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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

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.

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of the 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

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