EMS is All Wrong/Brief Hiatus

July is easily the busiest month of the year for me, and I’m overloaded with work until August. Seriously, my next day off is August 6. To keep myself from burning out, I’m going to be pausing from the blog just for a few weeks. I’ll be back August 8, with more Eragon, and at some point, a review of An Ember in the Ashes by Sabaa Tahir. I’ll leave you with just one more post before I go.

When I was thinking about tropes that bugged me, one that immediately came to mind was “We need to remove the bullet!” Because, as a series of disappointing Google searches told me, no, you almost never need to do that. TVTropes does a pretty good job of covering this, though, and I didn’t want to just rehash what they’ve already said. It did get me thinking, though, about other medical emergencies that fiction has portrayed completely wrong.

I’m trained in emergency response and CPR, but I was curious to see what others with more advanced medical training and knowledge thought of, say, the average cop show. I called on my good friend Sam, who works as an EMT in Central New York. That’s Upstate, by the way. There’s a whole lot more to New York than just the city.

Well, the guy who gets paid to save lives had a thing or two to say.

All quotes are taken from Sam’s email to me when I asked him about this.

EMS is almost always portrayed wrong in every respect. They get the ambulance right and that’s about it.

Stable (aka not currently dying) patients never get transported to the hospital with lights/sirens. We rarely transport anyone with lights/sirens because it’s dangerous to use them, especially when not needed.

EKG rhythms are usually never right.No one says stat.

Good emergency scenes are actually very calm.

We never wait for a police officer to bang on the back of the ambulance to let us know when we can leave. The first cop that does that is going to be asked not to hit the ambulance.

CPR is almost always wrong, because of it were right the actors would all have broken ribs.

No bystanders are ever allowed in the back of the rig during transport unless it’s a very small child or the patient is high as a kite and needs calming down.

When I asked if there was anything that was portrayed incorrectly enough so often that it drove him crazy, here’s what he told me:

Everyone dies too quickly. They get shot and only have about 30-45 seconds to talk about how they were only 2 days from retirement or how the main character was like a father to them. 
If that were true, every single person there bled out in 45 seconds. Not really possible unless they all get shot in the heart or rupture a major vessel. If you get shot in the abdomen, you have about 15-20 minutes to make it to an OR before you die. EMS uses “the platinum 10 minutes” to limit on scene time to only 10 minutes for major trauma. ED use “the Golden hour” to get some into the operating room. 

That makes sense to me. If you read news about shootings, they’ll often say something like, “Victim X was shot and died an hour later; Victim Y was shot and transported to the hospital.”

As I’ve pointed out before, even the most fantastic stories need to have some realism, or you’ll get a scoffing reader. Even if your audience doesn’t have a medical background (which is probably safe to assume), why kill off your character so quickly?

Let’s say you want to show how badass your character is and how much pain he can tolerate. Sure, you could have someone try to remove the bullet, but you’ll have more knowledgeable readers rolling their eyes, and potentially spread misinformation to your audience. If your character’s already been shot, they’re already in pain. And those ten minutes it takes to get to the hospital, the hour it takes to die, whatever–for that character, time is going to stretch out and feel a lot longer than it actually is. So they’re already suffering.

If you want drama, why not try to use “the platinum 10 minutes” or “the golden hour” rule to build tension? You need to get the character to the hospital, but you can’t emergency services. Or the ambulance is stopped at a railroad crossing and there’s no way to get around. Or some jackass is trying to remove the bullet and making everything worse. And just because someone gets help in time doesn’t mean they’re going to live.

Plus, if you can confess one deep, dark secret in the thirty second between getting shot and expiring, imagine all the things that might come pouring out in ten minutes, or an hour.

I know a lot of writers have heard the advice, “Kill your darlings.”
But why kill your darlings when you can torture them instead?