While we are on duty, anything and everything can happen.
I used to let the responsibility of being one of the people that other people call when things are out of control overwhelm me. I would sit frozen in place waiting for the bell to tip, hoping it was for something easy.
Eventually I realized that I could handle anything and allowed myself the luxury of relaxing while on duty, but only between calls. It was all about letting go of the idea that I had to be in control.
There were times I needed to be in control, but not over everything. I can only control the things that I am trained for, the rest is, well, out of my control!
Take control or be controlled
It is impossible to be an expert at all things. Motor vehicle accidents, falls, shootings, suicide, electrocution, sexual assault and the unexplainable can come at us at full speed at any moment. Knowing exactly what is in our control and what is not is vitally important. Taking control does not mean assuming command, just as being controlled does not let us flip a switch and become little more than an automaton.
There will be times that you will be first on scene. We are not superheroes, cannot stop the runaway train, extinguish the fully-involved house fire or treat multiple injuries at a mass casualty. What we can and must do is keep our emotions under control and make a cohesive scene assessment and relay that information to incoming resources.
Until they arrive, all you can do will not be enough. Knowing that others with my same level of training, rank or education would never be able to do it all either helped me.
Control of patient care
EMS is often the last resource to arrive on an emergency scene. We are responsible for patient care. The patient’s family and friends or the police may have been in charge prior to your arrival, or the fire department, maybe even the National Guard.
When lives are at stake, the ego of the people on scene can become a factor. Family members are possessive of the person you have been called to treat, and if you do not treat their loved one with respect, care and competence you will be in for a very unpleasant experience. Other responders may become possessive of the patient and reticent to relinquish what they perceive to be the best care available at the moment.
Taking control of patient care is far more complex than it looks. Making it look easy takes time and experience to master. It gets a lot easier when you become adept at taking control of yourself and your human response to tragedy, fear of failure and the overwhelming feeling of hopelessness at particularly difficult and traumatic scenes. Conquering your insecurities allows you to proceed with confidence.
Leadership control starts with confidence
Leadership ability is a learned skill. Not everybody is a born leader. I was not born a leader, but learned how to take control of my part of an emergency scene when necessary.
The first and most important ingredient in a leader is competence. Without knowing what you are doing it is impossible to lead others who do. False bravado is obvious when it comes time to do the work needed to be done.
People who dedicate their lives to emergency response tend to exhibit leadership qualities. People look for leaders in times of strife. Doing everything yourself is impossible. Barking out orders is ineffective. Put a group of poor leaders together and watch how quickly nothing gets done.
Proving yourself during stressful situations by growing and advancing through the ranks works wonders, however not everybody has that luxury. There will be times when nobody on scene has a clue who you are, what you are capable of or why they should trust or follow you.
Getting involved by introducing yourself to the victim, the family or friends and the crews on scene is a great way to get things moving. If time permits a detailed report from whoever appears to be in charge of the scene shows that you are willing to listen, able to follow constructive advice and ready to take command of your role in the incident.
Control comes from learning to trust others
Trust in the ability of others is vital. Responding to a gunshot victim or victims, when emotion is high and weapons are likely at a hostile crowd’s fingertips, trusting the police to secure the scene while you treat the patient is imperative. Waiting for a motor vehicle crash victim to be extricated from a crumpled wreck is torture, but we must heed the commands of the firefighters or rescue technicians working to free our patient. Allowing our mind to be free from worry of being assaulted or worse, or having a vehicle explode, move or be struck by oncoming traffic is the result of learning to trust the other people on scene who have learned to control their piece of a complex incident.
Calm, quiet professionalism roars like thunder when chaos rules. As EMS professionals there is no situation that we cannot make better. By doing our jobs within the scope of our training and protocols even the most impossible obstacles can be overcome. Knowing our limitations is key, and relinquishing control when necessary imperative.
