Role-Playing

      Rob is a paramedic in middle Tennessee, not far from where I live. Some folks kid him about his northern accent. Rob doesn't mind; at most, he'll remind his tormenters why Jefferson Davis' portrait isn't on any U.S. currency.

   On the second Tuesday of September, Rob will answer alarms, just as he did eight years earlier. This time, however, there won't be any 110-story landmarks falling on his head. As happy as that makes Rob, his mother is even more relieved. She knows the invincibility of youth is an illusion, vulnerable to maladies and madmen.

   Rob was one of the most seriously injured 9/11 responders transported to hospitals east of New York City. I know because I was the county administrator assigned to keep track of those things. As Long Island's command and control apparatus geared up for an influx of casualties that day, terse updates from area hospitals led to a grim conclusion: No one was dying because no one had lived.

   When the second of two jetliners struck the Twin Towers, I received a frantic voice mail from my home district's EMS agency to get my gluteus maximus on an ambulance bound for Manhattan. I couldn't comply because I was running medical control 50 miles to the east. It bothered me, though, to be managing my little corner of the crisis from a desk, rather than in the field. My role as a medic, hardwired to my psyche since Day One of didactics, was rescue.

   I picture EMS personnel responding to Ground Zero with that same hands-on bias before capitulating to medical and environmental factors beyond their control. Our colleagues encountered the ultimate uncontrolled scene. Their perseverance was remarkable, yet I'm not sure those rescuers ever got enough credit for meeting two of our profession's basic criteria:

   They showed up. Woody Allen once attributed 80% of success to showing up. His point, I think, was that outcomes of risky endeavors depend on participants' willingness to engage the unknown. How many people fleeing lower Manhattan on 9/11 would have accepted that challenge? I doubt more than a few citizens could have been coerced to make a 180° turn and stand by to help others. Even in less frantic times, the urge to look away hinders selflessness.

   I suspect there are many who'd like to have been in EMS without wanting to be in EMS. The after-action high is exhilarating, the camaraderie is compelling, the tools are cool, and the pay is...did I mention the camaraderie? If it were possible to live that life without having to mortgage one's mental and physical well-being, everyone would do it.

   Responding to emergencies is an unnatural act. The fact that we pay people for that--to show up even when death and disorder threaten their own families--does not diminish their contributions.

They adapted. We tell the uninitiated that EMS isn't for everyone because of graphic trauma and devastating illness, but the chaos quotient is an obstacle too. Exceptional EMS providers prepare to be surprised, deceived, enticed, endangered, alarmed and appalled. They understand that adapting to the unexpected is a full-time job.

   Before I got started in EMS, I was a card-carrying member of corporate America. For us, adapting meant getting accustomed to a new office, a different boss or "heart-healthy" cuisine in the cafeteria. There were inconveniences and indignities, but nothing like what you might find, say, at a train wreck managed by an interagency junta. Achieving competence in an industrial environment isn't complicated; it's mostly about learning lines, like a character in a long-running play.

   If the business world is Broadway, then EMS would be a night at the Improv--no script, only guidelines buttressed by the players' talents and instincts. Our roles are dynamic: students one day and teachers the next; drivers one shift and technicians the next; hand-holders one call and lifesavers the next. Perhaps our hardest role is staying ready, waiting for someone or something to prompt our next move.

   I've participated in dozens of drills designed to simulate death and destruction, but I doubt any amount of moulage can prepare one for an apocalyptic scenario. I don't know of an EMS curriculum that includes "Introduction to Skyscraper Collapse" or "Ballistic Airliners 101." WTC responders confronted casualties and risks well beyond the scope of their job descriptions; yet they embraced unfamiliar roles as our nation's first agents of homeland security, armed only with expectations of survival. We remember them with admiration and compassion.

   Rob, our transplanted medic, isn't only a survivor; he's my son. He showed up, adapted and played his role. That makes me very proud.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World’s editorial advisory board. Contact him at mgr22@prodigy.net.