Lights! Camera! Lunacy! EMS in the Movies

   Big-screen EMS fiction is just that: fiction. A totally realistic movie about EMS probably wouldn't get past the initial sales pitch, because most of what we do is about as exciting as changing batteries. (I know because I've spent some shifts looking for more batteries to change.)

   If I'd ever found an employer, a medical director and a legislature that allowed me to try half of what these movie medics do, I would have dropped anchor in that town and spent my workdays yelling things like, "I don't care what the book says; we're on the streets now--my streets--and you darn well better hand me that rib spreader before I hit you with this Halligan tool." (Memo to prospective EMS filmmakers: You can use that line if you promise to let me direct the airborne lung-transplant scene.)

   Despite a credibility gap wider than Montana, EMS movies can be entertaining when accompanied by a willing suspension of disbelief. At least that's what I tell myself every time I see some clueless actor rubbing defibrillator paddles together. I decided to pursue the notion of prehospital care as cinéma vérité by watching six rescue-oriented films, then offering commentary from an EMS perspective. Just a few ground rules about the format before we begin:

• Ratings are 0-4 stars of life, according to my admittedly biased concept of entertainment: Zero stars would be a home video of me lip-synching "It's Five O'Clock Somewhere," and four stars would be a Godfather prequel where Michael Corleone becomes a "made paramedic."
• One of the reasons EMS people watch EMS movies is to ridicule inaccuracies. We consider it our duty to educate non-EMS viewers, many of whom will never again accept invitations to our homes. Voodoo EMS previews scenes you might want to interrupt with snide remarks.
• Segments headed Say Again? show dialogue you probably wouldn't hear anywhere except on a movie set. I think you'll find these lines funny, although some aren't supposed to be.
• The beer is cold, the popcorn's hot, the kids are in the tool shed--it's showtime!

Broken Vessels (1998): Rated 1 Star of Life

Plot Summary

   Tom, who must be the only Penn graduate in history to settle for EMT certification instead of a degree, is hired by "L.A. City Rescue" as a partner for Jimmy, a veteran paramedic who passed burnout long ago and is headed for meltdown. We get the impression Jimmy knows something about medicine when he resuscitates a traumatic arrest and clears another patient's obstructed airway--on the same call. (Memo to the producers: I try to break the monotony of traumatic arrests and obstructed airways by delivering premature twins on even-numbered days.)

   Mostly, though, Jimmy does drugs. Then he steals from patients to do even more drugs. When Tom follows his lead, the result is a soulless, mutually destructive partnership that makes Leopold and Loeb look like the Sunshine Boys. Whenever you think it can't get worse, Tom and Jimmy commit another felony, then justify the outcome by babbling us-against-the-world rhetoric. All of this made me want to send Christmas cards to even my most incorrigible partners.

   Will Tom plunge ever deeper into Jimmy's nether world, or will he seek salvation after realizing he's the poster child for poor impulse control? Yes.

Voodoo EMS

• When the guys respond to their first call as partners, Jimmy distracts a sword-wielding maniac just before a police officer tackles the wacko through an open window. I'm sure they practice that at the academy. Then Jimmy subdues the EDP with a trans-trousers shot of an unnamed tranquilizer. Didn't I see that on Animal Planet? Without the trousers, I mean.
• When a docile patient takes offense at Jimmy's offer of a "beatdown," Jimmy wields a defibrillator as a stun gun (using classic temporal-temporal paddle placement). I think I had a partner who tried that once. On himself.

Say Again?

• "I can't believe I didn't check his air passage." -Tom, experiencing turbulent thought passage
• "So, you prefer the high-action calls?" -Tom to Jimmy, sounding like a mixture of Starsky, Hutch and Liberace
• "Coronary! We have a massive heart attack." -Tom, just as an elderly patient clutches his chest--you know, like they always do
• "What's it like to do heroin?" -Tom to Jimmy, getting a head start on CME

Subjective Assessment

   Broken Vessels is no more an EMS movie than Apocalypse Now is a war movie. My concern is whether the non-EMS audience understands that. Probably not, which is why I'm glad this flick was seen by maybe 83 people, half of whom were related to the cast or crew.

   This is a film about drug addiction--about reaching bottom and the consequences of irresponsibility. There's nothing noble about Tom and Jimmy. They don't deserve our sympathy. If you feel the least bit nostalgic while watching the EMS scenes, shred your card right now. Please. Or send it to me, and I'll do it for you.

   On the lighter side, there's a marvelous performance by Susan Traylor as Suzy, a quirky, hyperactive neighbor whose eccentricities are chemical in origin. Her fate demonstrates that even adorable drug addicts can be dangerous.

Bringing Out the Dead (1999): Rated 3 Stars of Life

Plot Summary

   Frank Pierce is one messed-up paramedic. He works the night shift at fictional Our Lady of Perpetual Mercy hospital in New York's Hell's Kitchen of the early '90s. He's still got game--in the opening scene he intubates a cardiac arrest victim and starts an IV in less time than it takes his partner to attach electrodes--but he's haunted by memories of an 18-year-old asthmatic named Rose who died under his care.

   Frank routinely calls in sick or shows up late for work, hoping he'll be dismissed and his torment will end. Instead of discipline, though, his supervisor substitutes sympathy, then cites manpower shortages and sends Frank back to the streets with a promise he'll be fired tomorrow. But there are no tomorrows for Frank--just one joyless shift after another, with partners like Larry, preoccupied by the timing and pedigree of his next meal, and Marcus, who's so burnt he's not allowed to work two nights in a row.

   As Frank, Nicolas Cage has just the right blend of intensity and vulnerability. John Goodman, Ving Rhames and Tom Sizemore give credible performances as Frank's erratic partners. My favorite character, though, was the supervisor who barked like a dog in mid-sentence. I'm pretty sure I rode with him.

Voodoo EMS

   On-duty drinking, abuse of patients, suicidal driving and other madness portray a system and city out of control. The carnage will make you cringe more than chuckle. The movie is even scarier if you consider that the nonstop procedural aberrancies, while exaggerated, are based on real-life aspects of NYC*EMS in the '80s and early '90s.

Say Again?

   The funniest lines in this movie are delivered by an unseen dispatcher, played by director Martin Scorsese, who sends crews to:

• A man hearing celebrity voices;
• An elderly woman abducted by her cat;
• A demonic possession;
• A man who set his pants on fire;
• A three-car accident--"two taxis and a taxi";
• A man with a noose around his neck and nothing to hang it on;
• Fired workers shooting each other at the post office.

Subjective Assessment

   When I first saw this movie 10 years ago, I found it disturbing and depressing. After eight years in EMS, the last thing I wanted was to spend my downtime watching composite replays of the scariest scenes, worst hospitals and most difficult cases I'd encountered.

   I still think Bringing Out the Dead is disturbing and depressing, but I find it much more entertaining now, perhaps because my memories of those same streets portrayed in the film are no longer reinforced daily. I also feel more sympathy for Frank, Larry, Marcus and all the paramedics sucked into primitive EMS systems that expect employees only to show up and answer calls, with little direction from anyone other than dispirited partners. You have to be at least a little crazy to survive in such an environment.

Skid Marks (2007): No rating until I grasp the concept of negative stars

Plot Summary

   Two ambulance companies, "Bayside Ambulatory Life Services" and "Downtown Intensive Care" (BALS and DIC--get it?), are battling over who can transport the most patients in this infantile caricature of infirmity, ethnicity and sexuality. The winning agency earns exclusive rights to Bayshore, "Home of America's Greatest Seaman" (yup, I'm still hysterical over that one). Rich, T-Bone, Karl and One-Foot (he's two feet taller than that--I'd explain if I could control my mirth) are the guys with BALS, while Neil and Bob work for DIC.

   Sorry, I can't help it. Watching Skid Marks makes me think like a 10-year-old, which is a problem because The Mickey Mouse Club seems to have gone off the air.

   Anyway, the good guys from BALS hang around headquarters and have unprotected sex, while the bad guys from DIC try to stick it to their rivals while having unprotected sex. The difference is that most of the DICs have sex by themselves.

   In the name of all that is holy, please, make it stop.

Voodoo EMS

   This movie could have been titled Voodoo EMS. We know it, the actors know it, even the audience knows it (I pray). So let's go the opposite way and highlight a few scenes that are just realistic enough to resemble actual alarms:

• A diff breather in a hospital gown alternates puffs on a cigarette and gulps of O₂.
• One-Foot responds to a patient pleasuring himself with a vacuum cleaner. (One of my partners answered a similar alarm, except the hardware of choice was an electric drill. I think the carnage was more traumatic to the crew than to the patient.)
• Rich tries tempting a cute coworker with nebulized vodka. No, I've never seen that, but I'm definitely curious.

Say Again?

   If you're an EMT with a fragile ego, beware: Skid Marks must have been written by an ex-colleague to whom self-loathing is an art form. Here's a sample:

• "We're EMTs. That's a step, or several stories, below a well-trained paramedic."-Rich, ruling out any chance of being elected shop steward
• "Paramedics [as opposed to EMTs] get paid a salary, have training and actually save lives." -Rich to the new guy, who might not have learned as much from that statement as I did
• "So I became an EMT, which affords me the luxury of no real responsibility." -Rich to his eventual girlfriend, who replies, "You're going to make some lucky girl a great ex-husband." Point taken.

Subjective Assessment

   If the measure of a movie is how much it makes you think, Skid Marks is a masterpiece. After watching the first five minutes, I started contemplating the path I had chosen--not the one about becoming a medic, the one about deciding to review this turkey.

   By the 15-minute mark, I was thinking up excuses for abandoning the project: the DVD never arrived, my mailbox was stolen, the dog ate my fingers, etc. After 30 minutes, I had to apply pressure to both retinal arteries because my eyes started to bleed. I don't remember much after that.

   Skid Marks is a comedy that needs comic relief. Then again, calling such silliness comedy insults all other attempts at humor not dependent on body fluids and bacchanalia. Take whatever money you would have spent on this movie and invest it in Gulf Coast real estate. You'll be better off. And if, like my children, you make a habit of ignoring advice honed by experience, at least wait to watch Skid Marks until there's nothing else to try, except mowing your lawn with a paring knife.

Mother, Jugs and Speed (1976): Rated 2.5 Stars of Life

Plot Summary

   Two ambulance companies are battling over...hey, didn't we just see that? No, not really. Mother, Jugs & Speed is to Skid Marks as champagne is to seltzer. Both are billed as comedies, neither is very funny, but Mother, Jugs & Speed captures some very realistic EMS moments, while Skid Marks abandons any pretense of accuracy in favor of idiotic gags.

   The main characters, Mother, Jugs and Speed--played by Bill Cosby, Raquel Welch and Harvey Keitel--work for F&B Ambulance, a mythical Los Angeles EMS agency. For those of you with only second-hand knowledge of the '70s, you'll snicker at the sideburns, disco soundtrack and leisure suits.

   The film tackles gender bias decades before EMS took baby steps in that direction. Jugs endures all the slights and taunts you'd expect someone nicknamed Jugs to suffer. When Jugs' boss, Harry Fishbine, president of F&B (Fish and Bine), tells her, "When I get hard-up enough to hire a woman driver, I'll be dead two years," we root for her to change his mind. She does.

Voodoo EMS

   By 1976, my only exposure to EMS was when I stopped a hockey puck with my face. I'll have to rely on those of you who learned to sling and swathe while doing the Hustle to tell us whether the following scenes were authentic:

• Two EMTs carry an obese female down several flights of stairs in a stretcher! Just watching it made my back spasm. Had the scoop and stair chair not been invented yet? Even NFL running backs moonlighting as bomb-disposal technicians must have had longer careers than EMTs.
• When an elderly male goes into cardiac arrest en route to the hospital, Speed simply announces, "He's dead," then looks sad. Was thinning the herd a '70s concept I missed?
• I've heard bite sticks were used for seizures back then, but sitting on patients' legs to control convulsions? Tonic/clonic/moronic, I'd say.

Say Again?

   Most of the humor in Mother, Jugs & Speed is subtle, with side tones of sadness, indignity, frustration and sociopathy. We get it, and apparently so do the producers. Here's a sample:

• "That's why I like working for you--because you have no self-respect." -Mother to Harry, who takes bribes from ambulance-chasing lawyers and pays kickbacks to phony patients, but still gets to work with Raquel Welch every day. So much for karma.
• "You drive my hours, you listen to my music, and you pay for your own beer." -Mother to Speed, echoing what every FTO would like to say
• "I think you got some trouble down here in your coccyl [sic] joint." -EMT Murdoch to a patient who happens to be a wrestler and female. Even if there were a coccyl joint, I don't think that's what he was touching.

Subjective Assessment

   I appreciated the realistic scenarios and sporadic, dark humor. Even those of you who are relatively new to EMS will relate to the call-buffing, ER diversion and hernia-inducing lifting. I commend the cast and crew for doing their homework.

   Speaking of the cast, viewers get a sneak preview of such rising stars as Larry Hagman, Bruce Davison and Harvey Keitel. The cameo by ex-linebacker Dick Butkus reminds us that acting isn't as easy as it looks.

Ambulance Girl (2005): Rated 2.5 Stars of Life

Plot Summary

   Kathy Bates plays Jane Stern, a bipolar food critic who wants to be a bipolar EMT. While visiting her hometown rescue squad, she meets longtime member Walter, who mollifies Jane's avowed aversion to body fluids by confiding, "Some of us end up heaving our guts out." Stern reluctantly buys into paroxysmal vomiting, joins the Grafton (CT) Volunteer Fire Department and begins an EMT class. Along the way, she and her husband, fellow foodie Michael, struggle with commitment, resentment and divergent career paths. EMS is tangential to the film's theme--that self-fulfillment is a by-product of stable relationships.

Voodoo EMS

•    Jane treats Michael's hand lac according to the directive, "Do no harm, but if you do, stop doing it as soon as possible." Here's the protocol:

  1. Apply direct pressure.
  2. Cover the wound with all of the ice from your freezer.
  3. Elevate the limb, thereby undoing #2.
• In one scene, all of the responders in the Grafton ready room are under 30, in shape and wearing neat, identical uniforms. I've never worked anywhere in EMS where even one of those traits was evident.
• A paramedic concludes his radio report about a conscious trauma patient with, "Blood pressure has not been obtained," just as the camera pans to the IV he's started.

Say Again?

• "You have to be prepared to deal with all sorts of unpleasant sights." -Walter to Jane, possibly referring to Kathy Bates' nude scene in About Schmidt
• "BSI, I'm Number One!" -Gung-ho EMT instructor Ed, exhorting students to echo his inspirational chant. Hey, Ed, at least make it rhyme. How about "PPE, I'm in it for me!" or "Puke and spit, be careful where you sit!"?
• "Scapula, maxilla--I love these words!" -Jane to an obviously annoyed Michael, who probably thinks she's hinting about male enhancement meds again

Subjective Assessment

   Whenever I see Kathy Bates, I think of Annie Wilkes, the deranged nurse who abducts, confines and cripples James Caan's character in Misery. Jane Stern doesn't seem psychotic enough to be played by Ms. Bates. When Ambulance Girl breaks some triage nurse's legs with a sledgehammer, I'll reconsider.

   The best actor in this flick is Robin Thomas, who plays Jane's husband. We have a lot in common: His name is Michael, and my name is Michael. He's a writer, and I'm a writer. He's a great cook...and my name is Michael.

   I recommend Ambulance Girl to conflicted, moderately obsessed, occasionally despondent EMS providers with significant past or current family issues. In other words, all of us.

Daylight (1996): Rated 2 Stars of Life

Plot Summary

   Remember Rambo, Sylvester Stallone's commie-crunching, bandolier-brandishing character of the '80s? Did you ever wonder how he would have turned out if, instead of joining the Army's Special Forces and becoming a one-man apocalypse, he had gone to EMT school? Daylight forces us to contemplate that alternative universe.

   As former NYC*EMS Chief Kit Latura, Stallone gets to treat rather than inflict sucking chest wounds in this disaster flick that will remind people my age of The Poseidon Adventure. Instead of an ocean liner, the scene is an unnamed Hudson River tunnel, looking a lot like the Holland, that collapses at both ends after a robbery getaway car collides with a couple of trucks carrying hazmat from Manhattan to Jersey City. Latura, who lost his EMS job after mishandling a South Bronx building collapse, responds Code 3 in his taxi cab to help triage victims at the New York entrance, debates rescue plans with incident commanders, then is asked to lead a mid-shaft rescue after the new EMS boss gets "pancaked" by tunnel debris. Whew! And I thought tub/toilet extrications were challenging.

   There are obligatory near-death and real-death experiences, tender moments shared by potential soulmates and soliloquies about life's inequities before this fast-paced film reaches a predictable conclusion. Oh, and there's this really cute dog that sometimes looks like he's eyeing his trapped human companions as dinner.

Voodoo EMS

• Frank, the acting EMS chief and the guy who had Kit fired, asks Kit if he wants to go into the collapsed tunnel alone, carrying only a few hand tools, to treat survivors and find a way out. It's a Rambo-esque moment when Kip replies, "Give me clearance." I think most of us would have said, "Kiss my trauma shears."
• A soaked, shivering patient pulled from a tunnel escape hatch is given a stat IM injection of...what? Hudson River antitoxin?

Say Again?

• "Breaker, breaker, we got a smoker, we got a smoker!" -George, the cop, to Command. If a fireball the size of a dirigible is "a smoker," then millions of gallons of water engulfing the tunnel must be "a leaker."
• "You don't achieve what I have without an instinct for torque." -Roy, a celebrity athlete, to Kit. I don't get this. Maybe he said "an instinct for pork." In any case, Roy's instincts weren't that good, considering he's a mountain climber who couldn't even find his way to sea level.
• "Hey, Mikey, you think we're pretty?" -It doesn't matter who said it; I just like the sound of it.

Subjective Assessment

   You know what you're going to get from Stallone, and it ain't Shakespeare in the Park ("Yo, Lord--what fools these mortals be, absolutely!"). He doesn't disappoint when the script calls for superhuman stunts, or even strenuous grunting, but dialogue still isn't his strength.

   Daylight got an Oscar nomination for Best Sound Effects Editing. Also for Best Retriever in a Non-Speaking Role.

   Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.