Response Policies, or, Responding Red at 11 pm

Only part of the conversation...

I recently participated in a social media conversation started by a former colleague of mine who openly questioned the response to a working house fire. At issue wasn't the emergent response but the manner of the response. I don't normally engage in these types of conversations, because there is rarely any real resolution achieved. However, seeing as I was an unwilling audience to the cacophony orchestrated that evening, I joined in.

Some background: I live in a "planned community" east of Rochester, NY. Not much happens there at night; traffic is generally non-existent after 10:00 pm except for residents coming home or going to work. I've lived there for nearly 9 years, and it's not a bad place to catch some shuteye without the drone of vehicles all night. 

So imagine my surprise when, at 11:00 pm, I hear what can only be described as a "mayday alert" traveling through the neighborhood. Multiple pieces of apparatus were rolling through to the aforementioned house fire using every audible warning device available on the vehicle: siren, Federal Q, airhorn. Simultaneously, and without relief.

Now, I have absolutely no concern with using sirens at night. In fact, state law requires it when lights are activated. However, situational awareness (and a little common sense) might dictate that the usage of all warning devices is overkill considering the hour, historical traffic pattern, and no reports of persons trapped. Needless to say, my statements to these conditions did nothing to appease the supporters of the local departments. One poster continuously pointed to "thanking" volunteer firefighters, another pointed to V&T law (which I had already agreed with), then provided the "kill:" you weren't there so you don't know if vehicles were failing to yield; maybe they did it on purpose; etc.

Therein lies the rub: as a public safety professional, you are held to a higher standard. If vehicles aren't yielding, back off, don't drive more aggressively. If you're raising the dead on purpose, someone needs to be held accountable. These are not the actions of a professional. If it's attention you're desiring, it's attention you will get, though I doubt it will be positive.

I'm going to add my own theory, something I'll call adrenaline. Adrenaline is a funny thing: it makes us go into Sonic mode ("gotta go fast..."). Unfortunately, those in the business of responding to emergencies need to harness that adrenaline and slow down. Making all the noise in the world and driving like a man possessed isn't going to get you there any faster (or safer).

Department leaders need to start stepping up and reviewing their response policies. This is already happening with the agencies I work with: all BLS responses and many ALS responses are now "green." There's just no data to support the usage of lights and sirens to be a time-saver in all but the most extreme cases of medical severity (think choking, cardiac arrest, or stroke) or distance. Before I get heckled for my lack of knowledge of fire behavior, I get it: fire doubles in size in seconds. But again, unless it's the most extreme cases (such as people trapped), there is zero need to make yourself look foolish to those you ask to support you.

Has it really been five years?

Five years ago today, I experienced what to that point had been the most frightening situation I’d ever encountered. It actually still ranks up there in the top two or three in my mind. At 30 years old, with young family and the bulk of my professional career with the company, I lost my job. No explanation, no “thank you,” just an abrupt “your services are no longer needed,” and out the door. It was a cataclysmic fall from a meteoric rise…and probably the best thing that ever happened to me.

I can’t blame the company. I mean, I could, and I did, for quite a while after my “meeting” that morning. I’d never been dismissed from a company before, and to have it happen without as much as a reason why shook me to my core. After all, I’d done everything that had been asked of me. I took every position asked of me, dealt with the “slimming down” of the management team, took on tasks once handled by three supervisors. To an extent I saw it coming, especially since I was asked to come in on a day I wasn’t scheduled. But regardless of how much I prepared, the result was still shocking.

I spent many hours (okay, years) brooding over this, feeling as if I’d never accomplish anything ever again. Being the personality type that I am, that many of us in EMS are, I needed a reason why. Why, after so many years of success, was I suddenly un employable by the company I’d been at the longest? Why, after doing everything I was asked to do (and more, in my opinion), was I put to the curb? Where did I go wrong? I still don’t have an answer, and I probably never will.

In the end, it was a rude awakening that nothing in life can be taken for granted and that I was way too comfortable in my position. Looking back, I see now that I was ignoring warning signs that probably started almost a year earlier. I was getting subtle messages that things needed to be changed, yet I did nothing to heed those warnings. I’m much more attuned to those little messages now, though sometimes I need to hear them a couple of times before reacting.

I also learned that feeling sorry for yourself for any great length of time isn’t going to change things. It isn’t going to get your job back, and it isn’t going to help you move forward. It’s only going to make you more miserable and restrict you to seeing that which you have achieved, not what you can still accomplish. It took me way too long to learn that lesson, and I probably lost more than one job opportunity due to my state of mind. Since then, I’ve doubled down on my chosen career field, made decisions to pursue certain opportunities while letting others wait. I’ve opened myself to more opportunities, especially ones that are outside my comfort zone. And while I haven’t achieved the rapid successes that I had in the past, the victories are considerably sweeter because I’ve opened myself up to something new.

Are You "Facebook-Proof"?

If you're local in the Rochester area, you've probably heard of the Greece high school teacher who resigned a picture of her using some questionable language in the classroom was posted to Facebook. Regardless of who was right or wrong in this case (there are questions surrounding the intentions of the student, the student's mother, and the teacher), it is yet another glaring example of how the proliferation of smart phones and cell phone cameras can lead to someone's undoing.

The damage isn't limited to just cell phones and Facebook however. You may recall my posting last year of the FDNY EMS Lieutenant who resigned over comments made on his Twitter account. There have also been cases in the media of fire and EMS personnel behaving badly toward those who were seeking to record their actions for whatever reason. Before the claims of "HIPAA violations" are heard echoing across the nation, remember that HIPAA laws do not apply to the actions of every day citizens. Sure, there are personal privacy laws, not to mention social norms and mores that may be at play in the decision of someone to record those who are receiving medical attention. Unfortunately, there are still some who are going to do their best to catch you at your worst.

We, as a profession, must work our way to becoming "Facebook-proof." What exactly does this mean? Situational awareness is one phrase that comes to mind. Unlike many others, we work on a very public stage at times. Being wary of those around you should come as second nature, especially when it comes to the safety of you, your partner, and your patient. If you happen to look up and see someone recording, catch your tongue and your thought process before going off like a firework. Calmly explain that the patient deserves privacy and respectfully request the individual stop recording the scene. If they refuse, drop it, expedite your packaging and move the patient to your vehicle. If the individual is truly recording you, and chooses to make the tape public, your behavior (if they choose to show it) will show you as recognizing the situation, attempting to address it, then taking action to protect the patient. I would also suggest that you write an addendum or report to be filed with your supervisor attesting to the events should anything be posted later.

Demonstrating competency is something else altogether. Though we all would like to think that we do the right thing every time, there are times that we deviate from "standard practice," sometimes due to unforeseen circumstances...sometimes for other reasons altogether. If you catch yourself taking liberty with standard care for the latter, stop, gather your thought process, and do it the proper way. If you absolutely must deviate, explain what you're doing and why to the patient, then document it appropriately. If someone is present and recording, again this information will be captured. Remember that Hollywood has some very different ideas of what EMTs do, and public perception is often based upon what they see on TV, not in real life.

Last, but certainly not least: don't let Facebook tell your life. Choose your "friends" carefully, secure your page, and share wisely. You may think the photo of your buddy being passed out drunk in the front yard is humorous, but he may not. In today's connected world, all it takes is one misstep to bring someone else's world crashing down.