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 unlikely 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 Maximum Overdrive, a 1986 movie by Stephen King. In the movie the earth passes through the tail of a comet, which has an adverse effect on machines all over the world: All types of machines instantly become sentient and homicidal. Eventually the main cast are held hostage inside a truck stop by vehicles that need them to pump gas. In return they allow the puny humans to live. Watching the film offers a glimpse into various trauma incidents involving just about every machine imaginable versus people. It includes steamrollers, drink machines, radio-controlled cars, lawn mowers, ice cream trucks, and more.
Typical EMS Response
Imagine the events of the movie as if they occurred in the present rather than in 1986.
Although the presence of the rogue comet Rhea-M was known to the general populace, no one expected the events to unfold as they did. The disaster in Maximum Overdrive happened fast. One minute all was normal, and the next, machines began a homicidal rampage as the Earth moved into the comet’s tail.
At first the EMS response would have been normal, as the events themselves seemed normal—an MVA here, an electrocution there. Most of the calls to dispatch would seem normal at first but would then become more and more odd and outrageous. It would still take time for dispatchers to interpret the incoming calls as something more than just a busy volume. For example, a call to 9-1-1 for a baseball coach “attacked by a vending machine” might be interpreted as a vending machine falling over on the coach. After all, that’s much more likely.
At some point dispatch would be overwhelmed, and almost every single call would be an attack of some kind by a machine. Think about your own dispatch and administration staff. How long would it be before they noticed a pattern and believed something so outlandish to be true? This gap between occurrence and believability is a critical one and often decides if a disaster will be dealt with decisively in the beginning or waited out until it is too late.
It happens all the time. How many of you were watching the news on September 11, 2001, after the first plane hit, wondering how in the world that could happen, when the second plane flew into the World Trade Center’s South Tower?
By the time leadership realizes something is wrong, it is likely that every ambulance, fire truck, and police car will be on the road, responding to calls, and messages will have gone out to all other personnel to report for duty. In other words, in this scenario every responder available is sitting in or near a vehicle that is now homicidal and stocked with equipment to kill them.
Soon calls will be coming in from responders asking for help against attacks by driverless ambulances, electrocutions from EKGs, exploding radios, and suction units that empty out entire body cavities. Those calls will come in only so long as the radios allow them to. At some point the radios will either shut themselves off or send messages that will draw more personnel to their deaths. Most of the communications center staff will die as those devices electrocute their users.
A typical EMS response to this disaster will likely result in the death of a vast majority of personnel.
Unique EMS Response
What would you do differently? Think of your current position and duties. On a responding crew your options are limited. If you’re still in the ambulance, there isn’t much hope. The doors will lock you in, and the ambulance will drive you into something if it can’t kill you another way. Either that, or you’re stuck inside while the ambulance does whatever it wants.
If you’re out of the ambulance on a call, you might be one of the lucky ones—that is, unless you’re working an MVA or holding a piece of electronic equipment.
If one of your crazier supervisors gets it (perhaps because he’s secretly been planning all his life for the apocalypse) and starts screaming over the radio, “The machines are killing us! Abandon your rigs!” would you believe him? If you did, what would you do?
Your only chance at survival is to abandon all vehicles and electronic equipment, even battery-operated items. This includes everything from the EKG to your smartphone. The only equipment you should have as you seek shelter inside a house or business is the jump bag you carried onto the scene with you. As uniformed medical personnel, you will be sought out by any injured taking refuge nearby. You will be seen as an authority figure who has answers. Are you ready for that solitary level of leadership?
Lessons to Implement
Regular providers rely on a great deal of equipment, much of it mechanical or electronic. If you suddenly lost it all, how effectively would you be able to deliver care? How effective would you be if you were on the run at the same time?
Medics in military and austere environments operate under these conditions all the time, and we can learn a lot from how they do things. By all means, become familiar at an expert level with every piece of equipment in your ambulance. But also consider how you would deliver medical care under less-ideal conditions, with all of that stripped away.
It might seem crazy to imagine a scenario like that in Maximum Overdrive, but there are countless conditions that could mimic the situation. Imagine you’re on a call with only your jump bag and an active shooter appears, there’s a chemical explosion nearby, or your patient turns homicidal. Any of these situations could place you on the run, with no access to your truck or equipment but still needing to deliver medical care.
During in-service training, conference competitions, and even during downtime at your station, practice scenarios like this. You could set up a simulation where you have to suddenly evacuate with nothing or set one up where equipment is periodically removed for some reason.
To paraphrase Matt Damon in The Martian, it’s time to medic the crap out of your jump bag.
Every crew should also practice scenarios in which the lowest-ranking or newest member runs the response. It’s a great way to learn leadership under fire in training before it happens for real.
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 redteamgoals.com.