EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.
Issue link: https://emsworld.epubxp.com/i/890710
50 NOVEMBER 2017 | EMSWORLD.com THE MIDLIFE MEDIC T here's a game I play with my crews when debriefing after calls. It's called "How do you make it worse?" We start with the core problem and then say, "How do you make it worse?" You then add layers of issues that occurred on the call—those confounding factors that are completely outside any- one's control and that forced the crew to adapt its plan repeatedly. After all, there is no such thing as a "regular" anything— every call, no matter how routine, has a story behind it. Here are some examples: "So, what was wrong with him?" "He was in CHF and really short of breath." "OK, how do you make it worse?" "He was 400 pounds and couldn't hold himself up." "How do you make it worse?" "He was deaf." "How do you make it worse?" "His wife was deaf too." "What happened?" "The car rolled over." "How do you make it worse?" "Three chil- dren were ejected, and one was killed instantly." "How do you make it worse?" "It happened in front of their classmates com- ing back from a day trip." "How do you make it worse?" "The grandfather of the deceased was the driver." "What was the call for?" "Man kicked in the head by an angry moose." "How do you make it worse?" "The access point to where he was hunting was 20 miles out." "How do you make it worse?" "He was disoriented, not sure where he was. There were no roads in, and the sun was going down." "And…?" "The moose was still there." Each round reaches a point where it becomes funny, even when dark. The sheer amount of detail becomes almost ludicrous in the retelling. The tragedy is often not in the event but the details. When providers are feeling over- whelmed or hard on themselves about their performance, pull the threads out of the weave of the call and identify them, one by one. Giving voice to the things that made a call that much harder to work through takes away their power. When the complexity of a call becomes laughable, learning from the experience shows providers that despite all of it, they managed to make some order out of the chaos and do the best job they could. You can do this for any call you're dispatched to. There is no such thing as a "normal" emergency. Details both great and small will go into your experi- ence bank and make you better at scene assessment, patient care and situational awareness. Lead crew members to their own con- clusions: "So how did you make it better?" "I called for additional help." "We worked up a communication relay involving lip read- ing and sign language." "I had no choice—I climbed over the goat." (That last one is a true story.) Break it down and let them see their successes, even the small ones. When you can demonstrate how they solved each problem as it presented, then the whole becomes an integrated effort and not an isolated failure. The nature of our job gives us front-row seats to the human experience, which is never boring or easy. The important things are to decide to act, formulate a plan and be willing to change that plan at least a dozen times before you get to the hospital. How do you make it worse? By assum- ing any call will be routine. How do you make it better? Be prepared. Take your education seriously. Train until you can't get it wrong. Never assume. Breathe. Read. Pause. Train some more. Remember to laugh. Remember to cry. Pay attention to your peers—they will need you. Unravel each story you find yourself in. Look at the threads and see just how much you were really up against. Then either be satisfied with your performance or do it better next time. "So what happened?" "There was an active shooter." "How do you make it worse?" "He was heavily armed and fir- ing hundreds of rounds a minute from an unknown vantage point." "How do you make it worse?" "He was firing indiscriminately into a crowded concert venue filled with 22,000 unaware men, women and children." This one falls outside the rules of the game. The factors that made it worse were endless in both number and variety. The only thing that could have made this one worse would have been to diminish its significance in any way. Part of that significance is the power of the individual—those countless acts of selflessness and bravery from civilians and service alike. Those who recognized, rose and responded. To the first responders at the Las Vegas shooting, thank you. You made it better. A B O U T T H E A U T H O R Tracey Loscar, BA, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, Alaska. She spent 27 years serving as a paramedic, educator and supervisor in Newark, N.J. She is a member of the EMS World editorial advisory board. Contact her at taloscar@gmail.com or www.taloscar.com. Make It Better By breaking complex calls down, you can more fully appreciate how you helped By Tracey Loscar, BA, NRP, FP-C "The world is a tragedy to those who feel but a comedy to those who think." —Horace Walpole