EMS Reruns is an advice column designed to address dilemmas you may have experienced in EMS that you did not know how to handle. If you think of an example like the one that follows, send it to us. If we choose to publish your dilemma, we'll pay you $50. E-mail ideas to Nancy.Perry@cygnusb2b.com.
You respond to an MVA at a familiar intersection in the middle of your town--a roundabout whose designer was probably smokin' crack when he designed the thing. It's confusing enough to cause at least 20 collisions a year, but somehow nobody ever gets around to fixing it. There's an engine company and a cop on scene ahead of you, and the cop is not your favorite guy. Bud is one of those people who says he used to be a paramedic. For some reason, he isn't anymore. But he still knows everything there is to know about medicine. He likes to tell you what to do, and he reminds you often that you're just an EMT. Today's not going to be different. The scene looks like a T-bone between a big SUV and a smaller 20-year-old minivan. You don't even get the ambulance parked before Bud's at the attendant's door, motioning for your partner to roll down the window (like he's not blocking the door, which needs to open real soon). Bud's all excited, and, as usual, this call is all about him. "The lady in the SUV is the mayor," he says. "You need to check her out first. The airbag made a mess of her face." For a moment, you find yourself wondering if that means the roundabout will get fixed. Then, just as you're imagining Bud as an airbag, you realize there are at least two people in the badly damaged minivan who probably didn't have airbags. You figure you're going to need another ambulance--one for the mayor's face and the other for the folks with injuries. That's when a media van pulls up, and you wonder how they got there so fast. Unfortunately, Bud hears you go "on scene" and call for that other ambulance. He zeroes in on you like a border collie while your partner does triage, but that pretty much takes you out of service. You sarcastically offer to control traffic while he takes care of the mayor, and he goes off like napalm. Your partner comes back and tells you the mayor's got boo-boos, the driver of the minivan probably has a flail chest and his wife is unresponsive.
Q. These guys seem to show up in every system. How are we supposed to get our jobs done? A. Remember, anybody can be a former paramedic. All they have to do is quit! Given a choice, the folks in this example don't need a former paramedic. They need a real EMT. But you'll never straighten Bud out in the middle of a call, and you may not be able to do it at all without the support of somebody who has a little more clout than you do. Given the fact that he interferes with your ability to take care of people, that needs to happen as soon as possible.
Q. Fine, but there were no supervisors on this scene. There was just no ignoring the situation. How do you defuse somebody like this, who does have some authority? A. First, don't throw gasoline on the fire. The comment about traffic control was funny, and it probably felt good to say it, but it made your job more difficult by forcing Bud to back up his big ego. None of us make good judgments when we're emotional. Second, give Bud something to do. If he's not going to do his real job, a former paramedic should be able to take care of a mayor's face. And third, there is at least one functional supervisor on scene: the company officer on that engine. Chances are, s/he has some experience in your system and therefore is familiar with Bud.
Q. Good point about the fire captain. But lots of times it's just us, and we're constantly running into people who interfere with us. Isn't there some way to mitigate them ourselves? A. Often, yes. But sometimes, no. The single most important thing you can do, call after call and year after year, is keep the calm people calm and calm the excited ones down. People are at their rational best when they're not excited. If you think you're dealing with someone who has ingested a stimulant, that won't work. You need help, and if you can't get that, withdraw. On the other hand, it works best if you're dealing with someone who's scared.
Raging egos fit somewhere in between.
Thom Dick has been involved in EMS for 37 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS Magazine's editorial advisory board. Reach him at firstname.lastname@example.org.