The Top Ten Emergency / Medical Myths

I've decided to take a break from the mountains of safety materials and advice to do something a bit more entertaining, light-hearted, and every bit as informative as the other posts: I'm going to be pointing out and correcting the top ten most prevalent myths, misconceptions, and mistakes regarding Emergency Services and Emergency Medicine on the TV and silver screen.

1. Shocking Revelations: To me, this is the most glaring and particularly painful myth because it's the one that my favorite TV medical drama- House, M.D. -violates on an almost per-episode basis, thus, I put it first on the list. The myth is that you can shock asystole (layman's translation: flatline, or when the EKG just shows a solid, flat line with no heartbeat) and get a heartbeat back. If you get specific to House, then the myth becomes something like "You can replace CPR chest compressions with defibrillator shocks ad nauseum." This is massively incorrect on both parts. Asystole simply doesn't respond to a shock because the heart's already completely devoid of electrical signal. Sidestepping walls of text explaining the whole shebang, I'll sum it up by saying that it doesn't work because it's like trying to flatten out pizza dough that's already been made paper-thin. It's a genuine execrise in futility. Also, shocking someone repeatedly and in rapid sequence cannot replace CPR and will only result in the patient's man-nipples catching fire / chest hair becoming magnetized. What will bring a patient out of asystole is early detection of a problem, early CPR, and rapid implementing of Advanced Life Support treatments. For reference, a defibrillator is used to shock a patient out of two killer rythms known as 'Ventricular Fibrillation' and 'Ventricular Tachycardia' or V-Fib and V-Tac.
Here's what V-Tac looks like on an EKG, credit to medonline.com

And this is V-Fib on an EKG, credit to learnekgs.com




2. Oxygen is Flammable: No, it's not, else smokers would kill everything instead of just themselves. Our atmosphere, after all, is 21% O2 (That's the chemical way to express what we call Oxygen, which is really two oxygen atoms attached to each other). You see, Oxygen supports flame and combustion, but isn't, in itself, flammable. Now, as you can imagine, this can be cause for some serious problem if someone lights up around running medical oxygen supplies. A lit cigarette, when held under running Oxygen, will go from a slow smolder to a volatile flare that would make a match insecure. A struck match becomes a brilliant, short-lived fireball under similar conditions. A lighter may become a weapon of mass destruction, as well as a wonderful prank. Seriously, though, I've seen ambulances with their whole top half burned off because the fire got to the onboard oxygen tank.

3. Nitroglycerine patches will explode: Well, there's a bit of controversy about this one. Generally, they are very stable, and you can sit there and smack those patches with a hammer until your hand falls off and it won't do anything. Generally, heating them up will only result in an inactive, useless nitro patch (which is why they tell you, when they're prescibed, to store them out of regular heat and direct sunlight). Where this comes into issue is regarding defibrillation. While most people will tell you that they're stable and won't explode when zapped, we're still all trained to remove the patch before we shock. Even if it did explode, though, the amounts would be so miniscule that it'd do little more than flare up and maybe leave a bit of a burn on the skin.

4. Holding on to someone or standing in the same puddle as someone else when they're shocked will result in you getting tased, bro: This is one that some people may end up wrongly classifying as a myth, but this one's fact. Holding on to someone or sitting in the same puddle as them can and will result in you getting zapped right along with them, and it's famously unpleasent, albeit usually harmless. It's the reason that we say "Clear!" before the shock is administered (though in real life, there's a bit more looking around to make sure everyone's clear), and it's also the basis for the number one lie told by Paramedics- "I said 'clear'!"

5. 95% of cardiac arrests are easily brought back: Sadly, even with today's technology and medical science back us up, the statistic is much lower in reality- closer to 5% in some cases, though that's 5% higher than before we had these interventions. Still, if the movies are to be believed, what that low statistic tells us is that our medical professionals aren't believing hard enough, aren't yelling "C'MON!" enough times per minute, and are sorely lacking in the appropriate musical montages for success. (On a side note: CPR-of course, preformed appropriately- is at least twice as effective in domestic dogs compared to humans. Don't believe me? Ask your vet.)

6. You can cut a hole in someone's throat and keep them breathing through that if you must: You absolutely must not EVER under ANY circumstances attempt it unless you've recieved the appropriate training and are operating under the right medical direction, but this one is actually fact. You CAN cut a hole in someone's trachea, stick some straws (if that's all you've got, giving them a massive respiratory tract infection might be the most distant of your worries) or an Endotracheal tube in there and help them breathe through that. It's a procedure known as emergency open cricothyrotomy, though it's got a little brother that involves the use of a specific kit or a large IV needle to improvise an airway.

7. Firefighters rescue cats out of trees: The Atlanta Fire Department actually does have a protocol for it. That is all.

8. Police Arrest EVERYONE: This is outright false. Police officers are like anyone else, they'd rather just avoid the hassle if they can. If you're not doing anything illegal, you're not acting like a wound-up, dangerous person, and can keep yourself from outright harassing the officer for daring to waste your time to try and ensure the public's safety, you should be okay. If you watch COPS a lot, like I do, you might be tempted to think otherwise, but what a lot of people don't know is that it takes fox 30 straight days of riding along with those officers to make a single 30-minute episode, so you miss out on a lot of the regular stuff. Just whatever you do, DO NOT, UNDER ANY CIRCUMSTANCE EVER MENTION DONUTS. You see, people are sensitive to stereotypes, especially then they're true. (Hey, any Officers out there, I kid. I've got infinite respect for you guys and I've got a great friend working in law enforcement. That's how I know you guys really do like donu- Wait! Hey! Don't tase me, bro! Don't tase m-AAUUUUGGHGHGHGHGHG

The Beloved Killer

There is something sinister that's taken root in the United States over the last century, and we're not alone- it's infected every industrialized nation in the world, even the third world ones. According to the United States Centers for Disease Control, it kills more than 41,000 Americans every year- 43,000 in 2005- which means it killed well more than 3x more Americans than homicide by firearm, and more than double the number of people killed by total gun deaths in the US (that is, counting suicides and unintentional as well as homicide), and over 10x the number of people killed in the september 11th terrorist attacks. This didn't just happen one year, or for a few years and then we fixed it, it's happening, every year. People die year-round, every day, around the clock from this killer that hides in plain sight. Even more shocking is that people, all the time, accept, and even want, this danger around them as part of life. Most of the time, we don't even think about protecting ourselves from it- and yet, it's easily the most deadly or unsafe presence in almost everyone's day-to-day life.

"Where is this killer?" you may be asking. Well, it's right outside your door. Don't believe me? Quickly now, run to your windows and look out at your driveway, look out on the street to see if you can see it moving past, or look in your garage to see if it's invaded your home. If it's got wheels and an engine, you're looking at our killer- motor vehicles. If you haven't thought about it before, maybe you should consider just how little respect people have for the use of something as life-endangering as a motor vehicle (especially when combined with the heart-stopping excitement of AM radio and additional cupholders). Take, for example, a regular road in a regular urban area: a 35 mph speed limit in both directions seems to be the normal thing. Seems safe, right? Well, when you consider that a head-on impact with another car actually obeying the speed limit means that you're really running into them at 70 mph- that's interstate speeds. Imagine running into a car parked on the shoulder of the interstate at that speed. Not pretty, is it? Urban roads aren't that wide, and it's not too difficult for a distracted driver to end up unintentionally blundering into just such a wreck. Visualize, with the same concept in mind, a head-on impact on a 45 mph zone- a total 90 mph impact assuming you're both, by some miracle, obeying the speed limit. Now imagine a head-on wreck on the interstate. Albeit much rarer, it's that much worse- being an impact at the equivalent of 140 mph.

The moral of this story is pay attention. Driving is dangerous business, no matter how safe you think or feel it is, and if you're not paying attention, you can't react in time to save someone else or yourself. Whatever it is- your cell phone, your dog, your baby, a stray soda bottle, a cigarette (I've watched, many a time, in mixed horror and frustration as a smoker has taken both hands off the steering wheel and took their eyes completely off the highway until they successfully lit their cigarette), IT CAN WAIT. Enforce a little common sense, wait until you reach a red light, until you can pull into a gas station, at a stop sign, and if it simply can't wait, then pull into a driveway or onto the shoulder of the road. The fact that you're probably saving yourself and someone else a traumatic event, at least a 15,000 dollar hospital bill, an insurance rate hike, and life should make it all well worth heeding this advice. To provide you with a good rule to go by, though, is something that I quickly learned when I first took up motorcycling: Assume that all other drivers are out to run you over. It's saved my life at least twice, so I'm sure it will help you.

Now, something that, being a rider myself, I feel obligated to stress to anyone who drives, be it from the front or the back seat, is to watch out for motorcycles. You've probably heard it a thousand times, but traffic studies back up the facts: most drivers simply don't see or even look for motorcycles. Now, the point isn't to call regular drivers stupid incompetents that aren't fit to be operating a hot wheels toy, let alone a car- despite what we all mutter to ourselves on our less than best days- but to remind them that, honestly, that's just the case. Most of the time, you only see other cars, trucks, big trucks, and bigger trucks because that's usually what you're looking for. You're not going to notice something that's maybe 1/4 of the size of a normal vehicle. Studies have also shown that the majority of motorcycle impacts occurred from the cyclist's front-left side and front. What this means is that whenever you're preparing to merge with traffic, move to the right lane, cross traffic, or make a right or left turn, it wouldn't hurt to slow down and take an extra half second to be sure that the way is truly clear. That half second may save someone's life and save you a whole lot of grief.

Now, let's talk traffic laws, saving the legal talk for the lawyers. Most of us consider traffic laws and installments to be a nuisance, right? What's the point of a stop sign if nobody's there, right? Or the point in obeying the speed limit or traffic lights if it's the middle of the night and the roads are abandoned? Why even wear a seatbelt? Most people simply view it as a way for police departments to rake in the cash, but I'd like to make a few points to the contrary. Traffic lights and stop signs all exist because people are selfish, and if they can help it, they're not going to yield to anyone unless they're plainly bigger and badder than they are. You'd end up waiting an hour at a busy intersection as opposed to a few minutes were it not for traffic lights. You'd probably have front-end and side collisions on a regular basis at intersections were it not for stop signs. Just imagine how many people would be more than happy to blast through an urban intersection at top speed without much more than a glance for other traffic or pedestrians. Even at night time or on a deserted highway, you should still obey these installations, as well as the speed limit, because you're not the only person in a hurry, and simply assuming the other guy, or even that you will be able to react in the sliver of time you've limited yourself to by ignoring them is just plainly absurd, and 99 times out of 100, you'll be coming to consciousness with me and a dozen of my buddies huddled around you inside the back of an ambulance. Speed limits exist because they are the safe speed for that road- considering the twists, turns, visibility, wildlife, width, and a number of other factors, that's about the optimum speed for both efficient travel and giving yourself plenty of room to react to any hazards. Your seatbelt is there because it-will-save-your-life. Next time an officer pulls you over to issue a ticket or warning for a vehicle malfunction, remember that he might just be saving your life with that slap on your wrist. Next time an officer issues you a warning or ticket for a driver malfunction, remember that he's enforcing good safety practice to protect both you and those around you.

If you regularly tailgate people- that is, you drive very close to the rear of the car in front of you- I'm shaming in your general direction. Be ashamed. Be very, very ashamed. Tailgating is a dangerous practice for the tailgater and the tailgatee because of a lessened amount of response time for the tailgater, and it leaves the tailgater legally responsible for any resultant accident damages in most places. A good rule of thumb is to pick a landmark- such as a mile marker- that the car in front of you is about to pass up. As soon as the rear end of your lead car passes that landmark, start counting in mississippis. Ideally, you should be able to count to two mississippi before you reach the landmark. If you can't utter the full "one mississippi, two mississipi" before you reach it, you're too close to the vehicle in front of you. For semi trucks, the rule changes to "four mississippi" because they're actually able to stop faster than your regular vehicle can to a shocking extent, as well as because once you get so close, the trucker will be completely incapable of seeing you behind him. Believe me, no matter who was doing what right or wrong, thinking that you'll win in a collision against a semi is like thinking that your head will win in a collision against a ton of bricks- give yourself and the trucker enough room to react.

If you're not fit to drive, don't drive. Get a friend to drive you, get a family member to drive you, get a taxi to drive you, take a nap in your car, or just wait it out over a cup of coffee. By driving when you're unfit to, you put both yourself and others in immediate danger. I don't care what it is- haven't slept in 72 hours, just got a dose of demorol from the ER, or if you're drunk enough to get others drunk by smelling your breath, it's all simple stupidity and outright indifference for the well being of yourself and those around you to be driving if you're not fit to, no matter the circumstances, no matter the excuses. What's more is that if you're not fit to be driving and you get found out, you could be on the business end of serious legal charges- though not nearly as serious or ugly as running from the police to avoid being charged. The worst part, though, is that the myth that impaired drivers often survive the accidents they create, even when their victims don't, leaving them with a crippling, unforgettable guilt- isn't a myth.

Now, it's time for some shorts:
- If you try to beat the train, the train will beat you. Every time. Seriously, there's not much to it: if your vehicle stalls out on the tracks, get out of it and call 911. If you're late, you'll be really late when what's left of you is getting packed into a closed coffin. Trains are about as deadly as it gets, treat them as one would treat a dozen rattlesnakes or a bucket of battery acid.

- If you're in a hurry, it is still absolutely no excuse to drive like an idiot and endanger not only your life, but those of your passengers and fellow drivers. If your relative is hospitalized, they're not going to be feeling any better if you get yourself hospitalized too. If you think you're late now, you're going to be really late when EMS sends you on the detour of a lifetime.

- If you see an emergency vehicle on the side of the road, tending to an accident or preforming a traffic stop, PLEASE try to give them an additional lane of clearance and, if you think you can do it without causing problems, slow down a bit or at least let off the gas pedal. Also, do your best to avoid rubbernecking. I understand that for those of you who don't regularly deal with it, and even for some of us who do, it's interesting, but rubbernecking a scene is a dangerous, not only because you can end up inadvertently drifting right into the middle of the scene and injuring the responders, but because you're not paying attention, and you could end up slamming right into the drivers in front of or to the side of you and take a ride in an ambulance yourself. Be patient, and be safe. Police, fire, and EMS, we're here for when you need us. If you see us and don't need us, respect the fact that someone else does, and you'd want that person to respect your need if you were in their shoes.

- On a related note, if an emergency vehicle (police, fire, ambulance) comes up behind you with lights and sirens going, the appropriate course of action is to -safely- pull to the right, pull onto the shoulder, or partially off the road. Do not slam on the brakes, please. I've nearly been the subject of a dozen accidents because drivers panicked and slammed on their brakes when they saw our ambulance, lit up like a Christmas tree and wailing like a banshee in their rear-view mirror.

- Next to pay attention, the number one rule of the road is to stay calm. If you're about to lose control, stay calm. Panicking can and will kill you, because you will lose your mind, therefore you will lose control. Even if a wreck seems inevitable, stay calm and stay in control. You can do a lot in those last seconds to soften the blow and maybe even avoid the wreck altogether. One more aside- try not to lock up if you expect a wreck. If you stay limp and loose, your body will be better able to survive and roll with any forces put on it by the crash than if you're tensed up. That's why impaired drivers will infamously survive the crashes they create while their victims won't- their reaction time is too poor to tense up before the wreck occurs.

- Follow the advice and instructions of your vehicle's manuals. Putting a baby in the front seat, facing forward, is absolutely dangerous. If you get in an accident and that airbag goes off, it will seriously injure and possibly kill that child. If the warnings say not to let a child younger than 12 ride in the front seat, understand the reason for it is because that child may be exaclty in all the wrong places for the car's airbag and end up getting hurt worse than if they didn't have the airbag there. Of course, respecting the airbag isn't just for children. We're basically talking about a huge balloon of air that's supposed to erupt out of your steering wheel or dashboard in a matter of a split second in order to counteract and soften the forces involved in a car crash, and that means that, ironically enough, that bag puts out a lot of force when it's activated. If you're driving, the best way to hold the steering wheel is at the ten and two-o-clock positions with both hands on the wheel- not only because it gives you better, more deliberate control of the vehicle but it also keeps your hands and body much safer from the airbag, because when they're designed, that's where they consider the driver's hands to be. The safest way to place a baby in a car is in the center of the back seat, as close to the midline of the car as possible, and, of course, secured in a car seat. Children up to as old as five can need car (or 'booster') seats to get the most of a vehicle's safety features.

-If you get in a major accident in which your car rolled over, severely cratered in somewhere, struck multiple times, you or a passenger was ejected from the vehicle, a passenger was killed or severely injured, the best place to go is nowhere at all. Turn your car off, if you can, and stay exactly where you're at (This is of special importance if you can see downed utility lines outside or on the car or if you've struck a phone or utility pole). Immediately dial 911, take a tally of your injuries and those of your passengers, remain calm and clearly relay what you know to the dispatcher so they'll be able to send all the right resources. Some things to take note of are how fast you were going when you crashed, how many passengers there are on your part, how badly a passenger or yourself is injured, and particularly whether or not you're suddenly missing a passenger or two. The only time you want to get out of your vehicle in the event of a major accident is once you're sure it is safe to do so AND if there is an absolute need to do so, such as the car catching fire or becoming submerged. Please allow EMS to 'check you out' and make sure you're stable, preferably while you're still inside your car.

- Finally, take the time to do your regular maintenance. Good tires will keep you on the road, keep you in control, and keep you out of accidents in situations where bad tires won't. A burned out indicator or dysfunctional brake lights can be the reason for a completely avoidable accident.

Prescriptions and You: Staying safe on your pharmaceuticals and using them to their full effect

Okay, so you may be asking yourself why I'm writing on this particular topic- it seems pretty idiot-proof, right? "Just take your stuff as prescribed, don't deviate, you'll be fine," you might mentally recite. Well, that's true, but it's not the whole truth. Pharmaceutical drugs, even when you take them exactly as prescribed, can open up a number of very dangerous complications for you- particularly if you allow yourself to remain unaware. Not only can pharmaceuticals pose an unknown hazard to your well-being (irony, innit?), but there are also measures that you could or should take when taking your prescription that could lessen side-effects or help the drug be more effective at doing it's job. Even more noteworthy is that some drugs may interact with common over-the-counter drugs and cause problems- sometimes quite serious- for you. Unfortunately, these important bits of information tend to fall through the cracks a lot more than they really should these days. So, to inform you of what to- and how to- educate yourself on your prescriptions, I'm writing this article.

First, we need to discuss what's important- that is, what is the information you should know about your drug? Instead of bombarding you with a huge, bland list that I'd otherwise recommend that you scribble down on a piece of paper next time you're about to go see your doc, I'll give you something a bit more user friendly, as well as cheesy. I'm giving you a mnemonic- SAFER.

S is for Special considerations. What this is about is asking if there are any activities- vigorous exercise, operating vehicles or machinery, staring at flashing lights, et cetera- that you need to avoid, any extra steps that you should take (such as drinking more or less water), or if there are any situations that should make you particularly cautious about this drug- such as liver/kidney disease, pregnancy, other ongoing diseases or changes in health, and other prescriptions that you might be taking. Side-effects also fall under this category. Feel free to subtract or add to this list as is specific to you. The reasons you need to know about this are that pharmaceuticals can sometimes agitate, cause, or be completely inappropriate for, some conditions. This is especially true for pregnancy, which can make the taking of some prescriptions highly unsafe. Do note that if you do have an ongoing condition such as an allergy to a drug or food, a disease like diabetes, an ongoing pregnancy, you may want to look into obtaining a 'medic-alert tag'.

The number of things that sit in this category is practically infinite, ranging from giving false positives on drug tests to turning your skin blue. Don't worry as much about memorizing these- your physician will usually be able to tell you about these considerations when prompted to if he didn't tell you before.

A is for All drugs, pharmaceutical, over-the-counter, and recreational.

Sometimes, as with epinephrine and cocaine (You know who you are), some drugs- prescribed or not- just do not mix. A number of different things can occur, but more commonly you'll see: a blocking of intended effects, the two (or more) drugs acting together to create an effect greater than the sum of their parts, drugs acting together to create a greater effect than the single drug could have, the drugs interacting to create a completely unintended or unexpected effect, and/or one drug allowing another to be considerably more effective. I know this doesn't sound dangerous, but all one needs to do anymore is point to a picture of Heath Ledger. It killed him, and it can kill you. If you're legally taking prescription drugs, or if you plan on or might take recreational drugs- this DOES include tobacco (cigarettes, chew, dip, whatever, it's all nicotine) and especially alcohol- you need to state them to your doctor so he knows to warn you against taking certain drugs while on that medication. Your physician may even go so far as to completely change what drug they plan on prescribing you based on this information.
One more very important thing to remember is to ask about over-the-counter drugs. A lot of people don't even think twice about it, but you could be taking a serious risk with your well being by not checking to see if the over-the-counter drug you're looking at is safe to take with your prescription. As things are unpredictable, I'd like to point out that even if you can't ask your doctor, you can ask a pharmacist at any drug store, and they'll be able to tell you if it's safe, and if it's not, provide you with alternatives.

F is for Freebie, as in, adjust this one according to your own specific needs and considerations (such as, but not limited to: pregnancy, foreign travel, on-the-job duties).

E is for Emergency Considerations
Some drugs can cause unique complications for both yourself when attempting to medicate for a known problem- such as hypersensitivity (the infamous 'peanut allergy' where someone's deathly allergic to something) or asthma- as well as for EMS and the emergency department. Drugs can either complicate an existing problem or create an entirely new one on their own- especially if care providers, unaware that you take a certain drug, end up giving you something that would cause a fatal or harmful reaction. A wonderful example of this are beta-blocker drugs, often used to help control blood pressure and heart rates. If you're on beta-blockers and have an asthma attack, you could end up hitting your albuterol inhaler multiple times with little to no change in your condition. That's because, as seen in the 'A' section, the beta-blockers actually block the sites in your nervous system where the albuterol 'plugs in' to ease your asthma attack. This could obviously cause very serious problems, so you need to discuss the possibility of this drug to contribute to an emergency with your physician and, if it's deemed necessary, even carry readily accessible information on you that you take that drug.

R is for Red Flags
There may be times where it will be absolutely necessary that you stop taking a drug right away, maybe even seek immediate medical attention. These sorts of things may not even be listed on your drug's typical warning labels- though it's still worth looking at- but listed as sneaking suspicions in medical journals. Make sure that you ask your doctor if there are any 'alarm signs', such as a sudden fever or bouts of an especially fast heart rate, that you need to be aware of to tell you that you either need to stop taking the drug right away or need to seek medical attention to be seen if it's still safe, if not both. Be familiar with them as long as you're taking that prescription.

Now, let's talk information resources. The first place you go, where you get your prescription, is also your best resource- your physician. When you first go to your doctor with your complaints and he prescribes you something, take the time to ask him about it. He knows these things, and he's probably read up on it, otherwise he'd have no business prescribing it to you. Most doctors will resist the urge to bolt out of the room and see the next patient long enough to answer any questions you may have, so don't be intimidated by his hurry to leave or brief, sharp answers. I'm not saying "be rude", and mind that some drugs are perfectly safe, but don't let their rush deny you the vital education you need when taking a prescription.

A good resource, possibly even better than your doctor, is your pharmacist. No matter the drug store, they have to have a licensed pharmacist on board or they're not legal to be filling prescriptions. Just ask to speak with them, and ask away. This is especially convenient if you feel you need an over-the-counter drug, and your physician is, indeed, still a physician, and thus unavailable to answer your questions without an appointment.

If all else fails, and even if you did ask, I'd recommend doing research online or in a physician's desk reference (commonly abbreviated PDR). You're likely to run into a good deal of junk data, but you should also be able to find valuable little nuggets of information that you otherwise wouldn't have learned. Just google or look up the name of your prescription, pick a website (if you're online. I, personally, have no preference as far as these sorts of websites go,) and read up. Easy as that.

Finally, a few quick notes:
-Take your meds as prescribed unless told otherwise.
-If you're on antibiotics, finish them! (unless told otherwise)
-If you're on drugs to control a condition or infection like Tuberculosis, Malaria, or HIV, do NOT discontinue use. It can and does make these get big, ugly, and grow bigger teeth.

When ya gonna call?

Just a quick aside- I'm working on finding more choice words, but if my proofreading has missed a profane word, please forgive it. Also, as to my background, I am an EMT-Intermediate '85', undergoing Paramedic training as of the time of this writing. I've decided to dedicate a blog specifically to providing what I'm quite sure are some fresh and valuable tips to you, the patient, on how to utilize the system in the US to its fullest. Please be aware, however, that when I speak of how a system operates, I speak in generalizations and operations can vary from locale to locale- thus, my statements may be inaccurate for your area. Please take the time to learn the details about your local emergency system. Also, if there are any questions, I'll do my best to address them within reason, so feel free to ask.

This first article is about when and when not to call for Emergency Medical Services (or more simply: 911, EMS, an ambulance, the paramedics, etc.). My reasons for choosing this as the first article- after a bit of debating between this one and 'A trip to the doctor's office'- come from my remembering that before my medical training, I really didn't know what the line was between what constituted an emergency and what didn't. I remember a few situations where I wondered to myself, in stalemate, whether or not I should call for an ambulance or not. In today's densely-packed society, the likelihood that any of you, if not all of you indeed, may encounter or, heaven forbid, have an emergency in the next few years is extremely high. Assuming that the rest of you are like I was, and couldn't actually decide between there being an emergency or not, I'm writing this so that you can be prepared and can properly identify an emergency early on and possibly save a life.

First, what constitutes an emergency? Well, there's quite a few answers, but here's a great rule of thumb: Any significant deviation from someone's normal status of existence. For example, if someone hasn't just had inexplicable and horrific chest pain their whole life, and they suddenly develop persisting and bad chest pain, you need to really watch them, because that's one major sign of an emergency. If a person who's usually pretty much like a normal person in the middle of the day suddenly starts getting confused, mentally 'slow', sleepy, and/or generally acting strange, chances are that it's an emergency and you need to call EMS. Here's a few solid guidelines of an emergency, along with explanations.

- If someone has had a persisting fever for three days OR has a fever over 103 F; that's 39.4 C for those of you who don't use Fahrenheit (see: Everyone). The reason for this is that it's an indicator of a very serious infection, be it viral, bacterial, or fungal. Also, the very high, persistent fever can be extremely dangerous to the brain and other body organs.

- If someone's having trouble breathing, especially if it's spontaneous. If they know what it is and can manage it with their own inhaler or other methods, then allow them to do so. However, stay attentive- if it doesn't resolve with self-treatment, and they're clearly having a lot of difficulty breathing (you can see their head moving back and forth from how hard they're working their chest muscles, you can hear loud wheezing sounds, they're leaning way forward, they can only talk to you one or two words at a time, you can see their nostrils flaring, you can see them using their neck/shoulder muscles to try and help them breathe, and ESPECIALLY if their lips start to turn blue) then you need to start picking up the phone. Stay nearby so that you'll know if the situation gets better or they stop breathing, in which case the dispatcher will be able to provide you with instruction on how to help until EMS arrives. Also related is if you find them not breathing or if they start choking. Call EMS IMMEDIATELY when you see that someone's choking (IE: Can't cough, can't breathe, can't talk, clearly struggling) because sometimes things like the Heimlich maneuver don't work and require more advanced interventions.

- If someone is completely unresponsive (meaning that you've tried to wake them by calling to them and that you've tried to wake them by pain stimulus such as pinching their fingernail against their finger) or is very lethargic or confused, particularly if it's clear that they shouldn't be. This should immediately start throwing red flags and cause you to start checking to see that they're still breathing or still have a pulse. If you can't stir them, or they look pale, sick, sweaty, or unusual in some other way, then you need to start dialing for an ambulance.

- If someone has a seizure. Of course, I'm referring to the classic Tonic-Clonic seizure that everyone immediately thinks of when you say 'seizure'. True, people have conditions that can induce seizures regularly, but they usually have medications that almost completely control it, so they shouldn't be having one in the first place. So, yes, call EMS. If they don't have epilepsy or other seizure-inducing conditions, then you should have absolutely no doubt whatsoever that it's an emergency and NEED to tell the medics about it when they arrive. Also, be careful to note if they hit their head on anything if they fell over. The reason seizures are such a big deal is that they can be an indicator of very serious underlying conditions, not to mention that they don't breathe at all during the extent of the seizure, so they could be suffering from dangerously low oxygen levels.

- If someone becomes suddenly confused or starts acting strange (particularly if they start acting drunk without actually being drunk) and it doesn't immediately resolve, you need to be reaching for that phone. Like seizures, it can be a sign of a very serious underlying condition that could be immediately hazardous to their health. Also similar would be if they spontaneously lose consciousness or fall out, even if they return to consciousness right away and especially if they hit their head on the way down.

- If someone has a new or sudden onset of severe, persisting (see: lasts more than a few seconds at a whack and clearly isn't something like muscle pain. If someone tries to pass off a very, very bad chest pain as indigestion, you need to remain skeptical about it, as denial is even considered to be 'classic' in the heart attack patient) pain, particularly in the chest and/or abdomen. There are a plethora of reasons for this, and almost all of them are very serious.

- If someone is found to be without a pulse and isn't decomposing (there are other ways to tell if it's far too late to resuscitate them, but those are better left to those trained to recognize it). Absolutely call 911, every, single, time.

- If someone starts vomiting or otherwise excreting blood in ways that they really shouldn't be (also, black, tarry, and sometimes face-meltingly bad smelling stool is a sign of a lower GI-bleed, which is also an emergency).

- If someone has been vomiting excessively for three days or more, thus unable to keep anything, even water, down. One day may pass, two days is on the fence and understandable if you call, three days should leave no question because now they're getting very dehydrated, first and foremost.

- If they've got an illness (like asthma or allergic reactions) that you're aware of and it's worse than you've ever seen it get before or it's getting to a clearly life-threatening point.

- Suicide threats should always result in a call to emergency services and should never -EVER- be shrugged off.

- If you're seriously debating on whether or not to call EMS, you should probably call. You can always ask the dispatcher to cancel the response if things get better.

- Trauma is a bit trickier to deal with, so bear with me. If they fell from three times their height or more (only twice their height for children), hit anything on the way down, hit their head/neck, or are clearly injured from the fall, who ya gonna call? Also, any car crash should always result in EMS being called (Unless all occupants assure you otherwise or the crash was clearly minor with minimal, if any, damage), particularly if the cars struck going in opposing directions. If someone hits their head hard enough to create a lump, cause bleeding, or cause them to lose consciousness, call EMS and insist that they seek treatment (mind that you can't hold them there because that's false imprisonment). If they were involved in an accident and broke a bone, the car rolled over, another involved person was killed, another involved person was ejected, or the cars or plainly mangled wrecks, it's time to call. If an eye was put out, call. ANY motorcycle crash needs to have EMS called. If anything was amputated, call. If they're bleeding and you can't immediately control it, they've lost/are losing a lot of blood really quick, have extensive injuries, or are spurting bright red blood, call. If they were burned (excluding all but the worst sunburn) over at least 1/8 of their body or had been on fire, had been inside of a structure while it was on fire, are still on fire, have burns around their lips, have a hoarse voice after being involved with a fire, or have burns with blackened/white and waxy charred skin, you need to call. If someone complains of neck or back pain after an accident or injury, you NEED to call.

- All of this goes doubly sensitive for children and elderly.

- If you smell alcohol on their breath but they're giving the impression that they may be having a medical emergency, such as having a large bruise on their head or stating that they're having chest pain, it's just safer to assume it's not the alcohol talking and call. Now, understand that it can be very difficult to tell if an intoxicated person is having an emergency or not because alcohol can mask a lot of signs and symptoms very well, as well as causing the person to answer questions inappropriately, so just be safe rather than sorry.

- If you notice a lot of people all passed out or behaving unusually in a certain area (ex: you walk in the mall to see everyone slumped onto the floor, everyone passed out or acting strangely inside of a neighbor's house, etc.), then you both need to get out posthaste AND call, because there's a very good chance that there's a hazardous materials incident (carbon monoxide in the case of the 'neighbor' example) happening. Also, call right away if there's an explosion of any sort that wasn't supposed to happen, if a tanker truck has overturned or crashed, if you notice any unusual clouds or smoke leaving a structure or vehicle, or any strong unusual smells- especially if you're in a location that handles chemicals, such as a home utility store.

- If they tell you to call 911, don't you even dare second-guess them. Do it.

- Pregnant woman in full, strong, late labor. EMS has the tools to help safely deliver a baby and handle any complications that may ensue. A taxi driver or a department store does not.

I know it's a lot, and I don't at all expect you lot to memorize the whole list, but if you even take a little bit away from this, it's going to help a lot.

Also, a quick note of the Dont's.

- Don't call EMS to take you to your doctor's office. We are EMERGENCY medical services, we do not take people to their doctor's offices. If you fake a problem- thinking it'll get you to your doctor's- you're going to the ER anyway. Not only do you put undue strain on a system that's spread thin in a lot of places to begin with, but you put other people's well-being at risk. This also goes for trips to the pharmacy and to visit relatives in the hospital as well as anything else of that sort. Just call a cab, they're at least $500 cheaper and you won't be putting anyone else's life at risk by stretching a thin resource even thinner.

- Don't call us because someone tapped your bumper and you think you're going to get more insurance money that way. People actually do this, and see above for why not to. Besides, it makes you look like a drama whore, and it makes you a drain on the system, both financially and logistically. If you're honestly in pain- honestly in need- that's fine, that's what we're here for. Otherwise, find some other way to abuse the system.

- If you need non-emergency transport to a specialized facility, don't call 911. Many ambulance services will have private, non-emergency numbers which you can use to schedule a non-911 truck to take you.

- We are not a rolling pharmacy. We cannot (excepting the UK's Paramedic Practitioner) hand out something for your headache or fever because we can't prescribe medications. There are a number of reasons for this policy, but the most important of them is because we don't want to disguise the symptoms of what could be a serious underlying condition and end up inadvertently causing more harm by allowing the condition to continue unrecognized.

- Don't turn away EMS because you're stubborn. If you're having an emergency, you need to go. Many a person has made themselves beyond help because they tried to tell themselves that their crushing chest pain was just indigestion for a good three days before finally admitting, well past any window for recovery, that it's something else. I understand money's tight these days, but you can't earn, save, or spend money if you're dead.