The Power of 'What the F**k?"

‘What the F**k’ is a powerful tool in the EMS arsenal.  You can think of it as ‘Whiskey Tango Foxtrot’ or ‘Huh?!?’ or whatever you like, based on your comfort level with profanity.  I cuss all the time (entirely too much, I will freely admit), so the rule to me is ‘What the f**k?’  But the point remains the same. 

Here’s the trick: You need to be deeply cognizant of the times that your subconscious brain asks, ‘What the F**k?’  Your subconscious brain may not even ask a question, but it may bring your eyebrows together and raise one of them in a questioning expression.  Whatever.  Those times are markers for needing more information.  It should lead you to asking questions, touching patients, talking to bystanders, or other methods of gathering intelligence.  Figure it out.  Get the whole picture.

Me: Do you have health problems?  Asthma, high blood pressure, stuff like that?

Patient: I have diabetes.

Me: Do you take insulin or pills?

Patient: Neither.

What the f**k?

You arrive to the scene of a dirt-transfer mechanism minor accident to find a cardiac arrest in the driver’s seat of one of the cars.

What the f**k?

Me: Has this ever happened to you before?

Patient: Yep.

Me: [Waiting patiently for more information.  Waiting.  Waiting…]

What the f**k?

You arrive to find an adult male lying prone on the ground, sweaty and roaring nonverbally, being held down by three civilians.

What the f**k?

You arrive to the scene of an adult male wearing a clown costume running in a small circle screaming at the top of his lungs about “…the man in the grey suit…”

What the f**k?

Me, opening the first aid room door: Um, hi.

Male: My employee, here, fell down and I want you to make sure she is okay.

Female: I’m okay.

What the f**k?

Patient: Don’t worry – I faint all the time.

What the f**k?

Dispatch: You’re going emergent to an intersection on a down party.  Look for the man next to the shopping cart with the cardboard sign.

What the f**k?

You pull up to find tire tracks in the snow on the left side of the road, and a vehicle stuck in a ditch on the right side of the road. 

What the f**k?

You arrive on scene of a reported incident of chest pain to find an adult male sitting with the precordial salute. 

What the f**k?

You are sent to a clinic to transfer a patient with a cough to the emergency department. 

What the f**k?

You, asking about a confused elderly patient: What is his baseline mentation? 

Family member: Pretty good.

What the f**k?

You: What does that mean?  Does he normally know what day of the week it is?

Family: Sometimes.

What the f**k?

You find a patient in controlled atrial fibrillation, with a verbalized history of “irregular heartbeat,” but also denying that he is prescribed medications.

What the f**k?

Patient: I had a heart attack last month.  I had to spend all afternoon in the hospital.

What the f**k?

You are walking through the mall and find a large puddle of blood at the base of the escalator.

What the f**k?

A car has a head star in the windshield over the steering wheel.  The reported driver is uninjured.  The reported passenger has a forehead hematoma and laceration.

What the f**k?

What the f**k? Why is there a family of stuffed raccoons in this article?
I guess you need to ask more questions to figure it out, huh?
(Photo courtesy Jeremy Johnson, Meddling with Nature)

You begin every call like this.  The process comes into play when you first arrive on scene.  You begin your call with wondering what is going on here, right?  (What the f**k?)  At that initial point of patient contact, can we agree that questions need to be asked and exams (of vehicles, bystanders, patients, etc.) need to be performed, right?   Why wouldn’t that need for information when feeling a nonspecific feeling of confusion continue throughout the call whenever anything doesn’t make sense?

If something doesn’t make sense, you need to figure it out so that it does make sense.

That is the main lesson.  The power of ‘What the f**k’ should not be underestimated.  Whenever your subconscious, or conscious, brain asks ‘What the f**k,’ more information needs to be gathered.  Repeat the process until your brain shuts the f**k up.