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Do we have the right stuff?

What EMS can learn from the NASA/SpaceX mission and a return to space


A SpaceX Falcon 9, with NASA astronauts Doug Hurley and Bob Behnken in the Dragon crew capsule, lifts off from Pad 39-A at the Kennedy Space Center in Cape Canaveral, Fla., Saturday, May 30, 2020.

AP Photo/Chris O’Meara

Five, four, three, two, One-Stop. Placing the emotional and upsetting events on the ground – the civil unrest across the country after the death of George Floyd – to one side for a moment, last weekend we placed two Americans into space from the U.S. mainland after a 9-year delay. After blasting off from the Kennedy Space Center and then whizzing around the Earth at speeds that eventually hit 17,500 mph, the SpaceX spacecraft carrying two NASA astronauts docked with the International Space Station, completing the first leg of a historic journey.

The mission marks the first time a private company has flown astronauts to orbit and flight tested a vehicle that could truly take us onto a journey that will boldly go where no one has gone before. NASA Astronauts Bob Behnken and Doug Hurley sit at the tip of the pyramid of tens of thousands of workers – and, importantly, disrupters and innovators – who have delivered new space vehicles, innovation and technology across years of research and development.

Against the backdrop of this stellar event, I asked several respected EMS leaders to identify what EMS can learn from the return to space.

Persevere: stay the course

First up: Page Wolfberg and Wirth’s Steve Wirth, a self-confessed space nut. Steve authored an article on leadership lessons from the 50th Anniversary of the Apollo 11 mission, which I highly recommend.

It has been 9 years since we put Americans in space from American soil in American rockets, and the SpaceX mission was delayed numerous times, almost to the point of wondering if they would ever succeed. Patience and perseverance have been key in the journey to the launchpad. Steve told me, “I think that applies to everything – we always want things instantaneously, but we sometimes have to go through some rough times to get to the positive outcome at the end.”

If we do what we always did we will get what we always got

Innovation and business disruption caused the bar to be raised to infinity and beyond. Steve noted SpaceX redesigned the spacecraft with touch screens, made the spacesuit more practical and reinvented other astronauts wouldn’t have even thought of. We are pretty good at innovating in EMS and finding workarounds to solve many practical and operational problems, but if we are content with accepting the status quo, innovation will stagnate.

Think outside of the box: nothing is impossible

Many thought Elon Musk was crazy. He predicted SpaceX would launch its rocket, bring it back to earth and land it on a small platform with pinpoint accuracy. Steve believes the lesson here is that we should all endeavor to think outside of the box; “Sometimes in EMS, we tend to get the blinders on and let tradition and the fact we have always done it this way get in the way of progress and development.” To be on the cutting edge of the progress, we must avoid narrow thinking and encourage creative thinking at all levels of any organization

Do not let a catastrophe shut you down

Just a year ago, SpaceX had a catastrophic failure when a spacecraft on the ground blew up. SpaceX called it an anomaly. Others called it a RUD: rapid unplanned disassembly of the spacecraft. “When that happened, people thought OMG – they are never going to put humans in space, what a bungling operation this is, yet they didn’t let catastrophe get them down, they had faith in their process, faith in their people and their equipment, and they quickly figured out the problem and got it taken care of,” Steve said. “The abiding principle here is that there may be setbacks, but sometimes, you have to get up, dust yourself off and get right back in the saddle.

Train, train, and train some more

Astronauts Behnken and Hurley and team had been in training for 5 years, living and breathing mission preparation to the point they could probably do it in their sleep. “The repetitive training made them do the job right and this is something we need to continue to do in EMS,” Steve related. “Often when we have budget problems, we tend to cut training as it’s an easy thing to cut, yet in reality, we need to put more money into training to avoid some of the bigger problems we see down the road.”

Practice humility and give credit where due

Despite the greatness the astronauts are no doubt achieving, humility is a major part of their DNA. Steve believes that “these guys are about as humble as you get,” with a “healthy confidence, not an ego that overrides their personality.”

They also had confidence in their people, processes and technology, and are always, willing to give credit where credit is due. Behnken and Hurley have been quite rightly willing to call out, identify and thank who’ve worked tirelessly behind the scenes to ensure the success of the mission. As with EMS, it takes the whole organization, from the front line to back office, to deliver the full job cycle of emergency response where we have to launch, dock, treat the patient and return to our mission control many times a day.

If you love what you do, you will never work a day in your life

Have fun at what you do despite how stressful, dangerous or difficult it is. Just after separation from the main rocket, the first image to drift in weightlessness across the screen on earth was the purple dinosaur. The ultimate fun, of course, is the launch of a Tesla car to infinity and beyond.

Take a lesson from private companies

NASA Administrator, Jim Bridenstine, stated that, “The mission foreshadows a sea change in the way NASA will do business in space. Instead of owning and operating the spacecraft itself, the future of the agency will lie with partnering with the growing commercial space sector.”

I also spoke with NAEMT President and MedStar Mobile Healthcare Chief Strategic Integration Officer, Matt Zavadsky, who acknowledged public-private partnership enables innovation, positive business disruption and progress, noting:

  • The rocket was leaner, more efficient and automated, with cutting-edge technology
  • The private sector generally brings more innovation to a mission
  • SpaceX figured out how to reuse booster rockets to save money
  • Sometimes you must blow up a rocket or two to figure out what doesn’t work to perfect a process
  • Whenever possible, leverage the power of strategic product-placement synergy – like driving a Tesla to the Falcon 9 rocket
  • It is valuable to co-brand expensive capital equipment (the rocket and capsule were co-branded with the NASA and SpaceX logos).

Have the moral courage to say ‘no’

I also reached out to Todd Stout, FirstWatch CEO. Todd admired the partnerships and the culture of safety the launch represented. The initial launch was scrubbed with minutes to go, on the recommendation of one member of the wider support staff.

If there is doubt or the situation, and therefore outcome, is uncertain, then any crew member can and must speak up. This sometimes takes a high degree of moral courage, which, when applied across the public sector, brings us right back down to earth.

If we see something going wrong – we must speak up lest the consequences lead to a tragedy.

The show must go on

With the ship docked and the whole world watching, the Dragon crew entered the ISS; what could go wrong? Astronaut Doug Hurley elegantly demonstrated the physics lesson that a body (in this case his) in motion stays in motion as he floated with a degree of velocity through the hatch and into the opposite bulkhead, striking his head. There being no opportunity to go to commercial break, he nursed his wound and carried straight on without missing a beat.

In EMS as well, once we commit, we boldly go and get it done for the benefit of our patients. Perhaps like NASA and SpaceX, team EMS is full of stars too. In the last 3 months, we have launched into a new frontier, and have done so with honor, perseverance and humility.

Do we have the right stuff? – EMS One-Stop With Rob Lawrence

For an audio version of this article, listen below.

Part and parcel of training for both astronaut and EMT is simulation. Sophisticated simulation exists in both arenas now, but to test if you have the right stuff, visit the SpaceX free simulator to see if you can dock the Dragon crew to the ISS. Like all simulation, it is not as easy as it looks and will develop muscle memory to ensure that practice makes perfect when it must be done for real.

If you’ve realized it’s not as easy as you thought it would be, here is a YouTube tutorial on how to do it like a pro – or even astronaut!

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.