Columns, Operations

You’ve Got to Know the Territory to Find the Patient

Issue 1 and Volume 43.

Three valuable skills for locating patients every time

My dog and I had our morning walk today through a neighborhood I’d been meaning to get to know better. It’s a new development, an offshoot from a more established area.

I started to turn down Abbey Mill Boulevard, but Google Maps set me straight, sending us a half-mile further to Abbey Mill Drive. I derived three benefits from this jaunt: a happy dog, some good exercise and a better map of the area in my head.

Who hasn’t been blindsided by similar road names when traveling to the scene? (It’s usually at night, in a blizzard and coming from the less-traveled direction.) Few feelings are more helpless than knowing a case is time-critical and being unable to find that patient.

Foremost among the many nonmedical skills of a capable and efficient field provider is actually arriving at the patient’s side. In the age of GPS and electronic navigation systems, an onboard guide usually tells you when to turn with a reassuring message that “your destination is on the right.” But not always … and there’s the value in knowing your territory in your bones.

What do you do when technology doesn’t cooperate, is inaccurate or isn’t available? My cousin lives 17 miles outside her Montana town, where her neighbors had to post a sign that reads, “Go back, your GPS is wrong,” because tourists were consistently—wrongly—guided to their house by faulty electronic devices.

If you’re relying only on technology, what will you do if you’re forced to find another way—literally? Short of sending out a smoke signal asking the patient to send up a flare, what can you do, especially for rural and wilderness calls?

It’s certainly helpful when callers can provide a clue—anything, such as blinking their porch lights or posting someone at the roadhead to flag down incoming crews. When other crews precede you, the good ones leave breadcrumbs or other clues at divergent driveways or paths. We help one another; that’s the rule. But being first in can be a challenge.

Whether your scene is a convoluted apartment complex or a thousand-acre ranch, there are three helpful skills to possess that will help ensure you’re quickly at your patient’s side.

Map Reading

I know, paper maps are relics, and they can be hard to use in a dark, bouncing vehicle. But knowing how to read them efficiently can matter. You’ll be ahead of the game by having an up-to-date paper map with you as a backup to your technology and knowing how to quickly pinpoint where you are, where you need to go and the best route in.

It’s very reassuring to be able to translate a two-dimensional map to what you see through the windshield, such as knowing a particular feature that’s on the map should be around the next bend and then seeing it roll into view.

It also helps enormously to have an intuitive sense for the cardinal directions (north, south, east and west). This skill is easily gained through an idle-time mental game of guessing which way is north, then confirming your hunch with a compass.

Know Your Territory

Master your space ahead of urgent calls and develop rock-solid knowledge of the lay of the land. The best drivers know intuitively how to get to anyplace from anywhere else in the district. Be like them. They know where that unmarked road just after the Jones’s dairy barn leads. They know the back ways and the shortcuts (and also not to use those they aren’t 100% sure of).

Keep up with road construction, traffic congestion patterns and your various route options. Memorize street name sequences. If you’re new to an area, study the district on maps that allow you to notice how different routes are related (or not). Tour your patch often—even while off duty. Consciously build a reliable mental map of the territory you serve. Take a walk with your dog.

Hone Situational Awareness

Complex navigational puzzles will sometimes arise. Pay attention, look for clues and use situational awareness to work out the answers.

You’re called to a remote ranch for a chainsaw incident and there’s no one to usher you in? Look for places someone might be cutting wood, watch for a parked ranch vehicle or fresh tire tracks. Listen for a barking dog. And when dispatch relays that the caller said he was “north of the house” before he passed out, you’ll be glad you played that mental game I suggested.


My friend and wilderness guide, Manolo, is one of those utterly unflappable people who instilled in me a great lesson: Always have a backup plan. If Plan A isn’t working, don’t just have a Plan B, but have a Plan C and Plan D, too.

Our Plan A is the convenience of modern technology that helps us efficiently find our patients. It usually works. But do you have the skills required for when the modern systems fail or a natural disaster rearranges the landscape?

What’s your Plan B, C and D?