“It’s Not My Emergency”

Part one of a two part series on scene presence. Part two is here.

A regular reader of The EMT Spot asked a great question recently. (Thanks Timothy.) “How do I keep my cool and not loose my head in stressful situations?” I want to give you a tip that has worked well for me in the past. It’s a phrase I learned as an EMT and it’s helped me on countless occasions.

“It’s not my emergency.”

I know. I know what you’re thinking. On the surface, “It’s not my emergency.” sounds like a very callous and uncaring thing to say. But give me a chance to explain.

I was taught the phrase, “It’s not my emergency.” by a talented young paramedic who was a mentor in my early years in EMS. Since I first learned it, I’ve heard it used in a much more callous and uncaring form. More often than not, when I hear people say this catch-phrase it’s said in a dismissive manner. “It’s not my emergency” has become, “It’s not my problem.” or worse, “I don’t care about your emergency.” It never meant that to me. That’s not how I learned it.

For me, “It’s not my emergency.” is a mantra that helps us remember our role in the trial and tragedies that befall our patients. It reminds me of my place in the human drama of EMS. My role is that of the caregiver, not the patient. And, until the day that I pick up a phone and dial 911, that’s how it shall remain.

This is what “It’s not my emergency means to me:

I am part of the solution. I am not here to be a part of the emergency. This is another person’s problem. I’m here to help solve it.

It’s important to keep our perspective about what role we’re playing in the emergency medicine show. We are the solution. We don’t serve the public interest or our patient by becoming a part of the emergency. And, believe me, there are lots of ways to contribute to the emergency.

Here are a few:

  • Freelancing
  • Being emotional to the point that we become ineffective
  • Becoming injured
  • Bringing our personal biases, prejudices, politics or psychological traumas to the scene
  • Adding to the sum total of stress and high energy
  • Making bad decisions
  • Sticking to our bad decisions and ignoring (or feeling threatened by) helpful input
  • Conflicting with the leadership on scene.

But you can avoid all of that. It’s all packaged up nicely into something I like to call scene presence. Develop your scene presence and you won’t have to worry about this stuff. You will always remain a part of the solution.

When we’re part of the solution, we focus on our role on scene. That means if the scene needs us to be in command, we remain in command. If the scene needs us to do patient care we do patient care. We are able to remain focused on our assigned tasks without becoming overwhelmed.

When we’re part of the solution we approach human distress with compassion and empathy, but we never allow our emotions to overwhelm us or cloud our decision making or add to others distress. We can make human connections with others without adopting their emotional state. This is their moment for grief, not ours. We can have our moment later.

When we’re part of the solution we place our safety above all else, knowing that nothing will cause the scene to devolve faster than an injured responder.

When we’re part of the solution we leave our psychological crap at home. It doesn’t matter if our friend was once killed by a drunk driver or the guy in the bar fight reminds us of a bully back in grade school or if our father abandoned us as a child because of his heroin addiction. We all have our stuff. Our patients are bound to stir up that stuff within us. The patient has their own stuff to deal with. They don’t need ours.

When we’re part of the solution we remain calm and professional. Sometimes it seems like yelling, running, barking commands and being visibly stressed is the best thing for everyone. It’s not. It never is. Once people see the ambulance crew looking overwhelmed they start to lose it. Your affect is a catalyst for everyone else on scene. That goes for your co-responders as well. You are the calm at the center of the storm.

When we’re part of the solution we make good decisions. Good judgment is the hallmark of good EMS. It isn’t good knowledge. It isn’t good skills either. It isn’t strong protocols or fancy equipment. It’s good judgment. Make good decisions and things will go well. And know how to ask for help making good decisions when you need it.

When we’re part of the solution we recognize that everyone on scene is a resource. We don’t need to have the right answers all the time, we just need to know how to use the team around us. Let go of the idea that your performance needs to be perfect. Be fallible. Be authentic about your abilities and limits with the other responders on scene and use them as a sounding board. They’ll help keep you out of trouble if they know you want their help and input.

When we’re part of the solution we understand that it’s our job to support the leadership on scene. It doesn’t matter if we like the person in charge. It doesn’t matter if we agree with them. We support them. If they make a mistake, we have their back. When we feel we have valuable input, we give it in a respectful way. We take care not to undermine the trust in the authority on scene, with the team or with the public.

“It’s not my emergency” has served me well over the years. I’ve said it to myself in the back of my rig alone with a patient who needed more help than I could offer. I’ve said it to myself on scenes with way too many patients and way too few resources on hand.  I’ve said it to myself with news helicopters circling overhead on incidents that you’ve heard of and probably watched. I’ve even said it when it was my emergency. And it works for me.

See if it works for you.

Now it’s your turn: How would you answer Timothy’s question? How do you keep your cool?

Read more EMS awesomeness:

Trust Is A Currency

Be Remarkable

Five Rules For One Shift

Unconventional Thoughts on EMS

Patients Define Their Emergencies

Comments

  1. hi steve, i’ve been a paramedic in singapore for almost 13yrs now. I’m currently heading a team of 13 paramedics at the station i’m based at. Today, i had a talk with one of my trainees about what’s acceptable and what’s not when turning out for call as he has been getting negative reviews from his mentor. I can’t seem to find the right words to tell him. Your article could not have come at a more timely manner! I really appreciate your contributions to the EMS community and especially to me. Thanks, Steve!

  2. There’s one line in the movie The Guardian that really brings home the message for me, “The only difference between you and the victim is the attitude in which you enter the water.”

    I’ll start applying “It’s not my emergency” to my current job and life right away by asking myself “is what I am doing helping to solve someone’s problem or just making things worse?”

    Thank you Steve for writing this post. It is already making me a better caregiver long before I even start training.

  3. I say this all the time.
    “It’s not our emergency, drive safely. After that I have only three rules. Warm lunch, warm dinner and go home safe in the morning. And the first two are negotiable.”

    Great aticle.

  4. This brought up another question for me – I’m working on a college campus’s EMS squad. We don’t transport, we just advise; sometimes we call for an ambulance. Sometimes the patient goes with a friend to the hospital, sometimes we send them to health services, and sometimes they sign ROCs and we advise them to call back if anything changes.

    Since we don’t transport, there are often times we have to decide whether we want to call for an ambulance or choose another route. With most patients, it’s easy, we involve them in the conversation, and everyone’s happy. But recently i’ve had a couple of calls to drunk folks who are on the line – A+Ox4 and ambulatory, but sluggish pupils and having a hard time keeping anything down, etc. One of these patients was also pretty belligerent.

    Both my partner and I are new to this, and neither of us wanted to make a decision without consulting the other, but we also didn’t feel like our patient needed to hear or be a part of the conversation. In fact, he was pretty adamant about just wanting to go home to bed. Do you (anyone) have any tips for communicating with a partner without undermining the patient’s trust in you?

    We chose not to transport since he’s A+O, he signed an ROC, then left and continued to drink. We got another call to him a couple hours later, and then we transported.

    Thoughts about communicating effectively with your partner would be awesome. Thanks!

  5. As always, great post!

  6. Great post Steve! I also like your comment in the non-conformist’s guide “Be authentic, step forward when your leadership is required.”

    When I completed Mine Rescue training one of the instructors told us “You did not make this person sick and you did not put them in this position. Your function is to extricate them to higher care as rapidly as possible without causing them undue harm. Most importantly go home to your family in the same condition you left.”

  7. Have to agree with Beaver Medic and yourself Steve. I have always worked with the rule of “do the best I can but this accident happened before I arrived and the world will go on when I leave.”

  8. Steve Whitehead says:

    @Noraini Singapore, awesome. You have a beautiful city. I’d love to come visit some time. I’m glad my post was helpful. thanks for the comment.

    @Timothy, great line. I love it. good luck in your training.

    @Happy Great rules. Thanks, I get to meet up with you tonight at Rock Bottom. See you then.

    @AJ You’re in a tough spot there. It sounds like you’re providing a vital service, but you’re being asked to make some very hard clinical decisions without a whole lot of experience. I address just how challenging these situations are here, http://theemtspot.com/2010/03/06/safe-at-home/ but I don’t give you a lot of good ideas to go forward with. Good idea for a future post.

    Regarding the partner communication / patient trust thing. I would really make an effort to just have the conversation right in front of the patient. There’s really no good way to whisper outside of the patient’s earshot without affecting trust. Be respectful and professional, but have the disposition conversation with the patient right there.

  9. Steve Whitehead says:

    @WV Thanks.

    @Beaver Medic and Shaz, Well said.

  10. I’ll right away seize your rss feed as I can not find your email subscription hyperlink or newsletter service.
    Do you have any? Kindly allow me know in order that I may subscribe.
    Thanks.

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