Have your students ever asked this question? Have you asked them? Questions like this are key to critical thinking and should be presented in virtually every class. But should we guide students to act in situations where what we’ve just taught them won’t work? The answer is to help students PACE themselves.
PACE is an acronym that stands for primary, alternative, contingency, and emergency. Originally developed by the U.S. Army as a framework to ensure continuity of communications, the PACE concept can be incredibly useful to emergency responders as well as those who teach them.
Have your students consider a goal—say, stabilizing an unstable forearm fracture. The primary objective would be to fully stabilize the forearm. A primary option for doing so might be a custom manufactured preformed splint. Great! This is our Plan A. But what if this fracture is so unstable we can’t fully achieve that goal? Or what if the preformed splint isn’t available? Perhaps our alternative plan is to stabilize pretty well with basic board splints and some padding? We couldn’t achieve the perfection we’re shooting for in the classroom, but this is still a pretty good Plan B.
But wait: This is an angulated fracture for which no standard splint will work. Then perhaps our contingency (Plan C) is to stabilize as best we can by making an improvised splint. But what if we have to move this patient quickly because of an immediate life threat in the area? Our emergency plan may be to simply have the patient hold their own forearm as stable as they can as we assist them to move away from the danger (Plan D).
It can be tempting to just keep telling students, “You can’t do that” or “That equipment isn’t available.” Part of the process is to help them consider realistic reasons why they wouldn’t be able to achieve a goal or use a preferred tool or technique. Try not to resort to, “Because I’m the instructor, and I say so.” It will make students feel the exercise is simply some form of sadism or punishment. No adult learner wants to feel they’re being forced to jump through extra hoops without a good, realistic, and useful reason.
Taking the time to review PACE choices helps us do more than simply review different solutions to the same problem.
It keeps students from getting stuck on only one objective (“I have to fully stabilize the arm—that’s what they told me to do!”). They learn to rapidly identify that when a desired objective isn’t achievable, they need to lower their standards, but only as much as they have to.
Students not only learn to most effectively use the resources available to achieve the best possible outcome, they also learn to move quickly from one choice to the next down. Thinking about your PACE choices ahead of time helps avoid on-scene “decision by committee” by giving students a framework to rapidly adapt to the situation: “Our primary solution didn’t work, so let’s move quickly to our alternative.”
It addresses the age-old phenomenon of “Forget what they taught you in class; here’s how we do it in the streets.” Sure, there are times when you can’t achieve the objective to the degree you’d like, but that doesn’t mean you immediately fall back to the emergency choice. That’s often just an excuse to be lazy or play cowboy.
It engages students of all stripes and backgrounds. Adults bring a lot to the classroom, and considering PACE alternatives lets them share what they know or think. A highly experienced provider might make different PACE choices than a yet-to-be-certified student. Having that discussion engages peer learning. This is more effective and interesting than just listening to a lecture about the first choice, next choice, “if you have to” choice, and emergency choice.
When students suggest their own PACE steps and explain the rationale behind them, if they make less-than-optimal choices, it lets you address bad choices or bad decision-making processes in class, where they can be corrected. When they make great choices, you get to learn great new and creative PACE ideas from your students.
EMS providers must always be ready to adapt to unfavorable conditions. Students must know the difference between successfully adapting to a challenge and simply taking a convenient shortcut. Coming up with good PACE choices and helping students know how to choose one over the other helps take an EMT or paramedic who’s great at performing a skill and make them great at deciding when or what skill to perform.
“What do you do when everything goes wrong?” In the words of Elvis Presley, “When things go wrong, don’t go with them!”
Rommie L. Duckworth, LP, is a dedicated emergency responder and award-winning educator with more than 25 years working in career and volunteer fire departments, hospital healthcare systems, and public and private emergency medical services. He is currently a career fire captain and paramedic EMS coordinator.