In This Episode: A remarkable letter from a reader who was inspired by This is True to do …what?! And another powerful tool in the This is True Thinking Toolbox: Scenarios aren’t just for critical situations, but everyday life.
- One of the “amazing stories” of working in the emergency room during my recertification training: War on Drugs (then scroll down to the section, “Drugs: a Real-Life Story”).
- The story of the deer that jumped in front of me on an ambulance call: The Risks of Emergency Responses.
- Menu of all EMS Stories in this blog.
- What’s a Kubotan.
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Randy: Welcome to Uncommon Sense, the podcast companion to the thisistrue.com newsletter with the mission to promote more thinking in the world. I’m Randy Cassingham.
Kit: And I think I’m Kit Cassingham.
Randy: When will you know for sure?
Kit: Next time I check my I.D.
Randy: Another two parter this week: a new tool in the thinking toolbox, and first, a letter from a reader that I really think is fantastic. Kit hasn’t heard this one yet.
Kit: I’m kind of looking forward to tonight. I don’t know anything about what’s happening tonight.
Randy: It’s from Kellie in Pennsylvania. She says, “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. Smiley face.”
Kit: Oh, cool. Good for her.
Randy: Now I have a smiley face.
Kit: And so do I.
Randy: Oddly enough, you’re actually wearing your dress uniform shirt right now.
Kit: I am.
Randy: Because unfortunately, we went to the funeral of a patient.
Kit: Not one we actually worked on.
Randy: No, we didn’t.
Kit: Somebody who was part of the community, a big part.
Randy: It was a family member of a community member that we work with and know real well.
Kit: And respect tremendously.
Randy: And unfortunately, we couldn’t do anything for her. She was killed in a car wreck.
Kit: Instantly almost.
Randy: Pretty much.
Kit: But: this is how we show our respect and be part of the team.
Randy: There were about eight of us, I think, in our dress whites.
Kit: Yeah, maybe 10.
Randy: As we said, it was a community member. It was standing room only. Every pew was shoulder to shoulder, and then all of us EMS people were just standing along the sides, and there were a lot of cops there standing up….
Kit: It’s very cool the way the first responders come together. We had state patrol, we had sheriffs and marshals….
Randy: State park.
Kit: State park.
Randy: Ouray Police. Ridgway Fire I saw there.
Kit: Ridgway Fire, some other fire, I think.
Randy: Yeah, I think so.
Kit: Then, EMS. I just named eight different departments, agencies.
Randy: Agencies, yeah.
Kit: This was not a first responder who died. It was just a family member of a first responder.
Randy: Right. So that was a pretty brief note from Kellie, and I wanted to know more.
Kit: Did you ask?
Randy: 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.”
Randy: “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.”
Kit: That is bravo — and smart for her to focus. We didn’t focus. We had to keep our full-time jobs.
Randy: Because this is a volunteer position.
Kit: Well, but yes, that, and that’s what we were doing. You didn’t have to put in so much, but I was putting in 90-hour weeks between work and school and study and stuff, for six months. It was hard.
Randy: Yes, because I had been certified before and worked in the field full-time for about six years, it was pretty easy for me to re-certify, even though there had been a 20-year hiatus.
Kit: That skill sticks with you.
Randy: Yes, so a lot of things change. Medicine develops over time, and the things we can do expand over time, so I did have to read the book. I had to learn what was new and what the protocols were. Very different from 20 years ago, and so it was more of a review for me rather than having to learn it all, but still, both of us were–
Kit: Well, and I had a science background, so it was easier for me than coming in cold with body parts and science and stuff. I didn’t read the book, I studied the book.
Randy: Yes, I read the book. Kit actually had to study, and we were both working full-time, and then going to school nights and weekends to get certified so we could help our community. It’s a big commitment. 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 and then riding an ambulance…
Kit: Going to the E.R….
Randy: We rode in the big city, Montrose, nearby so that we’d actually get some calls, because here in our county, we average about a call a day. You can’t get a lot of experience with that.
Kit: When we got certified, there wasn’t even a call a day average.
Randy: Right, and we also worked time in the E.R. so that we would be guaranteed to get hands on experience and see a wide variety of stuff. We did see some amazing things.
Kit: Even the first responder training here is not a picnic in the park. That’s a commitment as well, and I took that, which is what made me realize, “Oh, now I know enough to be dangerous,” so taking the next step was a delightful next obvious step.
Randy: Yes, that’s now called an emergency medical responder. It’s a level below emergency medical technician, and emergency medical technician is below paramedic. There’s various flavors and extra add-ons in there. There’s an advanced EMT, and we’re somewhere between a basic EMT and an advanced EMT here in our county. It’s because of those extra add-ons.
Kit: Like I.V. certification, yeah.
Randy: Right, so we can give a certain number of drugs. We can defibrillate, things like that. Because I’m a nosy journalist type, I love little details, I asked Kellie what job she quit and how old she is, because I said, “You don’t strike me as an unrealistic kid.”
Kit: And what did she say?
Randy: She was right back to me. She replied, “I worked as an automotive inventory specialist for an auction company. 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,” and yes, we can attest to that.
Kit: Well, we work for free!
Randy: “But 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.” Smiley face again. “I called the EMS office today about my vehicle operator certification, and it turns out their system is down, so they can’t put me in, but the gentleman I spoke to offered to contact the EMS agency and confirm that I’m certified, so I’m hoping to hear back early next week. Hopefully I can start in February. I got to spend over 60 hours on the truck as a student. My last shift was the first week of December, and I miss it already.”
You know, I can relate to that completely, because when I left EMS 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 I found I dreamed about it for years. I had tons of dreams. I don’t dream about it now when I’m doing it, but when I left, I dreamt about it again and again. 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 they asked me to when we moved to our rural home.
Kit: Did Kellie say what level of EMT she got, and is she nationally registered, as well?
Randy: I don’t know what they do in her state. I would guess that she’s a basic, because she’s basically starting from scratch, and that’s usually the minimum you need to work full-time in EMS is the EMT basic.
Kit: Around here, well, it’s an old designation now, but Montrose I think for a while required all their firefighters to be I level.
Randy: Yes, an EMT intermediate is basically being replaced by either moving up a notch to paramedic or down a notch to advanced EMT. Most people I think are going up to paramedic, because it allows them to do some more things, and it really is a much more complete certification.
Kit: Well, this may not be the right time to talk about it, but when you have a fire crew that has EMTs or they have to be certified for both, most of them want to be firefighters. I’ve heard a couple of them grumble: they resent having to be medics. Now, there are some medics who also have to be firefighters….
Randy: Sure. It depends on the department completely.
Kit: I was just going to say, ours is separate. We have EMTs who want to be EMTs, and we have firefighters who want to be firefighters. It’s perfect here.
Randy: Right, and they call it a third service. There’s police, there’s fire, and the third service is EMS.
Randy: I kind of like that division, but especially when you have a paid fire department, because of the success in fire prevention, they don’t have enough to do.
Kit: They’re like the Maytag repairmen.
Randy: Yeah, so that’s why a lot of fire departments have gotten into EMS is to keep the firefighters busy because they’re being paid already, anyway. It kind of depends. Sometimes they do resent having to do the medical stuff too because they really want to fight fires, but there just aren’t enough fires to fight!
Kit: Right. It’ll be fun to find out from Kellie where she is and if they do national registry there. I love the EMS work so much that I wish the concept had come in front of me when I was Kellie’s age, because I think I would’ve done it and enjoyed it and been good at it. I don’t want to do it now — full-time. We can’t do it full-time here. Even the full-timers don’t have full-time.
Randy: Right, so we have the volunteers, and then we have some paramedics that are full-time. That’s kind of nice to have that backup, too.
Kit: Oh yeah, it is.
Randy: If we come up against something hairy that we really need a lot of help with, we know that backing us up, here comes some paramedics. They are actually very good, considering they only get about a call a day. They train like mad, because you’ve got to have either experience or continual training.
Kit: They study and research and go to class.
Randy: Right, and teach too.
Kit: And teach, right.
Randy: One of the best ways to learn is to teach.
Kit: Keep your skills honed. So what I was trying to say is it would’ve been a good career for me at an earlier age. I don’t think it’s a good career for me now.
Randy: Especially where we live.
Randy: But it’s fun to do on the side. We both work out of the house. We can wear the pager. We can take off when we need to.
Kit: Well, my page comes through my phone, so I don’t even have to wear a pager anymore.
Randy: Right, but usually I’m listening to all the radios because I’m also the communications czar in this county.
Kit: The czar? Ooh!
Randy: I know when things are coming down. Very often, I can hear the cops going out and sometimes I’ll say, “That has the potential to turn into an EMS call,” so I’ll sometimes just send you a little note on text saying, “We might be getting a callout,” and then I can hear them request the ambulance and say, “OK, let’s go.” Usually, it takes 30 seconds, sometimes even a minute before the page actually comes out, and we can actually be rolling by then.
So let’s switch gears to the Thinking Toolbox. The feedback I got on last week’s Thinking Toolbox item, “Think first, react later, if at all,” was really positive. I thought we should jump right into the second tool, which Kit and I both do. … Do you know what it is?
Kit: Yes. The words are not coming to me. Scenarios.
Randy: That’s right.
Kit: It did come to me, yay.
Randy: We both run scenarios in our heads, and I actually didn’t know you did that too, which is kind of funny because we hadn’t talked about this before, and we haven’t done any prep. We’re going to do this all just on the fly. We haven’t talked about how we’re going to talk about it.
Kit: I’ve run a scenario for this one, so I’m set.
Randy: OK, good. So you thought maybe I’d ask you about this and now you have an answer.
Kit: No, no.
Randy: It is something we do in EMS, also.
Kit: And that’s where we started doing it together.
Randy: Right. I’ve been doing it for as long as I can remember. So what’s an example of a scenario? What if somebody broke into our house? What would we do?
Kit: Are we inside or outside?
Randy: We’re in the house.
Kit: Oh, OK.
Randy: We’re in danger because somebody is in our house now. Part of the thing is that we live in a rural area. We’re pretty much on our own: if we called 911 and said, “There’s a guy with a hatchet trying to kill my wife,” we 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. It takes a good 20 minutes for the ambulance to get here, which is why they have us stationed up here. Well, we live here anyway, which is why they’ve recruited us to be first responders so that when there is an ambulance call, we don’t run and get the ambulance and then go to the call. We go straight to the scene while somebody else runs and gets the ambulance and comes.
Kit: Somebody who lives close to the ambulance.
Randy: Right, and we don’t. It would take us 20-plus minutes to get to the ambulance, so if there’s a call up here on the mesa where we live, and that’s where probably about half the population of this county lives up on this mesa, if there is a call, we go straight there. We try to stabilize, start an I.V. if we need to. If it’s a diabetic problem, we can give them sugar or whatever. If it’s a cardiac problem, we can get an I.V. going so that when the paramedics get there, they’ve got the drugs and the EKG machines to find out what’s going on, the drugs to help stabilize them, and then they can transport. Then, while they’re transporting, we get to go home again, which I kind of like because that means we don’t have to do the paperwork, which is a big difference from when I was in EMS back in the ’70s and ’80s.
Kit: It’s a big difference now from when we started.
Randy: I really like that we can make a difference, we can get somebody stabilized, and get them off to definitive care.
Kit: So let’s get back to the scenarios, though.
Randy: Yeah: we’ll run these scenarios not only for medical calls, but for darn near everything. Like I said, as I started with, what do we do if there’s somebody breaking into our house? 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? I had to think about that. It’s not an automatic yes or no for me.
Kit: Well, so I’m going to back up a little bit. The scenario for me is, I’m in the house, somebody breaks in, what do I do? I grab a gun, I go to the base of the stairs and say, “Leave now.” If they don’t leave, if they come a step toward me, the answer is– I guess I’d say, “Leave now or I will shoot you.” If they step to me, I shoot at them. If they turn to leave, I don’t shoot at them, but I stay in the ready. I guess I should put my phone on my record if that happens so I can prove that I warned him, too. Litigious society. That’s how I run my scenarios, and you just heard me update my scenario.
Randy: Right, so you’ve obviously thought about this.
Kit: I did ask the sheriff deputy once what his recommendation was. I said, “Should I shoot him?” He goes, “Oh, no.”
Kit: I was really dumbfounded, and I had to update my scenario to be, “Yes, do shoot them.”
Randy: You’ll have to tell me later which deputy that was–
Kit: I think they’re long gone.
Randy: –because that’s surprising. I think all the deputies we have now would not hesitate. You’re a small woman, especially if you’re alone. We generally keep the doors locked. Most people in our area don’t. We had a neighbor, a woman who lived alone, and she didn’t know where the key to her house was.
Kit: I’d forgotten about that, yeah. It’s nice that we live in that safe a community.
Randy: It is.
Kit: And it is interesting that we’ve kept that aspect of city living with us. I lock my car when it’s the carport.
Randy: I actually do too, because I’ve got things in it like medical equipment that would be a real loss to the community if they were stolen.
Kit: ANd I don’t have anything, and it’s just a habit. That’s part of my safety for when I’m out. Always lock the door when I leave.
Randy: The scenario is that someone is coming into your house and they are either drunk or stoned, doing something stupid, or they’re there for no good. They are purposefully deciding that they are–
Kit: They’re coming to harm me.
Randy: –invading someone’s house. Maybe not that their motive was to harm you, but their motive was to commit a crime.
Kit: Or maybe they’ve come in to kill or rape me.
Randy: Yeah. In any case, they’re up to no good. They’ve made the decision to either ingest chemicals to alter their state of mind, or to commit a crime. If it comes down to them or me, they’re in my house: it ain’t gonna to be me.
Kit: Well, what other kind of scenarios do you run? Something that’s a little less onerous than somebody breaking into the house.
Randy: I run scenarios when I’m driving.
Kit: Like what?
Randy: Like, “What if that car pulls in front of me?” That car right there. I’ve got five seconds to decide.
Kit: You are proactive driver.
Randy: Yeah, so I will literally move my hand to the high beam switch because they’re not going to hear if I honk, so I’m going to flash my lights. And if I see them move, I do flash my lights, and then decide, “Do I need to slam on the brakes or do I need to swerve?”
Kit: I presume your foot comes off the gas the moment they move.
Randy: Yep, or are they stopping and not getting in my way? Where would I go if they did pull out? Is it safer to slam right into them, because there’s cars coming the other way and I can’t go in any other lane?
Kit: Or there’s a ditch that you drive off to, which is not a good idea.
Randy: Right. So probably the most valid scenario that I have that I actually exercised was, what if an animal darts in front of me? We’ve been to a lot of calls where an animal darted in front of somebody, and they swerved to miss the animal, and they’ve rolled over, they’ve gone into a ditch. Sometimes they’re radically hurt.
Kit: There was that car several years ago that hit a bear, rolled, and ejected one of the passengers. The bear didn’t make it, either.
Randy: And I think that was they swerved, but they hit it anyway. 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 what I’m going to do is slam on the brakes and keep the car going straight and hope for the best. And that actually happened. Unfortunately, we’re going to tie in EMS again because I was rolling a call for somebody having a stroke. So that’s pretty severe, and I was rolling, and a deer jumped in front of me. There was no way I could stop in time, and I hit it and did $6,000 worth of damage to my car. But my only alternative, if I swerved, I would’ve ended up in a ditch. There was a pretty deep ditch there. It was about four feet deep, and it would have rolled me over, especially since I was pushing the speed a little bit to try to get to this pretty critical call.
Kit: That was a month or two after I had a deer T-bone me.
Randy: You didn’t hit a deer. A deer hit you.
Kit: Well, and I did swerve a little bit to get away from it. It didn’t die immediately. It ran away, so I had only $3,000 worth of damage to my car.
Randy: Right, and I’m not saying I won’t do any maneuver. We both do safe maneuvers. We’re seeing if we can go into the other lane if there’s nobody coming, things like that. I did try that a little bit, but I couldn’t move very much. You moved a little bit, but it wasn’t enough, but the bottom line is, we thought about that beforehand. People don’t, and that’s why we get those calls of somebody rolling over and getting horribly injured because they did swerve. Most of our roads here do have ditches, and it rolls the car over.
Kit: While we’re talking about how we respond to potential accidents, I had a friend many years ago who was driving on an icy road. Oncoming traffic, somebody was spinning out of control into her lane. I have learned that the best thing to do is let it hit you, but she opted to drive off the road, and it was a 12 foot drop off of that. She was severely damaged, brain injury.
Randy: And that was only 12 feet, and we have roads here that literally are straight down three to four hundred feet. If you don’t think you’re going to hurt then, yeah…. The bottom line is, “What would I do if,” and come up with a scenario.
Kit: As a woman alone, I’ve been taking self-defense classes for years. The old thing of key between your fingers, and now I’m hearing that’s not such a good idea. I refuse to quiver in my house or dorm or wherever and not go out because somebody might hurt me. So I think carefully about where I walk when I walk, and I keep a key. Now, I have Kubotan. Actually, I’m not even carrying that. After 25 years, I’m not carrying my Kubotan.
Randy: Oh great, now you’re telling the listeners. They can come attack you!
Kit: No, no, they can’t, because I’m still a dangerous woman.
Randy: This is True.
Kit: But I stay alert. I walk with purpose. I’m always scanning the environment with eyes and ears, and that’s for people or animals. When I’m walking back and forth between my office and the house, we live in the country: there’s wildlife here.
Randy: There’s bears, there’s mountain lions, there’s bobcats, badgers, coyotes.
Kit: Deer, and during rutting season, a buck might take offense at me walking by. So I’m on the alert, which also means I get to see all the footprints and I see more sunrises, and I get to see the animals, even if they’re not bothering me.
Randy: So I think the bottom line that you didn’t hinted at but you didn’t actually say, is scenarios give you power.
Kit: Right, power and confidence.
Randy: Self-confidence, yeah. That is a tool that we both use a lot.
Kit: In various ways.
Randy: In various ways, not only for emergency situations, but what would I do if I got a call from Colbert to be on his show? It’s like, “Woohoo!” Not too likely, but how would I respond to that? ANd I have gotten calls, “Would you come to be on our TV show?” I’ve been flown to New York three times to be on TV, and it’s really kind of cool.
Kit: I bet. I’ll also run scenarios of what do I do if I’m driving down the highway and I get a flat tire.
Randy: Another good one.
Kit: What do I do when I try to jump into my car and I’m out on business and the battery’s dead?
Randy: Yeah, they don’t have to be life or death things. They could be very simple.
Kit: Minor or major annoyances.
Randy: Right. That’s one of the ways we prepare ourselves so that when we’re faced with such a situation, we don’t have to start thinking about it then. We thought about it before.
Kit: We’re not helpless.
Randy: It’s things we do when we’re otherwise not doing anything, like driving somewhere: we go through scenarios.
Kit: I also track, try to anyway, I forget sometimes, what mile marker did I just drive by? What happens if something happens on the road? What do I do? When I call dispatch or 911 or whatever, I can say, “I’m at mile marker 94 and a half, on such and such bound,” north or southbound.
Randy: The scenario is what happens if I come across a crash or somebody hit by a car or anything?
Kit: A dead animal in the road.
Randy: Anything. That happened to us fairly recently where we were in a very rural place. We were miles from any town. You were sleeping while I was driving, and you were awakened when I gave command to my phone, “Call 911.” You were up instantly, like, “What’s going on?” We just passed a 50 to 100 pound boulder sitting in the other lane….
Kit: I’d forgotten about that.
Randy: And if somebody comes around the corner and hits that, they’re going to be in a world of hurt. That’s going to be a serious wreck. It wasn’t in a safe place. We were in your car that doesn’t have the flashy lights on the roof like mine does, so I wasn’t going to stop in the dark on this curve and everything. So we quick called 911. Turns out that there was a sheriff’s deputy fairly nearby, and we saw him going the other way with his lightbar running because he realized, “Yeah, that’s a very dangerous thing. I don’t want to go a wreck on this road. I’m going to get there in a hurry.” We were able to tell him exactly where that was. It was just south of mile marker so and so. I don’t remember what it was anymore, because we were paying attention. I was at least because I was driving, as to where we were, so we could call and get that in there.
And the other thing was, the other scenario is when you’re in a rural area and you’ve called 911 and you get through, which hooray, we had cell coverage there, the first thing I did was as soon as there was a place to safely pull over, I did. Why? So I could keep that cell signal. I did not want to drive out of that coverage if it was limited. That’s just another thing to think about, because we do live in a very rural area, and cell coverage is spotty.
Kit: Well, cell coverage could be spotty in cities, too.
Randy: It can.
Kit: We’ve talked all about the county, the rural scenario running; we need to do it in the city too, and when I talked about not being locked in my apartment in fear, I was thinking of the various cities I’ve lived in and saying, “I will go out and I will do things and I will have fun.”
Randy: Because running these scenarios gives you an answer to, “What would I do if,” and that gives you power.
Kit: Well, and part of the scenario running is what is the safest street or neighborhood or whatever. When I was at the C.U. campus in Boulder, University Pond was a common place where women got raped. I didn’t go there at night alone.
Randy: Well how about that?
Kit: That was a scenario I ran and go, “OK, there’s something to avoid.”
Randy: So how can I avoid that area?
Randy: If I need to get from beyond the pond to where I am on this side of the pond — or where I need to be — how will I do that?
Kit: I’ve asked friends to walk me to my car, and then I’ll drive them wherever they’re going so that neither one of us is in danger.
Randy: Or inconvenienced.
Randy: All right, I think that’s a good place to wrap. I’d like to ask listeners to tell us about the kinds of scenarios they have run or that they think they should run. Let us know on the show page at thisistrue.com/podcast28. I’m Randy Cassingham.
Kit: And I’m Kit Cassingham.
Randy: And we’ll talk at you later.