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P o w d e r f u l D i s t ra c t i o n s Never let a chaotic scene cloud your judgment CASES WITH A TWIST By David Page, MS, NRP, & Will Krost, MBA, NRP 12 MAY 2016 | EMSWORLD.com T his case began at 10 p.m, when a woman driv- ing home after a large stir-fry dinner veered off the road and into a building. Her son, fol- lowing in his own car, witnessed the event and called 9-1-1: "My mother just crashed into a building. Hurry, I think her van is about to explode!" The 9-1-1 call was unneeded, as two police officers witnessed the crash from the community hospital across the street and responded immediately. They entered the building through the big hole in the side, trying to find the patient in the haze of grey smoke and a thick white cloud. The first-arriving fire engine was met by the patient, who was already out of her car and follow- ing the building's exit signs toward the front door. "Where are the officers?" the crew asked the patient. "I don't know," the patient answered. "I wasn't try- ing to rob the place." Within minutes paramedics arrived on scene to find the patient on the front lawn, being cared for by the fire crew, and two more police officers running into the building, still enveloped by a white cloud and thick, smoky haze. "Where are they going?" asked the paramedic as he approached the patient. "Putting out the fire, I'd guess," responded the firefighter. What followed next no one expected: A steady stream of humans covered in white powder came walking out of the building. "It was like the night of the walking dead," said the patient's son. "It's like the cops were abducted by aliens and were walking out like zombies." A paramedic student intern who'd arrived on the ambulance was uncomfortable. Afraid to question his preceptor, he entered the scene silently won- dering, Why are we this close? Shouldn't we retreat to safety? But real cases don't come with a rewind button. This rapidly changing scenario was unfolding without warnings. The responders were following their instincts until it seemed unbelievable. If the zombies were attacking, retreat was no longer an option. C R M T i p s Flat hierarchy: When it comes to safety, even junior or novice crew members have equal rights and responsibility to speak up. Everyone's input is valuable. This does not mean rank or seniority is ignored. On the contrary, command structure is key to good teamwork. It means leaders have a responsibility to listen, leave their egos behind and make changes based on team member input. Appreciative inquiry: Advocacy for safety and good patient care is essential. Learning four simple steps to respectfully raise a safety concern can save many lives. Begin with getting the attention of the leader, then state the problem as you see it, propose a solution and obtain agreement from your team.