EMS

EMS Ride-along Etiquette

Riding along with an ambulance crew is a great way to see the side of emergency medicine most ED-based physicians don't get to see. Just know your role and follow the code of the road.

The day starts at 8 am. It feels strange as you enter the station, as if you're entering someone else's home rather than their job. The paramedic and emergency medical technician (EMT) quickly greet you and are enthusiastic that you want to see their work. They tell you to make yourself comfortable and to ask questions when you have them. You store your belongings in an extra room and mention you brought bagels, which is met with excitement. It's not long before an alarm bell sounds, and a disembodied voice says, "Engine 501, Medic 505, K Deck 5, Full Code, 1234 E. Main St." Before you can ask what a "K Deck" is you find yourself in the back of a bouncing ambulance, wondering what awaits you at the scene.  

In the cab of the ambulance, the EMT says something into the radio while the medic sits quietly tapping on an industrial-looking laptop. Now you start to get nervous. There's no team of nurses and doctors awaiting at your scene. There are no consultants, no CT scanners, no labs, nothing but what is kept in this surprisingly cramped vehicle. All that your future patient has is the EMT's and medics who were earlier so excited about your bagels. But there's no anxiety shown from the two sitting up front. As the sirens begin to wail and you can see the blue and red lights bounce off passing buildings, you wonder, "How can I be helpful? What am I allowed to do? Where do I even stand?"

How to Succeed as an EMS Observer
A certain level of uncertainty is understandable on one's first ambulance ride-along shift. The EMS setting is unpredictable and uncontrolled and thus represents an opportunity to learn medicine in a unique environment – for those prepared to make the most of the ride-along and not get lost in the chaos. It's also a privilege; a poor observer can be a drain on a crew's shift, but a good observer can be revitalizing to EMS personnel. Here are the Do's and Don'ts to be an observer whom a crew would be happy to invite back to their shift.

Do

  1. Stay safe. From Day 1 of EMT school the question "Is my scene safe?" is drilled into every student's head. From environmental hazards to those presented by standing on the side of an active highway to the dangers of a domestic violence situation, EMS work carries some risk. As an observer, maintain situational awareness and follow the guidance of the crew. 
  2. Show gratitude. When you embark on a ride-along you are entering that EMS crew’s home. As you would if you were a guest in anyone's home, make sure to respect the rules and traditions of your host. Introduce yourself to every member of the crew, ask what you can do to help with station duties, and chip in for meals (or at least offer). Many firehouses buy food in the morning and then cook lunch and dinner, so bringing some cash to contribute can be helpful. Bring bagels or doughnuts to your ride-along if it's within your means. It is by no means expected, but always appreciated. 
  3. Show interest. Most crews like answering questions about their jobs. An engaged observer can be a revitalizing presence, helping to combat burnout or exhaustion in even the most jaded EMT. Be engaged and genuinely interested in the calls your crew gets dispatched to handle. You might know the medicine from the ED perspective, but prehospital medicine is different, and the nuances can be valuable to learn. Just do as you would with an attending during hospital rounds, and be mindful of interrupting. Try to ask questions when you’re between calls, rather than on scene, when the EMS providers are more focused on patient care or charting their call.
  4. Know the rules. Depending on where one is in their training/education, your role will likely change. It's important to establish before you ever accompany a crew on a call what it is you can and cannot do as a student. Are you a pure observer? Can you assist with patient care? Can you do an H+P? Speak with the crew supervisor and the crew about this and adhere strictly to the rules that are set. If you aren't sure what you're allowed to do, just stay hands off. Sometimes malpractice and liability issues make direct patient care difficult outside of the hospital. 

Don't

  1. Be a know-it-all. You might be a stellar ED resident, or an MS4 with lots of time in the ED. You may feel confident about your knowledge and abilities in emergency medicine. You should appreciate that some of this may translate to EMS – but a lot of it will not. Unless you have an EMS background, it's important to recognize that you're in unfamiliar territory as an observer. Most crews will be put off if their observer is constantly referencing "Well this is how we do it…" The desire to relate may be well-intentioned, but it can come across as arrogant if you haven't spent time working an unstable trauma in the back of a moving ambulance. The ED and EMS work closely together and their roles are intertwined. However, from the perspective of the ED you only get to see a few moments of an ambulance crew's work, which doesn't provide much insight into their role. As an observer, your goal should be to gain understanding about their role in caring for the patients you see. Humility is important in any learning setting, and a ride-along shift with an EMS crew is no different. 
  2. Be a fly on the wall. While this goes along with "show interest" and staying engaged, it bears further mentioning. To some, stepping into a fire house or an EMS station can be intimidating. It's like stepping into a stranger's home where everyone knows each other very well, and it can be easy to feel out of place. But don't let this discourage you. In the past, students have told me they have felt uncomfortable to the point they just held back on calls and kept to themselves. This is one of the worst things you can do on a ride-along shift! Crews are receptive to those who want to learn. 

Riding along with an ambulance crew is a great way to see the side of emergency medicine most ED-based physicians don't get to see. Every paramedic is required to spend a number of hours in the ED during training; seeking out opportunities to see the prehospital side of patient care is a chance to increase your understanding of everyone's respective roles. The culture of EMS can be difficult to adjust to, but if you follow the do's and don'ts here, you'll be welcome as an observer and you'll gain a valuable learning experience. 

Special thanks to Gabriel Orosco, CEP; Sean McMullen, BS, NRP; and Chris Wanka, MS, NRP, for their insight and advice regarding this article, and to Kristen Kelly, MD, Seth Kelly, MD, and Geoff Comp, DO, FAWM, for their guidance and assistance.

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