Home Paramedicine/The Job “The First 150 Are Exciting”

“The First 150 Are Exciting”


We were hanging out at one of the hospitals we sometimes transport to the other day and I was talking to one of the attending physicians. He’s a nice guy, worked in a number of places, and is very experienced. The talk turned to trauma and then shootings in particular.

Which is when he slipped in the sentence I quoted in the post title. The truth is that although new paramedics (and some that aren’t so new) get excited about shootings and trauma in general, they aren’t very challenging calls the majority of the time. It’s mostly ABCs, maintain the airway, monitor breathing, control the bleeding, drive to the hospital. Start an IV in most cases, just because. Fluid resuscitation is pretty much passe, MAST trousers are so 1980s, and more and more we’re being told that intubation kills trauma patients who might otherwise survive.

In other words, trauma is almost always a BLS call.

Still, it’s exciting stuff at first, but after a while the cachet wears off and they are messy and tedious. Or is it tedious and messy? Either way.

Until such time as science comes up with a magic elixir that can repair damaged tissue and a workable synthetic blood that carriers oxygen, paramedics will waste a lot of time transporting patients that can for the most part be handled by well trained and experienced EMTs.

It’s much the same for the doctor I was talking with. Seriously injured patients need to go to the Operating Room right away. Not so seriously injured patients go to CT or MRI, or get an ultrasound to see if they need to go to the OR. Even less seriously injured patients get treated for their injuries and admitted or discharged. Once the determination is made which category the patient falls into, the attending physician’s job is pretty much over. It’s even more so at big time trauma centers. A flock of surgeons descends on the patient and the Emergency Department physicians take a back seat. Interns do the interesting (messy) procedures because that’s how they learn to do them. By doing them.

So, you can see why my doctor friend doesn’t get excited any more when he hears that a shooting patient is coming in to the ED.

Or why I don’t get excited any more when I’m dispatched to one. Frankly, if I never see another person who has been shot I’ll be happy.

Previous article The Roots Of The Sub Prime Lending Crisis
Next article Now THAT’S Depressing
After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.


  1. How dare you!!!??
    Trauma is the bomb!!
    Why, why, why…else would anyone get into EMS except for the trauma calls!!

    I mean why run on some sick old person, whom you might have to do some thinking on!!
    Or sick kid!!
    Complicated diabetic with S/S of cardiac except denies any pain discomfort etc!!
    Or some boring thing like THAT you may have to like think and do skills other then basic BLS !!!??
    Or a CHFer you can actually give some relief using your medic skills!!


    Why Trauma is like the exciting-est thing there is to run on!!
    Why you get to apply…bandages, tourniquets, dressings, splints, maybe even a traction splint!!
    Put an occlusive dressing on someone!!
    Why those are the um mm BLS type skills I learned in First Responder/EMT…

    Trauma…stop the bleeding, immobilize, manage the airway and get them to someone whom can help them…like a trauma surgeon…Exciting, messy, boring….
    Okay you may get to needle a chest once in a while….

    • Even immobilization is being called into question. Needling chests is beneficial when done correctly, but often it’s ineffective in the field.

      • A needle in the chest is probably effective in the field.

        The problem is that too often the patient being harpooned by the needle don’t have a tension pneumothorax. Since the tension pneumothorax is a prerequisite for sticking a big needle in the chest, this is a huge failure.

        Decreased breath sounds is not an indication to stab someone in the chest.

        Unless the patient is crashing, or already pulseless, needle decompression is not indicated.


        • A surgeon I knew and respected thought that most in the field chest decompressions failed because a 14 gauge 2 inch needle wasn’t enough to get through all that tissue into the pleural space. Hospitals don’t wait for a pneumothorax to become life threatening before they put in a chest tube. Then again, what they do and why is not necessarily a reason for EMS to do something.

  2. Can I get a good third-degree block? Or at least a symptomatic bradycardia?

    Fortunately, I work in an area with an older population. I don’t see much trauma anymore. Lots of strokes, broken hips and constipation though.

    I needled a chest. Once.

    • I don’t see much of that either. A lot of chest pain of undetermined origin, congestive heart failure, and Asthma. Once in a while a tachy dysrhthmia that needs medication. Fortunately, strokes, hips, and most assuredly constipation are BLS calls in my system.

Comments are closed.