Duty to React

Half a century ago, 28-year-old Kitty Genovese was stalked and stabbed in New York City. I remember the case well—not because of its location or outcome, but because of the report that 38 people witnessed the crime and did nothing. Although that estimate has since been reduced to 5, the Genovese murder reminds us that not getting involved can have tragic consequences.

Much more recently an EMS forum I follow published a post from an off-duty EMT who wondered if he was right to answer a commuter-train crew’s request for help with an elderly victim of a fall. The newly certified responder, who checked the passenger’s pulse, took a SAMPLE history and evaluated her according to the Cincinnati Prehospital Stroke Scale, chided himself for not being able to determine the cause of her fall and questioned whether he’d helped the patient at all.

When I read his account I thought, Good for him; here’s someone new to our field who gets the part about helping others. Then critical comments like “I probably would have just called 9-1-1” and “Don’t get involved” started appearing, and I began to wonder how long it would take the ambivalence of colleagues to erode our diligent EMT’s enthusiasm.

Yes, there are risks to administering care away from one’s district, but I’ve never believed a uniform or a duty to act is the most important consideration when someone is sick or hurt. I try not to overthink the downside of good intentions; I only know I’d want others to show concern for members of my family in distress.

Maybe it’s inconvenient and just plain bad luck to be the only one with medical training at an emergency. It’s impractical and not at all fun to stop at a train wreck without gear or backup. Discovering the freshly dead is unpleasant enough when we’re on the job; dealing with the misery of serious illness or injury on a day off isn’t anyone’s idea of recreation.

When you’re there, you’re there. You can try to ignore it and keep driving while telling yourself it’s someone else’s territory, someone else’s scene. You might even justify that attitude by reminding yourself you spent the last 24 hours answering those kinds of calls and now it’s someone else’s turn.

Seriously?

What if there’s a delay? What if the responding crew lacks your training or experience? When did it become OK to bet a life with someone else’s chips?

I don’t think most of us entered EMS with lots of self-imposed conditions about when and how we’d engage in rescue. When I got started, I wasn’t too picky about which patients I’d treat on duty or off. I was on a 24/7 safari for the elusive good call—naive and even silly perhaps, but I wasn’t about to let any opportunities to play medic pass by.

Have you ever felt that way? When did it change for you? Was it when you realized we don’t make a huge difference every day—not that we don’t make any difference, just not as much as we’d hoped? Or were you on a call so horrific, you figured the only way to survive in EMS while achieving some measure of longevity was to titrate your compassion?

I get that, but sometimes we underestimate the difference conversation, counsel and even hand-holding can make to someone hurting and needy. No one had to explain that to Sophia Farrar, the only Genovese neighbor who left the safety of locked doors to offer aid. Without medical training, Farrar easily could have rationalized letting someone else be the rescuer. Instead she focused on what she could do. Genovese died in her arms.

The anniversary of Kitty Genovese’s murder is a sobering reminder of a population’s capacity for indifference. It doesn’t matter whether 38 people or 5 witnessed the attack; citizens who might have intervened favored refuge over rescue, convenience over care. The only contribution to society offered by most of those onlookers was clarification of the term bystander.

We in EMS are better than that, aren’t we? When faced with distress—not even danger—don’t we have a bias to intercede? We used to. You used to. You know who you are—the ones who set examples for me; the ones who took care of my daughter, my wife, my mother, my father. Please tell me you’re still out there.

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