July 2025 and the Texas Floods

As a Texas paramedic and attorney as well as having worked EMS in the Hill Country over the years, I’d be remiss as a blogger if I didn’t at least put some words and thoughts about the floods and the accompanying loss of life that came with them.

First, I need to blast, and I mean literally blast, a Houston area pediatrician and a former president of the State Bar of Texas who took advantage of the tragedy and the loss of life to not only politically pontificate, but to insult the lives lost and claim that the loss of life is what Trump voters voted for. If you know me, you know that I’m to the right of Trump. (Yep, that’s possible.) But damn, when a tragedy hits, if you’re not offering help, condolences, or even prayers, shut your mouth. Period. Part of the vows I’ve made professionally and to myself tell me that I don’t care what your politics are if you need help. Again, while Christianity is not my faith, I’ll leave words from the Book of Matthew. “I was sick and ye visited me.” Matthew 25:36.

And I’ll add one more point of personal privilege. If you’re blessed and fortunate enough to be entrusted to care for and protect others, this incident isn’t the one to make fun of. I had someone who I considered to be a good friend, even if they are immature, make a horrendous, ill-timed joke of the loss of life. He’s no longer part of my circle of friends. I get black humor. I get gallows humor. My jokes would keep me in HR for eternity if reported. But I know this. If you weren’t part of this scene or response, you don’t get to say those things. Period. Full stop. This reminds me of an incident at a previous department where a responder who was NOT on scene at a fatal crash made jokes about “barbecues.” Again, some things are just beyond the limits of good taste. If you weren’t there, you don’t get to joke about it. And if you were there, you probably won’t joke about it.

As for the floods, I’m not assigned to these incidents for a variety of reasons relating both to my lack of swift water training and my current role at my current department.  

I’ve seen a lot of tragedy.  I’ve responded to a lot of incidents for over 20 years. It’s not just the big disasters.  It’s the little tragedies that constantly pile up.  I’m always amazed by which incidents and moments stick with me.  But serving my fellow Americans and Texans is the highest honor and privilege of my life.  

For those of you wondering what this life is like, I would encourage you to read Johnny Joey Jones’s book “Behind the Badge.” It’s probably the best reflection of what those of us with a badge do. 

I complain about my EMS stuff way more than I should. It’s given me some additional meaning to my life aside from editing contracts. The BS is there in every EMS agency (or fire or police too). It’s just a different stench depending on where you’re at.

But there are two things you can always be certain of in these fields.

1. The people who last in it are the people who got in it to help people.

2. The friendships you make are amazing.

All the complaints aside, it’s been a fun 20 plus year ride. I’m eternally grateful for it. And every time I think I’m ready to say “F this, I’m done,” the universe reminds me that my tank isn’t that empty. Y’all are stuck with me for a little while longer.

Me?  I’m back at the office doing attorney stuff tomorrow morning. And truly frustrated that I can’t get out and be a paramedic as much as I’d like. Sadly, the opportunities for volunteering in public safety have shriveled over the years. And many of the remaining volunteer opportunities, at least for a Texas paramedic, aren’t nearly what they used to be, either.

Y’all be safe and hug your family. 

Advice For The New Medics And The Students

Lately, a lot of the EMS social media pages have been giving advice to new medics and students. Some of the advice is good. Some of that advice is not good, which is a charitable understatement, to say the least. So, today, when a medic student asked me for advice, here’s what I told them — and also just added onto.

Here are things you’re not going to learn (or learn enough) about in a paramedic program.

  1. Prescription medications. If you know and understand the medications that your patient is taking, half of your assessment is already done.
  2. Understanding physician specialties, the roles of other healthcare professions, types of healthcare facilities, and hospital capabilities. This makes sure you get the right patient to the right facility. As a point of personal privilege, if your EMT partner can run the call without ALS intervention, that’s the only time you should even consider transporting to a hospital without ICU beds. (Yes, little old Mrs. So-And-So with the UTI is sicker than you think and she’s quite likely gotten herself an ICU admit.)
  3. The ability to talk to a patient. A SAMPLE history and OPQRST aren’t enough. Period. Those start the questions.
  4. For every patient you see, think of 5 possible differential diagnoses for them. Use pertinent positives and pertinent negatives to narrow down your diagnosis. (A special thank you and tip of the ol’ Resistol to the dearly departed Gene Gandy for that advice.)

Here are things to remember right now.

  1. You’re not expected to have this down while you’re in school or while you’re the “new kid.” That’s why you’re in school or a new hire.
  2. If you think you have it down, go Google the Dunning-Kruger effect.
  3. Pay very little attention to the self-proclaimed EMS experts online, especially the EKG nerds. Many of those nerds speak with a great deal of certainty about subtle EKG findings that neither impact prehospital care nor are they absolute. Cardiologists will quibble about these findings.
  4. There is nothing in any law book that limits the scope of your education. Have at least one physician level text on emergency medicine, or better yet, internal medicine. So much of what EMS does is what I call unscheduled internal medicine.
  5. You become a good medic by seeing lots of patients. Emergency medicine, whether prehospital or in the ED, is based upon pattern recognition.
  6. Go to a busy EMS service to get experience, whether it’s for your clinicals or your first few years of work. See above about pattern recognition.
  7. It’s ok to be eager. It’s ok to be nice. Being “salty” isn’t a badge of honor. Nor is self-diagnosing yourself with a mental health condition because you’re in EMS.
  8. Have a life outside of EMS. (Unless you’re a lawyer. Then EMS is your life outside of law.)
  9. Humor at the patient’s expense isn’t funny. But it is a good way to learn about unemployment.
  10. The call may not be important to you, but it’s the most important thing to happen to that patient today.
  11. Be nice. Nice medics don’t get to meet lawyers.
  12. Always remember that if something goes wrong, your patient care will be judged by twelve people who couldn’t get out of jury duty.
  13. Lucky #13. Remember in ACLS where it says “Seek Expert Consultation?” That’s not the paramedic. It’s not even an emergency medicine physician. It’s a cardiologist or perhaps even an electrophysiologist.

And speaking of EMS social media, here are some things to remember about some of these “influencers” or pages.

  1. A good chunk of them are wrong.
  2. A good chunk of them are warning signs. (Fun little tidbit. Some EMS medical directors and chiefs have sock puppet accounts from where they can observe Social Media Assisted Career Suicide.)
  3. A significant portion of them are self promoters.
  4. Some of these people serve as a living, breathing example of why EMS doesn’t get to sit at the big kids’ table of medicine.
  5. Many of these people aren’t nearly as experienced as they claim to be. Their Google Fu is much stronger than their actual experience caring for a patient.

After a little over twenty years of doing this in between reviewing contracts and nasty letters, I wish someone had told me more of these things. And on that final note, that first impression counts for something, whether it’s for a clinical, a job, or that first patient contact. Tuck the shirt in and shine your boots occasionally. (Dear God, that makes me sound old. But then again, I am….)

You’re Neither A “Progressive EMS System,” An “Operator,” Nor “High Speed.”

Garison Keiler used to describe Lake Wobegon as "‘Where all the women are strong, all the men are good looking, and all the children are above average." EMS has a similar malady. Not every EMS system is "progressive." Not everyone in EMS is an … [Continue reading]

EMS Education Is Becoming Unaffordable

Those of you who know me know that I believe initial EMT education is, to use a play on words, way too basic. I have also told many of my friends, particularly those in EMS, that a paramedic certification, even without a degree associated with it, is … [Continue reading]

EDC – Every Day Carry for EMS

The other night, when I was a bit sleepless, I ended up on a YouTube rabbit trail and watched a few medics' videos of their "everyday carry" (AKA - EDC) of what they wear or carry on shift. After watching a few of these (and having opinions on where … [Continue reading]

Tax And Spend Politics

Those of you who know me away from the computer screen (and many of you who do know me only via the screen) know that I tend very conservative. I mean, very conservative. I'm not a libertarian for a variety of reasons, largely because libertarianism … [Continue reading]

An EMS Week Message to the Hospitals, Nurses, and Doctors

Well, it's once again EMS Week. Or to everyone else in healthcare who's not an EMT or a paramedic (and yes, there's a BIG honking difference), it's Ambulance Driver Week. And for most hospitals, that means y'all will feed us (don't forget we're a … [Continue reading]

The Current State of EMS as I See It.

We're getting closer and closer to EMS Week. What does that mean? For many of us, it leads to a slice of cold, cheap pizza and some random piece of EMS Week swag. For others, it's a chance for them to prove their bona fides as either an "EMS … [Continue reading]

I Know Better Than You Do

Over the last week, I've had some interesting conversations with some smart people in EMS. Likewise, I've had some conversations with people who think they're smart. During the course of these conversations, I noticed that a common trait of these … [Continue reading]

Doing The Right Thing

Last week, several EMS friends and colleagues asked me to look at the recent Kentucky case on EMS liability. Obviously, as a lawyer, my first and foremost answer is always going to be "it depends." I'd also remind you that even appellate cases are … [Continue reading]