034: I Have a Scenario For You

In This Episode A reader tells how she was inspired to change her life. And that leads to a powerful thinking tool: running scenarios can save your life. I’ll show you how, and tell the story of how they probably saved my life.


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Welcome to Uncommon Sense, I’m Randy Cassingham.

This is a requested re-issue of a first-season episode that was spurred by a letter from a reader. Kellie in Pennsylvania wrote, “I want to thank you for being such an inspiration with your stories about being a medic. Every time I read a blog post about your experiences, it stirred something inside of me. I became a certified EMT last week.”

She closed with a smiley face, and now I have a smiley face. But that was a pretty brief note from Kellie, and I wanted to know more. I asked her if she was volunteering on the side or what. She replied, “I’m actually hoping to make it a full-time career. The school I went to provides the program in partnership with the local EMS. After doing a few field shifts with them as a student, I realized that I really wanted to be part of their team. So I busted ass in school, graduated top of my class, and after interviewing with one of the people present when I won my award for the best grade, I have a tentative full-time offer from them.

“I’m just waiting on the state to put in my credentials for my certification to drive the ambulance, and they are moving at the speed of government. And then I can hopefully get an official offer. I’m being super cautious because I don’t actually have that official offer in hand yet, but I’m so excited and happy because I’ve dreamed of being in EMS for years ever since I started reading This is True and following you, and I’ve worked so hard to make this happen. I actually took a huge leap of faith and quit my full-time job so I could focus 100% on school, even though it was all night classes, and my wonderful husband has worked super hard to make that possible. I can’t wait to start.”

She later confirmed she got the job.

When my wife, Kit, and I got certified, we had to keep our full-time jobs: This is True readers needed their newsletters! And I needed to pay my mortgage. Because I had been certified as an Advanced Life Support medic before, and worked in the field full-time for about six years, it was pretty easy for me to re-certify at a lower level, even though there had been a 20-year hiatus. Still, things change in medicine in 20 years, so I did have to read the book. I had to learn what was new and what the local protocols were. Still, both of us wanted to be part of serving the community in a way that we could.

It isn’t something you just go to a weekend class and then get turned loose on the street. No, it’s hundreds of hours of school, riding an ambulance, and doing shifts in the emergency room to guarantee we get hands-on experience and see a wide variety of issues.

Because I’m a nosy journalist type, I love little details, and asked Kellie what job she quit and how old she is because, I told her, “You don’t strike me as an unrealistic kid.”

“I worked as an automotive inventory specialist for an auction company,” she replied. “I hated the way they treated me and the pay was awful. Everyone always told me to stay away from EMS because the pay is so low.” Yeah, I can attest to that!

“But,” she continued, “I figured since I wasn’t being paid well anyway, I might as well be chasing my dreams. I’m 25, old enough to be cynical and young enough to still believe in chasing the dream.”

You know, I can relate to her completely, because when I left Emergency Medical Services in the 1980s, it was because it wasn’t going to allow me to fulfill my own dreams. This was before I started at Jet Propulsion Laboratory and all that, and after I quit EMS I found I literally dreamed about emergency calls for years. I didn’t dream about it when I was working in the field, and I’m not now that I’m back in it. That kind of gave me a clue that I’d left a little bit too early, and that’s one of the reasons I was OK with going back into it when the chief asked me to when we moved to our rural home.

So how does this relate to Uncommon Sense? It follows on to what was covered in Episode 27, about “Think first, react later …if at all.” I’ll link to it on the Show Page.

And that follow-on is: Scenarios. They’re a big part of medical training: they allow you to pre-think — to plan out how you can handle a situation that you’re likely to see so that you can jump right into taking action when seconds count.

My wife and I both run scenarios in our heads, and doing that can not only save a patient’s life, it can save a rescuer’s life.

And it’s not just for people in emergency services or medicine. For instance, what if somebody broke into your house? What would you do? You’re in danger because someone is in your house now. For us, we live in a rural area, and we’re pretty much on our own: if I called 911 and said “There’s a guy with a hatchet trying to hack up my wife,” I could expect somebody to arrive here in about 20 minutes — if they’re not busy somewhere else, like on the other end of the county with a crash or something. The usual gag is, “When seconds count, the police are only minutes away.” Where we live, typically, it takes a good 20 minutes for the police to get here, so we’re on our own for quite awhile.

So the scenario for me could well be different than for you. I had to make a decision: would I be OK with shooting somebody that came into my house? People get guns and they don’t think about these things. If push really comes to shove, are you willing to raise a gun and shoot somebody if the police can’t get there in time to, say, keep an intruder from killing you, your spouse, your children? I had to think about that. It’s not an automatic yes or no for me. When it happens in real life, the typical reaction of an intruder is to run, and you don’t have to fire a shot. But what if they don’t run? You sure as heck don’t want to spend a few minutes thinking about it when there’s someone coming at you with a knife.

I also run scenarios when I’m driving. Like, “What if that car pulls in front of me?” That car right there. I’ve got three seconds to decide. I will literally move my hand to the high beam switch because they’re not going to hear if I honk, so if I see them move, I flash my lights, and I’ve already started to decide, “Do I need to slam on the brakes or do I need to swerve?”

Probably the most valid scenario that I’ve thought about repeatedly and that I actually exercised was, what if an animal darts in front of my car? I’ve responded to a lot of crashes where an animal darted in front of somebody, and they swerved to miss the animal, and they’ve rolled over, or they’ve gone into a ditch, and sometimes they’re severely injured.

Kit and I dealt with a call like that a few years ago: a car tried to avoid hitting a bear, hit it anyway, and rolled over, ejecting one of the passengers. The bear didn’t make it, and the passenger was injured enough to need helicopter transport. I’ll link to that story on the Show Page.

So long ago, thanks to thinking about it in advance — running the scenario — I decided there’s no way I’m going to swerve for an animal. I’m sorry if I hit it, and if I hit it oh well, but I pre-planned that I’m going to slam on the brakes and keep the car going straight and hope for the best. And that actually happened. That ties in EMS again because I was rolling on an ambulance call for someone having a stroke. While I was on my way to that house, moving right along since that’s a significant emergency, a deer jumped in front of me. There was no way I could stop in time. I hit it solidly and did $6,000 worth of damage to my car. But my only alternative if I swerved was, I would’ve ended up in a ditch. A deep ditch the deer had jumped out of. It’s about four feet deep, and it’s very likely I would have rolled over, especially since I was pushing the speed a little bit to try to get to this pretty critical call.

Now, I’m not saying I won’t do any maneuver. A couple of years before that happened, I was driving the same road when I saw a really tiny baby deer that was running across the road, its mother a little ways behind it. While this time I was going much slower, it happened so quickly that I didn’t even have time to hit the brakes: I was definitely going to hit it. But it was on a curve where I could still see down the road, and I had already looked ahead and knew there were no cars coming the other direction, so instead I swung over into the oncoming lane and
missed that baby deer. It was a beautiful day and I had the windows down, and I actually heard the fawn scream at this giant thing zooming by right in front of it. I didn’t know deer could scream when they got scared!

The bottom line is, thinking about “What would I do if,” and coming up with a scenario and how you would handle it, is doing your thinking advance, and you have a much better chance of coming out of a real situation in better shape than if you don’t do that pre-thinking. That’s definitely exercising Uncommon Sense.

They don’t have to be bad things, either. Like, what would I do if a TV producer called and said, can you appear on our show tomorrow? That’s happened to me a number of times: I’ve gone to Los Angeles and New York several times to be on shows, and only one time did I say no: when I was on my honeymoon! If this is something that could well happen to you, the time to think about whether you would say yes is before the call comes in, so you can be confident and professional when the question comes, rather than sitting there, stammering, trying to think about whether you could handle it.

It’s just one of the ways we can prepare ourselves so that when faced with such a situation, we don’t have to start thinking about it then. We thought about it before.

And it’s something interesting to do when otherwise not doing anything, like driving somewhere: I’ll come up with scenarios. Because running these scenarios gives you an answer to “What would I do if…” — and that gives you power and confidence, and helps keep you and your family safe.

I’d love to hear how you use scenarios, or how you’re about to! You can comment on the Show Page at thisistrue.com/podcast34.

I’m Randy Cassingham … and I’ll talk at you later.

Comments Note

Since this is a redo, comments start with those made on the original post — the dates are correct.

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13 Comments on “034: I Have a Scenario For You

  1. Wow, mentioned in the podcast! What an honor!

    I am certified nationally under the NREMT. Pennsylvania doesn’t do different levels of EMT like some other states, here you are either an EMT, an Advanced EMT (AEMT), or a paramedic. I’m in a fairly well populated area of the state, so there’s always a paramedic close by if you need one. If I get a few years into my career and realize I’m loving it and want to stick around long term I’ll probably try to become a paramedic.

    I’m happy to report that I did get an official offer, and I start in less than 2 weeks! I’m a little scared, but mostly excited. I feel very lucky to get in with this company, because the people are great and I think I can learn a lot from them and become a great provider.

    Thanks for the update, Kellie! Your area is lucky to have someone who cares there to serve them. Later, we can talk about how to avoid burnout…. -rc

    • Kellie, that’s fantastic! Your EMT levels are the same as here. What you heard were my outdated terms. 🙂 They work just fine for me. And congratulations on the job! What a lucky community to have you.

      Just to clarify, Colorado’s levels are the same, though with some grandfathered EMT-Intermediates are still licensed. But there are some interesting add-ons available, including I.V. certification for the Basic level that Colorado added to help patients who get into trouble in rural areas. That certification includes some injectable drugs, too, such as Naloxone (to treat opiate overdoses) and dextrose (to treat hypoglycemia, such as in diabetic emergencies). -rc

  2. I think you guys are more likely to have a bear try to get in than a human intruder! I know that was a scenario I encountered in my backyard when I lived in NM, and replayed it frequently.

    Over the years I’ve actually run most of the scenarios you’ve discussed, although not necessarily with the same diligence. On cross-country trips, mile markers aren’t always found, so I try to concentrate on landmarks. Probably from my old hiking days. In town/city, I try to pay attention to what businesses are open, especially at night. And I learned a long time ago that you are less likely to be bothered if you walk confidently and alertly, than if you are timid. Own your space. And if you need to run, you want to know where you’re running to.

    Indeed bears are an issue here, but we’ve never had one try to get into the house. We did get “cased” by burglars, though — and they were caught and are now in prison. -rc

  3. The interesting thing about using a scenario is that it answers the “Who, What, When, Where and Why” questions and decides AHEAD of time the actions you will need to take in any particular situation. It turns the unexpected incident into a pre-planned action, and removes indecision before fight or flight paralysis.

    I work on bank equipment (ATMs, cash security equipment, audio, video, vaults and Safe Deposit locks, etc), and I run scenarios continuously. I also drive many miles in a work vehicle, which provides ample use of and need for scenarios. I plan my actions before the need arises. Running scenarios has kept me accident free for a million CDL miles (previous job). Because of scenarios, I’ve avoided more accidents than most people have been in.

    A scenario is simply a process to plan responses so that the decisions are already made before people are under duress. It may be for safety, security, cash flow, or time planning but a scenario reduces stress. In previous podcasts, you have mentioned how you and your wife plan and coordinate your actions as a team. One of you goes right into a situation, the other gets the equipment and follows. Less stress, less indecision, better teamwork. All the result of a scenario on the way to a call.

    When I was learning to drive at age 14, my father said “Think of the most idiotic thing the other driver could do, then make plans to avoid it, even if it never happens”.

    A great summary at the top, followed by excellent examples. -rc

  4. Here is a scenario many should consider: what would you do if you are alone and you’ve fallen and cannot get up? Where is the phone and can you get to it if lying on the floor?

    My husband’s aunt fell when she had a stroke. She crawled to the table where her cell phone was and pulled off the table cloth until the phone dropped and then she called 911. I have 2 relatives that cannot stand up from a sitting or kneeling position on the floor even under normal circumstances. I recently had this discussion with my sister who would require lifting assistance if she fell.

    A pretty common scenario indeed. We’re lucky that these days, there are technology-based solutions available. -rc

  5. I worked for a company that provided first responder training to a small number of employees to provide immediate aid to anyone that experienced a health issue at work (we had a lot of 50+ age workers). After ten years of refresher training with no significant events, I left the company for another job. Within months of starting the new job, I experienced a life event that gave me a small window of insight into what the professional first responders experience.

    I was in a place I wouldn’t normally be in the manufacturing plant and noticed a couple of employees that seemed to be very upset. I asked if I could help and approached them to find another woman, on the floor, no breathing, no heartbeat. I don’t remember much about the next 8 minutes, other than very stressful application of CPR and shocking her with an AED multiple times, while we waited for the professionals to arrive. I was severely depressed after she was taken away, as the EMT had noted she had no heartbeat when they left. But, I was elated the next morning when told that she survived to get to the hospital. She ended up passing away two days later, as she had been down for 11 minutes prior to my arrival, but at least she was able to pass in the presence of her family.

    My point, is that these events can be stressful and emotional for the first responder, something we don’t consider (or understand) when we sign up to provide first responder support. Over time I’ve recovered from the event, and I don’t believe it will affect me if I run into another situation. How do you deal with these situations, especially when you do the job every day?

    By the way, my new company provided mandatory CPR training to ALL employees after the event, including how to recognize early indications of such events. I believe everyone should know basic CPR procedures. It may save YOUR life some day.

    Indeed, burnout is significant for full-time first responders. You have to learn to disassociate a bit from the patients, which has its own perils if taken too far (think of cops who get into an “us vs them” mindset — and virtually everyone is “them”). You clearly did a good job with your CPR case if she survived at all, but she was pretty much doomed by being down 11 minutes without any intervention, as I’m sure you already realized. -rc

  6. I love this discussion. In driver’s training classes in high school (50+ years ago) we were taught to “expect the unexpected” and this applies to any area of life where the unexpected could happen.

    I used to be a delivery driver for a company that serviced car dealers and service stations and car care stores across our state. On those long stretches of highway, with no other cars around, I would either try to create words to a song I was working on, or go over certain scenarios…not only for safety’s sake, but I was a budding fiction writer then and thought it would help me describe situations in stories.

    It is a great exercise anyone can do, and it helped one one winter. A terrible fog rolled in and I had already wondered what I would do if I couldn’t see too good, and I slowed down and pulled to the side of the road (it was a white-out and I couldn’t even see the hood of my truck). When I felt the gravel under my tires I stopped. Right then a big pickup zoomed past at a speed that was very unsafe for the conditions. When it cleared, I was able to go again and later saw this pickup in the median between the two roads of our freeway.

  7. I really enjoy your podcast and blog. This week’s was especially interesting because I got this same advice 60 years ago in a driver training class in High School. Thinking about what-ifs while I was driving has saved my life several times. I have passed this along to my Wife and Daughters. A few years ago my oldest daughter was driving on the Garden State parkway at a very complicated spot, thinking ahead saved her life and all she had to do was slow down and let a driver cut her off a safe distance in front. Thanks again for the podcast.

    It seems too simple to be true, but you proved it from another angle. Lose a couple of seconds in exchange for getting to live the rest of your life? That’s an easy tradeoff to make …if you simply take the tiny effort to think about it. -rc

  8. Back when we had pet cats, my husband and I sat down one fine day and had a calm and serious discussion about how much we would be willing to pay in vet bills for a cat if it had a one-time incident, or a serious/chronic illness. We wanted to be clear on our guidelines so if or when the time came and we were distraught, we had our guideline to use to make our decision. That never came to pass, but I think it was good we did it.

  9. Your homeowner/gun scenario is a key one. A good friend and I do some handgun and rifle shooting, both of us hold strong Christian views, especially about how to treat others, and he told me one day that he’d shoot someone in order to save his wife or son from deep harm or death, but could not shoot someone to save his own life if he were attacked.

    I’ve decided that if it came down to me/my family’s life vs an intruder bent on harm, I could and would shoot. However, I would give it as much stretch leeway as I could before firing. I would not immediately open fire just because they were in my house. I would not want to have to carry the fact I killed someone for the rest of my life.

    But given the alternative, sorry. I’d would be him, not me/us in every case.

    So he’d let the intruder leave his wife/son without a husband/father …which causes them harm. Hm. But yes, at least he’s started to think about it, which is more than so many do! -rc

  10. As a motorcycle rider, this kind of forward thinking/scenarios is essential. It was part of the learner training I did close to 15 years ago, but our local system has changed a lot since then and I’m not sure if it still is.

    I am always watching all of the traffic around me, and while where I live is not a very busy place, the traffic can get crazy/silly.

    Another part of the motorcycle training was lane positioning, “position yourself where the driver of a car would be, because that’s where people look, for the driver.”

    I was coming up behind a couple of slower moving cars a few weeks ago and changed lanes in anticipation. As I got within about a car length, instead of maintaining the drivers position I moved to the passengers, because I wanted some distance between me and the rear car as I passed, I had a weird feeling. What do you know, they changed lanes right on top of me. I saw them coming, gently swerved onto the rather wide shoulder and then back. If I had been closer, I would not have had the time to maneuver and would have been another motorcycle statistic.

  11. In my chemistry class lab, two students loosened the Bunsen burner too far and flames blossomed out. The students panicked, not knowing what to do. The chemistry teacher calmly walked over and turned the gas off. It made me think about the scenario.

    A few years later, at a friends house, the electric oven started sparking. Recalling the Bunsen burner episode, I walked over and turned the oven off. Think ahead works.

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