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The Art of EMS
by Steve Whitehead

Why EMTs should learn to trust their gut

Instinct is a very real, non-mystical process that you can and should develop when on the scene

By Steve Whitehead

Updated June 4, 2014

If you were teaching a class on scene safety, you would describe the scene around Tom as textbook.

We had established a perimeter to work within. Law enforcement officers were present on all sides. The scene was as well-lit as we might expect at an outdoor festival at night. And the crowd, while fairly intoxicated, was more or less compliant.

If you'd asked me at that moment why I felt the need to expedite our c-spine procedures and transport, I'm sure I couldn't tell you. Maybe it was an imperceptible shift in the energy of the crowd. Perhaps it was the waning interest of our police support or a subtle change in the patient's amenability to my questions. Most likely it was a combination of factors.

What I do know is that something gave me the feeling that it was time to leave. I'll never know if something was truly about to happen or not, but I'd felt the feeling enough times to know better than to question it.

I glanced at my partner, who was busy unraveling a blood pressure cuff, and said, "We need to move."

And with that, the urgency of transport changed.

Minutes later we were en route to the hospital, the busy street once again filled with drunken revelers, and the guy who fell over the curb became another story for them to share. I, safe in my rig, went about the business of transporting an intoxicated fall victim to the hospital.

What is "a gut feeling"?

Instinct isn't magical, it isn't voodoo, and it doesn't require that you align your chakras or meditate to the sound of falling water. Gut instinct is a very real, non-mystical process that you can and should develop as part of your scene presence.

We don't often talk about gut feelings or instinct in our EMS training. Medicine is, after all, a science. And things that are non-quantifiable and difficult to measure, like feelings and predictions, tend to be dismissed by our scientific minds.

Yet there is an explanation for the process that we refer to as our instinct, gut or intuition. In each waking moment, our brains process thousands of details from our environment. From the temperature of the air around our bodies to the hum of a distant air-conditioner, we dismiss most of what we experience before we are even aware of it.

As we gain experience with different stimuli, we make neuro-associations that allow us to attach meaning to all sorts of sensory input. Most of it is benign.

But when a detail has enough relevance, we become cognitively aware of it. We may never consider the sound of our car engine until it makes a noise we don't recognize. We may dismiss the noise of a crowd until someone speaks in a threatening tone, and suddenly our awareness shifts.

Now let's take that cognitive process a step farther. When our subconscious gathers enough details to make a somewhat accurate prediction about what might happen next, the information doesn't tend to present itself as a list of facts for our cognitive consideration.

Instead, we tend to develop a feeling — a sense, if you will — that something might happen soon.

This is your instinct at work. And the more experience you have in a given environment, the more accurate it will become.

Learn to listen

We don't need to develop our ability to process information from our environment. Our subconscious has been doing this for us since birth. Often, what we need to develop is our ability to listen for the feelings that help us predict what's going to happen next and then to trust them.

Even those most resistant to the idea of acting on information that lies below the level of cognitive thought can relate to the feeling of sensing something was going to happen before it did.

Have you ever sensed that a patient was going to crash or have a seizure even though there was no obvious indication of the fact? Have you sensed that a patient was lying but couldn't explain why? Have you had a sense that a scene was about to go bad a few moments before everything erupted into chaos?

None of these experiences were mystical. They were the result of your subconscious mind processing thousands of minute details below the level of your conscious awareness. Those details added up to your gut feeling about what was going to happen next.

Predicting the future isn't magic. You can do it, too. You just have to trust your instincts.

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at steve@theemtspot.com or at Steve.Whitehead@EMS1.com.
Comments
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Bob Darnell Bob Darnell Wednesday, June 04, 2014 6:15:41 PM Excellent article.
Bob Darnell Bob Darnell Wednesday, June 04, 2014 6:23:11 PM Good article
JorDona Laiacona JorDona Laiacona Wednesday, June 04, 2014 6:29:52 PM Enjoyed this, thank you.
Tammy L Field Tammy L Field Wednesday, June 04, 2014 6:48:47 PM I have this little bell in the back of my had that rings to warn me of something. I learned long ago to listen to that bell.
Tammy L Field Tammy L Field Wednesday, June 04, 2014 6:50:49 PM *head, even :(
Matthew Hicks Matthew Hicks Wednesday, June 04, 2014 7:08:16 PM Rolled up to an apartment complex for a call for "fillings fallen out". Before we got out of the truck, told my partner "something doesn't feel right". Walked into the house to find a gunshot victim. Did a rapid extrication from the house, only to get a call from dispatch telling us that more shots had been fired 2 minutes after we left the scene. Always trust your gut!
Tj Haraway Tj Haraway Wednesday, June 04, 2014 7:09:53 PM good deal they should let us conceal carry u never know
Brandie Moore Brandie Moore Wednesday, June 04, 2014 7:29:32 PM wow...glad you were out!!
Jimmy Dell Palmer Jimmy Dell Palmer Wednesday, June 04, 2014 11:33:35 PM Very well put. Now retired, at my prime I was very familiar with that"gut" instinct. It time and time again kept me and my partners one step out of that chaos and harm. Thank you for taking the time and thought you put into your explanation. It is the closest I have ever read to putting a definition of that "gut instinct" require to do the job and be safe at it.
Bill Moran Bill Moran Thursday, June 05, 2014 6:56:55 AM When the actor starts shooting at you and there are no police around, remind that actor that you're a good guy. I'm sure he'll drop the gun. If your scene becomes a "political, media and community nightmare" as a result of you defending yourself, revel in the fact that you are alive to see the drama. As a CPR trainer, I preach scene safety to my students, including the idea that your head should be on a swivel- always aware and looking for danger. Scene safety is fluid- a safe scene one second may have an active shooter in it the next. If it's a choice between the shooter and me, I look to the number one rule you posted- safety for ourselves. When you can't retreat and the shooter comes for you, you'll understand my point of view. Whether you survive depends on your point of view.
George Beltz George Beltz Thursday, June 05, 2014 6:42:44 PM That little warning bell has proven right too many times.

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