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Leadership/Management

The Midlife Medic: Buckle Up, Buttercup

A major part of my job is resource management. I have to keep an eye (or ear) on everything going on. That means I listen to the radio for my entire shift, with no real ability to turn it off. 

We listen all the time—from the very first time we enter the field, we’re monitoring someone’s transmissions. We get to know the voices, the vernacular, the cadence of the dialogue that cues us in—from “they sound amused” to “hmm, sounds like that was a sick person.”

It also tells us when something is very wrong.

I’d just sat down and was speaking with the deputy chief about a report we had to work on. I heard the crackle of the radio and then a single sentence. A female voice, one of the ambulances hailing dispatch.

That’s it, nothing more, but it was there: the quiver of stress, the higher pitch of pain, fear, struggling to get the words out.

We closed everything and started moving. Whatever the next sentence was didn’t matter; they needed help. Then she got the next sentence out: MVC, serious, need at least three ambulances, launch the helicopter. The entire system sprang into action.

There was more. A fatality. Not the crew or patient they were transporting—the other car. 

Air time is precious, especially when so many pieces are in play. You desperately want more information, but it must wait for that ridiculously long time it takes the next unit to get on scene.

Accidents in which emergency services are involved are surreal. They evoke images of battle, of fighting foes and losing. This huge truck, straddling the shoulder, its profile wrong, looking like it has an eye punched out and chunks missing from it, all the doors open and unattended, vulnerable and exposed. Then you come to the other car, or at least the remains of it.

The sun was shining, the road conditions were Alaskan, slushy shoulders and icy patches, the air clear and cold. An oncoming car lost control. There was no time. The driver had just enough time to call back before impact, the passenger side of the car taking the brunt of the impact, starting with the rolled steel bars designed to deflect thousand-pound wildlife. There was nothing that could be done—in a split second it was over.

The crumpled car sagged in the ditch like a bunch of discarded foil. It was impossible to see where most of the passenger compartment was. The driver was extricated and ultimately placed aboard the medevac. It would take some time before it was safe to remove the passenger. Sadly, there was nothing to be done for him now.

There was a tremendous exchange of energy here, physics on a grand and fatal scale. As the helicopter flew south, I could now check on the crew, waiting to be taken by the next ambulance. These women are precious to me, not just as coworkers but as friends, and it’s time to make sure my friends are going to be OK.

One sits in the cab of my vehicle, taking a moment away from the chaos of the scene. I put my hand on her shoulder. She falls into my arms, crying. She talks about how frightening it was, how fast it happened, how loud the crash was. Then, in between sobbing breaths, she says something that hits me right in the chest.

“That’s why…(snuffle)…you yell at us…(snuffle)…to wear seat belts in the back!”

All of them were belted appropriately. All of them—even the ones in the back. This included the intern, working her first shift ever. Even though they had a patient in the back and were still interacting with her, they had seat belts on.

The elderly patient was properly secured on the stretcher with restraints, including shoulder straps. The driver and front passenger had their seat belts on. Five people in that ambulance, and they all escaped with minor injuries.

Now I was the one crying—with relief.

This service averages thousands of miles of driving every week, in some of the most dramatically changing road conditions anywhere. That we’d not had a catastrophic accident to date was a statistical anomaly. 
It is also a young service, and they slide through their days with confidence in both their immortality and invulnerability. 

In recent months we had introduced an EMS safety course and been hounding them, day after day. Eye protection, vests, seat belts, every day, every time. Some days it can be a tough sell, even to me.

Our superhero culture is difficult to crack. It can take a very long time to introduce an idea as normal when it’s always been viewed as a weakness. Surfing the back of a speeding ambulance is a mark of honor—the ability to hurtle through time and space and still be able to smoothly complete a complex procedure. 

It often takes relentless effort to change a culture. Those of us with high mileage in this field need to acknowledge our share of responsibility in creating the practices (good or bad) that exist today.

They will do what you do, say what you say. Be fair, correct immediately, and keep doing it until it’s second nature. Because someday, perhaps a long time from now, something will happen, and it will be as my friend Jess pointed out, standing stunned next to the wreckage of her ambulance. 

“There was no time.” 

For more on this accident and its ramifications, see Tracey's guest editorial.

Tracey Loscar, BA, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. Her adventures started on the East Coast, where she spent 27 years serving as a paramedic, educator, and supervisor in Newark, N.J. She is a member of the EMS World editorial advisory board. 

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