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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 (, or email him at

The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Patricia Lynn Reay Patricia Lynn Reay Thursday, June 19, 2014 3:39:05 PM Well put! Teared up a bit but I think I might have needed that!
LaeAnne Farnsworth LaeAnne Farnsworth Thursday, June 19, 2014 10:25:29 PM Well said!! I needed a friend like you a couple times in my career!!!
Mark Moore Mark Moore Thursday, June 19, 2014 11:15:44 PM Thanks my friend, I needed this
Paula Materne Lee Paula Materne Lee Friday, June 20, 2014 12:05:13 AM i need this every day, just remembering old calls, some still haunt me, and some give me comfort, my intent was right, even if my nerves were raw, or my heart was breaking, sometimes your compassion gets the best of you, and puts you right where the patient or family is, you associate with them and grieve with them, but compassion is necessary to do this job, you are and will always be your own worst critic, and that is what will make you the best you can be.
Amy Laura Lynn Amy Laura Lynn Friday, June 20, 2014 2:06:55 AM Amen. Very well said. I would say anyone who's been doing this job for any length of time has those moments. You made a good point - you can be an awesome paramedic with excellent decision-making skills and hands-on skills to boot - but we are still human. We often forget that in the demand for perfect patient care... but, we are human and that's not a bad thing. Thank you for this "open letter." I also teared up reading it, but it was in a good way.
Allyson Chemelowski Allyson Chemelowski Friday, June 20, 2014 2:22:45 AM wow this is great, I must say I have had 2 baby code's in my years, and out of everything I have seen, they just stick with you
Colleen Nee Heinsohn Colleen Nee Heinsohn Friday, June 20, 2014 7:32:14 AM Well said. Thank you! And to the medic second guessing. Hang in there. Keep talking. Don't forget the good stuff.
Branden Jackman Branden Jackman Friday, June 20, 2014 7:40:20 AM WOW!! Absolutely excellent article that all us of should keep and read from time to time! I've been a medic for going on 20 years and at the end of the shift, take solace in KNOWING you did what you could!!
Lou Romig Lou Romig Friday, June 20, 2014 9:34:36 AM Bravo Kelly, beautifully said. You know this is a very special topic for me. If I can help at all, just let me know. Please pass along a grateful hug from me to your friend.
Barbara J Power Barbara J Power Friday, June 20, 2014 11:30:18 AM Amen.
Kate Catherine Kate Catherine Friday, June 20, 2014 12:08:31 PM This could not have come at a better time! Ty Kelly!
J.t. Cantrell J.t. Cantrell Friday, June 20, 2014 12:32:23 PM Excellent and accurate. Thank you.
Nate Zecco Nate Zecco Friday, June 20, 2014 4:28:59 PM As always Kelly, well written and on point. Thank you
David Crow David Crow Friday, June 20, 2014 5:20:39 PM This may sound hard but dead is dead whether its a one month old or a hundred year old person.You have to try and save the ones that still have a chance.
Emma Fischer Emma Fischer Friday, June 20, 2014 5:32:20 PM Very well said and very touching. It's such a hard topic, and I think we all needed to read these words.
Richard Bresnahan Richard Bresnahan Friday, June 20, 2014 5:35:57 PM Very well said. Thank you.
Debra Fields Debra Fields Friday, June 20, 2014 5:37:46 PM Thank you
Panther FyreMedic Panther FyreMedic Friday, June 20, 2014 5:41:32 PM Brother.... I don't know you, haven't met you, but I can tell you this... The OP is right... and I also know that often being "right" is no comfort at oh dark hundred when you're more alone than anyone who hasn't been there can possibly imagine... I've been there, done that, wore out that t-shirt and gotten a few more.... Brother, We ALL wish we could save them all... But we can't... And I'll bet you did the best you could with what you had. And that's all that can be asked of anyone... So if you need to reach out, do it. Heck, shoot Me a PM and you and I can talk... Sometimes it's easier to talk with a "stranger"... Talk to a CISD peer... Talk to a pro... Talk to friends and co-workers... Just don't let this eat you alive. Triage... One of the toughest things an EMT/Medic has to do... But there are more patients out there that need You and your abilities to help.... It's triage on the long-term, grand scale.... And as a wise peer counselor once told Me, "Maybe the real reason you were there wasn't to save the person, but let them know for just one moment, that SOMEONE cared.... and the someone... Was YOU..."
Mary Lynn Smith Mary Lynn Smith Friday, June 20, 2014 5:44:12 PM Another offering that hit a bit too close to home. Thank you, sir!
Vicky Gordy Shryock Vicky Gordy Shryock Friday, June 20, 2014 6:21:37 PM we all needed to hear this. amen!
Deborah Blaine Kee Deborah Blaine Kee Friday, June 20, 2014 7:09:07 PM Sure wish I would have read this, or have someone say this to me years ago - before I 1st left the profession. Excellent read.
Bonnie Matthews Bonnie Matthews Friday, June 20, 2014 7:28:54 PM I'm a retired EMS Lieutenant/Paramedic and was also on the CISM team during my career. I would strongly suggest that this individual seek out a CISM member for a chat. No harm, no foul, just a vocal purging of the incident. Best Wishes.
Rodney B. Ross Rodney B. Ross Friday, June 20, 2014 7:38:01 PM When we get into this business and sew on the First Responder patch or pin on the badge, we know this is coming. While we may fear moments like this - especially us rookies - it's the support we get from our brothers and sisters like you that keep us going. Thank you, Kelly.
Tommy Caldwell Tommy Caldwell Friday, June 20, 2014 7:44:53 PM This is well written about a part of our job we don't talk about often.
John Thomson John Thomson Friday, June 20, 2014 8:45:54 PM Thank You Mr Grayson, This letter could have been addressed to me reguarding a call I ran last week, this helps a lot.
Fred Hollands Fred Hollands Friday, June 20, 2014 9:18:57 PM Thanks for this, your timing is good.
Dawn Hart LaPlant Dawn Hart LaPlant Friday, June 20, 2014 10:30:49 PM God bless you sir.
Becky Heath Becky Heath Saturday, June 21, 2014 12:09:40 AM It's a road that we have all walked.. And we carry these calls with us every day. Just tuck it in a safe place and use the experience and understanding in the future. Remember-we're usually tougher on ourselves than anybody else is-when we care. I remember being told 'you can't save every patient'. Doesn't get any easier, but it makes you want to learn a little more, to be a little better out there. Nobody's perfect. This life is not easy.
Randy Bruns Randy Bruns Saturday, June 21, 2014 1:38:35 AM All you can ever do is the best you can every call. I personally had to "call" friends on different MVAs and work on strangers. No, it's not easy, especially when it comes to children. May sound a bit strange but I always kept a Spock quote in mind: The good of the many outweighs the good of the one."
Bruce Lager Bruce Lager Sunday, June 22, 2014 3:41:32 PM I have never met you personally, but I know you. We have all been there at one time or another. You are good, and you are needed.
Sheila DeSouza Sheila DeSouza Sunday, June 22, 2014 4:36:29 PM This is an amazing over view and story about the life of a Medic!!! As, great and talented and knowledgeable they are , they're not perfect..However, dam close!!! The only perfect man/women I've ever known to be is """GOD""" !!!! So, with all of this said and what I have read...Paramedics are only human, but in their field of expertise, the best at what they do!!! Signed: A MEDICS MOM XO <3
Hannah Rider Hannah Rider Sunday, June 22, 2014 6:09:35 PM Thank you.....really needed this
Gary Doxon Gary Doxon Sunday, June 22, 2014 6:41:57 PM We may forget names and faces over time but we are always " Caring for " our patients from the past. As has been said in the previous massages, Talk to someone about them, get the help you need to deal with it all in a healthy way. Time has no rewind button, we make our choices and use our options in the now of the call, if we make ill choices we learn from them so that it doesn't happen again, that's how we can do justice in ourselves for our past patients! Remember we are never alone in this, so reach out when needed!
Jesse Bell Jesse Bell Monday, June 23, 2014 1:37:07 PM Unfortunately, sometimes, tough decisions have to be made in order to work towards the best possible outcome. Triage is meant to help us make those decisions for what is best for the most amount of people. It's tough to decide who will live and who will die, but in the end, that organization is what allows us to do the most good with the least resources.
Pat E Howard Pat E Howard Monday, June 23, 2014 1:40:43 PM Great article--really hits where t needs to. Everybody be safe out there and just do the best of your ability--e are all human--nohing more--nothing less.
Pat E Howard Pat E Howard Monday, June 23, 2014 1:41:48 PM that is "we" are all only human
John Drady John Drady Tuesday, June 24, 2014 2:34:45 PM Perfectly said Kelly. I will read this again in the future as a means of keeping things in persepctive. And as you stated, we've all been there. Thank you.
Hairbearbill Wat Hairbearbill Wat Tuesday, June 24, 2014 9:08:32 PM I can completely understand and of course have been in that situation at the beginning of my services with St John Ambulance in Sth Australia in 1990.
Suzie Bartram Suzie Bartram Thursday, June 26, 2014 3:33:06 AM I could read this every day,
James David James David Saturday, July 05, 2014 8:11:03 AM Been an EMT since '77, had those heartbreaking triage calls and those " what if"calls also. Had "tunnel vision" as a paramedict
Julia Harris Julia Harris Saturday, July 12, 2014 10:51:58 AM Thank you!! I needed this today. For one of the few times I found myself crying at midnight. Really tough week, had to transport my best friend and roommate. I've been in this business for 13 years and a medic for 2. I question myself often!! It's scary to be the one in charge, but also rewarding. I can't imagine doing anything else. For the medic this post is about; know that we are the few and chosen! God is in control not us. I'm not religious at all but I came to this conclusion very early in my career and it helps when everything goes to hell. Also know that we are all behind you.
Wendy Hoechstetter Wendy Hoechstetter Saturday, September 13, 2014 9:46:26 PM So very true, Panther. So often we are there merely to bear witness, so that the dying don't die alone. That's just as valid an outcome as a save, to be able to help someone as they make that transition, so that they *aren't* alone, and even to be there to help comfort the family.

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