The Human Condition:

When You Call 911 – December 2, 2012

We had a medical emergency at home about nine o’clock in the evening on the Wednesday before Thanksgiving. I won’t go into the medical details, which are private and not really relevant to this posting, but I do want to recount our experience with calling 911 and dealing with our town’s emergency medical technician (EMT) team, which as in most towns is run by the fire department.

Our popular culture is filled with examples of how most city services—and indeed any local, state, or federal bureaucracy—are run by incompetents. To quote from a desperate Sarah Connor in the first Terminator movie, “Don’t put me on hold and don’t transfer me to another department.” There’s a reason for this perception, one that I understand as a writer of fiction: if everything goes smoothly, there is no story. If you can pick up the phone and get medical or police help in a matter of minutes, then you as the main character are not thrown back into an atavistic struggle for survival, requiring all your daring and resourcefulness to achieve a resolution. Getting jacked around by the 911 operator or the cop on the beat or the emergency room nurse is the starting point for many a fictional urban adventure.

I’m glad to say that—at least from my research sample of one, and my intuition based on that experience—incompetence is far from the norm in the real world.

From the first seconds of the call, I was impressed with how calmly efficient the operators were. The first person who answered 911 asked what the problem was. Upon learning that my issue was medical rather than crime, accident, or fire related, she transferred me to the EMT department. She not only transferred me, but she told me she was transferring me and why. Now, from the comfort of your chair, you may think that’s obvious. But when you’re standing by the phone and seconds are ticking away, it’s reassuring to be told what’s going to happen, rather than just hearing click-click!

Making You Part of the Solution

The EMT operator immediately introduced himself—not by name, like some customer services representative, but by function. That made it instantly clear to me who was speaking and why. He then asked me to explain the problem, and I stammered out a sentence or two. Being a writer, I tend to think in story form and begin at the beginning. As soon as he knew what kind of trauma and what part of the body were involved, he took over and began asking specific questions. On reflection, I recognize them as being part of a decision tree, a diagnostic technique. Unlike an old-fashioned doctor, who might try to impress you by saying “edema” instead of “swelling,” the EMT operator used plain language, common descriptions, and simple, direct, one-at-a-time instructions. Our exchange was maximized for clarity.

More than that, the exchange was maximized for time. He made me take action and save minutes by asking about things I could check, answer, and settle before the actual medical team arrived on site. He gave me simple directions for administering in-home first aid and preparing the person in distress for the team. All of this was delivered in a calm and authoritative voice, designed and no-doubt practiced through training to minimize stress and produce simple, direct action.

He told me exactly how soon the EMT team would arrive, so I’m sure he was in contact with them by radio and giving them information from my call. He also told me to prepare for their arrival by unlocking the front door, turning on the lights, securing any pets, and gathering up the patient’s medications. There wasn’t any reassuring blather about “You’re in good hands, sir,” while I was expected to stand by, waiting helplessly. They made me part of the solution, and that maximized the efficiency of the medical response and was reassurance in itself.

Performing a Manual Ballet

The two young men who arrived from the fire department—although they might as easily have been women—walked through the door with exactly the equipment they needed. This was no doubt due to the operator’s describing the nature of the emergency. They located the patient and moved the person quickly to just the right place and position to administer help.

Out of the four cases they were carrying came just the right equipment and medicines. What impressed me was that the two men didn’t have to confer with each other at all. There was no “Well, what do you think?” and “You do this while I’ll do that.” Their focus was on the patient. One took vital signs and performed the kinds of sophisticated tests you see in a hospital.1 The other administered medication, first aid, and common supports like oxygen and an intravenous drip. All of this medical technology was coming out of just those four cases.

Their movements were a fascinating manual ballet. They never fumbled or got in each other’s way. They never paused. It was clear they had trained and worked together to perfect these techniques. And I sense that they weren’t prepared for just this particular emergency. For any one of a dozen bad things that can happen to you, these men had the solutions and the routines for optimum delivery of treatment in minimum time.

As with the EMT phone operator, their voices, their questions and instructions were a curious mixture of brusqueness and compassion. They didn’t waste any time on the social niceties. I never learned their names, because names weren’t important. Their instructions to me and to the patient, their explanations about what they were doing and what would come next were delivered in calm, professional voices that lacked any sense of urgency or hysteria. Yet they were encouraging and gentle in their tone and their touch.

When the ambulance with a stretcher2 arrived to take the patient to the hospital, it appeared to be from another place or another department. It wasn’t at all clear that the two teams even knew each other, yet they worked together seamlessly. They told me where the patient would be taken—which was the regional center for that kind of trauma—and exactly what I needed to bring in support.

And as the ambulance team wheeled the patient out, the EMTs secured the area, repacking their equipment and policing up sterile wrappers and packaging. They and the clutter of the treatment process were gone as quickly, quietly, and efficiently as they had come.

This might have been an unusual occurrence. Certainly, it was unusual for our family, which has been blessed with good health. But I could easily see how well trained and practiced these young men—and, I’m sure, women in similar situations—were at their jobs. Their execution was perfect in thought, word, and deed.

From that, I apply simple logic. I don’t live in a special town—a good one, but not a rich community with high taxes and expectations of elaborate services. And I am not a special person, so that operators and public servants hear my name, get all kinds of giddy, and pull out the stops to impress me. It’s clear to me that this kind of sober, efficient, encouraging treatment is the norm in well-run communities rather than the exception.

This recent experience underscores my basic belief that most people are serious about their jobs, take pride in their work, and care about serving clients and customers.3 It’s easy to picture public servants as fools and incompetents, filling jobs in a government that’s the employer of last resort, and to depict them that way in popular fiction. But in the world I inhabit the popular stereotype turned out not to be the case. And for that I am truly thankful.

1. If you haven’t been around doctors and hospitals lately—lucky you!—you would be amazed at how computerization, cellularization, Bluetooth, and disposables have compressed, compacted, and miniaturized the nature of emergency medicine. Everything that touches the patient’s body and bodily fluids is plastic-wrapped, sterile, and disposable. The added cost is a guarantee of standardized service and minimized potential for infection.

2. Like all modern medical equipment, the stretcher is a marvel of technology: collapsible, expandable, flexible, maneuverable, and designed to fit in tight spaces and around corners. And it’s painted international emergency yellow, so it can’t be confused with anything else.

3. I see this even at the Department of Motor Vehicles. If any government function is less involved in making life-and-death decisions and more involved in following rules and pushing paper, I can’t imagine it. And yet the people at the DMV—at least in California—make an effort to streamline the process with plentiful online services, a system of appointments, and good on-site communications. They may be bureaucrats, but they have a sense of purpose and demonstrate efficiency.