EMS Reruns: Mono-Medic

You’re first on the scene of a freeway collision involving an Excursion that rolled over an embankment, ejecting a mother, two small girls and their dog, and killing their husband and father in the process. The lady is awake and articulate, but perseverating and very upset. The kids have survivable physical injuries, but they’re absolutely freaking out over the loss of their dog, which ran into traffic and was killed by another vehicle. None of them yet realizes there’s another death.

Your partner, Wayne, happens to be a dog nut. He raises border collies, and loves those dogs more than anything or anybody. As the driver on this call, he’s supposed to be coordinating your incoming resources and initiating traffic control, but it’s just not happening. So far, you’re unaware of the dog. You figure Wayne’s is in deep space or something, so you ask him to switch roles and start triage. Next thing you know, he’s carrying the kids to the back of the unit in his arms. He gets in with them and closes the rear doors, like the rest of the call just never happened.

There’s an engine pulling up, so you brief them and ask for their help with traffic control and manpower. An hour later, you’re at a Level One mopping up and stowing your gear, all by your lonesome, and Wayne’s nowhere to be found. You eventually locate him in a trauma suite, standing at the foot of the bed with his hands in his pockets and a goofy look on his face. You give him a shrug, and point to the ambulance bay.

Q. Wayne’s an experienced medic. He’s better than this. I felt like the whole call was on me, and not having early traffic control could have broadened the scope of this incident—not to mention jeopardizing our safety. I was really cranky, but I couldn’t think of a way to start a discussion. Any suggestions?  

A. Nobody’s perfect. Working with any partner, there will be plenty of calls that don’t go just right. Silence is a good starter, at least for a couple of minutes. It gives an embarrassed medic an opening to apologize, and their apology can tell you how much they understand about what could have gone better. Specifically for that reason, it’s a good strategy with a student, too. But don’t let it drag on too long.

Q. As I said, that whole call simply blew me away. I couldn’t think of anything to say. It was a long ride back to the station, and when we got back, Wayne disappeared again. What was I supposed to do?

A. If silence doesn’t prompt somebody to communicate (like in two minutes), it’s time for another strategy. A good, neutral, non-accusatory way to find out what somebody’s thinking is to ask, “How’d that call go?” (By the way, that’s another good approach to use with students.) Why not just let ’em have it, if they screwed up? Because people generally do what they do for a reason. Sometimes the reason makes perfect sense to them. Other times, they just make terrible mistakes. (Or we wouldn’t have jobs.) And medics, even great medics, are people.

Every one of us is susceptible to factors that can make specific kinds of calls especially difficult for us, depending on what we’ve lived through. I think that’s one of the things that makes us more comfortable with some partners than others.

Q. What do you mean by factors?

A. This call had several features that would challenge even the best medics. Frantic kids are hard for most of us. Death notification is an important, but difficult part of an EMT’s job, and no death notification is harder than one involving a sudden death. It’s bad enough in a modern, well-lit ED, equipped with a nice, warm cry room, a physician, a wise old ED nurse, a cop who’s not busy, and maybe an experienced spiritual advisor of some kind. But it’s terrible on the freeway to have to tell family members in need of immediate medical care (including little kids) that someone in their car whom they loved and on whom they depended just a few minutes earlier is now deceased.

Then there’s the dog. Anybody who’s ever been close to a loving dog knows how hard it is to lose one. It’s harder, I think, than losing some people. Wayne sounds like a guy who gets that.

I’d ask him if he’s OK.

Thom Dick has been involved in EMS for 40 years, 23 of them as a full-time EMT and paramedic in San Diego County. He is the quality care coordinator for Platte Valley Ambulance Service, a community-owned, hospital-based 9-1-1 provider in Brighton, CO. Thom is also a member of EMS World Magazine’s editorial advisory board. E-mail boxcar_414@yahoo.com.