A winning performance
My liftie colleague K. seriously questioned my sanity when I walked over to sort out the landing spot for the rescue helicopter I had just ordered. The radio chatter he had heard was as follows:
“Ski patrol to station F please, there’s someone here with a dislocated thumb”
“On my way”
A pause
“Ski patrol to K., helicopter coming in soon, make sure to shut down the lift.”
A dislocated thumb is not something that warrants a helicopter. But a suspected pneumothorax is. This is when due to an injury or crash to your chest, air leaks into the space between the lung and the chest wall. Since ski resorts still don’t supply us with mobile xray machines, ultrasounds and MRI’s, unfortunately we still have to perform good old fashioned patient assessments with no fancy technical medical equipment. By the time I got to my man with the (twice!) dislocated thumb, the thumb itself had started to turn white, which is not a great sign and after a few rounds of circular DC-ABCDE patient assessment, I had determined the thumb wasn’t his biggest problem.
It was his chest, his breathing and thus his circulatory system. When he crashed he had landed on a tree stump with his chest and as he answered my questions and endured my physical examination his breathing apparatus showed all the signs of a respiratory problem. There’s a rule in first aid treatment that comes in real handy in the decision making process.
The rule is: “Treat first what kills first.” And since an inability to breathe would kill him before a dislocated thumb would, I made the call.
Now mind you, “determined” is a strong word here. I was as unsure of myself as I imagine a deer in the headlights is when it chooses, against its own instincts, to hop away from the light, not towards it.
Patients are often puzzles that are hard to figure out. It’s a perfect storm of a difficult environment and symptoms which need hospital environments to diagnose. All we can do is try and get people to that hospital environment as safely and as quickly as possible, all whilst:
- not creating further harm to the patient
- not creating further incidents / injuries to ourselves or others
- being mindful of resources.
Sometimes I get briefly overwhelmed with the guess work, and the choices I have to make on the spot, which in any given situation could have all kinds of chaotic consequences.
If I were to pick a singular goal and make that my measurement of success, I would be pretty lost.
For example:
If my chosen performance goal was: “Get all patients to hospital as quickly as possible” -> I would call helicopters for non-serious injuries, taking up resources needed elsewhere and racking up insurance costs for patients.
If my chosen performance goal was: “Always adhere to the patient's wishes” ...let’s not go there, but let’s just say I’d be in jail by now. So I go back to what I call:
Ben’s Circle of Winning.
(Ben is one of my favorite ever EMT instructors).
When working on a problem you ask yourself:
What do I see? What does it mean? What can I do?
Then you see, listen and think -> then you do something (or don’t), and as you go on, patterns will emerge. You are now recalibrating your process to the only metric necessary: Will this improve things?
This ensures you can go to bed at night knowing you have done the best you can, and it loosens the mental grip on obsessing over a specific outcome whilst carrying you over in the general direction of your goal. Specific outcomes are a false friend, because in almost all situations in life, much of their achievement is out of our hands anyway. However, if we focus on a winning performance, we become less tense, which makes us able to come up with more playful and joyful solutions, and paradoxically, makes us more likely to reach that imagined specific outcome.
So don’t worry so much if you’ve made the right decision in the pursuit of your goal.
Worry if you’re delivering a winning performance on the way there.