Life and Death Matters, Professionalism and Decision Making for the first responder; How paramedics act decisively in the chaos of prehospital emergency medicine.



Life and Death Matters is devoted to the professional development of first responders. Most literature as it relates to first responders focuses on didactic medical knowledge. That is, medical principles learned in order to treat patients in the prehospital field. However, there is more to being a first responder than that. This book presents and develops the importance of an integrated approach to prehospital emergency medicine. Integrating professional character attributes, decision making principles, and medical knowledge creates a successful paramedic or first responder. The third section is devoted to the paramedic preceptor responsible for teaching others.

Introduction: An Integrated Understanding

The primary theme of this book is to develop an integrated understanding of how to operate as a paramedic. These tools go far beyond just operating as a paramedic; they are valuable to any first responder or firefighter.

Three primary qualities must be integrated in order for you to become extremely successful in your work. One is interpersonal skills and personal attributes. Two is decision-making. Three is didactic understanding or educational understanding, which is the knowledge that you gain through all of the study in paramedic school or a fire academy and beyond. Of all three of these, didactic understanding is usually what paramedics spend most of their time on.

Operating in emergency situations requires consistent and reliable decisiveness. Didactic understanding does not develop decision-making. Didactic understanding in and of itself does not provide you with the tools to interact with people and build patient rapport. Arguably the most critical aspect of being a paramedic is interpersonal skills in developing a rapport with your patient, with the community, and with your teammates—and then acting decisively.

First and foremost, educational understanding is extremely valuable but must be used and integrated within these two other concepts in order to be properly utilized. It does not benefit your patient, your team, or the community for you to be able to regurgitate information that is not applicable to your current situation or that is over the heads of the patient or your other teammates.

If you integrate your education with these other concepts, it will be clearly evident that you know what you are doing. Didactic understanding and knowledge is beyond the scope of this book. The purpose of this book is to integrate your classroom knowledge (which you have already learned) with two other principles: personal attributes and how to use those attributes to interact with others in emergencies by demonstrating calm and confident decision-making.

A simple analogy will serve to better illustrate why educational information alone does not produce a successful first responder or paramedic. Imagine a house. Imagine how to build a house. You can read all of the books in the world about the different aspects about building a house, from digging a foundation and pouring the concrete, to framing the house and building the different levels within the house.

The next step might be to install the plumbing in the house and then run electrical lines to the house. And then finally hanging drywall inside, roofing the house, and putting on the exterior and the interior finishes. You can read a book about every single one of these steps in building a house. Every single one of these tasks is extremely critical in building a stable, habitable house. But reading a book alone on how to do all of these different tasks does not give you the proper tools by which to act.

Eventually you have to make a decision on where you’re going to dig the foundation, how you’re going to pour the concrete, how you’re going to frame the structure. You can only gain this experience and understanding by doing it. The only way to truly become successful is to act and then reflect on the actions that you have taken. Once you have reflected upon the tasks, then you can start to develop, grow, and hone your skills as a homebuilder. And then the educational knowledge from books becomes second nature, and you understand the principles of how you’re operating, but now you have a much greater understanding of the overall mission and you are much more capable at building your structure.

But in order to make any of these decisions in the first place, you must have the knowledge, and that takes study and time to develop. In the end, however, the house will never be built if you do not act upon the educational information you have obtained.

Another point here is that you cannot watch somebody else build a house and believe that you are now going to be able to build the house the same yourself. If you are not involved in the decision-making of building a house, you will never be able to successfully build one.

Second, interpersonal skills and personal attributes are extremely important for a successful paramedic. You must be able to interact with people. This skill can be learned and developed. Just because it is not inherent in everyone does not mean that you can’t learn how to do this. But you must learn by doing—actually building the house.

You must remember that you are the professional and that someone has called for your assistance and you have to interact with them. By intentionally building rapport and conscientiously interacting with your patients and with the community, these interpersonal skills will become second nature.

It is critical to understand that we as first responders and paramedics interact with more than just a single patient at a time. We are in a constant state of interacting with the communities we serve at large. By this we mean interacting with witnesses and bystanders at emergency scenes. Interacting with business owners for pre–fire planning and pre–incident planning for possible target hazards. Interacting with the general public during public education workshops or tours. This can also be as simple as interacting with people while shopping for your meals for the shift.

The third concept in this book is decisiveness. You must develop a decision-making process for yourself. You can add to and contribute to your decision-making process the skills that other people have shown you and taught you. But in the end you must have a process that makes sense to you. This is how you will be successful and how you will be able to act decisively.

We discuss these three concepts in this book. However, understand that the first principle of educational knowledge cannot be fully elaborated on within this book. We stated earlier that it is beyond the scope of this book, but it is our intention to provide you with an understanding of how to integrate your knowledge with the two other main principles.

Educational understanding is discussed to some degree, but it is discussed because it is integrated with the other two principles. You cannot have one without the other two. We do not intend to replace or provide you with medical knowledge. That knowledge must be attained through continuing education.

These three concepts used in an integrated fashion will greatly enhance your ability as a paramedic. You will gain a better understanding of the overall objective that we as paramedics, first responders, and firefighters are attempting to accomplish, and you will know how to better serve the community that you are now working in. In order to develop a sound decision-making process, you have to integrate all these skills. Develop them all individually so they can be useful as one tool.

We want to make something clear. A paycheck is not what makes you a professional. Professionalism is the internal embodiment of how you conduct yourself. To all the volunteers out there, keep up the good work! Keep going out the door. Your selfless sacrifice to your communities is invaluable.


The Character of a First Responder

What are the key attributes or characteristics a paramedic should have to be successful? The job of a paramedic is not just medicine; it is much more difficult than understanding basic medical principles. An integrated understanding of medicine, personal interaction, and personal character attributes will help you grow as a paramedic and will give you the ability to teach others more efficiently.

Throughout this section we will explore the attributes that are key to providing successful and professional prehospital care. This is not an exhaustive list, but it is a starting point on how and why you conduct yourself as a professional. These individual attributes can be categorized into the three principles of medicine, interpersonal skills, and personal attributes. It is critical to your success as a paramedic to integrate these three principles into your practice.

An integrated understanding of these principles is absolutely essential. For example, your personal attribute of integrity will directly impact your ability to have effective personal interactions, which will then directly impact your medicine. Because of the integrated understanding that we are developing in the paramedic, some of these attributes are found in more than just one of the principles set forth.


Sincere humility is one of the most important attributes a paramedic must exhibit. However, this trait can be difficult for certain individuals because they believe they have sincere humility, but internally they express fake humility.

Fake humility is maybe one of the most dangerous attributes that someone can exhibit. Fake humility is destructive to your ability to apply what you know to properly treat someone. Fake humility is also dangerous in your personal life, because it never allows you to develop and grow.

This is dangerous because fake humility is lip service. In practice, you sit and listen to constructive criticism respectfully, but in your prideful arrogance, you do not consider what someone might be saying to you.

To better illustrate fake humility, here’s a simple and far-too-common example. Paramedic A is on scene and implementing an appropriate treatment plan. Paramedic B arrives on scene and is brought up to speed on what is going on with the patient and what the treatment plan is. Paramedic A has already developed a plan of action to transport the patient to the hospital and has initiated all of the proper interventions. Paramedic B then states that they want to do something differently. Paramedic A states they have already initiated this plan and are moving toward the hospital. Paramedic B then says okay, sounds good, and appears to be humble and recognize that a plan has already been initiated that is completely appropriate for the patient. Then, however, paramedic B does not help implement the plan and, instead, undermines the treatment plan in place. This is fake humility. Paramedic B is not humble enough to recognize someone else has implemented an appropriate plan and does not fully help to implement it as a team member.

True humility is such a key attribute for growth because it requires you to understand that there’s always more to learn. Because there are many avenues to learn new information, you have to be open to all of them—whether it’s taking new classes for education, reading, personal study, or other people’s constructive criticism. You have to be open to other people and their ideas.

True humility allows you the freedom and liberty to openly discuss new ideas and techniques. This attribute is important to new paramedic development. If you’re a new paramedic, it is dangerous for you to believe that you have full understanding of all the different aspects of all the different calls you go on.

The EMS system and the fire service in the United States and internationally are now so dynamic that you can never know everything. We would argue that you will never know everything despite how long you have been serving. You have to be open to new and better ways of doing what you do every day.

Humility allows personal growth. Without personal growth you will continue to treat people the same way that you always have. You will never allow yourself the ability to develop new ways of treatment for patients without humility. We will let you in on a secret: You don’t know everything. And you certainly will always have room to grow.

Recognizing that you don’t know everything is the foundation that needs to be laid in order for your success to take place. The quicker you embrace the fact that you will never know everything, which should drive you toward self-growth and professionalism, the better off you will be. The vehicle to do this is humility.

Now don’t misunderstand. Being humble should not hinder your ability to act in critical situations or on regular noncritical calls. Humility, on the other hand, should actually increase your ability to intervene and act. If you approach your work with the understanding that there may be something going on that you don’t fully understand, that you are not fully aware of, such awareness gives you more ability and mentality to treat the situation seriously. And by the time you get to the emergency room, their symptoms may have resolved, or you might have reversed whatever was causing the patient’s ailment. By being aggressive in the first place and having the understanding that you need to be aggressive and that things could get much worse, you stayed in front of the patient’s decline.

One of the other key features of humility is that it allows you to continue searching for other problems with your patient. It requires you to continue to have ongoing assessments. It allows you to see that there is sometimes more than one disease process taking place with somebody.

Humility requires that you, the paramedic, continue to search for other problems that might crop up during the patient care. Your assessment should never be complete until you pull in and drop the patient off at the emergency room, and we would argue care still doesn’t end there. Learning continues to take place. The learning that we’re speaking of is follow-up information with the patient to see if you were going down the right track.

Humility is a touchy thing, and most people understand that they should strive for it. Most people will tell you that they have humility, but in their head they are in a constant state of frustration and belief that they’re right all the time. This is demonstrative of fake humility. This is a dangerous place to be because it doesn’t allow for outside input and follow-up information to be applied.

Humility is a characteristic that people do understand they should have or should practice. In some way humility can be practiced and developed. In order to do so, you have to understand where it really comes from. Humility is a state of mind or an attitude. It is recognition of your own flaws and imperfections. If you practice and run your calls in a way that you are always trying to learn something new from a call—and you are in a constant state of practicing reflection and self-reflection and trying to learn from the different patients that you have this will help develop your humility. You realize that you don’t know everything. And the more that you consciously develop humility, the more you recognize how little you really do know and the more understanding you gain.

Practicing humility gives you the ability to act and intervene on critical patients. Your confidence increases because you understand that you need to stay in front of the game, so that if the patient does collapse on you, you have systems in place that allow you to more easily treat that patient. Because you practice humility, you anticipate a patient’s inevitable decline. As a new paramedic, or even as a seasoned paramedic, you should never assume you know everything.

Ego or Pride

On every single call you go on as a new paramedic or a seasoned paramedic, you better be checking your ego at the door.

Ego is perhaps the most dangerous personal character attribute of a paramedic. Emergency medicine has no room for your ego. New paramedics and their egos and seasoned paramedics and their egos are extremely detrimental to a patient. Your ego inhibits your ability to treat your patients. Your ego inhibits your ability to act. You cannot approach your calls with the understanding that you always know what’s going on.

We’ll reveal another secret here: It’s okay not to know exactly what’s going on. In fact, one could argue that it’s better to have a more global picture than to get caught with a narrow view of what’s going on with your patient. It is not the paramedic’s job to specifically diagnose somebody with a certain disease process. It is your job to recognize life threats and recognize what you might be able to do to intervene.


Integrity is a quality that each individual should always be striving to achieve. Integrity is elusive. Every individual is always tested and tempted with the easy way out, whether that’s in work or life. Integrity can have many different facets, such as discipline, accountability, and honesty. And the idea is that we have to constantly strive for it and implement it.

There are so many different ways to define what this word means, but everyone has a general understanding of what integrity embodies. A short definition of this word might look something like this: to do what is right even when no one is looking.

Integrity is difficult to attain because, in order to attain it, you have to conscientiously think about it. You have to will yourself in order to achieve integrity. Integrity is ever elusive and must be on your mind as often as possible. You must discipline your life to maintain your integrity. Practicing integrity must become habitual; then it will become subconscious. The constant act of having integrity will become easier the more you practice.

In your work and in your life as a paramedic, integrity plays an incredibly key role. You must always be on the alert for situations that will arise for you to take the easy way out. One of the biggest ways that this will manifest itself is usually in workload. The simple example of this is running a multi-car traffic accident with multiple victims and your determining that some are not patients because of minor injuries. Now, instead of doing assessments and refusals on these patients, you take the easy way out and assume that they will be okay.

This is an example of taking the easy way out. There can be major consequences for having this sort of thinking. Your patient may very well have a serious injury or be on the verge of a serious injury. You might miss a fractured cervical spine or internal bleeding that the hospital would have found if they were transported.

Integrity is vital to the paramedic. You have to practice it on almost every call you go on. Think about what we really do: going into people’s houses and into their bedrooms with absolute trust from the patient and the family members. The public trusts you, and trusts that you’re there to help, that you are not there to take advantage of them.

Your integrity is what builds relationship with each patient that you come in contact with. You will be asked many times to go get a patient’s wallet, or to get their keys or to lock their doors. It’s imperative that you do this with the utmost integrity. You are not only doing this for yourself, but the way you conduct yourself will affect every single paramedic in the country. Be professional! Your actions can have ripple effects and cause the public to lose trust in the system we have in place to help them in emergencies.

Do what’s right because it is right. If you’re not doing that, why are you in this job?Integrity filters down to more than just the patients that you interact with. Your business or your employer is trusting you with thousands and in some cases millions of dollars’ worth of equipment. You have to maintain this equipment; you have to use it appropriately and check it and make sure it’s in good working order.

You have to report errors and mistakes. In doing so, you build integrity. Instill trust with your employer, instill trust with your patient, and instill trust with your team. You will always accomplish more with your team than without them. Your teammates must trust you, and they must know that you as the paramedic are looking out for their well-being. This is demonstrated by how you treat and how you act around your patients. How you interact with the public is on display every single day. Your teammates can see clearly whether or not you conduct yourself with integrity and whether or not you’re consistent with it.

About the author

Christian Adams is a Nationally Registered and Colorado State Certified Paramedic. He is also certified in RSI (rapid sequence intubation). He is trained and currently functions as a paramedic with the city’s High Angle Rope Rescue team. He also functions as a paramedic preceptor for the CSFD. view profile

Published on December 20, 2018

Published by

50000 words

Worked with a Reedsy professional 🏆

Genre: Self-help

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