Respecting the Game

By the time you read this, I hope to be thanking my family for another round of Christmas presents that aren't diagnostic or personally protective. I've accumulated enough gloves, stethoscopes and pocket masks over the years to outfit my own EMS agency.

My favorite gift from Christmas 2009 was Heart of the Game, a baseball book by S.L. Price, who characterizes "the Game" as much more than an athletic contest. For those in the inner circle--players, coaches, managers--baseball is "a way of looking at life." I've known a lot of EMTs and paramedics who feel the same about EMS.

Heart of the Game is the story of Mike Coolbaugh, a career minor-leaguer with major-league values. By all accounts, he didn't let low pay, injuries, age, anonymity, third-class accommodations or just plain bad luck compromise his role--mostly as a mentor to younger players--during 17 years and 1,734 games, only 44 of which were with big-league clubs. According to teammates, Coolbaugh showed respect for baseball by approaching it with humility, balance and commitment. Each at-bat was a new chance to excel.

EMS, like baseball, is an insular society with a short memory, tolerant of neither fragility nor hubris. We're only as good as our last call. To respect our game is to move forward; to understand we are tiny parts of an institution that thrives on initiative and reliability.

Practitioners who dwell on the past often display more bravado than proficiency, and sometimes favor shortcuts ranging from impolite to unsafe:

• Substituting dispatch information for patient assessments. To me, "sick" is when I don't feel well, probably because some microscopic life form has invaded my gut or commandeered my cells as tiny nurseries. I've never needed an ambulance for that, but my definition of sick is by no means universal. We've all handled "sick" complaints that turned out to have cardiac, respiratory or other unstable etiologies. Those kinds of cases require more than a BP cuff and clipboard.
• Not restocking supplies. I've worked at agencies where I dreaded precheckout calls because I didn't know what meds, supplies and equipment I'd inherited. I started stuffing spares of smaller items in my pockets, but O2 bottles and defibrillator batteries present unique wardrobe challenges. Can we get together on this?
• Leaving a mess for someone else. Just yesterday The Lovely Helen commented on an allegedly inequitable distribution of housekeeping responsibilities between men and women. (I can't imagine where she got that idea, since most of our household chores are mysteriously completed before I have a chance to postpone them.) Yes, I occasionally assume my dishes and my ambulances will be washed by someone else. No, I wouldn't want that done to me.
• Trivializing or ignoring recurrent training. It's not unusual to hear EMS providers complain about biennial or triennial refreshers. I admit I get frustrated by the timing or content of some classes, but I know experience alone won't introduce me to new concepts, nor ensure I remember old ones. I agree with a 2003 position statement by the National Association of EMS Educators that flexible, high-quality CME is "the cornerstone of our progression" toward more proficient prehospital care.

I want to bring my "A" game to every shift. I try not to get distracted by things I can't control. But what if I'm not as good at that as I think I am? What if that bad mood I brought from home is more evident than I'd assumed? Or maybe that last call--the one that didn't go the way I'd hoped--has me preoccupied with failure when I should be focusing on a fresh opportunity to do better. What if my behavior convinces a patient or partner that quality care isn't my highest priority?

First I need someone close to tell me that. Next I'd better suppress a defiant streak I've been known to show, and consider the possibility I've lost my perspective. Then it's time to "reboot" my connection to EMS--to remember I left a perfectly proper but unfulfilling corporate career for the privilege of aiding others. To ignore signs of paroxysmal ambivalence would be disrespectful to those who served in this field before me.

On July 22, 2007, at Dickey-Stephens Park in North Little Rock, AR, Mike Coolbaugh was struck behind the left ear by a baseball hit so hard that even 90 feet away, he had less than half a second to react. That wasn't enough. The line drive crushed his left vertebral artery, depriving his brain stem of oxygenated blood. Although on-site paramedics, doctors and nurses-- many of whom were paying customers --initiated the most futile of prehospital algorithms within a minute of Coolbaugh's collapse, the consensus is he was dead before he hit the ground.

The Coolbaugh tragedy, while shocking, isn't bigger than baseball. The game goes on, with men like Mike who set good examples. His story reminds us that in sports, EMS or any occupation, dignity isn't measured in dollars, conscientiousness isn't dictated by contracts, and respect for one's profession--despite stress, frustration, malaise or misfortune--fosters excellence.

Batter up.

Mike Rubin, BS, NREMT-P, is a paramedic in Nashville, TN, and a member of EMS World Magazine's editorial advisory board. Contact him at mgr22@prodigy.net.