With every trauma call we run, there are two things that are almost absolute certainties. And I don’t mean that in the tongue-in-cheek sense, like, “We are certain that the elderly fall victim will live on the third floor and the elevator will be broken or nonexistent.” or, ”We are certain that the nursing home C.N.A. will call for that extended inter-facility transfer 12 minutes before the end of our shift.” type of certainty. I mean…even more certain than that.
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When people call us for trauma, these two things are certain.
1.) Two objects collided with each other.
2.) Someone called 911.
When we put these two certainties together, we can make some fair assumptions about trauma calls. Objects colliding with each other aren’t such a big deal. It happens all the time. If my fingers weren’t colliding with the keys on my computer keyboard, you wouldn’t be reading this right now. But nobody’s running off to call 911.
It’s the second certainty that gives us pause. You see, people don’t start activating 911 until things collide in uncontrolled ways. Trauma calls happen when things collide together in unexpected ways and with unexpected velocity. It’s as simple as that. Now that I’ve said that, it sounds so profound that I want to write it down again and put my name under it. Here:
“Trauma calls happen when things collide together in unexpected ways and with unexpected velocity.”
- Steve Whitehead
Doesn’t it sound more profound in quotes? I agree. …Lets move on.
As obvious as it sounds, it bears repeating for one simple reason. If all of our trauma calls originate with two or more objects colliding with each other, doesn’t it make sense to spend a little time learning the nature of how objects in our universe behave when they collide with each other? Regardless of what two objects collide, whether it be Grandma Smiths hip and her linoleum floor or a minivan and an SUV, there are some elements that are always true about the way things collide. When we understand them, we can better predict the potential for damage.
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Today we have a guest post from Sally Davison. Sally is one of the 
masterminds behind the website FireScienceDegree.com. If you’re looking for a degree in fire science, Sally’s site offers what just may be the most comprehensive, no nonsense resources on the inter-web.
Sally also knows her way around the EMT field and has some advice for new EMT’s preparing themselves for the prehospital environment. She welcomes your comments at sally.davison091@gmail.com Please give her a warm welcome.
There’s much more to being an EMT than just providing emergency medical care alone; in most situations, you are much more important than doctors and specialists because your timely response and actions help:
- Save lives
- Save limbs and prevent lifelong and debilitating disabilities
- Prevent brain damage and other consequences that happen when first aid is not provided immediately
- Prevent people from going into shock
- Stop uncontrolled bleeding
There are many other ways in which EMTs are extremely useful, and because of this, most victims are grateful for and satisfied with your work. However, there are some occasions when you are called upon to do much more than just administer first aid or provide medical care.
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In Greek tragedies, the hero typically displays some form of hamarita, also known as a “tragic flaw.” Hamlet was brooding, Othello was jealous, Macbeth was ambitious. For the most part, it is their tragic flaw that is usually the key to their undoing. When the hero ultimately falls, they tend to sow the seeds of their own demise with their respective tragic flaws.
People often use the word hero when they refer to EMS caregivers. EMT’s, paramedics, firefighters, we all get the hero moniker pinned on us from time to time. I cringe at the term. Most of us are uncomfortable with it to different degrees. And, if there is any truth to our hero title, it is certainly closer to the heroes of Greek tragedy that the comic book heroes we grew up with.
In other words, we all have our tragic flaws. Yes, all of us.
Here are eight of the most common tragic flaws of the EMS hero persona. I have, at one time or another in my career, embodied each and every one of these flaws to one degree or another. I’ve lived each one of them. I would guess that most of us do.
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I once thought that part of the goal of being a competent paramedic was getting to the point where I no longer felt any fear or anxiety about running calls. After all, most of the folks I worked with appeared to be absolutely
fearless. At least the competent ones did. They never go flustered or rushed. They smiled. They remained calm in the face of very real emergencies. I needed to be like that.
Eventually I figured out how to act like they acted, but I never really mastered the whole not-feeling-any-fear thing. It nagged at me for a long time. It took me almost a decade to figure out the secret.
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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.
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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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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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We all have our good calls and our bad calls. Don’t we? Sometimes things just flow. Sometimes the patient, the bystanders, the crew members, everyone just clicks. And it’s beautiful. It’s like that perfect drive off the tee box that keeps you coming back for another round. The three point jumper that makes you wonder if you should have tried to play college ball.
Unfortunately (perhaps) it is the rare scene that runs flawlessly. More often than not we look back on our calls and think about the things we could have, and should have done better. Of course, that’s how it should be. Without those moments we don’t grow or become better. Some EMT’s carry the philosophy that we should emerge from our field instruction with flawless medicine. Nothing could be further from the truth.
Here is my list of five common trauma scene mistakes I have encountered frequently in my career. I am guilty of doing all of these, some with painful frequency. In those moments of personal scene review, I rank these as my top five, “I wish we had done that differently.” items.
#1 Failing to manage the scene.
We learn a lot about patient care in school. Unfortunately our education regarding management of the scene may be limited to being taught to blindly recite the words, “Scene safe, BSI” as we enter our skills stations. Scene management can be hard. Especially management of big scenes with multiple priorities like calling for more resources, assessing hazards, protecting bystanders, interacting with family and friends of the injured and triaging multiple patients.
On these scenes, patient care suddenly becomes a warm comforting blanket. Caring for one patient seems so much more manageable. Patient care priorities like holding c-spine and doing an assessment call to us like a sirens song. Don’t do it! It seems obvious but, when it’s your job to manage the scene, manage the scene.
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