Taskmaster: Managing Yourself and Others On Scene

In the early 1980s, I worked for a hospital that was home to the regional paramedic program. Because the concept of advanced life support was still in its infancy, I found myself and three other paramedics precepting paramedic and Intermediate students for services in 13 communities spread across our 22-county region for two and a half years. To accomplish our precepting goals, we used a specially con- figured Chevrolet Suburban called Mercy 300 that had two full sets of paramedic gear in the back. I'd respond to a rendezvous point, drop one set of gear, and, when the local service arrived, I'd hop in with my gear and leave 300 locked by the side of the road. I would either pick it up after the call or, if we came with two medics, Mercy 300 could immediately go back in service (hence the two sets of gear), though that was rarely the case. It was usually a oneman show.

Today, a nontransport vehicle like Mercy 300 is usually called a "sprint" or first response car, with the primary focus of extending the reach of advanced life support out into the rural areas. For probable ALS calls, the local basic service is dispatched simultaneously with the sprint car. With this approach comes a unique challenge, as the sole medic in the sprint car finds himself not only in a provider role relative to any medic skills that need to be performed, but also in a supervisory role, as the senior-level provider on scene is responsible for managing overall patient care, along with the actions of the other EMS team members.

One of the main reasons this is so challenging is the almost total lack of preparation that EMS providers get relative to field supervision. If you look through the EMT-B curriculum, the only time you even see the word manage used is in the context of managing airways. Doesn't it seem a bit odd that we ask providers to perform a complex management function, yet deliver virtually nothing during their initial training and education to prepare them for the task?

You see, there is a world of difference in being in a provider role, where you are responsible for doing things, vs. being in a supervisory role, where you are responsible for making sure things get done by others. If you find yourself working in a dual role as both provider and supervisor, here's a short list of what I believe it takes to wear two hats at the same time.

You must be able to delegate tasks effectively.
As EMS providers, we are all tested individually. While some skill stations, like seated spinal immobilization, involve multiple players, in the end, one person is in the hot seat. With the individual responsibility to perform comes the inherent desire to do it yourself. Of course, choosing to perform four tasks by yourself while two or three other providers stand around and watch is a model of inefficiency. Have the IV tech start the line and an EMT-B work the AED. Breaking patient care into smaller, manageable tasks is a mental skill you have to master before you can delegate tasks effectively.

You must know everyone's capabilities.
Before you can delegate tasks effectively, you must first know the capabilities of your EMS team members. Knowing everyone's certification level is the simple part. To truly be effective in managing your people resources, you need to have real insight into everyone's strengths and weaknesses. You may have two IV techs at your disposal, but if the situation calls for someone to establish venous access on the crashing trauma patient with a BP of 68 over Patent Pending, you really have to know who's best at that task.

You must be able to work and watch simultaneously.
Only with true mastery of your skill set can you perform the tasks needed and, at the same time, oversee the work of other team members. Ideally, if you need to manage at a high level, delegate all the tasks; put your hands in your pockets and step back to give yourself a better view and a better perspective. Rarely does the situation afford you that luxury, but when it does, it takes real mental discipline to perform that role when you are used to doing things yourself.

You must have excellent communication skills.
To choreograph the work of others effectively, you must be able to communicate what you want each team member to do. Another key element is having the ability to remain cool and calm throughout the call. Calls are hectic enough without the person in charge getting all lathered up. If you are yelling and appear to be out of control, others have to yell to be heard. Shortly thereafter, they are out of control as well, and patient care suffers.

When it's all said and done, you have to know prehospital care inside and out to manage calls and people effectively. If you don't understand what needs to happen in what time frames and in what sequence, how can you function as both provider and manager? The simple answer is, you can't. It takes time in the street; maturity; a cool, calm, professional approach; and a desire to master this on your own, especially since it wasn't taught in school in the first place.

Until next month...