The Navigation Puzzle

      You're in the back of your rig with a critical patient. Between the bumps, stress and chaos, you happen to glance out the back window just in time to see the same gas station whiz by for the third time. Your instinct tells you your new partner is lost. What should have been a 10-minute ride to the emergency department has just turned into an extended tour of your service area.

   You try not to yell at the new guy, but it's obvious you're mad. This only makes him even more nervous, and he ends up hitting the curb as he turns the last corner into the hospital parking lot. There are nine hours left in your shift, and you swear you'll never work with a new guy again.

   Anyone who has been in EMS long enough can relate to this. But we must remember what it was like to be the new guy. Everyone gets lost. Navigation is probably the weakest part of any EMS provider's training. Schools rarely cover it. Good luck trying to find anything in a textbook on it. Most training institutions believe navigation training is the responsibility of the company that hires you. This needs to change.

   There are two common beliefs that must be challenged. One is the belief that since every service area is different, why bother teaching navigation? Yes, every service area is different. Yet there are some simple rules that apply to every one. The sooner you understand the basics, the better off you'll be.

   The other is the belief that technology will solve the problem. No, it will not. Machines fail. Software crashes. Batteries die. Do not put all your trust in technology. Your brain is the best piece of technology in the rig. Sure, most EMS systems have AVL and GPS, among other things, but they should be there only to assist you.

   I have a partner, Rick, who is famous for saying with his great southern drawl: "We ain't never not got there yet." Let's keep this in mind, because it's true. Remember, the average time it takes to learn a service area is about 8–12 months for a full-time employee. Hopefully knowing the basics will make it easier and cut the time down. This article is designed to give you 10 crucial "tools" to overcome navigational problems.

1. KNOW WHICH WAY IS NORTH

   You've spent hundreds of hours learning lifesaving skills and memorizing drugs and cardiac algorithms, but do you know which direction is north? Sounds silly, doesn't it? But the absolute first thing you must know is which way is north, south, east and west. It is amazing how many new people will jump into a rig, ready to speed off to the rescue. They look at you eagerly for directions. You tell them to "head west on Main Street." And they drive east. Before you do anything else, know your basic directions.

2. KNOW YOUR COMMUNITY'S NUMBERING SYSTEM

   Every village, town and city has a numbering system. Each one is different, but the key is that there is one. Some address numbers are on a grid system, others follow natural landmarks such as rivers or mountains. If your EMS service doesn't teach you the local numbering system, take a long, hard look at your map books. The numbers of homes usually correspond to the numbers of streets. You can figure it out in a short time. This will give you a major advantage when trying to find any house number. Even if you don't know where the call is, you can at least get close (usually within a quarter mile) if you understand the local numbering system. If all else fails, ask the local mail carrier to come in and teach your staff how the numbering system works.

3. BECOME FAMILIAR WITH LOCAL ROADS AND HIGHWAYS

   You've spent thousands of dollars on paramedic training, yet you won't spend $30 on a tank of gas. I've had this discussion with dozens of new people over my EMS career. If you are really serious about learning your service area, take one of your days off and drive all the major roads and highways in it. You will not be under any pressure, and you can learn at your own pace. The amount of money you will "waste" on one tank of gas will more than pay for itself in the future.

4. KNOW THE ADDRESS WHERE YOU ARE BASED

   The hardest addresses are the ones right next to you. It sounds weird, but it's often true. You get a call three blocks from your base, but it takes you five minutes to get there. The reason this occurs is because we take our primary bases for granted. We don't learn a base's actual address number; we simply call it by its assigned name, such as "Main Base" or "West Base," etc. Then, when the call comes out, we scramble to figure out where it is. If you know the addresses of your bases, finding calls right next to them is much easier.

5. DON'T FOLLOW THE COPS

   Never "just put down the map book and follow the cops." If you work in a midsize to large area, you stand a big chance of getting burned by this one. Most police and fire departments respond to multiple types of calls. Nothing is more embarrassing than following the cops to what you think is an EMS call, only to find out it's something totally unrelated. You look and feel really stupid. Ask anyone who has been in EMS for more than 10 years about this.

6. RETRACE YOUR STEPS TO GET OUT

   The way you go in is the way you go out. This little rule will really help you during the first year of your EMS career, when you're trying to learn your service area. If you respond to a call in an area you're not familiar with, do not try to find a "quick way" out. Retrace your steps until you get to an area you are familiar with. It may take a few extra seconds, but it's not worth the risk of getting lost on your way to the ED, especially if the patient is critical.

7. KNOW WHERE YOU'RE GOING BEFORE USING LIGHTS AND SIREN

   Do not turn on your lights and siren until after you have a good idea of where the call is. Blasting out of the garage with your lights flashing and siren blaring is dangerous if you don't know where you're heading. If you get a call to an unknown address, take a few seconds to look it up. Or, if you know the area it's in, start that way and wait until you know exactly where it is before turning on the lights and siren. Driving with your lights and siren on will only add to the stress and increase your risk of an accident if you don't know where you're going.

8. NEVER SAY "RIGHT" EVEN WHEN YOU ARE

   Learn to say "yes, "correct, "yep," or "okay." Or you can really sound cool and say "affirmative." Just do not say "right" when you are discussing how to get to an address with your partner. This may seem trivial, but it will save you a major headache.

   It goes something like this: You are driving with your lights and siren on down an unfamiliar street. There are two people in this drama: you, the driver, and your partner, the navigator.

   Driver: "This is Maple Street up ahead. I take a left?"

   Navigator: "Right."

   Driver: "Okay." You then turn left.

   Navigator: "Turn right!"

   Driver: "You said turn left!" You then swerve to the right and nearly miss a stopped car that was yielding to you.

   This seems like a slapstick comedy, but it happens all the time. When it comes time to give your partner directions, never say the word right.

9. KNOW WHO'S THE DRIVER AND WHO'S THE NAVIGATOR

   This one is hard, especially for old-timer medics who may be a bit on the controlling side. But the driver is the driver. The nondriving partner is the navigator. The person driving must focus all of his/her attention on the road. Do not expect the driver to perform any navigation that requires taking their eyes off of the road. In other words, do not show the driver the map book while you are moving. This sounds really simple and almost silly, yet it happens all the time.

10. IF IN DOUBT, STOP TO FIND OUT

   When you get lost and neither crew member knows where you are, find a safe place to stop and shut down your lights and siren. Let both of you look at the map books or call for assistance if you need to, but do not drive around blindly with your lights and siren on. Driving aimlessly in traffic with your lights and siren on is dangerous and only adds to the growing stress. Taking 30 seconds to calm down and recheck your map books and reestablish your bearings will make all the difference.

   Most of these steps are commonsense to EMS providers who have worked the streets for a few years. But to those just starting out, it's new material, most of which probably wasn't covered in their EMS training. Hopefully, by using these 10 tips, you can get to patients and ultimately assist them with their problems faster and more efficiently.

   James Newberger, EMT-P, has worked at North Memorial Medical Center, a Level 1 trauma center in Minneapolis, MN, for 21 years.