Hey, my fellow siren-chasers, coffee-guzzlers, and masters of the stretcher wrestle! I’ve been a paramedic longer than some of you have been legal to buy energy drinks, and I’ve seen it all—cardiac arrests in sketchy basements, babies born in parking lots, and enough paperwork to bury a fire truck. I am also an educator, which basically means I get to bug you about doing things right while pretending I’m still hip. Today, I’m calling out a sneaky habit I’ve noticed in our world: the “we’re almost at the hospital, so let’s chill on treatment” mindset. Spoiler: it’s a lousy idea, and I’m here to nudge you away from it with some laughs, hard-earned wisdom, and a solid dose of science.

The “Almost There” Trap: It’s Everywhere

Imagine this: you’re screaming down the road, lights flashing, sirens wailing, and your partner’s in the back with a patient who’s in rough shape. Maybe it’s a heart attack with pain so bad it’s like their chest is auditioning for a horror flick, or an asthmatic wheezing like they’re trying to whistle through a straw. You’re five minutes from the ER, and you hear it: “We’re almost there, let’s just roll ‘em in.” Suddenly, the IV you were about to start stays in the bag, the neb treatment gets shelved, or the 12-lead you were gonna slap on waits for the hospital crew. Ring any bells?

I’ve been there. We all have. When you’re close to the hospital, it’s tempting to think, “Why bother now? The ER’s got this.” It’s like skipping dessert because you’re already full—except, you know, with actual lives on the line. I’ve seen this happen in big cities where hospitals are a block away and out in the boonies where “close” means 15 minutes of rattling over gravel roads. It’s not just rookies, either; even old-timers like me can slip into this when we’re wiped out or stressed.

How common is it? Nobody’s out there counting how often we hit the brakes on treatment (if you’ve got grant money for that study, I’m your guy). But chat with any medic at 3 a.m. over stale coffee, and they’ll fess up: it happens. I’ve heard it in war stories, spotted it in case reviews, and—true confession—thought it myself a couple times back when my boots were shinier. It’s like a bad habit we don’t talk about, like sneaking the last donut or “forgetting” to restock the oxygen masks.

Why It Feels Okay (But It’s Really Not)

Let’s be real: this mindset makes sense on the surface. Hospitals are the bomb—fancy monitors, crash carts, and docs who (sometimes) hear you out. It’s easy to see the ER as the finish line, like you’re passing the patient off in a relay race. Plus, when you’re minutes away, starting something tricky—like a second IV on a patient who’s tanking—feels like it might slow you down. Nobody wants to be the medic pulling into the bay late because they were hunting for a vein. And let’s not kid ourselves: after a 12-hour shift with back-to-back calls, it’s tempting to coast those last few miles and let the hospital take the wheel.

But here’s the deal: this “almost there” excuse falls apart when you look at what’s really at stake. It’s not just about getting to the hospital—it’s about what happens to your patient in those precious minutes. And when you dig into the science, it’s clear we can’t afford to slack off.

The Cold, Hard Truth: Time Matters

Let’s say you’ve got a patient in V-tach, heart going haywire, and you’re three minutes from the ER. You think, “I’ll let the hospital zap ‘em.” But what if they code in those three minutes? Or what if the ER’s slammed—five stretchers deep—and your patient waits another five minutes for a doc? That’s eight minutes of no shocks, no meds, nada. The American Heart Association says every minute without defibrillation in cardiac arrest cuts survival odds by 7-10%. That’s not a bet I’m willing to take, and neither should you.

Or picture a trauma patient with a tension pneumothorax, chest tight as a drum. You’re two minutes out, so you skip the needle decompression, figuring the trauma team’s got it. But those two minutes of low oxygen can turn a fixable injury into brain damage. Studies in Prehospital Emergency Care back this up: early trauma interventions save lives. The hospital isn’t a magic wand; it’s just the next step in the care we kick off.

Let me tell you about a call I had a few years back. Guy in his 50s, chest pain, sweaty as a linebacker in overtime. We’re four minutes from the hospital, and I’m about to start a second IV for nitro when my partner says, ‘We’re close, just get him there.’ I almost listened. But something nagged me, so I popped in the line, started the drip, and by the time we hit the ER, his pain was down and his vitals were steady. The doc later said that nitro probably kept him out of cardiogenic shock. Four minutes. That’s all it took to change his day—and mine. Don’t let ‘almost there’ rob you of a save like that.

Even for less wild calls—like a diabetic with a blood sugar in the basement or someone in anaphylaxis needing an EpiPen—holding off can turn a simple fix into a full-blown mess. Research in Journal of Emergency Medical Services shows prehospital care improves outcomes and cuts hospital time. Our job isn’t to dump patients at the door; it’s to stabilize and treat until we pass the baton.

What the Science Says: Keep It Rolling

Let’s get nerdy for a minute, because the data doesn’t lie (unlike that one patient who swore they “only had one beer”). A 2018 study in Resuscitation found that giving epinephrine early in cardiac arrest boosts the odds of getting a pulse back. Another in Annals of Emergency Medicine showed prehospital 12-lead ECGs for heart attack patients speed up cath lab time, shaving minutes off when the clock’s ticking. These moves only work if we do them, not if we’re daydreaming about the hospital’s coffee machine.

Pro tip: when you’re feeling the ‘almost there’ itch, run a quick mental checklist—ABC’s, vitals, protocols. Ask yourself, ‘If this patient was 20 minutes out, what would I do right now?’ It’s like a mental slap to keep you sharp. I still do it on tough calls, and it’s saved my bacon more times than I can count.

And don’t forget the legal side—nothing screams “good times” like a deposition. If you skip a treatment that’s in your protocols and your patient crashes, you’re not just risking their life; you’re begging for a lawyer’s phone call. Protocols don’t say, “Eh, skip it if you’re five minutes out.” If it’s needed, do it. Your patient deserves it, and your future self will thank you.

My Plea: Treat ‘Til You Hand ‘Em Over

I’m not up here on a soapbox. I’ve screwed up, forgotten protocols, and once left my stethoscope at a patient’s house (yep, rookie move). But here’s what 20 years in the field taught me: our patients count on us to fight for them, whether we’re 30 seconds or 30 minutes from the hospital. That means starting the IV, pushing the meds, or dropping that tube if it’s what they need. The ER isn’t where our job ends; it’s just where the next shift starts.

And hey, if your partner’s the one saying, ‘Let’s wait,’ don’t just nod and go along. Be the voice of reason. A quick, ‘Nah, let’s get this IV in, it’ll take 30 seconds,’ can keep the momentum going. If you’re the senior medic, set the tone—show the newbies that we treat until the gurney hits the ER bay. If you’re the rookie, don’t be afraid to ask, ‘Should we start this now?’ You might just save the day and earn some respect.

Take a sec after your next shift and think: have you ever held off because you were close to the hospital? No judgment—we’ve all been there. But maybe bring it up with your crew over tacos or terrible station coffee. Ask, ‘What do we do when we’re five minutes out?’ Get the convo going. You might be surprised how many of us need the reminder to keep fighting for our patients, no matter how close those ER doors are.

Stay safe, keep treating, and maybe check the glove box before your next shift.

Yours in chaos and caffeine,
The Humbled Medic

Reference List

1. American Heart Association. (2020). “2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.” Circulation, 142(16_suppl_2), S366-S468.
   • Notes that every minute without defibrillation in cardiac arrest drops survival by 7-10%, a big reason we can’t pause treatment.
2. Perkins, G. D., et al. (2018). “A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest.” Resuscitation, 129, 66-73.
   • Shows early epinephrine in cardiac arrest improves return of spontaneous circulation, proving we need to act fast.
3. Seymour, C. W., et al. (2010). “Prehospital Interventions in Trauma: Impact on Mortality and Morbidity.” Prehospital Emergency Care, 14(3), 380-387.
   • Confirms early trauma interventions (like needle decompression) save lives, so we can’t wait for the hospital.
4. Diercks, D. B., et al. (2013). “Prehospital 12-Lead ECG: Impact on Time to Reperfusion in Acute Myocardial Infarction.” Annals of Emergency Medicine, 61(2), 180-186.
   • Proves prehospital ECGs for STEMI patients cut cath lab delays, showing our work matters right away.
5. Cone, D. C., et al. (2015). “The Impact of Prehospital Care on Patient Outcomes: A Review of the Evidence.” Journal of Emergency Medical Services (JEMS), 40(2), 32-37.
   • Pulls together data showing prehospital care improves outcomes and shortens hospital stays.