September 10, 2001, was my first day of vacation after a summer of long days and few days off. We drove from northern Wisconsin to the Mall of America where we spent the evening wandering the mall, seeing the movie “Rat Race,” and preparing for a mid-morning flight to San Diego. Our 9/11 flight, like thousands of others, was first delayed and then cancelled. We watched the Twin Towers fall with shock and grief.
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Just like then, we never know if today is the day before the biggest day of our careers, but we can prepare as if today is the day before the call that we’ll reflect on for years to come or that might even define the evolution of our profession.
With that in mind and after a long layoff from direct patient care, here’s my checklist as a now regular, paid-on-call EMR in a combination department, for the day or shift before the unknown.
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1. Arrive early
I give myself a chance to wish the shift that’s ending a pleasant day; inquire about the highs and lows of their shift; and get an update on equipment that needs to be fixed, has just been put back into service or is missing. If there’s time and they have interest, I like to hear a few stories, mentally reminding myself to listen more than I talk.
2. Gear check
The vehicle and gear check are at the top of my list. I follow the quick response SUV electronic checklist to make sure everything is in place and ready to go. Lights. Mirrors. Fuel. First-in bag. Oxygen. Monitor. AED. Gloves. Check, check and check. Once the SUV is ready, I take a few moments to organize my personal gear. Snacks. Lunch. Sunglasses. Hat. Double-check BDU pockets. Emesis bag, left-pant pocket. Reading glasses. If I need it, I want everything to be where I expect it to be.
3. Training
I don’t know what calls we will run, but every shift I follow Gordon Graham’s timeless wisdom that “every day is a training day.” At some point during the shift, I review at least one EMS protocol and the relevant equipment and medications. If coworkers want to train together, I jump into the mix. Solo or in a group, I’ve recently reviewed firefighter rehab, OB emergencies, lung sounds, active assailant, IV pump and ventilator settings, and pediatric respiratory distress. Learning is a constant and the resources available to me in 2026 are unparalleled.
4. Fitness
After years of running, cycling and cross-country skiing, my cardiovascular fitness level is high but my upper body strength is relatively low for the tactical strength requirements of EMS. Every shift, usually with about an hour left, I do a circuit of arms, shoulders and chest. I want to be better prepared to administer manual CPR, carry gear, and lift and move patients. I am fortunate that my station has a weight room, but if it didn’t, I’d be using our first-in bag for a farmer’s carry and chest press reps, and the monitor or LUCAS for overhead presses.
5. Connect with coworkers
After years of remote, work-from-home employment, being face-to-face with coworkers is important to my mental health, readiness and social wellbeing. It’s also one of my top reasons for returning to the field. On a recent shift, we barbecued lunch, ran verbal patient care scenarios in the conference room and received a pick-up load of sweet corn from a farmer. Whether it’s training time, mealtime or down time between calls, I want to take advantage of these opportunities to socialize and connect with people. Building our connectedness will be useful on call, after the call and in my life away from the station.
6. Reflection time
At least once a shift, I close my laptop, stow my phone and find a quiet space around the station for personal reflection. A few moments of gratitude or intentional breathing, especially mid-shift, help me reset and refocus for the remainder of the shift. You might choose prayer, meditation or intentional breathing exercises.
If you’re not sure where to start, try taking five box breaths. Inhale for 1 second, pause for 1 second, gently exhale for 1 second, pause for 1 second. Repeat. Or try this five senses exercise that I have learned from Mike Taigman and Joel Neild.
7. Keep your affairs in order
This isn’t an every shift item, but a principle that I as a first responder I owe to my loved ones is to have my affairs in order. At the least, we should all have a healthcare power of attorney, last will and testament, and have had a discussion about funeral arrangements with a spouse, partner, parent or member of the clergy. I also extend affairs to manage to include how to access financial accounts, passwords and combinations, and ensure bills are paid on time. Fully-funded retirement accounts, college savings accounts for my kids, a life insurance policy and minimal debt are also part of my what-if, worst-case-scenario planning. If your affairs aren’t in order, here’s a couple of articles to get you started, “Living wills for frontline workers” and “Basic estate planning for first responders.”
8. Leave work at work
Depending on the shift and the calls, leaving work at work is easier said than done, but here are the things I try to do at 7 p.m., after briefly visiting with the oncoming EMRs. Turn off my pager. Eat a healthy meal before 8 p.m. Take a 20-minute walk around my neighborhood. Decompress with a few minutes of television and continue my habit of 5-10 minutes of core strength exercises before I get into bed. Dock my phone in the closet and read a chapter or two of a book. Lights out by 9:30 with certainty that I have prepared myself for tomorrow, whether it be mundane or a shift I will never forget.
