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A chief’s lesson on the importance of empathy in the field

Takeaways from a GSW response that quickly escalated into chaos


“We can’t forget what our people endure every day and how stressful it can be, even if it’s nothing more than listening to their complaints or cries after a bad call,” writes Neill.

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I was reminded of the importance of empathy and compassion towards family and coworkers the other night. Having seen the worst that human beings can do to each other can harden an individual’s resolve and make them unable to empathize with others in their darkest moments. As leaders, we sometimes easily dismiss someone else’s grief to move on to the next call and the next call.

The other night, I found myself the first medical provider on the scene of an individual who suffered a mortal wound from a gunshot. As I approached, I could see what appeared to be family members who were stricken with extreme anguish while also attempting to perform resuscitation measures on their loved one.

As usual, I gave a brief incident report and directed all responding units to my location. I assessed the young man and realized quickly that no number of life-saving measures could change his outcome. His vital signs fell below the range for any positive outcome in a traumatic arrest and met our department’s field criteria for withholding resuscitation. No amount of optimal life-saving efforts by even the best EMTs or paramedics would have brought him back or changed the outcome.

Restoring order to the scene

I made the difficult decision as the first medical provider and field supervisor to withhold resuscitation. It was at this moment that even the best training in the world could not have prepared me for what would happen next. We teach others what to expect when the family is stricken with grief and in a state of denial. We attempt to prepare them for the outcome by allowing them to witness our efforts and termination. We teach medical providers how to deal with the mental and emotional impact of having to look a patient’s loved one in the eyes and tell them there is nothing more we can do for their deceased family member. It seems so easy until we find ourselves in a situation where the family member is unwilling to accept the outcome and pleads with us to keep trying.

Although it may have only been a few minutes until my fellow responders arrived at my side, it seemed like forever. I found myself quickly surrounded by family members, neighbors and strangers begging, pleading and screaming for me to continue resuscitation. My attempts to convince them that it would do no good only fell on deaf ears. Instead, I was faced with a sister, girlfriend, mother and brother who all insisted that I keep trying. All I could hear were screams of, “you’re not even trying,” and “please don’t let my baby die!” I had forgotten that this lifeless body was someone’s son, brother and loved one.

I found myself trying to calm them by talking louder, only to be silenced by screams from the family. I found myself yelling at the two police officers on the scene, angry that they weren’t helping control the hostile crowd. I forget that even the most well-trained police officer is only a human being who falls victim to the chaos of an event. In those few moments, I decided to continue the resuscitation of this lifeless individual, knowing that regardless of our efforts, they would not change the outcome.

My loneliness was quickly relieved with the assistance of the firefighters on the engine and the medic crew. As they were approaching, what was going through my mind could only be described as pure chaos. I was relieved that my fellow responders had arrived at my side so quickly. My coworkers were there to help me mitigate the scene and help restore some semblance of calm to a chaotic scene.

As we quickly packaged the victim and moved him to the awaiting medic unit, my mind was racing with anger. I was angry at myself for not controlling the scene, angry at the family for screaming at me and at the police for not helping me. How could I be angry at the family? God knows if that had been my loved one lying there, I would have reacted the same way, if not worse. How could I be angry at the police officers? They were doing the best they could do.

After the call was completed, I had time to myself to defuse and think back on the events of the call. I was amazed at how quickly it escalated on the scene and how quickly it was resolved. As soon as the medic unit left the scene, the crowd of spectators that were screaming at us dispersed back into their homes. I found myself sitting in my vehicle, hands trembling, breathing hard, wondering, “what the heck just happened!?”

Learning empathy

As medical providers, we easily forget that our compartmentalization of traumatic events can manifest into post-traumatic stress. We try to harden ourselves with each stressful call and forget about them or diffuse stress with attempts at humor. As leaders, we tend to forget that these types of calls can inflict long-term mental and emotional stress on our coworkers.

It’s easy to sit behind a desk and tell others what to do on the radio, but it’s different when we are out there, “shedding the same blood in the same mud.” We must be there with our people to watch their backs and make sure they get home after the shift is over.

Regardless of what the department’s administration tells us about maintaining public trust and preserving the image of the department, the people come first. Their job is to take care of the patient and get home safe; our job is to make sure they do that.

It’s easy as new leaders to become enamored with the prestige of being a chief and wearing the shiny collar pins, but we can’t forget where we came from and who helped us get there. Our job as leaders is to mentor others and to make leaders of them so that they can make the department even better than we left it.

We can’t forget what our people endure every day and how stressful it can be, even if it’s nothing more than listening to their complaints or cries after a bad call. Empathy and compassion are part of leadership, and they cannot be taught; they must be learned and passed on.

Andrew Neill has been a paramedic and EMS educator for over 30 years. He has worked for the Nashville Fire Department/EMS Division for 24 years and is currently an EMS district chief for one of the busiest districts in the city. He is a Tennessee paramedic instructor coordinator and has a Doctorate in Adult Education. His goal as an EMS educator and leader is to instill the importance of empathy and compassion in other providers and to show how stress and fatigue in EMS impact organizational recruitment and retention. He can be contacted at