It strange to think that it’s been almost 20 years since the first time I did CPR. I still remember it so vividly. How the time flies.
I was fortunate to have good mentors and teachers in my early days in EMS. One of them was Phil Rigardo. As an EMT student, Phil had invited me to come do a few ride-along’s with him. I owe a lot to Phil. He was one of the first major influences I had in EMS and he framed the job in a fun and exciting way. I’ve managed to carry that initial frame (EMS is fun) for most of my career.
I had been riding with Phil for a few shifts when we got dispatched to a cardiac arrest. This was the first really sick person I had ever seen Phil treat. My first chance to see him in action. That was a big deal to me.
The engine crew arrived before us and the three man crew had been working for a few minutes prior to our arrival. I remember the narrow staircase that lead up to the crowded upstairs apartment. Clothes and furniture and bags and the stuff of crowded people living crowded lives filled the place. Three firefighters were crammed in to a bedroom made for one doing CPR on the bed. The Captain was speaking in a raised voice and stress was evident across his forehead. Our patient filled the bed and bounced with each compression.
Phil walked in and did something I never expected.
He smiled and then he said in a low, calm voice, “Hey guys it looks like we’re going to need some working room. I’ll check the living room.” And suddenly we had a plan. Everyone began speaking in lowered tones and moving fast. I followed Phil and his partner to the living room where we started about the task of pushing furniture to the walls and clearing an area to work. As we finished the fire dudes appeared dragging our victim down the hall to our stage.
Once he was positioned in the middle of our action area CPR was resumed and Phil started asking everyone how things were going. “Do you feel like you’re getting a good seal on that BVM?”, “How do those compressions feel?”
In what seemed like moments a cardiac monitor was applied, IVs were started and the patient was intubated. Drugs were pushed, the scoop arrived and we prepared for transport. All the while, Phil maintained his calm pleasant tone. Saying please and thank-you when he asked for things, asking pointed questions to the family members and directing the team.
He talked me through my first real CPR experience and made sure it was a good one. He conveyed to the family a sense of compassion and he lead the team flawlessly. In the end we delivered an apneic, asystolic patient to the ER. Sometimes even the best of care can’t change that. And somewhere between that jam packed bedroom and the ER doors, Phil taught me some enduring lessons about how to care for people in EMS.
Here are a few of the things I learned.
1.) Being nice works surprisingly well. It brings the mood down, it focuses everyone on the task and it motivates people to want to help you. Saying please and thank you takes no time at all but has a powerful payoff. You haven’t heard what an authentic sounding thank you sounds like until you’ve said it when asking for a BVM to ventilate an apneic patient.
Sometimes people get the idea that effective delegation has something to do with barking at everyone like a junk-yard dog. People who delegate effectively know how to say things in a way that makes people want to help them. Try bringing some kind table manners to your next scene and see how it feels.
2.) Bring the team together. We work in groups. There’s no way around that. Sometimes we work with each other and sometimes we work against each other. Good EMT’s have a way of working with everyone on scene.
Learn to ask for consensus when you’re throwing out a plan. “Let’s bring the stair chair up here and carry her down to the first floor landing and do the transfer to the pram by the elevator. What do you guys think?” Asking for input isn’t a sign of weakness. It’s a sign of confidence. There’s nothing wrong with asking, “Does that sound like a good plan?” or even offering, “Does anyone have any other ideas?”
There’s a reason why there’s more than one person on scene. Include everyone. And when someone has a better idea, recognize it, acknowledge it and use it.
3.) If you want to know if you’re really in charge, lower your voice and see if everyone else gets quieter so they can hear what you’re saying. Have you ever been on that scene where multiple personalities are vying for control? The tendency is to talk louder and louder.
I’ve always felt the most impressive leadership was soft spoken leadership. Good leaders don’t need volume to lead. They lead with the confident respect given to individuals who know their job well. Do you want to know if you’re that person at any given time? Try lowering your voice. If everyone quiets down to hear your contribution, you’re there. If everyone rushes to talk over you, step back and help where you can. You’re not in charge anyway.
4.) Finding room to work trumps all other medical priorities. I’ve violated this rule in the past and I’ve paid dearly for it. If you want your scene to run smoothly find some working room and bring the patient to it. I teach this lesson in EMT class during scenarios. I throw rescue mannequins in closets and in stair wells and let the teams go to town. Student’s quickly learn the benefits of taking the first 15 seconds and carefully moving the patient to a clear spot.
You can’t always find good working room and it also help to have some confined space techniques in your tool box. But whenever possible make some space and use it.
5.) Sometimes, people still die. Life is a terminal process and, so far, the act of being alive has demonstrated a 100% mortality rate. You EMT skills don’t grant people immortality. Sometimes people die. Sometimes they die tragically. Sometimes they die young. The more tragic and unexpected the circumstances of an individuals death, the more likely it is that we will be involved.
It’s important to make peace with that fact. The patient’s death is not necessarily a commentary on your care. If you made mistakes during the call, learn from them. If there were things you could have done better then focus on them. But let go of the idea that we save people and win or they die and we loose. Sometimes we can save them and loose and sometimes we can loose the patient and still win.
It all comes down to how well we did our job.
I’d like to hear what you think about all that.