The Pause: Don't just do something. Stand there! - Administration and Leadership - @

The Pause: Don't just do something. Stand there!


Thom Dick | | Friday, July 25, 2008

Christmas is over with, thank goodness. No more seductive booze commercials, no more beautiful old songs butchered by howling gospel singers and no more stupid new movies about Santa. Time for a nice rest before I start on my taxes. Whoopee.

Rudy had a red nose, all right. But the Rudy in our town was no reindeer. He was a drunk, and when he didn't have a snootful, he was real cranky.

My partner at the time was a Georgia EMSer named Mark Mayo. You may have read Mark's name in this column more than once because he was plum brilliant. There were so many skills the rest of us had to learn by struggling, but Mark seemed to be born with them allƒincluding a firm grip on his ego.

The hardest thing for any EMT to learn is how to think your way through a call. That, of course, and how to teach someone else to do the same thing. On medical calls, Mark had that down to four questions: What's wrong with 'em, is it killing 'em, what can I do about it and when do I transport? Similarly, he would ask a trauma patient four questions: What's your name, what happened, where does it hurt most and can you take a deep breath? He built a lot of elegant clinical investigations on those simple foundations, Life-Saver; in three years as his partner, I don't think I ever saw him miss.

I'm by no means alone in my respect for Mark, and I have since learned that when you earn the respect of full-time, working paramedics, you're pretty special. But one of the best skills I learned from Mark is something you really deserve to know about.

Rudy's roommate had called us to her apartment one night because Rudy was acting strangely. When we arrived, she met us at the curb and told us Rudy was unconscious. She was pretty upset about it, even considering that Rudy usually drank himself into oblivion whenever he could find the means.

We couldn't help noticing numerous fresh bruises on her face and her right forearm. When we asked about them, she just crossed her arms and looked at the ground. We called for PD but decided to go in. Rudy was nasty, but he had never scared us.

On the way in, Mark led us down the hall to the back bedroom, carrying the drug and airway kits. He signaled us to be quiet, and before entering the room, he paused for a few seconds outside the doorway. Then he called to Rudy in a loud voice, commanding him to wake up. ˙Come on, Rudy,Ó he said. ˙Paramedics. I saw you close your eyes just now.Ó

The next thing we knew, Mark dropped the kits in the doorway and turned toward us. ˙Gun!Ó he shouted, and motioned for us to beat feet. He'd no sooner uttered that word than we heard a sequence of clicks coming from the room. It turned out Rudy had a double-action .357 revolver in there, about the size of a howitzer. Fortunately, he spent all his money on booze instead of ammo.

The whole idea of subtlety was a good one, and it was part of Mark's routine. But it wasn't just about silence. Nor was it limited to safety. However briefly, Mark disciplined himself to make his first assessment from a distance. He did that at traffic scenes long before anybody taught their EMTs much about ˙scene safety.Ó

He did it on every call because it helped him to get a wide-angle view of what was going on before he zeroed in on one or more key problems. It also helped him coordinate resources during the first few moments of a call. In fact, when dealing with neurological issues, I often saw him stand up and back away from the patient for a few moments and fold his arms across his chest, just to get a better look at how a patient was presenting.

What kinds of things would that help you to see, hear or smell? Oh, I don't know. Status epilepticus. Abnormal posturing. Bruising, or fluttering eyelids. Paralysis. Unusual respiratory patterns. A patient's interaction with a relative, or maybe the earliest hint of reverse peristalsis. Even nasty old drunks who think it would be funny to scare the crap out of you.

Or worse.

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Related Topics: Administration and Leadership, Leadership and Professionalism, Provider Wellness and Safety, Patient Management

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Thom Dick

has been involved in EMS for 43 years, 23 of them as a full-time EMT and paramedic in San Diego County. He's currently the quality care coordinator for Platte Valley Ambulance, a hospital-based 9-1-1 system in Brighton, Colo. Contact him at


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