The Illussion of Control

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

While we’re talking about scene presence, I think it’s important to bring this one up. I’ve hesitated to talk about the illusion of control on the blog even though it’s a learning point that I invariably discuss with new students on the rig in the first one or two shifts. The illusion of control is deeply applicable to learning scene presence, but, quite frankly, it contradicts something I’ve preached here on The Spot for some time.

It contradicts my advice to always be authentic. When it comes to authenticity, the illusion of control is the exception to the rule. I suspect that some of my regular readers may have take issue with that. It’s OK, I’m a big boy. I can handle it.

In the world of scene management and scene control, the illusion of control is a metaphor for how we should respond when things don’t go the way we planned.

There is an awkward and embarrassing moment that we all have to deal with while running calls. It helps to think it over before it happens. If you’ve been in EMS for any length of time, it’s already happened to you. So let’s talk about it now. How do you react when you make a mistake during a call? What do you do when things don’t go as planned? How do you respond when you make an outright flub, guffaw or blatant error right there for everyone to see?

My answer, “The illusion of control.” Allow me to explain.

Once you’ve made a mistake, you can’t rewind time and redo it. (Oh, but we wish we could.) You can only respond. At that moment you can certainly respond in ways that make the mistake worse or amplify the error. Or you can respond in ways that minimize the error and move on. Given a choice, I would chose to minimize the error and move on…most of us would. But that isn’t our natural instinct.

Our nature is to focus on the error, the mistake or the embarrassment. It comes crashing to the forefront of our minds and completely derails our plans. There are a lot of behaviors that will only amplify our mistakes and they all seem like the right choice at the moment.

  • We get angry
  • We get embarrassed
  • We talk about it
  • We cuss
  • We blame someone or something

Here’s a different idea…an idea counter-intuitive to your natural response. Act like it happens all the time. No really…this works. Be casual and continue on like that stuff just happens (because it does.)

You see, we have a very powerful tool on our side and we don’t recognize it. The patient doesn’t run emergency calls every day. The patient doesn’t have training and experience in what we do. They don’t know how many times it takes to start an IV on average. They don’t know how long it takes to untangle an oxygen cannula or any of that stuff. They can only gauge the appropriateness or inappropriateness of our care by our reactions to our own behavior. So, if things aren’t going as planned, don’t announce it!

Carry on and keep moving in the right direction. Miss the IV? “Well that one didn’t work, let’s take a look on the other arm.” Need your kit, but you left it in the rig? “I have just a few more questions while my partner runs out and gets some equipment that we’re going to need.” Drop the patient? “Terribly sorry about the rough landing, let’s get you the rest of the way to the pram.” I’m not saying you can’t acknowledge that things could have gone better. You just don’t have to advertise it to everyone.

Let me put it another way. When you go to see a magic show, you know there’s some behind the scenes shenanigans going on right? (Well, I’m sorry to spoil the show, yes…there is.) But you don’t want the magician to tell you all about it. If two bunny rabbits were supposed to come out of the hat and only one shows up, he’s not going to stomp his feet and declare, “Damn it, there were supposed to be two!” He’s going to hold up the one rabbit and say, “Ladies and gentlemen, behold my amazingness!” Or something like that.

The illusion of control is about presentation. It’s about having a little bit of showmanship. It’s about style. The show must go on, so continue in style. You’d be amazed at what your patient will usually let you get away with if you simply do it with a little grace and casual style.

So the next time things don’t go as planned, don’t lose your cool. Take a deep breath. Maybe smile just a little bit. Apologize if necessary. And announce what you’re going to do next.

Ladies and gentlemen. Behold my amazingness!

Now it’s your turn: How do you react when things go wrong? What’s your traditional response? Does it work for you?

Read More Cool Posts:

Safe At Home

Passion Counts

What Is Ketosis Anyway?

Wrong Medicine

The Art of The Pulse Check


  1. Jaymazing says:

    It’s so tough to go against that natural instinct…But you put it in such a way, I feel like it might stick. I’ll be sure to let you how smooth it goes…

    Bravo on another wonderful post

  2. Capt. Tom says:

    I was lucky and learned this early and it ‘stuck’. I never get excited or discuss miss-steps or errors and I teach all our new folks to work on their undertone verbal skills and eye-contact communications with their partners because of a simple error I made back when I was a CFR.
    We were called to a pt. who had passed out in a small exclusive bistro type restaurant. Probably too much wine, but he had hit the floor without support and we had to take ‘all precautions’. I was working the call with an experienced EMT and she asked me to do the collar while she finished up the baseline vitals. So the pt. is laying on a carpeted floor and I slide the collar under his neck as I am explaining why we need to do this and the collar gets snagged on the carpet and the pt’s hair. Not wanting to cause any discomfort and of course without thinking I said “OK sir, if you could just lift your head a tad so I can slide this thing all the way ’round.” The EMT was just finishing the B/P and never even looked at me, she just muttered under her breath in a easy going barely audible manner “hmmm, now that’s an intersting way to do it”. I instantly realized what I had done and turned red as a beet. Never made that error again and also learned a new appreciation for telling your partner they screwed up without telling the world. We also work a lot on adding support in a non-threatening manner, such as “do you think O2 would be appropriate for Mrs. Smith here?” as opposed to “why haven’t you given this patient oxygen yet?”
    We all make small errors, big mouths just make them worse. The patient doesn’t know if the mistake you made might kill them, or was just a small mis-step that can be fully corrected.
    When I took my FSI II they reminded us that the student does not know waht is in your class content. If the plan goes awry, there is no use in telling them that things aren’t going as you planned. Just take the lemons you have and make lemonaide.
    Capt. Tom

  3. Funny enough, this mentality applies anywhere where the “customer” or receiving person doesn’t really know the details about what you’re doing.

    Sure as heck works in theatre, let me tell you that! The unexpected happens all the time, and I always do my best to make it look like NOTHING is wrong to the audience. 🙂

  4. Steve Whitehead says:

    @Jaymazing Sometimes we do well, sometimes we don’t. All we can do is try to have less bad ones and more good ones. Good luck.

    @Capt. Tom We usually learn this kind of grace-in-motion by watching others who have it. It’s hard to describe, but once you experience someone who is just naturally graceful about errors, you get it right away.

    @Scott Exactly. 😉


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  2. […] only an EMT Basic.” and “It’s not my emergency.” Then we wrapped up with the illusion of control and the helmet / c-spine […]