To stay with the theme of my last blog, you can also be right and wrong at the same time. As with so many things in life, it’s a matter of perspective, or competing priorities.
When I was in college I was on the rescue squad. Lyndon State College, at the time, was one of the very few colleges that had a fully licensed ambulance on the campus, run by students. The rescue squad was actually the reason I chose LSC over other schools that I had applied to. Not only did Lyndon State Rescue Squad (LSRS) provide EMS coverage for the campus, we were also the primary ambulance for eight towns around us, and one of only three transporting services in the district. We were real rural EMS.
One afternoon, an idyllic summer day really, we were dispatched to a one car accident on I-91, north of town. Although I was a crew chief, I was the scheduled driver that day. The crew chief and I were both EMT-Intermediates, meaning we were equal ranked when it came to providing care. By policy, the scheduled crew chief is the leader of the crew and responsible for all assignments and operations.
When we arrived on scene, we quickly realized the incident was far worse than the dispatch had led us to believe. We already had a second ambulance enroute and called for third and fourth ambulances as soon as we arrived. What was supposed to happen next was we step into the mass casualty incident (MCI) protocol. The crew chief should become EMS command and the driver becomes the primary triage officer. The third on the truck, who was an emergency care attendant (ECA) this day, becomes the treatment officer. The goal is to quickly assess all of the patients (6 in all), perform immediate, life-saving care, and communicate to incoming resources, and the hospital, what our needs are. Our protocol then stated we should stage resources to treat the patients and direct arriving resources (ambulances, fire trucks and police) to provide care, first to the most critical patients, then to the next most serious and so on, until everyone was treated, then packaged and transported.
While I was performing my duties as the primary triage officer,the other members of the crew decided to focus on a couple of patients rather than following the protocol. I recognized what was happening, and that high priority concerns were not being addressed. I began trying to pick up some of the highest priority concerns, but stayed in my role as primary triage officer. My reasoning was that the crew chief outranked me because he was the scheduled crew chief and he and I held the same level state certification. I did what I was supposed to do, and some other critical things, but overall, I did not correct what I clearly saw was a poorly managed scene.
In later discussions, there was a lot of back and forth about what happened and what should have for the both of us. Nothing could have been done differently to change the outcomes of the patients. In the end a lot of good care was provided that day, but there was a lot of room for improvement.
Over the years, I have reflected on that call many times. One of the lessons I learned from it, a bit later on, was that I can be right and wrong at the same time.
I was right that I didn’t have any rank or specific authority over the crew chief on that call. I was right that my role as primary triage officer was crucial and needed to be performed. I was right in the way I performed that role and the care I gave. Inside the box of the role I was assigned, the certification I had and the protocols we were given, I was right.
But I was also wrong. There was a bigger picture.
Even in that moment, I recognized a failure and I didn’t address it. I saw the lack of command, and the need, but I consoled myself with doing “my job” and staying in “my lane”. There are times when that is what a person should, or must, do. There are also times, and this was one of them, when a leader would have stepped up and taken on the bigger issue. That day, I wasn’t that leader.
It can be a challenging call, when and where to step up, particularly where rank and title matter. Sometimes we try and get rejected. Sometimes we may even make things worse. Those possibilities shouldn’t discourage us from evaluating new situations and looking for what the biggest right thing we can do is, and stepping up. When a situation, whether it’s a car accident, a safety issue on the job or a financial challenge or whatever else, comes up, we should always be aware of the bigger picture and what else may need to get done.
I love the question, “How can I be helpful?” I’ll offer a tweak to that when you are dealing with a large, complex or emergent situation. Take a couple extra seconds to evaluate and then ask, “How can I be most helpful?” Questions such as, “What needs to be done first?” and “What needs to be done the most?” may bring a higher level of awareness and help you make a “more right” decision, even in a bad situation.
Again, nothing would have changed the outcomes for any of the people involved in that accident that day. Our lack of incident command was not what caused the injuries, and good incident command would not have changed the results for the patients. In this case. There are cases where command is the difference between success and failure, life and death. There are times when leaders who step up, regardless of their official role or certification, are the difference between success and failure, life and death. Lean into that and ask the bigger questions like, “How can I be the most helpful?”
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