January 26, 2025
Two years ago, my license to practice as an Emergency Medical Technician expired; it was a bittersweet moment for me. I became an EMT during my junior year of high school as an entry step toward a career in medicine, which I did not end up pursuing. Through a Jewish geography connection from one of my best friends, I ended up as a member and leader of Syracuse University’s Ambulance, which was one of the best experiences of my life and still benefits me to this day.
Truth be told, I haven’t been an active caregiver or ridden an ambulance in nearly a decade. Certification lasts for three years and in each of the past two cycles I’ve recertified thinking this will finally be the year I make time to get back to EMS. Now with two full cycles without touching a stretcher, I am able to realize when ranked against the other things in my life EMS is merely a Priority 3, more on that later.
EMS has fundamentally impacted the way I view work, friends, relationships, and nearly everything in life, and I want to take a step back to codify and timestamp what I’ve learned.
Like most other things in my life, I tweeted learnings from my most recent recertification process in 2019 that inspired most of my thoughts here.
Prioritization and triage are the most important skills you can have
Emergency Dispatch Entry Questions © Priority Dispatch
Emergency Dispatch Chest Pain Questions © Priority Dispatch
The images above are taken from a set of predetermined questions that Emergency Medical Dispatchers ask. A dispatch sequence starts with broad questioning about the incident and location and along the way asks more focused questions about the nature of the illness or mechanism of injury. Think of dispatch cards as a decision tree where each body part or system has a series of questions associated with it so the dispatcher can send the needed resources and give medical guidance until the providers arrive.
The first image above shows what is known as entry card questions. These questions are structured to pull the most important info for a caller in the correct order; always be mindful that during a true emergency, the caller will likely be frazzled and could disconnect at any time. If a dispatcher could only ask one question it needs to be the location so even if they know nothing else they have an address to send responders to. The takeaway here beyond EMS is what is the keystone question that either enables the rest or makes the mission impossible without an answer. Once a dispatcher knows the location they can at minimum send a team to explore more in person. If they don’t have the location, they can do almost nothing.
The second image is a focused card with questions specific to a chest pain emergency. One of the challenges in EMS is understanding the true nature of the illness or mechanism of injury. Often, 911 calls come in with imperfect information and it becomes a game of telephone. Very easy for a bystander to misinterpret what they are seeing so it becomes especially important for dispatchers to confirm what’s happening.
On the bottom of the second image you’ll see Priority 1, Priority 2, and Priority 3 which codify based on the information from the caller how serious of an emergency exists at the scene. This also routes to what level of response is required ex. Lights and sirens or if advanced life support is needed
The main lesson that has stuck with me for the last decade or so is the importance of prioritization and triage; especially in a business world where we are rarely if ever saving lives.
The patient is your fourth priority on scene
Generally one of the first lessons in EMS is about the importance of scene safety. TV and Movies paint this heroic vision of rescuers running into dangerous scenes and saving the day. While that does happen the general consensus is making sure you are safe above all else and not risking your own life to save a patient.
I remember one of my first lessons being shocked by an instructor telling us that the patient is not the first priority on the scene.
At first I thought this was blasphemy. We’re here to save lives aren’t we?
The hierarchy is as follows:
- Yourself
- Crew and other first responders
- Bystanders
- Patient
And then it was explained to me that your first responsibility is to make sure you come home at the end of the night and you aren’t endangering yourself, crewmembers or bystanders. Not to mention there are real downstream effects to ignoring the above hierarchy. If you get hurt on scene there are now 3 crews that are impacted by that. First your crew can no longer take on the original call, there needs to be someone to take care of you, and finally another crew needs to go take care of the original patient. Scene safety and prioritization is certainly about making sure you are safe but also ensuring resources are managed effectively.
This is similar to the old “put on your own oxygen mask before helping others” saying. There’s probably some corollary to the business world and our ordinary life here as well but the main takeaway is the task at hand isn’t really the task at hand until it can become the task at hand after the scene is safe.
You never need to run
“Several studies have consistently shown that the use of Lights & Sirens, on average, shortens response and transport intervals by 1.7 minutes to 3.6 minutes and transport times by 0.7 minutes to 3.8 minutes” – U.S. Department of Transportation’s meta analysis of EMS response procedures
Driving a five ton Ambulance with lights and sirens on is a very cool experience. You own the road in the spirit of service to others and you get to drive (responsibly) fast. I highly recommend it if you ever get the chance and it is one of the things I miss the most about EMS in addition to of course helping other people.
Good times aside, lights and sirens don’t really save that much time in a clinical sense. They also increase the risk of an accident for all parties involved.
How does this translate to business and life? One of the challenges of the modern workplace is level setting on the speed at which we need to operate. I find workplace conflicts often start around misalignment in turnaround time and communication. I find myself energized by people who are able to accurately identify the priority and nature of a business objective. Not everything can be done immediately and every action has an opportunity cost. Consequently I am exhausted by the type of operators where everything is a five alarm fire at all times. Having had true EMS experience has brought me a healthy understanding of what really matters in the context of the business challenges we are facing.
RIG CHECKS
At the start of every shift a crew will go through a rig check which makes sure that the vehicles and devices are working as expected and that the ambulance is stocked with the correct items. This is somewhat laborious and often has 50+ steps with very granular instructions like confirming the correct number of bandages are onboard and that there’s enough gas in the tank. Conventional thinking may wonder if this is necessary: if you use a bandage shouldn’t you just replace a bandage? Sure in a perfect world we put back everything we use but with high stakes high stress world of EMS there is little margin for error. Perhaps the crew before was working nonstop and didn’t have time to restock. Having a rig check at the start of every shift is a strong control point that makes sure providers can give patients the best care and ensure there’s plenty of margin for safety with extra and often intentionally extra sets of supplies. Another value proposition is the uniformity. When possible the supplies are organized in the same fashion in each of the ambulances so there’s even less of a learning curve when trying to find the right tool or supply.
The startup sequence for a shift is something I am working on integrating into my both personal and professional lives. Many nights before bed I set the intention of starting or ending my day with a workout, then some learning, and maybe a stretch or two before diving into the real work and building habits that I do essentially on autopilot; but rarely if ever is this how my day starts. I wake up and reflexively grab my phone and open my inbox before taking my first breath. If i step back I realize the only person forcing this on me, is me. I’m striving to create more intentionality in my day and avoid jumping into fighting fire mode. I think i’m a better consultant, husband and friend when I can have a startup or shut down sequence to bring uniformity to my life.
Deputization and clear communications bring order to chaos
Another early lesson is crisp communication: both over the radio and in person on scene. Public service providers traditionally use radios for communication and have to learn a series of codes that mark their progress along the way. There is a call and repeat sequence of announcing each step along the journey and having the dispatcher confirm receipt. Not only does it help manage resources it also serves as a critical timestamp for a medical record, court case or further inquiry. Keeping proper timestamps helps public health officials continually improve services and create best practices across the nation by looking at population level data instead of just the call logs from one micro locale.
In the field crisp communication is even more important. There are distinct roles and responsibilities across public service denoting who is responsible for driving, gaining access, patient care, advance services, and transport that leaves little if any ambiguity on who is doing what. I will never forget failing my first CPR exam because when it time to call 911 I told somebody to do it. In times of crisis we need to be very clear on who is responsible for what so the correct action was to pick someone by name, avoid bystander apathy, and have them call 911 instead of hoping that someone would rise to the occasion.
While it might not be killer in the business world, bystander apathy is quite commonplace in the working world. We’ve all been on calls where “someone” is needed to volunteer for a new bucket of work that they don’t want to do. Reflecting back now I am realizing that EMS is probably the main reason I try to end every meeting with at least a recap of who is responsible for what.
The End?
I write this knowing my time in EMS for the foreseeable future is over.
Compared to the other demands for my time it is not a high priority. I’m newly married and eventually will have a bigger family and probably more work responsibility. It wasn’t until writing this that I realized how deeply these lessons have stuck with me.
I hope I can get back to it someday