Those who Save Lives: The Royal Humane Society

Royal Human Society

Mostly, people get into healthcare because they want to help people. And there’s no bigger and better way to help than saving lives.

Of course, that’s not really a cool thing to talk about, and we’re nothing if not cool, so most new folks clam up about lifesaving pretty quick. Then before long they’ve transitioned all the way to full-on Nicholas Cage burnout mode and managed to forget about that heroic stuff completely. To quote Dr. Saul Rosenberg: “I think the current generation of young people are terrific…. so much smarter, and so much broader, and so much more altruistic. At least until they come to medical school.”

But the fact is that there’s something very basic and very noble about the simple act of saving a life. To help shine light back on that deed rather than on the more ignoble parts of the job we do, I’d like to talk about some notable lifesavers throughout the years. Maybe we can learn a few things from them. Or maybe, at least, we’ll be reminded about the things we used to admire.

Today, let’s talk about…


The Royal Humane Society

In London in 1774, there were a whole lot of people drowning.

It wasn’t hard to understand. Most folks couldn’t swim, and many lived and worked on or near the water, especially the Thames river that flows through the city. Shipping and other water-based commerce was common, along with recreational activities like ice skating (sometimes on thin ice). To make a long story short, death by drowning was a frequent occurrence.

The science of resuscitation was in its infancy, and little was known about what could be done to bring back near-drowning victims. There were some interesting new ideas, but even if they were effective, there wasn’t much opportunity to use them — victims were usually presumed already dead and therefore beyond help.

(Any of this sound familiar? The problem of bystander intervention remains the toughest part of saving lives even today.)

William Hawes and Thomas Cogan were a couple of English physicians who believed that, with the current techniques and their best efforts, some of the drowned victims might be saved. (Hawes had, in fact, been paying out rewards to anyone who brought him recently-drowned bodies still “fresh” enough to be revived.) They thought that medicine could do better. So with some friends and colleagues, they sat down and founded the elegantly named Society for the Recovery of Persons Apparently Drowned, a sort of club with the goal of saving Britons from drowning.

The Society gave out cash rewards to anyone who attempted a rescue, more if they succeeded, and even awarded money to homeowners and publicans who allowed victims to be treated in their buildings. People being people, this quickly led to two-man scams where a “rescuer” and a “victim” would stage a drowning, then split the reward. So monetary prizes were soon discarded, except in rare cases, in lieu of certificates recognizing the lifesavers.

Gradually, the Society (after a few years switching to the the shorter name) began setting up stations and “receiving houses” near the water, where volunteers stored equipment and launched rescues. They were undoubtedly responsible for popularizing the concept of resuscitating the near-dead, and were among of the first to develop any type of rescue service for civilian medical emergencies. Kinda like the grand-daddy of EMS. In their literature, the Society asked:

Suppose but one in ten restored, what man would think the designs of the society unimportant, were himself, his relation, or his friend — that one?

The Society still exists, and has shifted from solely recognizing water rescues to acknowledging all manner of lifesaving heroism using a range of different medals and certificates. Awardees have included Alexander the First and author Bram Stoker.

Read through some of the most recent winners. They’re all good yarns. Humane Societies (not to be confused with the folks who protect animals) now exist in many countries of British descent, such as Australia and Canada, as well as other regions (including my own state of Massachusetts).

If you are honored by the Royal Humane Society, you’ll receive a medal stamped with their emblem: a fat cherub holding a sputtering torch, blowing at it with puffed cheeks, doing his best to fan a dying flame. Across the top:

lateat scintillula forsans

“A small spark may, perhaps, lie hidden.”

Royal Humane Society medal

Love in the Time of Melena

wine riot

Most regular folks don’t realize it, but an ambulance company is basically a dating service.

I can’t speak for the fire department, which is pretty dude-heavy in most places, plus you ride around with a crowd. But private EMS is another matter altogether. Mostly, it’s just you and your partner, and at many companies, that means many hours of posting — backed into a nook somewhere quiet, sitting together in the cab with diesel idling.

Really, it’s a date. Am I wrong?

It starts when you check your schedule and learn who you’ll be working with. The folks who work with a regular partner (like Scenarioville’s Sam Spectacular) miss out on this thrilling daily game of chance, but even they can pick up someone else’s shift, or roll the dice when their usual partner stays home with strep (or a hangover).

Who’s it gonna be? An angry old plowdriver who smells like castor oil? Some 18-year-old kid who narrates Yelp-style reviews of every female butt you drive past? Or maybe — just maybe — your one true love?

Well, go shake their hand and find out.

On the agenda for today’s date (which, by the way, might be lasting from 8 to 24 hours):

  1. Activities you can do together, emphasizing teamwork, problem-solving, and communication
  2. Banter and wisecracking (required)
  3. A mandatory dresscode with provided uniforms, so your awful fashion sense can remain a secret
  4. Eating one or more meals together
  5. Many hours of conversation as you’re forced to sit side by side — but no need for eye contact, since you’re both facing forward, and no awkward silences, since the radio’s crackling and you can always kill time playing with Facebook
  6. A perfect excuse to get their phone number (“I’m gonna get some coffee — not sure if there’s reception in there — call me if we get something, mmkay?”)

Maybe things won’t work out. That’s okay, because it’s not actually a date, so it just reverts to a shift at work — no harm done.

But maybe there’s a spark! And a good thing, too, because some folks in EMS are pretty maladjusted, and may not get a whole lot of social contact otherwise. Fortunately, we’ve got an employer-sponsored matchmaking service to help hook us up with the other weirdos.

Now, things won’t always be happily ever after. And it’s hard to imagine a more awkward experience than the first shift you work with someone after the ugly break-up. Folks have gone to supervisors and legitimately said, “If ya put him on my truck, I’m quitting.” Bosses who’d make you work with a broken femur have caved in such situations.

But if it goes smoothly, you’ll get to spend most of your day with your significant other. Of course, maybe that’s a little more time than you’d like. I know couples who stridently avoid working together on the grounds that “I already see his ugly mug in the morning and when I get home — if I have to listen to him tell me I’m lifting the stretcher wrong, there’s gonna be workplace-related violence.”

Don’t stay partnered up, and you’re running a different risk, however. Because if Jenny EMT isn’t working with you, she’s working with someone else. Maybe a guy.

16 hours every Monday and Wednesday. Dating somebody else. Have fun with that mental image.

No, folks, one thing’s for sure. Dating in the ambulance is a flat-out bad idea.

That’s us in the picture above, by the way. She microwaved SpaghettiOs for lunch, and sashayed into rooms towing our admit and asking, “Did somebody order a roommate?” I made her a glove balloon and let her steal my ice cream.

Happy Valentine’s Day to all. This job isn’t all frowns.

A Saving People Thing

This isn’t a criticism, Harry! But you do… sort of… I mean — don’t you think you’ve got a bit of a — a — saving people thing?

Harry Potter and the Order of the Phoenix, JK Rowling


In a few weeks, I will be leaving the ambulance indefinitely.

I’m moving a couple states away to return to school, a Physician Assistant program that begins in June. And while I hope to try and work an occasional shift with a more local service, it remains to be seen whether that will be possible. So I’m now approaching a crossroads where, after approximately four years of wearing a patch on my shoulder (many different patches, to be sure), I might soon be giving it up forever.

It’s a strange sensation. It’s been pointed out that, unlike other professions — butcher and baker and candle-stick maker — EMS has a unique ability to dominate the lives of its men and women. How many doctors and nurses do you see with bumper stickers, tattoos, and T-shirts proudly advertising their trade? For many of us, you don’t work as an EMT or a paramedic, you are one; it’s part of our identity. (That’s why it can be so devastating when, through life or injury or the whimsy of employment, we suddenly find ourselves without a uniform to wear — many of us don’t know what to replace it with.) There are prominent physicians of many years who still include “NREMT-P” among their credentials. That’s like an attorney listing his high school oyster-shucking job on his CV.

There are probably many reasons for this. Buckman has observed that becoming an EMT is one of the fastest and easiest routes to “feeling important” — one quick class, and you can break traffic laws and tell everyone you’re a lifesaver. We like that, I’m sure. There’s a lot of ego in this business.

But I suspect that it also attracts people who embrace its fundamental nature. At the bottom, this job is about going to people in distress and helping them. And there is something in us — I think in everyone, although stronger in some — that wants to do that. It resonates with us as humans. (Of course, many other things resonate with humans, including sex and bacon and a great parking spot. But that’s all right. We’re complex creatures.)

The point is, this business allows us to play that role in a unique way. I believe that someday I may enjoy sitting in an office and treating patients who walk in the door, or waiting in an emergency department, or roaming a hospital floor. But that’s different; you are the all-knowing Man on the Mountain, and your patients come and form a line to beg for your wisdom. On the ambulance, people call for help, and we go to them. We take the trouble; we’re the humble servant. Yes, they have to ask, but once they do, we bring the noise, we say: “There, there. We’re here now. Everything’s going to be all right.” In the simplest, most fundamental template of this job, people have problems and they call us; we hear the call and we drive toward them; we walk into their home or business or any of the places that people go; we see a human being in distress; and we kneel beside them and ask, “How can I help?”

By coming to people in their time of need, we get closer to the heart of it all. By our willingness to kneel, we open ourselves for the dying eight-year-old to ask: “Mrs. Nurse, will you hold my hand? I’ve never died before and I’m scared.” And that’s special, and it’s not such a bad thing to elevate it, even though — as Thom Dick reminds us — no matter how much we love it, it won’t love us back.

No matter where I go from here, for me, EMS will always be about that feeling of kneeling beside someone. Or the experience of sitting on the ambulance bench, alone, just my own thoughts and a trusting and vulnerable patient.

That moment when I walk into the room, and all eyes turn to me.

The mental perk-up as the radio crackles, and the extra acuity that dials in as I recognize my call sign and my gears start turning.

Opening my mouth to give a report to a trauma bay filled with nameless people wearing scrubs.

Holding an old lady’s hand as we bounce down the road.

Touching a shoulder as I say good-bye.

Iced coffee from Dunkin’ Donuts, titrated to my tiredness.

The smell, sound, and non-stop rumbling of a diesel engine.

Black shoe polish.

Sitting beside a partner and feeling like it’s the two of us against the world.

There’s a lot that’s wrong with this job. But there’s something that’s right about it, too, and it’s something important. And that’s why we keep coming back.

I’ll be busy soon, and this site will have to take a back burner. Updates will come less frequently, and I can’t guarantee new scenarios or new posts or new Library material on any reliable schedule. But wherever I end up, I don’t plan to turn my back on it. Because even if you leave the ambulance, I’m not sure if you ever stop being an EMT.

Happy New Year

On this most auspicious of Sundays, EMS Basics is one year old!

A year ago exactly, I threw this site into the EMS 2.0 blender <head>-first, giving me something to engage my brain between dialysis runs and hopefully teaching a few new and new-at-heart EMTs which way is up. Since then, we’ve made 81 posts on a variety of vaguely educational topics, and over 30,000 people have landed on our digital shores.

Our five most popular pages:


The top five search results leading here, not surprisingly:

  • agonal breathing (or agonal respirations)
  • coagulation cascade
  • orthostatics
  • jugular vein distention (or jvd)
  • cheat sheet


The most commented-upon post:


All in all, it’s been a great year from my side of things, and I hope you’ve have gleaned something of value as well. It’s a truism that the best way to learn is to teach, but I can personally attest that even if nobody in the world had clicked in this site, it would still have taught one person a great deal — me. The research that goes into every post, and the actual act of developing and writing it, has made me a far better provider, never mind educator.

As we round this milestone, I want to call attention to a few shadowy figures behind the curtains. This site would not exist without the work of Dave Konig (The Social Medic), who runs the entire EMS Blogs network. Dave is a hard-working, incredibly selfless enabler and supporter who is now directly or indirectly responsible for the voices of over 20 EMS bloggers reaching the public eye, including some of the very best. He does this for no real pay (ad revenue comes back to us authors), minimal recognition (he’s out there plugging our sites, not his), and presumably no reward except the desire to help further the community. But today, for once, we should drag his butt out into the spotlight. Because although he didn’t invent the EMS blog, he’s done more to promote it than anybody else.

I also want to mention Tom Bouthillet. Tom has been a driving force in bringing the art and science of ECG interpretation back into the forefront of modern emergency care, and his website is one of the best resources available for anybody who makes clinical decisions using the electrocardiogram. It’s true that he’s been well-recognized for many of these efforts, including most recently a web series at (go check it out!). However, he’s more than just an ECG wizard. (He also makes a wicked cherries jubilee…) As I hope this site demonstrates, I’m a real believer in the power of the web to educate and elevate those of us working in medicine. The key attributes that make such distributed training possible are: it’s free; it brings world-class experts directly to your screen; and it allows interaction and discussion that pools our collective resources. EMS 12 Lead and Tom’s other projects are an absolutely shining example of how this can work, and although he would not admit it even with thumbscrews applied, he has been a true role model to me. If I can reach half as many people in half as profound a way, I would consider this site an overwhelming success, but even my meager achievements wouldn’t be possible without his example.

Finally, I’d like to point a finger at David Hiltz of the AHA and HEARTSafe. David is an example for everyone who claims to serve the public with his utterly tireless, shameless, unflagging devotion to improving survival from sudden cardiac arrest. In any cause célèbre, there are those who dip their toes in, look for the easy gains, and jump ship when things get rough; but the people who watch them come and eventually see them go are the ones who get the real work done. If there’s one thing that’s true about cardiac arrest, it’s that most of the aces have already been played, the silver bullets deployed, and everything from here forward is going to be a slog. There’s little glamour or reward in that grind, and we should acknowledge the efforts of those pushing the millstones, because twenty years from now, it’s the fruits of their labor that we’ll be enjoying. Most of all, though, David is a generous and earnest supporter of small fry like myself, and I owe him a great deal for his help and guidance.

I hope to see you all in another year. Remember that if you have any questions, requests, or suggestions, my door is always open via blog comments or email. In particular, I love to hear what type of material you like to see — although I can get a certain sense from site traffic and links, it’s not always obvious, and what seems valuable to me may not be interesting to you. So stay in touch (the Facebook page is an easy way, and we share other interesting tidbits there too), and don’t go far — more good stuff is just around the corner.

The Way You Do the Things You Do

Cops are gruff and authoritative. Librarians are helpful and a bit bookish. When a plumber bends over you can see his crack.

We’re all sophisticated and modernized folks here, so we understand that stereotypes aren’t true. Moreover, their broad, unthinking application can lead to many errors and evils.

Still, there’s often a certain amount of truth to them, or at least a systematic error behind them, and it can be worthwhile to ponder on this kernel. Why, for instance, do we associate certain personalities and affects — certain demeanors — with certain professions?

There are doctors of every shade out there, but what do you typically expect when you meet one? Probably his shoes are tied (and even polished) and he looks well-groomed. He shakes your hand and looks you in the eye. He listens carefully, expresses himself clearly, and generally presents the image of a serious and dedicated professional.

Nurses? Again, there are more varieties here than at any Baskin-Robbins, but we find that some traits are common. A bit hurried and no-nonsense, you might say, and a little feisty. Yet deep down, they’re caregivers at heart. And they wear comfortable shoes, and they dig free coffee.

My point is, we have these stereotypes because to a certain extent, the jobs dictate, demand, and develop certain types of behavior. The physician spent twelve years working towards this job title, a large portion of which was spent either trying to get himself accepted somewhere important or being instructed on how he should look, talk, and think. The nurses, they spend eight hours a day walking quickly from bed to bed, playing middleman between the vagaries of difficult patients, difficult doctors, and difficult bureaucracies. Imagine how you’d behave.

So, once we’ve put in enough time that we’re walking the walk and talking the talk, how do we behave in EMS?

Mostly, we behave with a kind of breezy insouciance. One part humor, one part world-weariness, one part quiet competence (if not outright cocky arrogance), and a large dash of sarcasm and cynicism (which we hopefully remember to switch off when we meet patients). We strive to be the kind of people whose panic-o-meter has no readings higher than Hmm…

We are unflappable; we’ve seen it all, done it all, and the only thing crazier than the stories we hear in the crew room are the ones we try to top them with. We are generally unimpressed. We haven’t run toward or away from anything since high school gym class. We happily eat our lunch after cleaning brain matter from our boots.

The prototypical paramedic rocks out to Journey en route to the call; he jokes with the patient and reassures them with casual self-assuredness; he easily improvises an IV using a cocktail straw and large safety pin; he’s businesslike and to-the-point with bystanders; and he flirts with the receiving nurse at the hospital. A hundred years ago he could have gotten away with wearing a cape and a sword; a hundred years from now he’ll probably own a jetpack. He is not quite a god, but he does understand if you got them confused.

As always, there are variations. But this is the basic mold of our kind.

Why are we this way? And is it a good thing?

In EMS, we do our work fast, and cut shallow. Most of our patient interactions last under an hour in total, which doesn’t leave much time for either nonsense or space-filling. Yet we also work with high-acuity, high-risk pathologies — heart attacks, major trauma, and so forth — that need to be quickly found, explicated, and managed. In the chaotic prehospital environment, our patient, our scene, and our course of care is often muddled with obstacles and red herrings; in order to function, we have to cultivate powerful and aggressive pattern filters that allow us to isolate the essential elements of a situation and pursue the key decision-points like an unshakable bloodhound.

The attitude also protects us, and perhaps it protects our patients. By skimming over the surface of every call and every patient, we never get dragged too deeply into the mud. As they say, it’s not our emergency, and if we acted like each emergency was a freak-out, we wouldn’t last very long. If we treat it like a laundry run, we can remain ready and in service for the next one. And the patients? They get the reassuring sensation of being cared for by someone who projects the message: “I’ve treated six people sicker than you already, and I haven’t even had my coffee yet.”

So is this a good thing? It clearly has benefits. But it has its negatives as well.

When we try to imagine behaving in the field like that well-tempered physician behaves at the bedside, the very idea seems bizarre to us. A swashbuckling air seems central to who we are; could we still bang through a full patient interview and physical exam in 120 seconds otherwise? Could we still concoct the same weird and wonderful solutions for our problems? C’mon, we couldn’t do this stuff by speaking slowly and wearing a cardigan.

And maybe there’s truth to that. But it’s also true that we lose something when we go this route. We lose a degree of professionalism, which affects our perception in the eyes of colleagues, patients, and the public. We lose the ability to form a certain type of bond with the patient, based upon a certain type of trust and respect; we gain a different sort of bond, but the loss is still real. And maybe, by standing too far back from the action and poking it with our toe, we also lose some of the compassion and humanity that make this job worth doing at all.

So I don’t have any prescriptions, and I’m not suggesting that we make an industry-wide effort to change our culture. But these are things worth thinking about, because automatic or implicit behaviors are the hardest to recognize, and the fact that we all do something doesn’t mean it’s the best thing.