How do we make decisions in EMS? Sure, we are guided by our protocols and medical control, but truthfully what is our focus when we make a decision as a paramedic or EMT on an emergency call? Is it fair to say that most of those decisions are based on what is going to happen in the next 15-20 minutes? In the most critical instances, I’d say that it is.
When we work a code, we are fighting for that ROSC. We want it quickly so the patient has the best outcome. On a STEMI call, we are basically doing prep work for our patient’s trip to the cath lab. Those IVs we start, the medications we give, and the serial 12 leads we perform are all gauged to getting our patient through the ER as quickly as possible. For a trauma patient, often times surgical intervention is the focus. Unless there is some other underlying cause of that trauma, “medical” treatment is usually not necessary, or secondary to the potential surgery they could receive when they get through the ER.
The next 15 minutes. That’s what matters. It is what we are trained to deal with. We are there to deal with these acute emergency situations and quickly bring calm to the chaos in the best way possible. When you want to transition from the streets to the front office, how does that thinking change though? How do our problem solving processes have to change?
In the field, the attitude of “just do it and get it done quickly” is great, but that doesn’t translate well to making decisions that could effect departments that might be staffed by hundreds of providers. Messages need to be clearly relayed, and people need to be given notice of change. That’s the unique thing about EMS. It’s a 24/7 business, and implementation can be a real challenge. You can’t close the doors on Friday, and tell your people that “Monday morning, we are changing ‘X’ ‘Y’ and ‘Z’” it just doesn’t always translate well.
This is where I feel great field providers struggle in the transition to be great supervisors and managers. The critical thinking and problem solving in the field differs so much when making those same decisions in the front office.
In a management role, one must identify the problem, hypothesize the cause, come up with a solution, test the solution, and reevaluate to determine if other changes are needed. Â All of the necessary information might not be right there at face value, so some digging, gathering, and analysis might be needed.
When solving for the next 15 minutes, time lines really aren’t that important. Our “deadline” is when that truck arrives at the ER. In the business and management world, they are everything. Timelines need to be set and stuck to. It gives us a chance to evaluate progress, and adjust our course if needed. Also, involve the team in the problem solving. As a provider leading patient care, it is often difficult to welcome input because things need to get done. When dealing with business plans that’s the exact opposite. Other points of view and solutions could be exactly what you were looking for.
Finally, communicate. Just like that radio report and patient report at the ER, keep those that you are serving up to speed on what is going on. People who feel that they are involved in the process are much more likely to be involved in, support, and drive a potential change. That kind of communication starts from the top. It doesn’t mean that you should have to see every single employee who works for you, but those who serve immediately under you should know the full story so they can then share it with those who serve under them.
In the challenging, adrenaline fueled world of EMS, fast problem solving often with a Macguiver’esque attitude and ability will often get the job done. When managing a department though, it often leads to failure and confusion. Take the time to do things right the first time, get your people involved, and let them know what is going on. They will appreciate you for it.