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August 11, 2012 / jeffmedic

Quicksand

This is an article I wrote for the internal newsletter of a local EMS agency. I’d love to hear how y’all handle quicksand.

There is a scene in the movie The Replacements where Coach McGinty asks the team to name their greatest fear. After several ridiculous answers the quarterback, Shane Falco, responds “quicksand.” The team could quite understand what he meant so he explained it to his teammates this way.

You’re playing and you think everything is going fine but then one thing goes wrong and then another, and then another. And you try to fight back the harder you fight, the deeper you sink until you can’t move. You can’t breath because you are in over your head. Like quicksand.

This description applies to EMS as well. We have all been on calls where things didn’t go as smoothly as we would like. It usually starts with something small. You leave a key piece of equipment in the truck. The previous crew didn’t replace a small but important part on the suction or the monitor. Anything to break your rhythm.

Then you miss an IV and maybe another. Now you forget the list of questions that you had for the patient. You start to get snippy with the other team members on scene. They respond in kind and now intra-team communication suffers. Finally you give up trying to have the call go well and you focus on just getting through it.

I hope this isn’t a common occurrence for you but I’ll bet you have all experienced something similar, especially early in your career. I hope the following suggestions will help when you confront quicksand.

The first step in avoiding quicksand is to be prepared. Come to work able to focus on patient care. Check your truck thoroughly making sure to look over the little but vital stuff like the suction system. Spend a little time every shift studying your profession and preparing for the next patch of quicksand that you encounter.

Second, take a deep breath. You cannot control what comes your way on a call but you can control how you respond to it. If you allow your sympathetic nervous system to take over, your ability to think will be inhibited. You can help this by taking some deep breaths and giving your mind a second or two to refocus on the problem in front of you.

Third, learn from your mistakes. When you encounter quicksand, do your best to work through the problem and then when the call is over and the paperwork is done, go think about something else for a while. Once the emotion of the call has left, sit down and analyze what went right about the call and what went wrong. Identify ways that you could prevent the situation from happening again. Be brutally honest with yourself. Don’t be afraid of being wrong the first time you are presented with a problem. Be afraid of being wrong the next time you are presented with the same situation.

EMS providers are surrounded by chaos. Our job is to bring order to that chaos and get the patient to the hospital in the best condition possible. Identifying, overcoming, and/or bypassing quicksand will minimize the chaos encountered during calls.

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