Your Captain Speaking: Take a Minute to Debrief

“Samantha, I wish I had done more ‘debriefs’ at the end of EMS calls, more than I did. We did them regularly as a pilot, sometimes just between the two to four pilots, and admittedly less with the whole crew of 20 but still common. There were some surprising pluses that outweigh the negatives.”

A debrief is a step above just two folks on a call, and much less than a Critical Incident Stress Debriefing (CSID). Let’s compare notes on what we found!

First, a brief chat with your partner does not have to be a super tense call for the paramedic. It’s not even necessary for the senior partner to ask for a short debriefing. It can go either way, with the important distinction being that the other partner say “Sure!”

For example, on a call for chest pain—and sure enough it’s a STEMI—the paramedic doesn’t want to say in front of the patient, “Dude, You’re having a heart attack,” and the EMT is not sure how to best help. Patients and family often don’t know a lot of our terminology, but they are very good at reading body language. Other times they know exactly what terms we’re using.

If, after running the 12-lead ECG, your partner is not aware it’s a STEMI, they will have a “lost” demeanor and perhaps show frustration in their body language you don’t recognize. If that’s happening, that’s on me, the paramedic; I should have been keeping him in the loop better.

The biggest barrier to doing a debrief is (gulp) our own ego! Asking for a debrief could result in the other people telling you that you did something wrong. That’s possible, and I’d like to answer the question. I might, in fact, have been wrong, but I’d really like to know that and will tell them, “I agree!” It also gives me a chance to explain why I did or not do a procedure on scene.

The key here is it’s not about who’s right or who’s wrong; it’s about getting better and reinforcing good patient treatment and coordination. A good call to debrief is one in which everything just seemed to go right. Here’s the call, here are the curve balls thrown at us, and here’s how we adapted. Our patient treatment was great, communication and transfer to hospital or nursing home staff went smoothly. Tell the other person or people that they did a great job. It might have been a “tough” call or an easy one—if you get a chance to compliment other people, do it. Be honest and sincere; it shows through.

These debriefs are a possible mechanism to identify the need for a CISD. Every person is different and might trigger to different events. Know that a “routine” call to you or me could be extremely stressful for another. Honestly, I’d look at the body language of the other people involved. If one of us goes to the back of the ambulance to have a cry, let that happen, then have a debrief for sure. There will always be a call waiting out there for me that will break my heart. Is a CISD appropriate? Maybe.

Another sign is to look to see whether there are displays of anger by anyone. OK, if you’ve gotten to the ED and have been holding up a wall for the past hour, a CSID might not be the right call, but a debrief is a good idea. As far as holding up a wall at the ED, maybe there is a right to be mad! Maybe there is something you could do about it in a professional manner.

The big summary: Think about holding a debrief at the end of a call, or maybe at the end of the day. A good call reinforces the good, and repeats it in the future. A debrief after a call with a poor patient outcome is important as there is an unwritten rule in EMS: Even though you did everything perfectly, you can still have a poor outcome.

Debriefs are not just for the ambulance team; bring in other players such as the nurses, technicians, or even the ED doctor as appropriate. A debrief is not an appraisal or evaluation. It’s a chance to learn and grow. Know that in the aviation industry, we have debriefs all the time. Let’s go fly.

Dick Blanchet, (Retired) BS, MBA, worked as a paramedic for Abbott EMS in St. Louis, MO, and Illinois for more than 22 years. He was also a captain with Atlas Air for 22 years on the Boeing 747 with more than 21,000 flight hours. As a USAF pilot for 22 years, he flew the C-9 Nightingale Aeromedical aircraft. A USAF Academy graduate with a Bachelor of Science degree, his Masters in Business Administration is from Golden Gate University.