Ariel Wai, EMT-P, FP-C

It was a warm Oregon summer day, a couple weeks into my paramedic internship.

“Ariel?” 

I turn around from my position knelt next to our patient. My preceptor and his partner are standing behind me. “Yeah?”

“Is there anything you want us to be doing?” He asks with a little sarcasm.

“Man! I’ve done it again,” I think to myself. I was so engrossed in patient assessment, checking vital signs, and grabbing equipment that I’d forgotten I was leading the call. “Oh yeah,” I say, taking a step back and look around the room, noticing certain elements of the scene for the first time. “Can you check her vital signs and get an IV for me?”

Years later, being a medic preceptor myself, I see this same scene unfold over and over. There is so much to learn when leading an EMS 911 call, it’s easy to miss the big picture. It seems there are certain aspects of the job our textbooks can’t well equip us for.

After letting my students test their wings for a few days I inform them they’re no longer allowed to do anything. Everything that they want to happen, including certain assessments, must be delegated. I suspect delegation is especially difficult because most of us in EMS are task-oriented by nature. Getting caught up in these details though, especially early on in our careers, severely limits our ability to observe, plan, and direct. In a sense, we miss the big picture. There’s been more than once during a handoff report in the ER where I could hardly remember what the patient was coming in for; having been so absorbed in patient care I’d missed the patient.

So how do we do this? One trick I encourage, when arriving on scene, is to pull out a notepad and pen and not put them down. Doing so forces us to delegate. It also creates an opportunity to keep our thoughts and observations centered. Second, as I mentioned, don’t do anything unless you’re the only one that can do it (e.g. intubation when part of an EMT/Medic crew). Finally, and maybe the most important factor in saving yourself on a scene is to foster the professional work relationships you have.

In one of the systems I worked for years, fire and EMS were separate entities. Fire responded and gave assistance on nearly every medical call however. Occasionally, stories would circulate of fire captains and crews leaving the scene halfway through a call because of something a new medic had done or said. Regardless of whether you work in an integrated system or not, relationships have the potential to be strained.

The best way I’ve seen to combat this is simple - say thank you. Showing genuine gratitude goes a long way in an under appreciated field. Give thanks freely, to anyone and everyone, as often as possible, even for just showing up on scene. Another equally important habit is allowing and encouraging your partner or team to speak up if they see you’ve missed something. This is one of the foundations of effective crew resource management. Not only will it save you, but it helps others feel valued, allowing them to give their best.

The next call I ran with my preceptor I was determined not to touch the patient. Everything would happen by delegation. The timing of this lesson could not have been better. It took six firefighters to carry our hypotensive GI bleed out of the home. Me? I had my notebook and pen.