How to Keep the Scene Serene

In 1995, not quite three months into my paramedic career, my partner Donna and I responded to a diabetic emergency. The patient, a brawny, combative, insulin-dependent male, was brandishing a two-to-three-foot-long metal bracket—something you’d use to support something else.

I knew from the man’s daughter that her dad had probably over-medicated himself. He’d done so before with the same outcome. The situation called for a strategic retreat until the police could be summoned, but I was still basking in the confidence of my new paramedic-ness, and was intrigued at the possibility of convincing our patient to put down his hunk of hardware so I could give him glucose. I moved closer, not all that mindful of danger.

Fortunately, Donna had called for help as soon as we got there. Arriving even before the cops was Andy, one of our most experienced EMTs, who suggested we all step back, especially me. I complied reluctantly, then watched as Andy struck up a conversation with the man from a safe distance and, over time, convinced him to drop the construction material and drink some juice. Our patient got better and I got smarter.

Being Unspectacularly Effective

EMS is more about avoiding battles than winning them. Leaders who respond to conflict with ego-driven defiance risk lives and compromise their reputations. Often the best way to maintain authority is to demonstrate it as little as possible.

From scene size-up to departure, priorities should be safety and assessment—neither of which I paid much attention to on that diabetic call until Andy showed up. I was more focused on “disarming” our patient than on safer alternatives. I felt personally challenged, and thought the best way to protect myself and my crew from our patient’s aggressive stance was with force. I’m not sure why; maybe I’d watched too many John Wayne movies as a kid. All I know is the idea of deescalating tension with patience and pleasant conversation, as Andy did, hadn’t occurred to me.

Getting the job done on scene in a way that works for everyone is difficult to teach. Classroom exercises often fall short of portraying real-world decision points, such as when and how to engage safely with patients. Even experienced providers can benefit by examining their potential weaknesses as leaders.

Leading Questions

Forget about medicine for a moment; think about your coworkers. Pick one with whom you’ve worked in the field recently, then ask yourself these questions about that partner’s performance:

Can he subordinate his ego to the job? EMS teaches us to be proactive in the field; to take charge. That doesn’t mean we can’t also take advice. There’s nothing wrong with asking for abridged opinions before making difficult decisions. Considering opposing points of view shows strength of character, not weakness.

Is he missing opportunities to do less? This will sound counter-intuitive to some, but I’ve learned to take pride in shutting up and letting my subordinates make things happen. That process begins with leaders who focus on good outcomes, not on who’s responsible for them. It helps to have a bias for delegation. Just enjoy watching your people show how capable they are.

As he leads, does he also serve? What should leaders do while subordinates are working effectively without a ton of oversight? Listen and help. Bring the stretcher. Carry the bags. Revel in a reversal of roles. Be mindful of big-picture objectives, but suppress the urge to speak just for the sake of being heard.

Does he ever succeed by doing the opposite of what others expect? Sometime during the second half of my career in the field, I started looking for opportunities to constructively deviate from whatever behavior was expected of me. For example, if we were on a difficult call, I’d try extra hard to show a relaxed demeanor, keep my voice steady, and even make harmless jokes to ease some of the requisite stress. Conversely, on non-emergent calls, when junior crew members expected me to participate in cynical commentary, I’d make a special effort to demonstrate concern for the patient, and to consider the possibility of a legitimate underlying cause for what appeared to be a frivolous complaint.

Can he be the sanest one on scene? The more authority you have, the more responsibly you have to use it. Effective leaders don’t succumb to the insanity of the moment—quite the opposite. They see themselves as possibly the only unbroken link between hostility and civility.

Does he ever stop setting good examples? Good leadership is about doing all of the above, always. If even one of your people try the same techniques when it’s their turn to lead, you’ve accomplished something lasting and exceptional.

Now turn the above questions inward. How do you think you compare to your partner? It’s not a contest—just a way to make your self-evaluation a little easier.

As I went through that exercise just now, I realized I’ve changed a lot since 1995. Although I still have to remind myself at times to say less, listen more, and not take opposition personally, I’m much more aware of my responsibilities to others, and am determined to keep coolest when conflicts heat up.

Thanks, Andy.

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