James O. Page

Recently I was looking through “The Magic of 3 A.M.” a collection of articles by the late James Page, former editor of JEMS magazine.

The first article in the book is entitled “Shades of Gray” and relates then Fire Chief Page’s response to a cardiac arrest at a local running track.  The patient in the article is successfully resuscitated, but suffers irreversible brain damage and dies three weeks later.  

Chief Page had an opportunity to speak with the man’s son shortly before the patient died.  The son expressed his gratitude that everything possible was done for his father despite the poor outcome. Although Chief Page considered the response a failure due to the patient’s condition, the family was clearly appreciative of the efforts of the EMS crew and bystanders that responded.  

The final sentence of this article states “In the “game” of saving lives, there are some shades of gray between winning and losing”.

Think back through the calls to which you have responded and consider that statement.  How many of your responses ended up in a gray zone, where you did everything right, used your skills and knowledge to the best of your ability, but yet the patient still had a bad outcome?  Probably more than you care to remember. 

Despite what the public sees on television, not every call turns out well. Most of our patients found in cardiac arrest do not survive.  Patients that are severely injured in motor vehicle crashes typically have a long period of recuperation and therapy before they can return to a normal level of function, if then.  Despite our greatest hopes, best skills and extensive knowledge, we can not save all of our patients.

Perhaps a better question to ask is “Did you make a difference?” 

Did you hold the hand of a little old lady that hadn’t had her hand held in years?  Did you give a mother time to say goodbye to her only son or daughter?  Did you give a family time to gather from across the country?  Did you give someone time to make amends or to say that they were sorry?  Did you minimize the damage that had already occurred?  Did you make the last few moments of life comfortable? 

Estimates indicate that only approximately 10% of EMS calls are true life threatening emergencies, where minutes make the difference between life and death.  On these it is easy to know whether you had an immediate impact on whether the patient survived.  The other 90 percent of calls, the ones that happen every day, may be somewhat harder to pin down.  The difference that you make may not be as obvious or as dramatic, but may be far more lasting.

Often it is the little things that people remember.  They remember that you gave them a warm blanket.  They remember that you smiled.  They remember that you were polite and they remember that you made them relax.  They remember that you made a difference on what may be the worst day of their life.

In the wake of Hurricanes Katrina and Rita, many health care practitioners volunteered to provide assistance in the impacted areas.  After the initial response, these healthcare professionals settled into roles providing various levels of care to the survivors.  Some became shelter managers, others provided care through clinics staffed with Disaster Medical Assistance Teams (DMAT’s), and others provided medical support to relief and recovery efforts by providing immunizations. 

EMT’s and paramedics, in addition to providing regular EMS care, assumed non-typical positions in community health.  Regardless of their role, almost universally, the things that they remember are the people and their interactions.  As one paramedic returning from Louisiana stated, “I re-learned to treat people as people rather than as patients.” 

Their lasting memories are the people that they met along the way, be it in a shelter, during a transport or along the road.  For some, it was a life changing experience.  Treating people who could maintain a positive outlook despite being able to pack all of their remaining possessions into a couple of shopping bags made a profound impact on many of these volunteers.  For the people they were treating, a willing ear, kind words and a simple willingness to help was likely of more assistance than the medical care that they provided.

Even in those times when you can do nothing more medically for the patient, it is the simple gestures;. holding a hand; lending a willing ear or a shoulder to cry on are those that are remembered. Even when the patient can not be helped there is still the family, friends and even bystanders that need support and assistance.

Some of the best EMT’s and paramedics that I have ever had the pleasure to know and work with were one’s that did their best work after the call was over.  They made sure the patient and the family were comfortable, asked if they needed anything, or if there was anyone that they could call.  They went out of their way to address the needs of not only the patient, but also the needs of the family.  They went out of their way to make a difference.

In EMS there will always be shades of gray— and always opportunities to make a difference.

When it's all over, it's not who you were. . . it's whether you made a difference.

--Bob Dole