We pay a lot of lip service to “saving lives” in EMS don’t we? From our sarcastic replies to the polite greeting, “How’s your day going?” to our citizen “Life-saver” awards, the saving lives terminology and mentality pervade our industry. The media raves about life saving technology and we debate if our interventions were truly life saving. And the cold, hard truth of the matter is, none of us have ever really saved a life. Not one of us.
I’m sorry. As much as I hate to burst the life-saver bubble, I think it’s time. I think it’s time to rethink our life-saver mentality. The more I learn about emergency services and the complexity of modern medicine, the more I see the truth. This is the truth I see.
We are a small sliver in the pie that makes up a patients entire course of care. Our role is deeply significant and in many cases essential, but EMS does not exist in a vacuum. We are one person, in a team of thousands, who are all essential to proper patient care.
Let me put it to you this way.
Let’s go back and take a closer look at the last life you saved. Perhaps it’s a mid-sixties male who was found in cardiac arrest. All the stars aligned. He had good CPR. You were positioned close to the scene. You walked in, defibrillated a coarse v-fib and got a pulse back. A week later the dude walked out of the hospital with two new stents in his left anterior descending coronary artery and a full plan for rehabilitation and a return to health. Ta-da. Well done.
Now picture yourself standing in the middle of a football stadium. The stadium is empty. Make it a big stadium, because we’re going to start to fill it pretty quickly.
Let’s start with that guy who did good CPR. Surly he needs a seat in the stadium…front row, fifty yard line. But wait. He didn’t teach himself CPR. He didn’t invent the technique. Put his CPR instructor next to him. That gal did a great job teaching him. And while we’re at it, let’s put her instructor-trainer next to her. But none of them created the technique of CPR. Let’s put all the researcher who contributed to the body of knowledge that is our current understanding of effective CPR right along side of them. The stadium’s starting to look full and you haven’t even arrived on scene yet.
How about the 911 system. The call went through to a well trained dispatcher who sent the right unit and gave good instructions. The 911 system was well designed to place the resources in the proper area. So now let’s add them all to the bunch. This dispatcher, the dispatch trainer, the dude who designed the EMD system, the I.T. gal that keeps the computers running smooth, the radio technicians; all of them played a role. And while were at it, let’s not forget the ambulance mechanics. They need to get their job right every single time too.
Now that you’re on scene, lets talk about that fancy defibrillator. I’m sure the design team, the engineers and the technicians at Zoll would like a few seats in the stadium. Lets put them
down in the lower deck. Add in all the folks who contributed to defibrillator design and development over the past twenty years. You didn’t create that fancy machine yourself did you? How about the researchers who figured out that defibrillating the patient right away was the right move? They’re going to need a whole section. Box seats go to the instructors who taught you ACLS. We might as well have a party-section for all of your instructors.
Holy guacamole. We haven’t even left the scene yet and our stadium is filling up far to fast. Where will we put the doctors, the nurses, the cath-lab technicians, the specialists, the physical therapists, the dozens of technicians and lab workers and all the folks who trained them. How about the cleaning staff that made sure the patient didn’t end up with an extended ICU stay for a MRSA infection or the dietitians that dutifully served low sodium foods each day. We’re going to need a big, big stadium.
Now let’s come back to you, standing proudly on that 50 yard line. Let’s give you a microphone and hook you in to the public address system. Let’s give you a chance to talk to all those people that played an essential role in this patient’s care. Think about it. If any one of them didn’t show up and do their job correctly, the patient’s course of care could have been much different. But they did show up. They showed up and did their jobs, just like you did.
What will you say to them?
I doubt you’d have the hubris to say, “I saved this guys life.” I imagine you might say something like, “Thank you for letting me be a part of such an amazing team.”
We fill a privileged role in EMS. We are the public face of an amazing team of people. We get to be there at the moment of truth. Sometimes we get to perform the intervention that keeps the whole ball moving forward. We get to perform our jobs right there in the public eye. Sometimes people who don’t understand how it all works get the misguided impression that we saved someones life. When they make that mistake we should correct them.
We owe it to the rest of the team.
What do you think?: Do you save lives? How do you see your role in the emergency medical process?
Read More EMS Goodness:
I see a lot of your points, Steve, but at the same time, there’s that little part of me that is divided.
A lot of what you are talking about is contributions to the process. People teaching people, people putting that technology together to help make a difference, but it takes a special person to gather up all of that information and technology and execute it.
Right place at the right time? Absolutely. Could another similarly trained provided have made the same difference? Sure. But that person was there, and was able to apply what they had learned and lead that team of skilled providers.
I think though that if you want to look towards real true life saving events, you need to move away from the Cardiac Arrest scenario.
Case in point:
I was working my part time job last summer, and a guy walked into our station. All he wanted was some tylenol for the jaw pain that he had. Once he stepped into the light, I got a good look at him, and man, he didnt look good at all. I convinced him to let us check him out a little bit more, got a blood pressure on him, and through a deeper assessment, I found that not only did he have jaw pain but he also had chest and arm pain. That led to the 12 lead, which showed a clear and definitive STEMI.
So here was this single father with his kids insiting that he hop in his car and drive home. I wasnt hearing it. With a lot of persuading, we were able to convince him to take a trip to the hospital with us.. it was going to happen, because I wasnt going to take no for an answer.
We packaged him, and 45 minutes later, he was in the cath lab where his 95% occluted LAD was corrected.
Was I trained by ACLS instructors? Yup I was, and I thank them for that. Did Physio do a great job giving me a machine to show me that MI? You bet, but it took our recognition skills, and our ability to change this man’s mind and start his treatment and get him to the hospital. Were we a piece in the life saving chain here? Yes, but in this case I feel that we were the most vital.
I could have never taken ACLS and realized that this guy was sick. Physio’s monitor could have failed, but I had my assessment to fail back on. If we had let him walk back out that door and go about his business, he’d be dead right now.
The Cardiac Cath is what truly saved his life, but without that access, without him using that gateway into the system that is EMS, we’d had two kids without a father today.
We saved his life.
Thanks for your post, Steve. As always, they are very thought provoking!
I’ll see you in Dallas.
Scott
I get the whole being a part of the bigger picture. This can be applied to just about everything.
Does the firefighter put out the fire or is it the water?
Did the salesman make the sale or was it the product, marketing and brand?
If it wasnt for my mom and dad kissing on that 3rd date (my mom is ole fashioned) I wouldnt be here.
Like Scott mentioned, without that integral part of the puzzle. The FF, the salesman or the EMT, the fire wouldnt get put out, the sale made or the life saved.
So while I sometimes feel that I can do say 6 calls on a shift and go home feeling like I didnt help anyone. Recognizing a STEMI, having a ROSC etc, does mean that a life was saved becuase of me. Me being part of the big wheel that I am just a spoke in. But without that spoke the wheel is gonna be pretty wobbly.
Steve, this is an interesting and timely post for me. Because of a recent job change I have been thinking a lot about how I can contribute and be a part of EMS without being involved in the hands on patient care. I would rather be on the sidelines or background than standing on the 50 yard line.
I think standing on that 50 yard line, I would say “We saved a life!” Yes, we’re all vitally important, and I owe so much to my instructors, all the bloggers who’ve taught me, my coworkers, my dispatchers, the bystander, the researchers, the equipment engineers, the firefighters who helped carry him down the three floors of spiral staircase… everyone you said.
I think it’s even more impressive that a team that large and interconnected can work together so vitally when it really matters; that everyone, doing their tiny part, can get this guy back on the street. Does that mean I didn’t save a life? No, it just means I didn’t do it alone.
My first reaction here was to thank you for trivializing what we do and reinforcing the whole we’re just amblance drivas personna. But after staring at the blank screen for an hour or so tryng to figure out how not to write an expetive filled rant, having a few smokes, and doing my relaxation exercises, I can except that you were promoting the whole team aspect rather then just trying to insult me.
Let me say that I am not a beating my chest, I’m a hero, pat me on the back type of guy. I am not a hero, neither was my cousin who died in Tower 1 on 9/11. The hero’s were the guys that went up the stairs instead of down, took the plane down in PA, and fought the fights after, but I have spent years promoting I guess what you would call the direct opposite of what your post implied.
My pet peeve in EMS is the whining and bitching about the so called BS calls. Maybe it is not saving a life as much as making a difference but I’ve have spent years preaching how both are intertwined. Maybe there are no traumatic injurys in the MVA but your actions may keep someone from going into shock. Proper immobilization, even of a non life threatening injury, maybe keeps a person from paralysis, which maybe they could or couldn’t have handled (or lived with) certainly you changed thier life if not “saved’ it. You notice and report abuse, domestic, child, elder, do you have to bring some one back from the brink of literal death to save their life. What of the old man who calls for no apparent reason other then he’s lonely? Is it possible that your presence there kept him from sitiing in his garage with the car running and the door closed?Is it possible that you saved his life?
I dont think that there are to many of us that would be out on your fifty yard line alone and i don’t see the harm in celebrating a job well done even if we don’t acknowledge Henry Ford for inventing the automobile and starting the company that would eventually build my ambulance.
@Scott. Great example. I agree. And it makes my point perfectly. We are critically important to this whole system. In your chest pain example, if another dude showed up to work that day and he didn’t want to look any farther, that guy may have died. He would have at least lost a bunch more cardiac muscle than he needed to.
But you showed up, and you did your job, and the dude is alive and well.
But you can’t show up alone and make that happen. Everyone has to show up. Everyone is vital. In this case, you were the linchpin that made everyone’s effort in the stadium worthwhile. Without you, everyone else could have showed up and the dude still would have died.
I’m sure he’s glad that you showed up. When he says thank you, don’t forget to mention that you didn’t do it alone.
@Jim When I’m on the nozzle, I would say that the firefighter puts out the fire. My engineer would say it was the water.
Both are essential. Love the spoke analogy.
@Greg And i would say that you can make an essential contribution and save even more lives by passing on what you know through quality education. You still have to show up for work and do it well. And your impact can be enormous.