During the Vietnam War, the average life expectancy of a Marine Corps lieutenant was about two months. Usually, the newly commissioned lieutenant had no combat experience and was a graduate of one of the military colleges or an ROTC program. The life expectancy increased if the lieutenant had a crusty platoon sergeant who probably had seen action not in Vietnam, but in the Korean conflict - and, if really lucky, World War II.
Even though the lieutenant was in charge, it was obvious during the heat of battle that most in the platoon took direction from the crusty sergeant. After all, when the heat is on, who would you listen to - the experienced platoon sergeant or the kid who just graduated from college?
After six months of retirement, I have had a chance to reflect on the lessons I learned while working the streets of St. Louis for 24 years. Not that I am a "crusty old sergeant" (at least I would like to think I am not), but toward the end I could truthfully say there was not much I had not seen or experienced. Working in a busy urban environment is truly a learning opportunity.
Advice For The "Newbies"
Here are some lessons I learned and I would like to pass on to the "newbies" just entering the profession:
1. It's all about people. Unlike many fire calls, where you may never have to interact with the public, every EMS call involves a person. Treat all people (patients, family, bystanders, witnesses, police officers, etc.) on any scene as though they are the most important people in the world. Everybody wants to feel important or that what is a concern to them is also your concern. Nothing can make a scene go from good to bad like a cocky, know-it-all medic who bosses, humiliates and is disrespectful to people.
More than one medic has been physically attacked by an irate family member after making some smart-aleck comment to a loved one who happened to be the patient. Don't forget - you are in someone's home. If the TV or radio is too loud and it is tough to do a patient assessment, ask permission to turn off the set. Don't just turn it off without asking. It is not your property.
2. On a sidebar, another thing that can create personality clashes on the scene is when the medic arrives with an attitude because the call did not meet his or her expectations. Perhaps you were toned out of bed at 2 o'clock in the morning for a shooting that turned out to be an ordinary two-week-old sick case. Sure, you're not happy, but if you have an ugly attitude, so will the patient or family members, or both. Eventually, the scene goes down the tubes from there.
3. Don't do your ABCs. Throw that acronym out the window. Do your WABCs - weapons, airway, breathing, circulation. Always be alert to weapons on a patient. Even though the patient you are treating appears to be a victim, he may have been the "bad guy," but only had the tables turned on him.
4. Intersection accidents account for about 95% of all accidents when responding urgent. If you have a red light, pay particular attention to the intersection and ensure all vehicles have come to a stop prior to proceeding through. This is common sense.
One of the biggest dangers is present when you think everyone has stopped, but there is always that one car zooming along the curb lane whose driver cannot see what is going on in the intersection and you cannot see the moving car because the stopped cars are blocking your view to the curb lane.
The results are predictable. I assure you, just as you accelerate to proceed through, that one car will bust into the intersection along that curb lane.
5. When you arrive at a residence and you knock on the door, don't stand on either side of the door because you think someone can shoot through the door. Don't you think the bad guys watch the same movies in which the police stand on either side of the door? I have seen drug houses where all the bricks, insulation, etc., have been removed from either side of the door and the only thing separating you from the bad guys is a thin piece of siding. If you are looking for a safe place to stand, stand about four feet away on either side of the door.
Drug houses are usually booby-trapped and can pose significant risks for fire and EMS personnel. Some of the most innovative ambushes I have seen include removing the vocal cords from ferocious dogs, so you do not hear them barking or coming, and cutting a large hole in the floor in front of the door. With the large hole in front of the door, the only way you can access the patient is to have the occupants of the residence slide a large walking plank across to you. Without the plank, one wrong step and you will find yourself in the basement. Obviously, the hole in the floor also poses significant risks in firefighting operations.
6. One little habit I developed was touching the hood of the car parked in the driveway of a home I was entering. I would usually touch it to see if the car's engine was hot or cold. Usually, that piece of information did not tell me anything, but coupled with other information could mean a lot. On one particular occasion, I touched the car hood while entering a residence and the engine was cold.
Once inside, we found a woman stabbed to death with a distraught husband telling us he had just gotten home and found his wife lying on the floor. One question I did not ask him was, "If you just got home, why is your car engine cold?" Of course, I let the homicide sergeant know of his comment and my initial observations of his car.
As always, stay safe. Next month, part two of "Lessons from the Street."
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the managing director of The Ludwig Group, LLC, a professional consulting firm specializing in fire and EMS issues. He retired as the chief paramedic of the St. Louis Fire Department after serving the City of St. Louis for 24 years. Ludwig has trained and lectured internationally and nationally on fire-based EMS topics. He can be reached at 314-752-1240 or via www.garyludwig.com.
