Through Clear Glass

     In a classic case study, EMS is dispatched to "shots fired, man down" at a local tavern. As the medics pull in, they see a squad car, and, assuming the scene is secure, decide to enter the bar. A crowd of about 15 people beckoning to them seals the deal, and in they go. Once inside, in spite of the place being in a relative state of chaos, they manage to find their two patients. Both are indeed down: a police officer with a knife buried in his left thigh and the bar owner, who has two through-and-through shots to the right chest as payment for the knife attack.

     Question 1: What triage category is each patient?

     Question 2: Whom do you treat first?

     The gunshot wound is clearly the more serious of the two injuries and would be triaged as red (critical); the knife wound would be tagged green (walking wounded). When confronted with this scenario, most providers would triage appropriately, but then treat the officer first—not because of triage classification, but because the officer is thought to be the "good guy." As one provider said, "The bar owner is going to jail…I have to work with that officer every day." However, the truth of the matter is that the officer had been shaking down the bar owner for "protection" money for the last several years. With increasing greed came rising prices, and the bar owner finally got fed up and took matters into his own hands.

     This is a classic example of where providers make value judgments about who's at fault and who's not. As you can see from the example above, judging that the officer was the good guy simply wasn't true. That's why we have a legal system to determine right and wrong. That's also why we are expected to be objective and fair in our provision of care.

     In hopes of avoiding the error in judgment portrayed above, a big part of the process is arriving at a given scene and doing our best to remove bias, preconceived notions, etc. from our perspective—trying to see through clear glass.

     The prehospital setting where we work is a unique place, full of challenges and uncertainty on a 24-7 basis. We work with limited physical and technological resources in unstable, dynamic environments. We cannot be safe and effective as EMS providers if we see our world and our work through rose-colored glasses. We are the ultimate "reality show." Day in and day out, we do reality. Having a rose- colored, Pollyanna perspective will certainly impact your care and may potentially get you or other members of your team hurt or killed.

     Just as dark brown or black glasses filter out the harmful, burning rays of the sun, they filter out light as well. On the other side of the equation from the provider who looks through rose-colored glass and perceives that everything is OK and all will work out well are the providers who see their patients and their world through dark glasses and the dark imagery they provide.

     Frequently, those with a dark perspective see their patients as adversaries: an us vs. them mentality. With this view, they think everyone is trying to scam the system. It's one drug-seeking person after another. It's another unnecessary ride to the hospital in an ambulance when ANY other form of transportation will do.

     Clearly, this is a dangerous perspective as well. Along with the adversarial take on their job and their customers, it removes the human element from their practice by putting emotional distance between them and their patients. With enough distance, the patients cease to be people and instead become little more than conditions. They are limbs to be splinted, wounds to be bandaged and necks to be immobilized.

     As much as possible, we need to see our world and our work through clear glass, as bias-free as humanly possible. The more bias that enters your field of vision, the more likely it will screw up your thought process. In turn, that makes it more likely that you will not use your knowledge and skills to the best of your ability and in the best interest of your patients.

     Consider the statement: "We really need to like people, but we don't have to like what people do." When the drunk driver passes out, drifts over the center line and wipes out an innocent family, it is brutally difficult to not be angry at the unfairness you have just seen. However, this still brings us around to where we started. Our job is not to judge others; it is to care for others. That's why we have a legal system in place to make those judgments.

     We just need to do our absolute best to look through clear glass and not introduce any unnecessary subjectivity or bias into our care while, at the same time, not removing the humanity that makes our work what it truly is: taking care of people to the best of our ability.

     Until next month…

     Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.