Back when I only had a few months on the job, my crew and I responded to a cardiac arrest. I was assigned to the engine that day, and because I was the rookie, I jumped on the most physically demanding task – chest compressions. Just as the patient’s ribs began to give, Bob, the senior firefighter pushed me out of the way and took over. He said, “You’re the paramedic, you tell us what to do.”
Being a firefighter/paramedic isn’t easy, especially if you find yourself in an agency that is perpetually short on candidates willing or able to obtain the latter half of the certification. So many times I found myself in the odd position of being both a junior firefighter and also the lead medical provider, meaning I carried the most liability but had the least amount of authority.
Today, I am a battalion chief, and the lessons I learned during my time as a firefighter/paramedic have started to come into focus. I see now how those years of experience leading scenes without rank prepared me to be a better incident commander.
How to communicate
As the only firefighter with a paramedic license on a medical scene – a common occurrence – I was legally responsible for overall patient care, but within the organization, I had no rank. If I had barked orders at my crew, I would have been alienated, marked as a know-it-all, or as we say in the South, “too big for my britches.”
I had to pay attention to how I spoke when I needed something done. This is no easy task when a patient’s condition is heading south. But no matter what was happening, I had to watch my tone. So instead of phrasing what I needed done as an order, I phrased it as a request. So where I could have demanded a coworker to “put the patient on the EKG,” I would say, “will you put him on the EKG?” Followed by a simple, “thank you.” In other words, I was respectful and polite.
This awareness of speech produced an invaluable byproduct. By paying attention to what I said and how I said it, I developed the ability to remain (or at least appear to be) calm.
Now that I am a battalion chief, I don’t have to be so nice – but I try. While it is true that I don’t say please or thank you on the scene of a house fire, I do remain aware of what I say. The way I communicate sets the tone for the entire scene. And it’s no secret that there is a direct correlation between success and an IC who can remain calm.
Trusting my team
As the lone firefighter/paramedic on the scene, only I could read the EKG, start the IV, intubate, synchronize cardiovert, transcutaneous pace or push the array of medications we carried in our drug box. But where the firefighter/EMTs I worked with lacked textbook knowledge, they made up for it with experience. While I was on the phone with a doctor, or drawing up meds, they were usually two steps ahead of what needed to be done. Getting vitals, spiking a bag of fluids or planning a way to carry a patient out to the street. They didn’t need me to tell them what to do.
Now, whenever I assume command of a scene, I often see that my crews are already doing what needs to be done. And the best thing I can do as the IC is to stay out of the way and let them do it.
Making decisions
The most difficult part of running a scene is the constant barrage of decisions. Do we push? Do we pull back? Do we have enough people? Should I cut someone loose? Is that power line about to come down?
In high-pressure situations, things can get overwhelming. But the only way to get better at making decisions is to make decisions. For a lot of firefighters, that day doesn’t come until they find themselves in charge. Firefighter/paramedics start making decisions on their first day on the job.
Furthermore, I’ve known a lot of very smart people who have known what to do but failed to know when to do it. Being an expert may make you a valuable asset, but it doesn’t make you a leader. Decision-making is a skill that comes with practice. When I look back on those long sleepless nights I spent as a firefighter/paramedic, I can say with confidence that I got plenty of practice.
Operating in the spotlight
Because firefighter/paramedics were a scarce commodity in my department, we tended to operate under a spotlight. On a typical ambulance shift, I would respond with five or more engine companies from all over the city. For some of those engine companies, their first call of the day would be my thirteenth. While they had spent their day at the station, I had missed lunch. While they were in the gym doing PT, I had been at a hospital waiting for a bed. Sometimes it didn’t seem fair. But that didn’t matter. I still had a job to do. If I didn’t do it well, that engine crew would bear witness – and then tell everyone they knew.
As an IC, that spotlight has only gotten brighter. I can expect each decision I make to be critiqued over the seven dinner tables across my battalion. If I choose to cut corners or make an order that is unsafe or unethical, the whole department will know about it by shift change.
You can’t ever forget that when you’re the guy in charge, everyone is watching. The good news is that talking about a guy who they see always doing the right thing makes for boring gossip. Do your job well and the crews will move their dinner table complaints and speculation to one of their other all-time favorite targets – city council, the mayor … or the fire chief.
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