Copy, Roger Roger

I took my original EMT class in Northern California, where I was taught by a firefighter/paramedic from Santa Clara County. My first job was with the 911 service from the adjacent county, where I worked for half a year before picking up roots and crossing the country to the Boston area; I’ve now worked here for several years.

Working in EMS on the two coasts has revealed some differences in equipment, protocols, and system operations, but one of the first things I noticed was the changes in lingo. This business may be similar across our big wide nation, but some of the words we use do differ; people will likely understand what you mean if you use the wrong one, but you’ll get some funny looks. Some examples:

West — Your ambulance is a rig
East — We drive a truck

West — The patient lies on a gurney
East — The patient lies on a stretcher

West — Trauma patients get c-spined
East — Trauma patients get backboarded

West — A mixed Paramedic/Basic crew is “1-and-1
East — A mixed crew is “PB

West — Traveling with lights and sirens is called Code 3. Incidentally, Code 2 is urgent but with the flow of traffic, and Code 4 is “all’s well.” Firefighters flash you four fingers as you drive up to cancel you…
East — Lights and sirens is Priority 1, a hot transport, or simply a response.

West — Patients who don’t want transport sign an AMA (Against Medical Advice)
East — Patients sign a refusal

West — When arriving on location, you are on scene; when leaving, you are transporting
East — When arriving, you are either on scene or going out; when transporting, you might be occupied

West — You call to alert the receiving hospital with a patch
East — You call in an entry note (short for “notification”)

West — EMT-Bs are usually EMTs
East — They’re more often called Basics, or just BLS

West — Working as a dedicated unit for a special event is a standby
East — You’re working a detail

West — Continuing education is CEUs
East — You take con ed

West — Your certification is a cert, card, or license
East — You earn your ticket

West — When acknowledging radio traffic, you copy
East — Traffic is received

West — Patients are ideally AOx4
East — Patients are at best, usually AOx3, with “event” omitted

These are certainly not representative of the entirety of the two edges of the US mainland, but just a couple regions where I’ve hung my own shingle. Anyone else want to share? What’s in the local dictionary in your area?


  1. Everything was spot on for my reflections of being an northeastern EMT except AOx3.. I still use 4. I never realized there were so many differences, nice list!

    • x3 kinda bugs me because I’m not sure if the patient is fully oriented, or was asked what happened and had no idea!

      CAOx3 is also popular around here, and I have no idea what “conscious” adds to “alert.”

  2. Ha! Fun post, Brandon!

  3. From my neck of the South we’re fairly different from the East it seems!

    Sometimes we call it the bus (other times the truck or rig).

    Some folks call it a trolley, but most often the stretcher.

    Crew composition is double medic or single medic, the other provider level isn’t mentioned.

    We’re on 6 levels of traffic under our priority dispatch:
    Omega: Cold; Good intentAlpha: BLS/ALS Cold; no priority symptoms.Bravo: BLS Hot, ALS Cold; urgent conditionCharlie: BLS/ALS Hot; emergent conditionDelta: BLS/ALS Hot with first responders; immediate threats to lifeEcho: BLS/ALS Hot with first responders; cardiac/respiratory arrest, active choking

    Like the West, we are on scene and transporting.

    We make a call in to the hospital (either a routine or ALS notification).

    We carry cards.

    We copy radio traffic.

    • “Bus” showed up back West some too.

      Elaborate priorities! I like “Omega” 🙂 What’s good intent? Do you send BLS and ALS separately to every call?

  4. As an Ohioan ready for school to start I just want to get on a Rig!

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