Administration and Leadership, Columns

Don’t Let Training Box Providers into One Type of Response

Issue 12 and Volume 41.

The “myths” of EMS is a perennial topic at conferences, in trade publications and in the blogosphere. You’ve probably heard or read something about the golden hour of trauma, or about the eight-minute response time for ALS, or any of a number of others that we’ve debunked in our discipline.

We often hear about the benefits of training, and how it’s something you can never get enough of. When a fire or EMS system ends up front and center in the media’s critical spotlight, system leaders often fall on their swords with the go-to admission that “there’s a need for more training,” whether or not training is the solution for whatever seems to be going on. Nevertheless, everyone typically walks away reasonably satisfied.

At worst, the additional training may be like the chicken soup cure for a cold, or like giving oxygen or IV fluids to patients who don’t really need them: “It might not always help, but it probably can’t hurt either.”

A Double-Edged Sword

We can train and train, like soldiers taking apart and reassembling their weapons in the dark, or Navy SEALs getting into and out of their scuba gear underwater, and this simple, seemingly endless repetition results in responses to certain situations that seem almost involuntary.

Memorization through repetition isn’t a bad way to learn things we need to recall quickly from memory, like following the ABCs (or CABs) of the primary assessment for patient stabilization. But the management that follows is often a lot more complex and requires training designed to anticipate or somehow predict what might happen next. When things unfold in a somewhat predictable fashion, it allows us to have a repertoire of responses ready.

Training is a dangerous double-edged sword, though, because sometimes we don’t want to get locked into a set of predetermined responses to anticipated events, we just need to go through the ABCs to ensure our patient is stable.

Fly the Airplane

When Capt. Chelsea “Sully” Sullenberger successfully landed U.S. Airways Flight 1549 in the Hudson River, all of his training probably came flooding back to him.

But like most airline pilots, he never trained to land in the water. He was trained to land at the nearest airport and to follow emergency checklists. But the opportunity for Sully land at another airport was lost when the time available for him to safely land the plane was suddenly compressed into several hundred seconds.

Something other than training and checklists came into play here—a kind of fluid and fluent response to events that unfolded in a surprising and unpredictable fashion. Sully didn’t so much fly according to the pre-established flight plan as he flew the plane the way he knew how. Executing an emergency water landing wasn’t something he was trained to do, and his success was likely a result of the knowledge and skills gained from years of experience. With every judgment made, decision rendered and action taken over the course of his entire lifetime, Sully had made deposits into a survival account, right up until the moment that he needed to make a large withdrawal.

John Coltrane, the great jazz sax player, once described how he prepared for his performances (if you’ve never heard him, try listening to one of his sublime works, Mr. P.C.). Coltrane said that he would practice each piece in every key and every possible fingering, but that when it came time to perform, all that got thrown out and he just played.


All of us who feel that our EMS agency will never be able to provide enough training or field time needs to remember what we learned from Sully and Coltrane—the ingredient list for success includes more than just training or emergency checklists, or even protocols for that matter. There’s something else, something more intangible that gets cooked in as you assess, manage and transport patient after patient through many years of experience.