The Perception of Time

You are the medic on a busy urban unit dispatched to a serious call of your choice (cardiac arrest, shooting, STEMI, you pick it).  You arrive on scene, and get straight to work on your patient.  IV’s are started, maybe the patient is tubed, a 12 lead is done.  Holes that were not there before the incident that are not a direct result of actions of you and your partner are plugged.  You feel like time is dragging on, and you need to get going.  The patient is loaded, and your truck rumbles off lights and sirens blazing to the closest appropriate facility.

Once you arrive at the ER, the patient is turned over to their staff, and you retreat back to your truck to write your run form.  All that is going through your head is “boy, we were on scene for a while, I need to justify this.”  You sit down in front of your onboard computer in your unit and wince as you bring up your times.

Your eyes, however, get big as you do the quick math, and realize that you were actually only on scene for 8 minutes.  You share your surprise with your partner and move on to your run form.

Anyone who has been in this field for any amount of time has experienced an incident similar to the one above.  When an emergency happens, time just seems to slow down.  Everything moves in slow motion.  If the experience of that sensation is true for someone who is a trained medical responder, imagine what it is like for someone who has no training.  Seconds feel like a minute.  A minute feels like five.  The perception of time is so incredibly subjective.  The reality of time, however, is not.

This is why we have dispatchers who track times.  This is why most of the cardiac monitors out there today have event logs that allow you to track what you do and when you do it.  This why when you arrive at the ER with just about any critical patient, there is one nurse who is dedicated to charting.  Accuracy is so important, and one must overcome that perception of time to maintain accuracy.

Now, apply those principles to the plane crash in San Francisco last week and the video report released by the Associated Press that JEMS publicized to prehospital providers.  The headline reads: “Asiana Passengers Called 911, Begged for Help.”  The clip itself is just shy of two minutes long and features three 911 calls from passengers on the Tarmac.  Three of those calls feature the voice of a woman who grows increasingly angry and upset from call to call stating that there was not enough help there for the people that are injured.

The general public needs to realize that there are a number of factors that play into an incident beyond the subjective perception of time that I discussed above.  For one, there is the safety of the responders which the AP quotes San Francisco officials, saying that “ambulances could not come too close to the plane out of concern that the plane would explode.”  This is the first rule of EMS: survey the scene.  Do your best to guarantee the safety of responders to the best of your ability.

Then, let’s move on to the concept of triage.  The general public needs to realize that the most imperfect skill that we practice in EMS is triage.  Mistakes are going to be made.  “RED” tag patients might end up as “YELLOW.”  When dealing with an overwhelming number of patients like what the SFFD was dealing with when they rolled up on that scene with a limited number of responders as compared to the number of people they were presented with, well, mistakes might be made, but knowing what I know about the San Francisco Fire Department, I guarantee that every single person that walked onto the scene did the absolute best that they could.

Finally, let’s not lose sight that there is probably only a limited number of apparatus on site at the airport.  Further assistance from both San Mateo County, and San Francisco units with longer ETA’s might have taken a couple of additional minutes.  Those minutes, like I said, could feel like five, or ten, or even twenty, like the caller cited.

I think that we are all quick to forget that prior to the plane crashing, San Francisco was dealing with whatever they view as a “typical day” of calls.  Their units were not all sitting in wait for some major incident.  They were out running calls, responding to emergencies, or held up in triage in some overtaxed, overcrowded emergency room.

It is a shame that the Associated Press seemingly blindly released a report without all of the facts.  Before potentially justifying the claims made by what seems like 3 calls by the same individual, have a look at the times she called.  Have a look at how long after the crash occurred that units arrived on scene, because I guarantee they arrived in waves.

One thing that I learned from my response to the tornado of 2011 and the gas explosion of November of last year was that sometimes the only way for a scene commander to keep control of a scene is to create some sort of “bottleneck” at a staging area to slow down units rushing into a scene, allow them to gather themselves to prepare for what they are about to experience, and to have any ability to keep track of who is going where and with whom.

Ultimately what it all comes down to is that Main Stream Media needs to learn what this entire process of a response to a major incident entails, because frankly they do not.  From all reports and accounts from every trained professional involved from the flight attendants to the last ambulance to pull off that scene, the heroic actions of everyone involved potentially saved countless lives.  Let’s focus on that, and not the blind, emotionally fueled assessment of the scene by an increasingly agitated 911 caller.

Kudos to the San Francisco Fire Department.  Thanks for all you do.