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Operations

A Lot to Ask

Classroom games were an important part of medic school for me, both as a student and as an instructor. One of the most challenging contests was a contrived but thought-provoking Q&A session between teacher and pupil that might have been called “Name That Disease” if we’d thought to title it. The instructor would pretend to suffer from an illness within our scope of practice; the student would vector toward that malady by interviewing the “patient.” We learned a lot about assessment through those scenarios, but the backstory was our growing appreciation for inquiry as an art form. Could asking the right questions be more important than knowing the right answers?

Good question. Let’s go back to school.

As a paramedic student, I spent as much time studying multiple-choice questions as answers. I felt it was an advantage to know not just what material would be covered on exams, but how. We didn’t have access to old quizzes, so I’d review questions I’d already answered in workbooks accompanying our texts. On most exams, many of the questions resembled those I’d studied. Some were identical—not surprising, given the people creating those tests used the same books I did.

Later, as a lecturer for that medic course, writing test questions was one of the best ways to review material I was supposed to present. Any urges we educators had to flex the curriculum were tempered by knowing our class would eventually have to pass a state credentialing exam derived from a similar question bank.

Sometimes I tried to stimulate scholarly debate by answering students’ questions with questions—the so-called Socratic method of teaching, which debuted 2,500 years before my first lecture. The results were mixed; occasionally those discussions devolved into spiritless, sleep-inducing sessions of the kind portrayed hilariously in Ferris Bueller’s Day Off  (“Anyone know what that is? Class? Anyone?”). I blame myself for not always infusing enough energy into some topics.

Knowing the right questions is also important when evaluating applicants for EMS positions. As an interviewer, I tried to get candidates to open up; to feel at ease talking about themselves. My goal was to discover behaviors or beliefs that might be problematic, such as strong biases or histories of conflict with authority figures.

If you’re the interviewee, be honest, but don’t answer questions that aren’t asked. For example, you might regret volunteering your lifelong allegiance to the Boston Red Sox when you discover your interrogator is a Yankees fan (not that I can imagine that ever happening). Stay focused on the same fundamental question as the interviewer: What decision is good for both of us and best for me?

What about fieldwork? There are opportunities on almost every call to nudge outcomes in favorable directions by asking ourselves key questions during operational “moments of truth”:

Dispatch—What am I dealing with? Dispatch details aren’t always accurate, but they’re all we have en route. We might as well start thinking about the resources we’ll need if the presenting problem resembles the 9-1-1 version.

Arrival on scene—What’s behind that door? Fellow EMS World advisory board member Skip Kirkwood recently wrote about the dynamic nature of scene safety. As Skip pointed out, visualizing a scene as an evolving entity begins with a go/no-go decision at the front door, based on what we know or think we know.

Patient contact—Is this person stable? Are signs of distress from the doorway so obvious we need to expedite treatment or transport? When monitors, pulse oximeters and stethoscopes merely confirm our initial impressions of instability, we should have already been doing something more important.

Assessment—Could this be cardiac, stroke or something else time-sensitive? Symptoms of heart and brain attacks can be so subtle, we might miss them if we don’t cultivate our suspicious natures. Begin treatment to limit damage, but don’t waste time on scene fine-tuning diagnoses.

During transport—How can I make a difference? Recognize when patient comfort is more therapeutic than emergent care.

After transport—How do I get ready for the next one? What supplies were used on that last call? Do batteries have to be recharged? Is the back of the ambulance a biohazard or just a little messy?

As the French philosopher Voltaire said, “Judge a man by his questions rather than his ____.” Anyone? Rhymes with dancers. Anyone? Anyone?

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

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