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Book Excerpt: ‘Streetsense: Communication, Safety, and Control, 4th Edition’

Kate Boyd Dernocoeur contemplates the art and science of prehospital care, and how streetsense enhances the skills learned in EMS training


Early in her career on the streets, Kate Boyd Dernocoeur realized how much more there was to learn beyond the straight medical training. From her mentors and years of observation and experimentation, she learned the craft of emergency care. This book offers scores of tips and tricks (and traps) for helping people in crisis.

By Kate Boyd Dernocoeur

Variety is the spice of life, and nothing varies as dramatically as the people we meet when a medical emergency arises. It is always interesting to see how our skills and knowledge can help someone else who is having a lousy day. We routinely enter scenes of chaos, interact with many people at once, coordinate and facilitate plans, and do the job of prehospital care.

To get all that done with a clear mind and an effective, efficient style – that’s streetsense. Our work is so much more than the mere mechanics of medicine. It demands effective communication, strict attention to different elements of safety, and the ability to control situations time and again. That’s why these are the three major pillars of streetsense.

The concepts underlying streetsense fuse the art and science of prehospital care. As we deliver assistance to strangers in crisis, a prime component is people skills. It’s knowing how people tick, how they are likely to react in stressful situations, and how to meet them halfway. It’s knowing when to push and when to yield. Having strong people skills is a hallmark of high-quality, efficient, effective emergency medical caregivers. Those with that intangible umbrella of humanistic capability in combination with strong technical/medical skills are the ones that others at the scene – coworkers, the patient, and bystanders – will look to and respect.

The notion of being well-rounded in this way may sound pretty grand. But everybody should strive to be the very best emergency care provider possible. The chance to develop these skills begins in initial training, but don’t stop there. Developing streetsense is an ongoing process. Simply passing the exams and getting licensed is not all there is. Continuing education, both formal and informal, is vital. Every call, routine or not, has something to offer, something for you to learn. Being a part of the world of emergency medical service (EMS) isn’t difficult. The real challenge is being really good at it. It isn’t easy to excel, especially when you are at the bottom of the seniority heap. It is frustrating to have to obey questionable orders. Every person in a leadership role should be a student of streetsense. So should the people on their way up through the ranks. By recognizing and developing all three components of streetsense, each of us, from entry-level first responder to inner-city paramedic, can benefit. In more detail, these are as follows:

  • Communication. People skills are the soup stock you can use to cook up answers to the full range of the human emergency spectrum, from critical situations, to medical and trauma challenges, to routine transfers. You may not be in a position to say a single word out loud, but as a member of the team arriving to help you can still “say” a great deal by such actions as wiping your shoes as you enter. This demonstration of consideration and other nonverbal behavior speaks volumes. Verbal communication brings an even greater opportunity to employ effective, interaction-enhancing strategies. Good communication involves having an accurate sense of self-awareness. Know yourself! With this as a starting point, you can learn how to interact fluidly with patients, their families and friends, your EMS team, and other emergency and medical professionals. Failure to get along with other people can be a career wrecker.
  • Safety. In the name of self-preservation, every member of the team needs to know how to ensure both personal and team safety. No matter where you work, the streets can be hazardous. Inner cities may have a violent reputation, but people are people everywhere. The principles of safety go beyond self-defense in the face of violence. Streetsense encompasses many simple, daily safety measures – some that are quite ordinary. Heeding the various principles offered in this book might save an important life: yours. Even very experienced people don’t know it all (although some seem to believe they do). Prehospital professionals with good streetsense know many ways to reduce or eliminate the risks inherent to our work environment. Many have probably learned by the traditional seat-of-the-pants method, but the school-of-hardknocks approach is hazardous and unnecessary. This book offers ideas for safe EMS practices that can help anyone make smart decisions about personal safety and control that can benefit the whole EMS team. Of course, there is always more to learn.
  • Control. If you think you have no control because you aren’t in charge, you’re wrong. For starters, everyone needs self-control, and that’s not always easy. Also, whoever is in charge may ask you to care for someone else, such as a relative or people with minor injuries. Each individual representing an emergency service at a prehospital scene has some control responsibilities. In addition, the basic principles of “control” extend elsewhere.

They include control over your responses to stress, your attention to your own wellness, your understanding of legal matters related to EMS, and your control over life after the streets (both daily and once you retire). All of these topics are addressed in detail.


Reprinted with permission from “Streetsense: Communication, Safety, and Control, 4th Edition” by Kate Boyd Dernocoeur

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Since 1979, Kate Dernocoeur, NREMT, and firefighter (ret.), has written numerous books, articles and columns for emergency service personnel. She has spoken at many EMS conferences nationally and internationally for more than 20 years. Her start in emergency service was with the Vail Mountain Rescue Group (Colorado), and she served with Denver’s famous Paramedic Division from 1979 to 1986. She was an EMT-firefighter for the Ada, Michigan Fire Department from 2012-2019. She currently serves as a SARTECH-II with Kent County SAR’s K9 Unit. She began her work as a medical examiner investigator (MEI) in 2016.

Kate wrote the book “Streetsense: Communication, Safety and Control” in 1984. Regarded by some as an EMS classic, it was released in 4th edition in 2020.

She co-authored the seminal dispatch book, Principles of Emergency Medical Dispatch with Dr. Jeff Clawson, MD (first edition, 1988) and EMS Safety: Techniques and Applications for FEMA in 1994. In addition, she authored A Worthy Expedition: The History of NOLS in 2017. She was also editor of one of the first online EMS magazines, MERGINet, from 2000-2003.

She holds a bachelor’s degree in journalism from Boston University’s College of Communication and an MFA in creative nonfiction writing from Western Michigan University. She also authors a wide-ranging blog, “Generally Write.” A Colorado native and mountain girl at heart, Kate has been settled in Michigan since 1987.