Hey There, Buckaroo

In the early days of EMS, especially in many urban settings, there was a “cowboy” mentality.  Paramedics and EMTs were expected to rush into situations, some more dangerous than others, swoop down, and scoop up their patients and then rush them off to safety.  I’ve heard stories of paramedics carrying everything from mace and collapsible batons on their belts to as extreme as a shotgun under their bench seat.

Paramedics from yesterday will tell you “It ain’t like it used to be” I know this for a fact because I say it myself.  As an 11 year medic, I feel I have earned that right.  Newer providers will sometimes try to emulate the “old days” in their own way, carrying black “whatcha gonna do” gloves in their pockets or knives visibly displayed on their belts.  It’s time for everyone to remember that times have changed.

While the environment that we work in is still strikingly similar to what it was fifteen or twenty years ago, scene awareness (not scene safety) is taught in a much better fashion.  Thanks to priority dispatch, we are able to deprioritize those less urgent calls allowing us to send crews into certain scenes with more help than they had before.   

It is time for us to abandon that cowboy mentality completely and move on to a more patient oriented focus.  As scopes of practices expand, as we are seeing in different parts of the country, the role of the prehospital provider is changing as well and we need to better prepare ourselves for that.  We are asked to solve problems every day, but now we need to use our brains more than our brawn.  A wealth of knowledge and a cool head will take us farther than brute strength and a led foot will.

I work urban EMS.  I have for the past twelve years, and I love it.  As someone who came from a calm, cool suburban background, the high volume, potential for high acuity and fast pace keeps me interested in the field.  I have, however, also come to realize that sometimes a safer response comes from either approaching a situation a little more slowly or even occasionally disengaging from a volatile scene instead of rushing into it.

I have never once worn a bullet proof vest, not because I don’t feel it is necessary but because I rely on scene awareness to keep me safe.  If someone considers buying a vest I always try and tell them to remember that while it might keep them safer in some situations, they need to not let it give them a false sense of security.  As a matter of fact, I have one colleague who carries one on the back of his seat.  He has put it on for a few calls, and I tell him all the time that the time he spends putting that vest on could be better spent relocating himself to someplace more safe for him and those around him.

Speaking of false senses of security, what about when the police department is on scene?  Does that mean that the scene is “safe?”  Of course not, but I think when they are present, we go into a scene with blinders on, less aware of the general picture.  While PD can certainly help keep a scene more orderly, we need to keep in mind why they are there: because the scene was for some reason unsafe to start with.  With the amount of disregard that people have for law enforcement, we cannot expect their presence to guarantee us our safety.

Over the two years that this blog has been on the internet, I have seen two scenarios, one in Mississippi that I wrote about previously and the second late last year in Oakland, California where a community official criticized paramedics for not rushing into a shooting scene, stating that they should because “people are dying.”  It is true that there is an inherent risk in this field.  Every day we step onto the truck, we are stepping into the unexpected.  The day could be a short one with maybe one or two low acuity, questionable calls, or it could be one filled with action, excitement and danger.  We do not know.  Ultimately though, it us up to us to minimize those risks and to be as safe as possible.