to indicate. Ambulances have been around since at least the Napoleonic Era, advanced a bit during the Civil War, and then were unchanged in function if not form, up until the late 1960s. During most of that time, treatment IN the ambulance was secondary at best. It wasn’t too long before I first worked on an ambulance in 1973 that it was pretty common for them to not even have oxygen. My first EMT text was entitled “Emergency Care of the Sick and Injured” and had one chapter on transport, which was how to drive safely. You seem not to understand the basics of the field. For those keeping score, despite the fact that I have several people who worked for NYC EMS before it was ruined by the FDNY, it has always had so so care. Which is why it still has the lowest cardiac arrest survival rate of any major city. Which isn’t a shot at those EMTs and medics who work there, but is a shot at the managers and doctors who set the tone. With that, I’m going to stop commenting on this post. It stands on it’s own merits, despite what you may think.

  12. Hey, that sucked. People just flamed each other over slang. And quite frankly, from the original post, it certainly evolved into something entirely different.I fail to reason how discussing ones preferences for colloquialisms somehow detracts from “the important issues” in EMS. That’s like saying “Dammit, stop talking about your favorite ice cream, we need to be discussing the obesity epidemic and global warming.”Unfortunately, TOTWTYTR (did I get the acronym right? I tend to stick with TLA’s), no longer wishes to discuss the fun parts of this post. hrmmph.P.S.: I resent the fact that the last angry post immediately follows mine. I may not matter, except in my mind, or some other witticism thereof.

  13. Paracynic, you matter to me! I’m a caring health care professional. BTW, the word hasn’t quite spread yet, but global temperatures have been dropping since 1998. Most serious climatologists are worried about another Ice Age, not increasing temperatures. Sunspot activity is unusually low, even for this early in the cycle. I might do a post on that whole thing later on. One last comment on that. Historically, humans have thrived at temperatures a couple of degrees higher than what we’ve seen in our life times. Climatic stability is a myth, as is our ability to effect what the climate is going to do. Sorry to drift, but it’s my blog and I’ll ramble if I want to, ramble if I want to.

  14. Around me, we call it a bus, as well as rig, truck, etc. I think bus is one of the better ones, but to each their own. I, too, list “transportation” on my profile. When you boil down our profession to the barest, most pure form, what do you have? Transportation of the sick an wounded. Anything you can do for them on the way is just a plus. In many cases, we spend far too much time on scene providing care. With some exceptions, in my opinion advanced care should be administered while en route.Obviously on-scene cardiac monitoring/resuscitation, breathing treatments, and the like are appropriate. On scene dopamine drips or RSI in the medical patient? Usually not as appropriate. You should be transporting by then.Forgive me for rambling.

  15. Most systems have gone beyond the barest minimum, but some apparently haven’t. The difference is in knowing when it’s appropriate to transport and when it’s appropriate to stabilize and then transport.

  16. OLJ! This has gotten insane! I think the important point in the post was lost amid discussion of other stuff. We should work to have good relations with the other responders on scene because it makes all our lives and jobs uch easier. and NYCWD: If you have to put on your big girl panties then you’re not yet a big girl. Sometimes we like to blow of a little steam and talk about things that aren’t as heavy. A little laugh never hurt anyone. lighten up.

  17. You’re right, many systems have gone beyond the barest minimum- but the fact remains that we can’t do much for a PE, and a stroke requires a hospital, and a STEMI just can’t be treated in the field beyond the minimum of stabilizing care – which damn well better be administered en route. We remain, and shall ever remain, a transport based service. When there just isn’t anything else to do, all we can do is transport.In a couple of areas that I work in, if you are the medic, you operate from a flycar and very often arrive on scene before the volunteers can even get an ambulance off the ground, and you can end up on scene for up to 45 minutes in some cases. Your care often gets exhausted by the time your ambulance arrives… and all you can do is transport.

  18. @Gertrude – First, I appreciate you actually addressing me instead of talking about me in the third person as you did in your original comment.While I can understand where you may get the notion that the point of the post was lost, I think more importantly the lesson to be learned from the comments on it is far more important. We need to have good relationships, first and foremost, with the responders in our own field. I am not saying that everyone needs to be BFF, have sleepovers, and make S’Mores (not that I am opposed in anyway shape or form to the combination of chocolate and marshmallow) but I think that we need to recognize that the diversity needs to at the very least be respected. Because of that diversity we need to keep in mind point of view. What one of us may consider “light”, someone else may consider it to be “pretentious” or “insensitive”. The one thing I can credit David S Becker’s original column for is that he admitted that he would not look to change the region where the term is predominantly used. He understood that point of view.As for “lightening up”, I am light as a feather (contrary to what the chocolate and marshmallow consumption may say) while, admittedly, being quite the sarcastic bastard. Of course, I can understand where your point of view would view that as being nasty or trollish… but at no point have I degraded into a profanity laced tirade (which I can do quite well) or not explain my position as clearly as possible (although how it was interpreted is a different story). Therefore considering all that, whether you agree with my position or not, surely you would agree I am in fact a big girl.

  19. Witness, I don’t know about your system but in mine we have a STEMI Point of Entry Plan, are expected to do at least one 12 Lead EKG, give ASA, start a line, give NTG, and sometimes a beta blocker and Morphine. We are also required to call the receiving ED and inform them that we have a STEMI. They are supposed to mobilize the cath lab before we even arrive. We have both a 95+% accuracy rate for calling STEMIs in the field and a good record of getting cath labs mobilized with our call. Notice that we do the interpretation in the field, we don’t transmit the EKG to the hospital. We also don’t have anything close to a 45 minute on scene time. All of which is to say that our system is quite different than yours. Read my very first blog post and see what I said about temporizing and you’ll see that I’m fully aware that transport is part of the treatment package. However, it isn’t the only part and knowing when to transport and what to do before and during transport is an integral part of being a medic. That answer is also going to be different in your system than it is in mine. If I spend 45 minute on scene with any patient I have to explain why. If I spend 10 minutes or more on scene with a trauma patient I have to explain why. Your requirements are probably much different, but I’ll bet there comes a point where you have to explain a scene time that varies from the norm.

  20. Yes, of course we have the same sort of STEMI guidelines. And of course, we interpret in the field and all of that. That’s assuming the paramedic is not too lazy to do a 12 lead, as is common in one of the systems I work in.I am not a paramedic, I’m just a medic student who’s finished class, but I’ve diagnosed STEMIs based on symptom pattern alone after the local FD BLSed them to us for transport. At that time, your only real option is to transport.In the areas I work where you may have an on-scene time of 45 minutes, it’s due to distance and lack of volly crews. While I don’t agree with it, I can’t do much about it – you just can’t transport someone in a flycar. When the ambulance arrives, all appropriate treatments should be administered.I’m sorry I came off as de-emphasizing patient care- but what I meant was, if all else fails, our treatment is a diesel bolus. Of course we have to explain 45 minute on scene times, but it’s as easy as “there was no ambulance.” It’s the unfortunate truth.

  21. The diagnosis of MI is supposed to be made on H&P, not squiggly lines. The EKG confirms and helps to localize the infarct, but the physical presentation of the patient also helps with that.

  22. Yep, you’re right. However, since both my partner and I were both BLS, the patient was lucky I at least knew enough to alert the docs instead of saying, “flu like symptoms.” I happen to know the patient ended up in the cath lab inside an hour due to my higher index of suspicion.The FD medic wrote off her lower-than-normal BP, vomiting, and dizziness as the flu, when she’d had three MIs in the past two years.

  23. I’d make a comment, but it would just draw out the “fire departments should be the only ones to run EMS” crowd. I’m too busy savoring the Celtics victory to have my mood ruined. 🙂

  24. Fire departments should never, ever, ever be allowed to practice at more than the CFR level.My own opinion, and I’m drawing the fire.

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