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Home > Topics > Health and Wellness
June 19, 2014
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The Ambulance Driver's Perspective
by Kelly Grayson

An open letter to a medic who hesitated

Triage is a cold and calculating decision; to make the correct decision, you have to subvert a bit of your humanity.

By Kelly Grayson

I knew what you wanted to talk about when I saw your number on my caller ID. I’d heard about your call, of course.

Grapevines being what they are, I declined to offer my opinion until I heard about it from you directly, but you should know that the stories were universally sympathetic. No one judged you harshly.

It was one of those situations that no human being should ever have to experience. Yet, EMTs will handle at least one in their careers — often, quite a bit more.

And the story was told to me in a, ”hey, did you hear about so-and-so?” fashion, delivered with a rueful and sympathetic shake of the head, as if the teller of the tale were thinking, “There but for the grace of God, go I.”

And you know, when we hear such tales, we all do think, “there but for the grace of God …”

Nobody does everything right

No medic, no matter how much adrenaline junkie still abides within him, ever wants to be faced with the decision you had to make. And most of us wonder if we’ll be able to make the right call.

We’ve all heard the stories of impossible saves, and wished we were the ones who had made them. And we wonder, if or when the time comes, if we’ll be the ones who miss the chance to make that save because logic, circumstances, or triage told us the attempt would be futile.

After all, if we let logic dictate those choices, the saves wouldn’t be all that miraculous, would they?

So yes, I knew what you wanted to talk about when I answered the phone. And knowing you as I do, I knew you’d be blaming yourself in some way; that despite everything you’d done right, you’d be asking yourself in the dead of night if there wasn’t something — anything — that you had done wrong, something that would have changed the outcome.

And my answer is … maybe.

But that’s not the point. None of us does everything right. The only perfect call is the one you haven’t yet run. All we can do is, well … all we can do.

It may not all go according to plan, but as long as we keep our heads, use our education and training, and practice care with compassion, the vast majority of those decisions will be the right ones.

The torture of ‘what ifs’

Your introspection is a fundamentally healthy thing, but don’t overdo it. When you hold that mental post-call critique, don’t discount all the things you did right.

Don’t focus on all the “what ifs” and “could haves,” because such mental torture just leads to paralysis when you have to make that decision again. You know as well as I do that there are times when we must be decisive and not hesitate in our actions.

And remember, I’ve worked with you. I know you’re skilled. I know your decision-making is sound.

I’ve seen you make mistakes, yes, but that’s what rookie medics do. They screw up. They learn. I was no different, hard as that may be to believe.

So you think you hesitated. Or, in your words, you “froze.” Yet, when you laid the facts of the call out in your story, none of it suggests that you were paralyzed with indecision. You just hesitated, and that momentary hiccup in your thought processes didn’t adversely affect patient care.

You had three dead people on scene, and one live but critical one, and because one of the dead was a baby, you wavered in your triage decision for a few seconds.

I’ve got news for you: I don’t want a medic working on me or my loved ones that wouldn’t feel that moment of hesitancy.

Everything you did do

Triage is a cold and calculating decision that no one outside emergency medicine will understand. They don’t get that some of the people we triage as unsalvageable, still have signs of life.

To make the correct decision, to focus your efforts on the patient you have a reasonable chance of saving, requires you to subvert a bit of your humanity. We have to be careful that we don’t subvert too much.

So instead of focusing on those 10 seconds where you hesitated, ask yourself instead if it compromised care. Were your scene times unusually long? Did the one viable patient you had get transported in a timely fashion?

Did you provide appropriate care along the way? Did you do your best to assuage that patient’s fears? Did you assure that the destination you transported to was the best available to continue the patient’s treatment?

I already know all those answers. The important thing is that you do, and believe it.

More grace and compassion

And I’m sorry I wasn’t able to give you all the support and assurance I could when you called. I was running calls myself.

And answering you in this way may seem a slight violation of confidence, but you’re not the first medic who has felt this way, and you definitely won’t be the last. Answering it here may help a great many others who have been in your shoes.

And while we’re at it, don’t let the conversation end here. We have a crisis counselor whose job is to provide all the answers and reassurance I just did, and she can do it with far more grace and compassion than I.

Reach out to her. It’s not weakness to admit you need support. Weakness is denying it.

You weren’t hesitant, my friend. You were human.

And there’s not a damned thing wrong with that.

About the author


Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com.

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