The Midlife Medic: Dangerous Assumptions

Here in the “Last Frontier,” I often feel like a foreign visitor. My responses and actions do not always align with the culture. Learning to adapt has been a challenge both fun and frustrating. At least sick and injured people are the common denominator—that’s a language I can speak.

One night not long ago, there was a call for a gunshot wound to which I was a first responder. One patient, the result of a foiled home invasion. A shooting—finally something I am fully familiar with, I thought. At least it falls within this city girl’s skill set.

I arrived on scene to find it secure. I checked with law enforcement and then entered the home, cognizant of things like blood spatter and shell casings. The patient was an elderly gentleman sitting at his dining room table with a bloody bath towel wrapped around his arm, his distraught wife with him. The primary survey was good—no life threats, bleeding controlled—we egressed. Outside the home the officers did some additional interviews with him, even taking photos of his wound. We loaded the patient into the ambulance and reassessed. His vitals were stable, bleeding still controlled. I released him to the care of the ambulance crew for treatment and transport to the hospital. Easy-peasy.

The next day at an operational meeting, my chief said, “You know they took a gun off that guy at the hospital.” I thought he was kidding at first. “He had a Derringer tucked into his waistband the entire time.”

How had I missed that? This is Alaska—everyone has guns (seriously). The old man is the one who foiled the invasion—why didn’t I think to ask if he had any other weapons on him? How did I get through an entire call without noticing it and/or remembering to check with law enforcement to see if he’d been searched before allowing the crew to take him? I had been so pleased with myself over how well the call had run (and it had), yet one crucial oversight left all of us at risk. I knew the answer, I just dreaded admitting it: I assumed.

I assumed that, because law enforcement had been there in force and for a while, when they said it was secured, it was. I assumed that a 75-year old man, huddled with his crying wife, was no threat. I assumed that because he was stable and the care was well-managed, a head-to-toe wasn’t necessary. Worst of all, I assumed someone else had taken care of a task that sat squarely on my shoulders as the operational supervisor on scene: the safety of my crew.

One of the gifts that come with age is confidence. You will never have seen it all, but you have seen plenty. Intuition is about coalescing all those fragments of past experiences into a sense of direction. After all, if you are reasonably sure what’s going to happen next, then things aren’t so frightening. If you haven’t seen it before, in all likelihood you will have seen something close enough, and it will inspire you to make a plan that will work.

Confidence is also contagious. It helps keep the scene calm, reassures the patient and their family that you know what you’re doing, and is a critical element to sorting through the logistics of a call. If it is not balanced out by dedication to good practices, it can make you dangerous. It can lull you into a false sense of security, luring you down the path of assumption into the pits of complacency. You get sloppy or simply cut corners because you are statistically certain everything else will be as you expect to be. Until it’s not.

Confident providers make mistakes too.

My crew was not in danger from that old man, but a firearm on board represents risk, and it should not have happened. What about the next time? A lecture I frequently give has to do with scene assessment, the importance of small details and how to stitch them together—not only for crucial situational awareness but to help you develop a cardinal impression before you even make patient contact. I drill into my students the importance of not relying on your assumptions. Yet here I was, in the wee hours of the night, making that exact mistake. Shame on me. What if on their next shooting call, they emulate what I did here and miss a weapon that gets used against them?

To my fellow silver-hairs, my challenge to you is to sit back and look at your practices. Are you cutting corners or disregarding details because you “know better”? If you are, then you are depriving those looking to you for mentorship of the advantage of developing solid habits in a culture of excellence. Let them grow up and make their own mistakes, not pay for yours because you assumed and got it wrong.

Tracey Loscar, NRP, FP-C, is a battalion chief for Matanuska-Susitna (Mat-Su) Borough EMS in Wasilla, AK. Her adventures started on the East Coast, where she spent the last 27 years serving as a paramedic, educator and supervisor in Newark, NJ. She is also a member of the EMS World editorial advisory board. Contact her at taloscar@gmail.com or www.taloscar.com.