Engine Company EMS: The Simple Things

A fire department ambulance

By Michael Morse

Making it look easy does not come naturally in EMS or the fire service. There are no, “fake it ‘til you make it” opportunities when it comes to managing other people’s emergencies. Either we know what we are doing or we don’t. There are no gray areas. People live or die based on our interventions; the learning curve is incredibly steep. There are no crash-test dummies in our line of work; we need to perform well from day one until the day we retire, and every hour of every day in between.

I spent months in EMT school, then another year honing my skills so that I could recognize irregular heart rhythms and treat them accordingly. My instructors were fantastic and well meaning, but I neglected to learn how to operate a portable oxygen tank–a skill that became rather obvious on my first real EMS call.

I fumbled around for a while before figuring out exactly how to turn the valve on, set the desired flow, attach the proper delivery device and place it on the patient. A nasal cannula is a fairly simple device, and rather easy to use after some practice, but quite a puzzle to a brand new firefighter dispatched to the home of an elderly female with shortness of breath who happens to be surrounded by a dozen concerned family members. Inside my head was the knowledge needed to get the job done correctly. I simply lacked the hands-on experience needed to make it look effortless.

The stretcher is another of those mysterious pieces of equipment that our preceptors forget to practice with us. Once we figure out how to lower, raise, and roll it, we quickly forget. It looks easy only after learning how it is done, and even so, the first few times are a bit tricky, especially considering the cargo is a living, breathing (or not) person who called us because we are the trained professionals.

I found the best way to make things look easy is by doing the things that look easy a few dozen times when nobody is watching. Taking it upon ourselves to perfect the mundane tasks that undoubtedly will fall upon the newest member of the crew is always a great idea.


Understand what you are working with. Compressed oxygen cylinders are the most basic and simple form of oxygen therapy, and one of the most reliable. The cylinders consist of a tank filled with compressed oxygen, a valve that is manipulated to deliver a specific amount of oxygen, and a plastic delivery tube. Pure oxygen is a volatile gas, and under pressure it can become dangerous. The tanks are constructed to keep the oxygen from combusting, but additional care should be taken to secure the tanks in an upright position, at relatively low temperatures, and away from any potential falling objects.

Connect and disconnect the pressure regulator: portable oxygen tanks eventually empty. Changing one out on the fly looks easy only after doing it a number of times. There is no time like the present to practice.

Operate the oxygen delivery system: familiarize yourself with the delivery devices including nasal cannulas, non-rebreathers, simple facemasks, pediatric masks, tubing, etc. In a tense situation, getting the delivery system out of its packaging, onto the oxygen tank, and attached to the patient without tangling everything into a ball of spaghetti can be a challenge. Incorrectly assembling or placing the device on the patient, delivering too much or too little oxygen—all these things can have consequences. Repetition makes everything flow, and the best time to practice is when there are no witnesses, or better yet, no people who will suffer if you perform badly.

Stretcher Familiarization

Whenever an opportunity presents itself, take advantage. Get to know your equipment, even if that equipment happens to belong to a different company. During a medical emergency or trauma, the EMS crew will have their hands full and will depend on the firefighters dispatched for assistance to retrieve the stretcher from their rig, transport the patient on it, and get it back into the truck with the patient secured to it. Often you will provide assistance at the emergency department as well, being responsible for off loading. Sometimes the patient is unconscious, sometimes cooperative, but often not. Knowing what the stretcher is capable of helps avoid tipovers.

Sometimes the simplest things can be problematic. The greatest firefighters often struggle to operate the simplest EMS equipment because it is expected that they understand things that “everybody knows.” The only way to actually know the simplest things is by doing the simplest thing: training!

Michael MorseMichael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.



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