Lessons From the Field: 

A Medical Director’s Perspective on EMS Wins and Mistakes

There’s a special kind of beauty in watching EMS at work — it’s medicine meets NASCAR pit stop, with a hint of stand-up comedy and just enough chaos to keep everyone humble. As a Medical Director, I’ve had the privilege (and occasional terror) of observing the full range of field medicine — from flawless saves to “we might not tell anyone about this” moments.

Here are a few lessons—hard-earned, often hilarious, and hopefully instructive—from the frontlines of prehospital care.

Lesson #1: Gravity Always Wins

Let’s start with the universal constant that governs all EMS operations: gravity.

I’ve watched stretchers tip on ramps, IV poles take flight like NASA prototypes, and clipboards achieve impressive altitude before succumbing to Newton’s Law.

The scene is often the same: someone says, “I got it,” right before something valuable accelerates toward the ground. We’ve lost airways, monitors, and on one memorable occasion, a chicken sandwich that had just been unwrapped for lunch.

Lesson expanded: Gravity does not care about your shift, your call volume, or your blood sugar level. Secure your gear. Strap the patient. Lock the wheels. And if you ever think, “It’ll be fine,” know that those are famous last words. Every piece of unsecured equipment is a lawsuit waiting to happen—or at least an awkward conversation with your supervisor.

Lesson #2: “Because That’s How We’ve Always Done It” Is Not a Protocol

Few phrases raise a Medical Director’s blood pressure faster.

I once read a report that proudly explained an unusual medication choice with, “We’ve always done it this way.” That’s not medical reasoning—that’s family tradition.

EMS evolves fast. What worked in 1998 doesn’t always cut it in 2025. Guidelines change, data changes, and yes—sometimes we even discover that the drug we’ve been giving for years does absolutely nothing.

Lesson expanded: The best medics are flexible thinkers, not protocol parrots. Know the why behind every what. If your justification sounds like your uncle explaining his secret barbecue method (“It’s just how we’ve always done it”), it’s time to recheck the COGs. Medicine is a science, not a superstition.

And when in doubt, pull out your phone and check the latest protocol—because somewhere, a Medical Director is doing the same thing, hoping you did too.

Lesson #3: The Patient Is Not Faking—Until They Are

Every EMS veteran has a story about the “seizure” that miraculously stopped when the patient heard the word IV, or the “unresponsive” who perked up when asked for insurance info. But for every faker, there are ten genuine emergencies where early doubt led to real harm.

Lesson expanded: The truth is, you never really know until you know. That’s why we treat first and question later. Your worst outcome is giving a little oxygen to a drama major. The alternative is missing a real crisis because you assumed wrong.

And when you do encounter a creative patient (“Doc, I swear I was having a heart attack until you showed up”), take it in stride. EMS is equal parts detective work and patience practice. Be kind, stay skeptical, but never cynical.

Lesson #4: Nothing Good Happens After Midnight

There’s a shift in the universe after midnight. The streets get quieter, the calls get stranger, and the probability of encountering a shirtless man holding a raccoon increases exponentially.

EMS calls after midnight fall into three main categories:

1. The Real Ones — the heart attacks, overdoses, and car crashes that justify every ounce of training.

2. The “It’s Been Hurting for Three Weeks but Tonight It’s Unbearable” Calls.

3. The Truly Bizarre. Like the patient who swore their neighbor’s WiFi was giving them chest pain.

Lesson expanded: Night shifts are where composure becomes a superpower. Keep your humor intact, your sarcasm internal, and your documentation immaculate. And remember, the patient who called for “gas pain” at 2 a.m. might be having a silent MI—so treat everyone like they’re the 1% who actually need you right now.

Lesson #5: Communication Saves Lives—and Sanity

EMS communication is a thing of beauty when it works. When it doesn’t, it’s like a bad group text—confusing, incomplete, and usually ending with someone mad.

From scene to hospital, clarity is king. “We’re en route with chest pain” is good; “We’re coming in with a 58-year-old male, chest pain radiating to jaw, 2 nitro given, pain down from 8 to 3” is better. “We’re coming in hot!” is not a medical term.

Lesson expanded: The best medics paint pictures with their words. Good radio reports save precious minutes in the ED, reduce chaos, and earn you silent respect from everyone listening.

And remember: your documentation is your defense. Write it as if your future self will need to read it in front of a lawyer—because someday, you might.

Lesson #6: Wins Matter Too

It’s easy to focus on mistakes—every Medical Director does it. But the truth is, the wins far outnumber the errors. I’ve seen field crews pull off miracles: STEMIs diagnosed on porches, infants resuscitated in driveways, patients revived who were gone moments before.

Lesson expanded: Every correct decision, every calm hand, every subtle catch that changes an outcome—those are victories worth celebrating. We talk about “learning from mistakes,” but you can also learn from success. Ask, What made this go right? Then repeat it.

Recognizing wins isn’t just morale boosting—it’s burnout prevention. EMS is hard, unpredictable work. Take pride in what you do right, and remember: the best systems aren’t perfect, they’re constantly improving.

And yes, sometimes the win is simply making it through the shift with your sanity, your partner, and your equipment all intact.

Final Thoughts

Being a Medical Director is equal parts teacher, referee, and occasionally, crisis negotiator. But it’s also one of the most rewarding jobs in medicine. Every day, I see people out there doing impossible work in unpredictable situations—often with humor, humanity, and a can-do attitude that rivals any hospital team.

Mistakes happen. So do miracles. And if you’re out there on the front line, tired, sweaty, and wondering if anyone notices—you’re the reason people live who otherwise wouldn’t.

So keep learning, keep laughing, and for the love of all that’s holy—empty the suction canister.

Action Plan

• Audit your habits: Find one thing your team does “because we always have” and see if it still holds up.
• Document smarter: Make your narratives readable, detailed, and defensible.
• Mentor others: Pass down lessons, not just war stories. EMS grows stronger when knowledge flows forward.
• Celebrate wins weekly: Highlight a good catch, a perfect call, or a small victory. It changes the whole culture.