Beyond the Books: The Three-Second Pause

I remember the call like it was yesterday. As we rolled into the scene, we immediately saw the “man down” we had been dispatched to. Even from a distance, it was apparent our patient was covered in blood. As we got closer, we saw plenty more blood on the ground around him.

Fortunately for both the patient and my EMS team, a steady drizzle had made the bleeding look far worse than it really was, but he still had significant blood loss from the 30-inch chainsaw that had carved its way into his left thigh. As with any call like this, the first few minutes were pretty hectic as we worked to control the bleeding and establish vascular access, leaving us little time to connect and socialize with the patient.

With the bleeding under control and two 16-gauge IVs in place, things were far more stable than they had been a few minutes earlier. As we got the wheels rolling toward the trauma center, I had a chance to get some background information on just what had gone down. As the story went, he was out chopping up trees that had come down in a windstorm a couple of weeks earlier. None of the trees were close to the size that required such a hefty chainsaw, but he told us his 14-inch electric saw wasn’t working and he was tired of hearing his wife complain about the mess in the yard, so he decided to get his “big boy” and take care of business. As you might have guessed, adult beverages were involved, and that’s never a good thing when using a chainsaw. He ended by admitting he was just trying to wrap up the project and get out of the rain when he stepped onto the logs and made the next cut between his legs. He was almost through the cut when the saw bound up, kicking the saw upward as he fell backward, with the end result being a massive 10-inch cut into his posterior thigh that miraculously stopped just before digging into the femur.

Having finished his tale of woe, he looked at me and said, “I guess what I did was pretty stupid, wasn’t it?” To me, the answer was a no-brainer, but as I had been taught earlier by a sage physician, I gave a three-second pause before offering my reply: “I don’t believe it’s the best choice you’ve ever made.”

Arguably, one of the more profound observations about our profession, which I’ve heard dozens of times, is: “Unless stupidity and alcohol are outlawed, employment opportunities in EMS remain golden.” While the message remains a bit glib, one cannot argue the validity of the statement. We see countless events that are the result of drinking and doing something stupid shortly thereafter.

That being said, it is important to note that stupid things are not solely in the domain of stupid people. I had a 24-year-old patient with a BS degree in physics who hit one of his father’s nitroglycerin tabs with a steel shank hammer to see if the substance remained “explosive” after being made into a pill. His got his answer when part of the hammer was blown off, tearing a massive rip in his face as it went by. You don’t get a BS in physics by being stupid, but hitting a nitro tab with a hammer would never, ever get placed in the Smart File.
Part of the practice of quality prehospital care is our commitment to treat each and every patient with courtesy and respect. Of course, woven into that is the need to communicate with patients honestly. To tell a patient he is going to “feel a little stick” when you are holding a 16-gauge IV in your hand is an outright lie. Any catheter you can almost see through is by no means a “little stick.”

This is where the three-second pause really comes in handy. That brief interlude actually gives patients the opportunity to answer their own question. At times when the patient doesn’t add up the numbers quickly and accurately, you still need to answer the question. In that case, the three-second pause gives you time to come up with a truthful answer that doesn’t bludgeon the patient emotionally. Like the question from my chainsaw-wielding patient, I could just have easily answered, “Hey, I just Googled the word stupid and your picture came up immediately.” Clearly, that is an unprofessional response that serves no purpose other than to humiliate another human being.

The next time you get tossed the question on stupidity, be kind and courteous as you count to three and deliver the answer. It will serve to soften the blow of your message.

Until next month…

Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma
Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.