Thursday, February 26

Learning Not To Act

What do EMT students and kindergarteners have in common? In both cases learning what not to do is sometimes harder than learning what to do.

On Wednesday night I coach basketball. I am not a very good basketball player, and would not profess to be much of a coach, but the organizers asked and I was too stupid to say no. When the players range in age from 4 to 6 the coaches are hard to find and any deficiencies are not noticed by the players.

Paint yourself a picture:

Location – Racquetball Courts (yes, a small space with rock-hard walls which reflect all sound!)

Baskets – 6 feet tall portable units.

Ball – Kid sized.

Kids – 8 to a team. High energy. Some played last year, some have never played before in their lives.

Format: 30 minutes of warm-up and drills and 30 minutes of “game” against another “team” (3 on three “full court”).

You can image I leave with no hearing and no patience (and the thrill of being able to windmill dunk does not go away…).

Give a kid who is 4 or so a basketball and the general goals of the game and the results are predictable. They run to the basket (without dribbling) and heave the ball at the hoop with full force. On defense they tackle the other player and knock the ball free. Not a bad initial plan given the goal of the game is to make a basket and not let the other team score. From the kids’ perspective the rules just get in the way. As a coach part of my job is to teach them the necessity of rules and the role the rules play in making the game more interesting (not to mention safe) for everyone.

What if your goal is to help others in need? In EMT class Monday we talked about scene safety and extrication. There was a lot of squirming in seats as the “rules” were explained to us. Few people in the room got involved in emergency medicine in order to watch from a distance as people need help or to say “that isn’t my job”. But the rules say there are times when that is exactly what we are to do. Person shot with the “actor” still around and no police presence? Wait at a safe distance until the police secure the scene. Truck turns over spilling a caustic on a minivan full of kids with the kids screaming from the burns? Wait at a safe distance until a decontamination team arrives and can deliver your patient to you in a decontaminated state. Even if that means the kids die in the interim? Yes. Really? YES!

Apparently some subset of three things can happen if you violate the rules:

1) You are called a hero by the press.
2) You die, or worse, get injured and take up valuable rescue resources that could have been given to the original victims.
3) You get reprimanded or kicked out of your corps (or fired).

Six weeks into basketball and my charges are learning to play by the rules and are having fun. But it is still hard work for them to avoid the impulse that comes naturally.

In EMT class scene safety is being driven into us relentlessly and I dare say all of us are going to be slow learners on this issue. I have to assume that it is better for the EMT, and in the long run better for the patients, if we follow the rules. Clearly, however, my peers and I want to run without dribbling and heave the ball at the hoop, as our gut impulse is not to sit and wait while people are in need.

Maybe I need to go back to kindergarten to relearn self-control.