Don’t teach them everything you know

If you have reached this stage of “cautious confidence” and practice in a system that affords you the opportunity to make such calls, this article is for you. I extend to you a thought that may not have occurred to you in regards to such practices. If you happen to find yourself with a new probationary member/employee, (rookie or recruit), you may want to consider the following.

He or she is looking up to you and taking note mentally, and sometimes literally your decisions and actions. They are basing their future independent practices upon what they learn from observing you. While this is a good thing and what is supposed to be taking place, they may misjudge how to handle certain scenarios.

Here are some examples: Your system doesn’t utilize EMD (emergency medical dispatch) and all responses are supposed to be emergent with lights and siren. You do, however have a mobile data terminal that provides detailed information provided to the telecommunicator by the caller. The call was for “headache.” While we are all aware that a headache could be an indicator of a critical event such as a stroke or aneurysm, you read the details of this particular event: The patient is 14 years old, left their glasses at home, strained to read in school and has developed a worsening headache that started hours ago. You’re only five miles from the call and you choose to respond non-emergently. This is probably a very good idea, appropriate for this call. It would be tragic to be involved in a fatal collision on the way. It should be made explicitly clear while reminding your trainee of the potential emergent etiologies of headaches, if no details are available, an emergency response is warranted.

You’re dispatched to a gunshot wound with police not yet on scene, and your response time is less than 10 minutes. The scene must be secured by law enforcement prior to your entry. It is absolutely senseless and reckless to respond emergently fueled by adrenaline often associated with this type of dispatch, only to sit and wait up to 10 minutes for the police to notify you of safe entry. Again, it would be particularly tragic to become involved in a collision in this scenario, when patient outcome and response time would have no ill impact from a safe, nonemergent response.

Without going into lengthy detail, here are a few areas where experience and judgment may vary based upon experience:

• The decision to institute spinal precautions
• Diverting to or bypassing hospitals
• Canceling a helicopter when you anticipate a fatal outcome for a trauma victim
• Sending a patient with BLS care vs. ALS care
• Allowing a patient to waiver AMA versus medical control or law enforcement involvement

There should be little room for argument when solid fire ground tactical procedures exist, however this same concept applies when preparing a firefighter for the role of company officer. Below are some aspects of the fire service where decisions may be based upon the experience of the officer in charge:

• Offensive vs. defensive fire attack
• Water can, booster hose or 1¾” attack line selection
• The extent of damage necessitated by evaluation of fire extension
• Laying in or instituting water supply on fire alarms
• Response and staging levels of responding companies on alarms
• The degree or effort of searching for victims in the area of unattended MVA’s
• How to handle subsequent alarm activations at the same location

Again, making decisions based upon a level of “cautious confidence” attained through years of experience most often results in making the “right” call. Keep in mind that experience cannot be taught, and operating procedures, tactical plans and protocols should be followed more closely by new paramedics and company officers.