Scene Command for Rookie EMTs and Paramedics
You and your partner respond to a 36 year-old female seizing. You arrive on scene with police and fire. The family is freaking out and your scene looks more like an episode of Reno 911 than the well managed algorithm that you've recited 1000 times this past year. Its your first week as a medic and the number one thing you need to know is:
NO ONE ON SCENE HAS ANY CLUE WHAT TO DO AND THEY ALL THINK THAT YOU DO!
So don’t worry about standing up and taking charge, that's your job, and you're not going to make anyone angry by doing it. Police, Fire, and Bystanders; in general all want to help, but they lack direction. Sounds simple, right, that's because it is. Lets break it down!
Command Rule # 1: SLOW is smooth, smooth is FAST
Adrenaline is a curious thing, a vestigial response to a stressful environment, left over from our evolutionary imperative to get as far away as quickly as possible from a stressful situation. However, its our job to respond to stressful situations. We get stressed because we're afraid we won’t know what to do, or because the scene situation isn't what we expected it to be. As a result our heart rate increases, our oxygen demand increases, and pretty soon our heart rate is faster than our patient's. Jumping out of the truck and running to patients is what they do on TV, not what we do in real life. Perfection demands attention and tunnel vision is the the antithesis of attention. This response can be all but eliminated by actively remembering to SLOW DOWN. When we speed up, we lose sight of the details. A good rule of thumb is to move at about half the pace you think you should be moving at. If you're still out pacing an Energizer bunny on meth, talk it out, go step by step through those National Registry checklists. Perform each step as you say it, you can't move faster than you can speak.
Command Rule # 2: Speak with the authority you have
You are there to direct medical care over the patient, the police are there to make the scene safe, and fire is there to lend a hand. Momma never gave you s*&!, unless you said "Please" right! Don’t expect to get the help you need unless you know how to ask. Be Direct and Plain. Clearly engage the individual you are about to command, "Hey man! I need you to help me," is not super effective at getting a police officer with his back turned to you to tase the 350 lb. distraught family member that's about to bodyslam you because you're not moving fast enough. Instead use direct, to the point statements; “Officer, I need you to move the family away from me” . Don’t be surprised, if you're met with blank stares from firefighters, when you say “ We need to get some D50 in this guy”, when what you meant was: "Sir, could you please get a line on him while my partner grabs the medication and I manage this guys airway".
Command Rule # 3: Be the Medic you want to be
Chances are when you feel unconfident your body language changes, you slouch over, you became less receptive to your environment, and you became a slave to your own thoughts. This leaves you feeling like a victim instead of the superhero you're supposed to be. So stand up straight, observe and embrace the challenge! Shift your attention away from your feelings of inadequacy and focus your attention on the patient. It's easy to practice this on a cold day. The next time you go outside this winter to drive to work, don’t turn your heat on, instead of focusing on how cold you are, Embrace the Cold, acknowledge that it's cold and move on. You’ll find that once you push past the initial discomfort, your mind is free to consider other things. Discomfort is Discomfort regardless of the cause. If you practice building a mental fortitude with everyday activities, it becomes easier to apply it on scene, and after a while, stress will be just an afterthought.
The unfortunate reality of medicine that they don’t teach you in EMT or MEDIC school is that no amount of reading will prepare you for your own internal conflict. The stress of managing a scene is a burden that gets easier with time, but it's only through practice and exposure that you will ever feel like you have a handle on it. Don’t get caught up in past mistakes, evaluate them and challenge yourself to do better. Follow these tips and embrace the suffering. After all, you wanted to work in EMS because it's not a boring desk job right??!!
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