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Applied Imagination: What Can We Learn From Bird Box?

Business author Josh Kaufman describes counterfactual simulation as “applied imagination.” It’s done by coming up with an outlandish scenario or intractable problem, planning for it, and applying the results to the real world. It’s a “what if?” exercise where you imagine something to be true, and your mind fills in the gaps between here and there. It has been used to develop many large-scale government plans and responses to actual incidents.

An example of this would be planning for an alien invasion of the United States (a simulation that’s actually been run). The real-world application of this simulation would end up producing a master plan for defending the United States against a numerically and technologically superior force. Similar exercises—using outlandish scenarios to encourage out-of-the-box thinking—may be useful for EMS. In these columns we consider examples.


The inspiration for this month’s column is the 2018 movie Bird Box, which starred Sandra Bullock. In the movie an unseen entity causes people to look at it, whereupon they either kill themselves or go crazy and force others to look. Soon the normal characters still alive cover their eyes and do everything blindly. Neither the book nor the movie fully reveals what the creatures are, although the prevailing theory assumes them to be some type of demonic presence.

If you haven’t seen the movie, this column reveals spoilers.

The EMS Response

Like most large-scale events of any nature, this one starts slowly but then becomes overwhelming in hours. The first close-up patients in Bird Box are seen in a hospital, where we see medical personnel at work in the opening stages of the end of the world.

The problem presents itself as a wave of mass hysteria that sparks suicides of all types. Most of the affected are seen killing themselves in fast and violent ways, such as stepping in front of vehicles, gunshots, and even sitting in burning vehicles.

At first EMS would respond to individual calls. As the event swept the globe, though, most responders would be affected on their way to calls. You see in the film what happens on the roadways soon after it starts.

A small section of the population isn’t pushed to suicide by the entities but is affected differently. It is theorized that this subsection is likely socio- or psychopathic. One would have to wonder how many providers would be affected in this way. There are a rare few individuals who have those conditions but can mask them and function as regular contributing members of society.

Like some disasters, the primary danger in this is the speed at which the world changes. The chances of someone on the radio screaming to cover your eyes and seek shelter would be miniscule. They’ll be fighting for their own lives by that point. As most responders will be in the thick of it on calls or on their way to one, their chances are slim. In the movie the only people who survived did so mostly out of luck in right-place-right-time scenarios.

In the event any responders make it to safety alive, they will simply be well-trained survivors and no longer responsive to calls other than incidents among others hiding with them.

Unique EMS Response

So lots of people are going to die—let’s think in the other direction. Assume a group of responders quickly realizes what’s happening and manages to save themselves and their station. (Chances are this happens because one of the team is a big-time prepper who’s always going on about the coming apocalypse!)

To avoid being overrun with patients and entities, the crew would have to shut down the station until the threat was over. Everyone else would be on the radio screaming for help, rendering radio communications useless in the initial stages.

Now imagine an EMS crew responding to calls much like the food run in the movie. The crew could blindfold themselves and, obtaining vehicles with collision-assistance alarms (granted, too few ambulances have them), become responsive. After the initial deaths the main survivors would be other blindfolded people in need of assistance.

Crews would have to either deliver care blindfolded or inside safe structures with no entities. Sending police in to secure a dangerous location won’t work anymore; there’s likely to be no assistance or command structure for a very long time.

And don’t forget about the roving bands of people who can still see. They’re driving cars and will come after you. Good luck avoiding them while navigating by collision assistance at 10 mph.

Lessons to Implement

Among unlikely scenarios this movie rates high. The question for us is, what can it teach you?

Have you ever tried to deliver care in a sightless environment? Any veteran medic has worked in low-light situations such as basements, caves, or calls at night. But even then they rarely work without some type of artificial light like a flashlight, truck-mounted floodlights, moonlight, or even a smartphone screen to provide illumination.

You should try training like this. In some of the military classes I’ve been through, we often trained blindfolded. In classes to become certified for scuba diving in caves, we would even place black tape over our masks to simulate a worst-case scenario where all lights died deep inside a cave. It’s intensely stressful, but it helps you realize that if you train this hard, you can manage any number of smaller incidents in real life.

Even if you don’t expect to work in pitch blackness, try doing this in your EMS training. It will make all your skills better. If you can drop a tube or immobilize a patient blindfolded, think how awesome your skills will be on normal calls.

Not only that, it will teach you to manage stressors better. Patient trapped in a car upside down needs an ET tube? Heck, you did that last week—blindfolded.

David Powers, ThD, BCETS, BCECR, is a decorated veteran of the U.S. Marine Corps and U.S. Army and a founding member of the Department of Homeland Security, where he participated in disaster planning and helped war-game scenarios and responses. He is a popular speaker at public safety conferences and for various government agencies. Contact him at 

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