September 15, 2013

Two Rules of EMS

I have two rules for EMS:
Rule #1: Don’t kill anyone
Rule #2: Look cool

Actually, that is the original version of my EMS rules.  Rule #1 has morphed from “Don’t kill anyone” to “Don’t make anyone worse off” to leaving people better off – make their issue a little bit better than it was when you met them.  But that isn’t as catchy and memorable a thing to say for the two rules.

We spend a lot of time in classes learning to save lives.  It’s unfortunate that nobody expressly explains that our job isn’t often to save a life.  Our job is to start the process of fixing the problem that people called us for.  Everyone has a different threshold at which a problem is unmanageable to them.  For some, it is being pulseless due to a gunshot wound.  For others it is loneliness.  But our job usually exists somewhere in between those two.  Your problem threshold isn’t germane to the discussion.  We understand that it is probably higher than your patients’.

If I count lives saved as the only way that my time was not wasted and the only metric of a successful call, then I will burn out quickly. 
We.  Do.  Not.  Usually.  Save.  Anyone. 
Sorry to break that to you.  I will grant that there are rare calls in which we can save a life – a chunk of steak in an airway comes to mind.  But those only happen a few times in a long career.  Even a cardiac arrest with field ROSC hasn’t been saved by EMS – we only started a very long process that is continued by dozens of people in the hospital.  All we did is to leave them better off than they were when we found them.  Thus, to me, it was a success.  This is also true for the pulseless GSW victim who was pronounced upon arrival.  That patient may have died, but I left them better off than when I found them (for the most part, hopefully).   It may not have even possible to save their lives.  So if the hospital pronounces that patient, does that make everything I did a useless string of failure?

It is a successful call when I can give analgesia to someone in pain, comfort someone who is scared, offer good advice to someone who doesn’t know what to do, or even just set up the hospital for future success by starting an IV and taking vital signs.  All those are successful calls.  We have a lot of them.  Just focus on leaving people better off than when you found them when you are not on a life-or-death call – no matter what their problem is.  Your self-image will more closely align with reality, you will have more job satisfaction, you will be happier, and you will be able to focus on what your job really entails.

As for Rule #2, I don’t think that I have to say that you cannot succeed at Rule #2 if you have failed at Rule #1.  Maybe I will expand more on the concept of looking cool later.

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