Your Captain Speaking: Where Was the Line?

“Samantha, that was a rough call you were on. It was much harder than anything I’ve seen in a classroom scenario. Having been there too, I want to tell you about the line that helps me sort out my feelings with my partner after hard calls.”

Let’s be honest, there are damaging aspects of many calls we take to heart. They can affect our mental well-being in subtle ways we don’t recognize. Too often we know of people who leave EMS because of such bad calls. They were once compassionate and caring, but as time went on they became less so.

Here’s something that has helped me, as well as others, during calls and afterward.

If a patient has very minor signs and symptoms, we don’t necessarily need to aggressively treat them with interventions or drugs. We can throttle back. If a patient is seriously injured or very ill, then we must be much more aggressive in our treatment. Our aggression level may adjust up or down throughout calls. We’ve all been on calls that didn’t seem too bad at first, but then right before our eyes, everything changed, and it took us a moment to recognize the deterioration.

There is an imaginary line you can picture. When a patient is above the line, they will do just fine with routine or even no treatment. If they are well above the line, even when providers do the wrong things, the patient may avoid serious or long-term damage. As patients move below the line, however, their outcomes get more doubtful. In situations where they are very ill, a good outcome is possible but contingent on absolutely no slips or trips—everything needs to go well. Too far below the line, and they could be a hopeless cause, independent of our desire to help.

Get a general impression of the patient as part of your primary survey. This is where you should start to decide how aggressive you need to be going forward. Sometimes it’s a “load and go,” while other times you can be much more patient with interactions and questions. You won’t always get it right—nobody’s perfect. Should you beat yourself up after bad calls, even when perfection may not have changed the outcome? Sure, feel bad about it, but consider where the patient was with respect to that imaginary line.

Stay Inflated

Consider a beach ball analogy for your mental health and compassion for others. Picture in your mind a big, colorful ball, full of air and bouncy. A bad call can be like a tiny, sharp needle that pricks the beach ball. A small amount of air may escape, yet the beach ball still looks good and bounces. More pricks to the beach ball, however, will take their toll and eventually deflate it. Sometimes we can put more air into the ball, but we also need to patch those tiny holes.

Consider that in terms of recharging your own mental outlook. Look back after your call—where was the patient with respect to the line? Was there a change to your first general impression in your primary survey, and did you recognize it? Look to your partner and ask yourself if they could be bothered by that last call. You are responsible for your own mental health, but don’t forget events may have been disturbing for your partner too. Don’t hesitate to discuss the calls you’ve run together. You’d be surprised how just a few kind words can add air to their beach ball or even apply a patch.

After calls talk to your partner about what you did right and what could have been done better. You might even mention where your patient was with respect to the line. There were many times I would have liked to talk with some my peers about calls we just had. The line is a concept that lets you both learn from the call and open up some compassionate listening as well. Consider it for your next call.

Dick Blanchet, BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, Missouri and Illinois for more than 22 years. He was also a captain with Atlas Air for 22 years and an Air Force pilot for 22 years. He is a graduate of the U.S. Air Force Academy with an MBA from Golden Gate University.

Samantha Greene is a paramedic and field training officer for the Illinois Department of Public Health Region IV Southwestern Illinois EMS system, a paramedic and FTO for Columbia EMS in Illinois, and a full-time paramedic at the St. Louis South City Hospital emergency department.