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Never move faster than your ability to make good decisions

How I explained response speed to the question “why don’t you run to the patient?” from an EMT student


Never allow yourself to move faster than your ability to make good assessment and treatment decisions.

Photo/Greg Friese

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Chris was a just-out-of-college EMT student doing his mandatory field rides on my medic unit. He comes from a family of lawyers but he had decided to break the mold and give emergency services a try. Halfway through our shift, we sat together in the station kitchen, sipping coffee and discussing the calls we had just run.

He had the same basic questions that most students offer. “How can I get better at hearing the blood pressure? Do you always do a full secondary assessment?” Much of our interactions were the typical fare for a young student trying to wrap his head around the ins and outs of emergency service.

And then Chris offered a question that proved harder to answer than I might have imagined. We had just run a call for a possible unconscious party at the courthouse. He asked, “Why don’t you run?” I look a bit puzzled so he expanded upon his question.

“When we parked out front I kind of expected that we would grab the gear and … you know, run inside.” Hidden in Chris’s question I saw the seed of disappointed expectations, planted by years of watching Hollywood movies and “Chicago Fire.” Why weren’t we dashing to the rescue like so many of our movie industry counterparts?

Someone could be unconscious.

Shouldn’t we run?

I know Chris isn’t the only one thinking this. From passersby in vehicles at the scenes of motor vehicle crashes to worried family members, I have no doubt that rarely a shift goes by without someone watching me do my job and thinking to themselves, “That guy should hurry up.”

I pondered Chris’s question and then I took a few stabs at why I refuse to break into a run when operating on-scene. Then I tried to break down the complexities of what truly determines how fast I’m willing to move. We talked about the importance of gathering intelligence and knowing how to get out of Dodge.

If you happen to be one of those responders who find yourself occasionally running to the scene of the emergency, here are some compelling reasons to slow your horses down:

Scene safety and size-up occur in real time

The National Registry of EMTs skills station allowed you to rattle off a verbal list of on-scene considerations as fast as you can speak. In a matter of a few short seconds, EMT students are allowed to address proper BSI, scene safety, resources needed, patient counts and the nature of the problem. On-scene, those are all very real considerations that need to be addressed in real time.

Is the scene really safe? What is the nature of the problem? If the scene becomes unsafe, how do I get out of here? Who is my patient? How does the scene look? How does it smell? Who is in control? Is anyone out of control? What issues will likely need to be addressed in the first two minutes?

Running to the patient’s side is a great recipe for missing important details in those first few most critical moments on scene. The aggressive bystander, the power line lying across the road or the empty child car seat; a million little details for you to take in and consider can all be missed if you rush through your walk to the patient’s side.

You’ve got to know the territory

Have you ever been “deep in country” in an office building or a big-box retail store and after a brief assessment you place the patient on your pram, look around and think to yourself, “How do I get out of here?”

Your walk to the patient should be slow and deliberate enough to allow you to develop a map of the environment that should include important details like alternate exits and how many people are between you and your closest exit. You should also be noting staircases and other obstacles that may present a challenge if your patient is non-ambulatory.

When you arrive at the patient’s side, you’ll hopefully have a good idea of the best way to get them back to your medic unit. In your first few minutes of patient contact, you’ll know if you require additional personnel or special equipment. You’ll also have a good idea of how long it’s going to take to transfer the patient from their location to your vehicle.

Our pace and cadence influences the pace of those around us

One of the more damaging and often overlooked aspects of rushing into a scene and pushing the pace of care is the detrimental effect it can have on everyone else around us. All of us have an internal speed at which we are most effective. Once we exceed that pace, we become ineffective.

Shooting specialists have adopted the phrase, “Slow is smooth, smooth is fast.” They’ve come to understand that the most efficient speed is not necessarily as fast as you can move. A rushed effort is rarely a perfect effort and the mother of speed is economy of movement.

Consider that once we are on scene, our demeanor and cadence will have a dramatic influence on the behavior of everyone else on-scene. Anxiety spreads faster than calm and panic is contagious. If we, the professionals, start running back and forth and barking out orders, everyone else will likely begin to move faster.

In this circumstance, not only do we become ineffective, we make everyone else on scene less effective. We also dramatically increase the odds that someone will make a mistake or hurt themselves. A recent paramedic line of duty death in Virginia illustrated how a single error in judgement, while moving too fast, can have fatal consequences.

Moving at the speed of your mind

I don’t always move at the same pace on each scene. The more I thought about Chris’s question, the more I tried to relate the many different variables that influence me to move quickly or to move more slowly. I related circumstances when I moved very quickly, and others when I intentionally slowed things down, and even stepped back from the scene.

As he thoughtfully absorbed my examples, I realized that I was struggling to capture a universal theme that would guide a new EMT in finding his own right pace. How do we find that perfect speed that allows us to be both efficient and effective at the same time? With that question in mind, I offered this rule:

I never allow myself to move faster than my own ability to make good decisions.

That pretty much summed it up. In every situation, there are a million variables that determine how fast I’m willing to move. I move faster in daylight than I do in darkness. I move faster when performing familiar skills than I do performing unfamiliar tasks. I move faster outdoors than indoors.

In each of these examples, it isn’t the environment or the patient’s presentation that guides my speed. It is my own internal pace of decision-making. The more decisions I need to make, the more information I need to absorb, and the more complex the decision-making process, the slower I allow myself to move.

These are typically the times when our internal sense of urgency tells us that we should be speeding up. It isn’t a natural response to slow down just when the chaos and complexity of the scene start ramping up, but that’s exactly what you want to train yourself to do.

When the stakes are high, you need to allow yourself to slow down just enough to make good decisions. A few extra seconds are rarely ever valuable to the patient, but every good decision that you make is priceless.

Read next: Why paramedics do not run to treat patients

This article was originally posted June 1, 2015. It has been updated.

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