“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.

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L.C.E.S. For EMT’s

Some of you who are familiar with wildland firefighting are already well versed in the safety acronym L.C.E.S. It was developed in 1981 and continues to be taught in wildland firefighting curriculum as a handy checklist of things we should have in place when operating in dangerous environments where conditions can change fast.

L.C.E.S. came about when retired U.S. Forest Service Superintendent Paul Gleason looked at fatal fires over the previous 20 years and identified the four elements most likely to save your butt when stuff goes really wrong. The acronym he created is simple and it works.

In wildland firefighting changes in weather and fuel sources can mean that the operating conditions can go from good to “everybody run” in the blink on an eye, so L.C.E.S. is practiced pretty religiously.  One area of EMS where I feel is has tremendous application is when we’re working in traffic on accident scenes. I’d like to see us EMS folks adopt the L.C.E.S. mindset any time we’re working in the street or on the roadside.

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The Ultimate EMS Protocol

I don’t handle the card much anymore. It stays inside a plastic sleeve in my planner. The edges are worn and the words are faded. It wasn’t printed on kind of paper that travels well in a wallet for twenty plus years. But it’s been worth carrying. It is, quite simply, the ultimate EMS protocol.

I don’t read it often. I’ve read it enough times over the past two decades to have it pretty well memorized. It’s my STAR CARE card.

I got it back when I was a paramedic student at Baystar Ambulance in San Mateo California. It was 1992. I always believed the original author was none-other-than EMS guru Mike Taigman. Mike had signed on to be the quality care guy at the fledgling service and I knew the cards had originated in his office.

The idea was simple. We can’t write a policy for eveything you may encounter in the field. Instead, use this guideline. If the decision you’re about to make passes these eight tests, we support you. NO matter what. Come hell or high water … we have your back.

It’s brilliant really. It’s the policy to end all policies. It’s the grand daddy algorithm. It’s the ultimate protocol.

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The Normalization of Deviance

In the span of a generation, NASA has lost two spacecraft and 14 pilots in the collective disasters of the space shuttles Challenger and Columbia. Can you tell me why? Trust me, it’s worth exploring.

The space buffs in the crowed might recall that faulty O-rings in the Challenger’s solid rocket boosters failed and allowed supper heated gasses to escape. The result was a catastrophic explosion and a sullen announcement from my school principal in the middle of sophomore science class. In his quiet monotone, we learned that the mighty Challenger, moments before, had been destroyed and the crew was lost.

Our teacher didn’t know quite what to say, and in the silence that followed, my sixteen year old world got a little smaller.

More of you might recall that Challenger’s sister ship, Columbia, burned up on reentry returning from a mission in 2003. The Columbia’s heat tiles were damaged when a piece of foam insulation dislodged during takeoff and struck the tiles on the wing. Those tiles later failed under the heat of reentry and the craft burned up over the mid-west. Interesting right? But what does all this have to do with EMS? Follow me on this next part.

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The Oklahoma State Trooper vs EMS Mess

This has gone on long enough and gotten big enough that I feel compelled to say something about it. By now I’m sure you’ve seen and heard all about the Oklahoma State Trooper / EMS roadside circus.

First we had the cell phone video of an upset family member recording an odd looking scuffle between an Oklahoma State Trooper and an ambulance crew on the side of the road. It starts with a narrative by the family member and ends with the ambulance dude in a disturbing looking choke hold.

Then the driver of the ambulance went public and started giving news interviews, stating he was compelled to do so by the statements of the trooper in his report. Somehow he felt that the media spotlight would be the best place to get this off his chest. He was followed by his partner, calling for the officers badge on The Early Show.

The OSP finally released the dash cam video showing an ambulance yielding appropriately to the officer and never taking the aggressive swing at the trooper as initially reported. Then the biggest clown of all chimed in when the OSP lawyer held a press conference to say that everything we saw on the tape was normal and appropriate except for the gross negligence of the ambulance crew failing to yield for a full 24 seconds. What?

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Hydrogen Sulfide Suicides Come To The U.S.

Be Aware of This New Trend 

Two recent suicides in the US have brought a disturbing Japanese suicide trend to the media forefront. I must admit that I have some trepidation about posting this story. This seems like one of those things that becomes more popular the more it is reported. I’ve decided to write about this because I believe that, if this trend continues, sooner or later, an Emergency responder is going to get hurt. I think this info is worth passing on to other responders …. discretely.

Over the past several years Japan has been hit by a wave of suicides involving hydrogen sulfide gas. Some sources like USA Today report a death toll of 517 and climbing.

Apparently, significant amounts of hydrogen sulfide can be created by mixing household detergents and liquid cleaners together. How much is significant? Enough to kill everyone in the room where the chemical is mixed, evacuate an apartment complex and send 10 other individuals to the hospital.

Some of these deaths have been linked to group suicide pacts. Most of the dead found the recipe in internet chat rooms and online suicide forums though the recipe was even published by Bloomberg at one point. (The media outlet later rethought the idea and removed the article from its online database.)

I consider myself fairly internet savvy and after a 15 minute search, the exact recipe to kill myself with hydrogen sulfide eluded me. I did find one source willing to name two specific products, but details regarding quantities and technique were mindfully absent. I wouldn’t say that the instructions for this type of suicide are “readily available” as some media outlets have claimed, but I’m certain that the information can be found by those suitably motivated to go forward with this plan.

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