Advice From an FTO

As we begin to wind down on the pandemic-level of constant 911 calls and the endless hours waiting on a room in the ED, we find ourselves in a time to reflect a little before our next call. Like so many services, we have a new influx of eager young professionals. Recently, a new student asked me, “how do you guys keep doing this day after day?” Not an unusual thing to ask lately, and my reply was this:

“determination and our perseverance to make sure our patient gets the definitive care and treatment they need.”

COVID-19 has really stretched us thin, not just with staffing, but with supplies, training, willpower, and people who actually WANT to learn. Training new hires and students can be tedious and frustrating if you don’t have the opportunity to learn and adapt along with them in addition to teaching them what they need to know. You must become extremely patient and place yourself into their boots. If you don’t empathize, you risk placing yourself in the position of doing harm. Not only to your student, but to the patient, and most likely our profession as well. We need to be resilient and steadfast, showing them the ropes and thoughtfully placing them into the patient care position supported with good proctoring and mentorship.

Second Thoughts on 'Scene Safety'

In addition to my regular job, I continue to proudly serve as a medical first responder in my home community. But, now, in the wake of a Christmas ambush of firefighters last year and yesterday’s hostage situation during a fake medical call, I am thinking back on the doors I have rushed through attempting to offer my help to someone in need. When I respond to that late night page, I review in my head the details given to me by the dispatcher and construct my index of suspicion regarding the medical condition I will likely encounter and never suspect I am entering any sort of trap. Just like you, I was taught to say “scene safe” during my drills and exams, but that was in a classroom setting which is far different than I have ever experienced in the field. Now matter how good your imagination, that fluorescent lit room full of desks and chairs never becomes the cramped, dimly lighted bedroom down a narrow hallway. So, how do we relate the real-world idea of safety concerns into practice in the field? Back in school, we have simulators for patients that can respond to treatments providing feedback on my care and mock-ups of ambulances that even make noise to disrupt the use of my stethoscope, but where is the effort to really teach recruits caution before entering a home? Or even how to deal with the dangerously irate family member once we reach our patient? Maybe we need to go down the hall of the community college and ask the theater students to join our tidy little scenarios as grieving relatives.

And it doesn’t always have to be the setup of a deranged psychopath to present a danger, there are times I have simply gone to the wrong address. And in my state, a homeowner is justified in using “deadly force” on anyone who “was in the process of unlawfully and forcefully entering a home.” Hopefully by announcing myself and asking who called 9-1-1, I can argue the “unlawful�? part if logical debates were possible in those late night situations. Fortunately, I have never found myself in a situation where my life was truly in danger. But I suspect other responders have felt that same casual assurance before things went sideways for them. Arming medics is also not the answer. My “concealed carry” training was very good, but it doesn’t begin to help me understand how to react in a hostage taking situation even assuming my hands weren’t already full of equipment when entering the room.

I read of states like Iowa and New Jersey that are having trouble recruiting volunteers and in some cases offering incentives for service. I have always felt that EMS is a calling however. We don’t just need more bodies in uniform, we need the right people to care enough about helping patients. We also need to do a better job of protecting the professionals (including volunteers) who give of themselves already. We must use the CLIR E.V.E.N.T. database to share experiences of how to make EMS safer and better for responders as well as patients. Take the recent events that have happened and let them make you more aware, not more afraid. Work with others to help them understand the real-world of “scene safety” and practice it in every call. Let your “index of suspicion” always include your own safety, because we need you back doing this job again tomorrow!