The Decider – Blake Caplan

To this day I don’t understand the compulsion of some or most to overindulge on New Year’s Eve only to begin the New Year with a raging hangover. Perhaps it’s an effort to dull the pain of the closing year. I can understand those impulses and have certainly indulged from time to time myself, but on New Year’s Eve, I chose a different way to spend my time. Beginning in 1997, I chose to volunteer for the NYE shift at my local Ambulance Corps. This choice kept me clear of alcohol and put on full display the perils of excess.

For years, it was a fun night. The EMTs and Medics cooked, watched movies, made fun of each other, and laughed. But as the clock neared 11 pm our festivities would move from the station to the street. It became a bit cliché. The college frat boy who tried to clear an entire flight of stairs in one jump or the unfortunate casualty of the haphazardly concocted cocktails that reduced a naive college freshman to a drooling mess in the fetal position. For the most part, we were called to rather benign events. We packaged the poor soul up, gave them some fluids and dropped that at the ER for detox and an uncomfortable discussion with their parental figure(s).

There were, of course, exceptions. About an hour into the year 2000, the station lit up and the alert tones blared. I glanced at my pager and saw that we were being dispatched to a situation with a pedestrian who was struck by a car. As the Paramedic on the crew, I took my seat in the front and called the dispatch center via radio to advise them of our response. The dispatcher promptly responded. “Ok, be advised, police on the scene reporting a male in his 20s unconscious with labored breathing and bleeding from the legs and head.

The scene was less than a mile from the station, and we arrived in under 3 minutes. The police had the road shut down and were doing their best to administer what aid they could. The sounds of sirens and the sight of flashing lights prompted a mass exodus from the neighboring watering holes and, as such, we had quite an audience.

We quickly approached the patient with all of our gear. I asked the police officer on site to hold cervical stabilization while I assessed the patient. The patient’s pulse was rapid and blood pressure low, a clear sign of fluid loss and a grave threat to life.

I would describe the ensuing 15 minutes as robotic. The crew and I moved in concert and with purpose. The patient was packaged, and care was initiated to maintain life while on route to definitive care. Given the nature of the injuries and the patient’s condition, I requested the patient be transported by helicopter. We quickly put the patient in the ambulance and drove a few miles to the local high school football field which would serve as the landing zone.

A patient in this condition requires a host of interventions to preserve life. While en route to the hospital, the patient was intubated, IV access gained, and a host of drugs administered to control pain and maintain life. The badly fractured pelvis and femurs required stabilization, patient vital sign monitored, and a host of other tasks. All of which require rapid and accurate execution.

As quickly as the dispatch began, it ended. The helicopter crew met us at the back door of our rig, and we transferred the patient to the helicopter stretcher, and within minutes the helicopter was back in the air for a quick trip to the nearest trauma unit.

By this point in my tenure as a medic, I had succumbed to the cynicism and callousness that is prevalent in the industry. I never followed up on the patient, but my guess is he didn’t make it. I do remember debriefing the crew and feeling proud of the work we had done. We had made countless decisions without much thought or a need for discussion. What gauge IV to start? Should I intubate? Should the patient be transported by air or ground? Issue met action without much debate.

The story above along with vehicle rescues, fires, and a host of other emergency response stories prompted me to reflect on my decision-making process. My default and dominate process is closely aligned with the Recognition-primed decision process, or RPD. I use my subject matter knowledge and previous experience to quickly source a solution and decision. But this may result in the decision being the first workable option, not the best option.

A couple of years ago, I began to notice an employee dependence on me to make every decision. It made perfect sense, the company had a culture of micro-management, and I was perpetuating the cycle. Luckily, in a moment of frustration, I responded to a request for my support with sarcasm. “You do this every day…why don’t you already know the answer?” She promptly shared that she does, in fact, know what to do, but she thought I needed to be the one to decide.

Working in the emergency response field made me more comfortable with making rapid decisions, which has served me and others well at times. The downside is that it also made me more prone to micromanagement. Outside of an emergency, it pays to be collaborative and give my team space to work problems on their own. Shifting to corporate life forced me to rethink what it means to be “in charge”. Success is no longer measured by how quickly I can make the right decisions, but instead by how well I can coach others to make the right decisions on their own.