Alright folks, pull up a jump seat and let ol’ Rusty tell you a thing or two. Twenty-odd years riding the streets of Houston, and I’ve seen enough flashing lights and heard enough sirens to last a lifetime. One thing that’s become clearer than a good chest X-ray? This job isn’t always the high-octane, adrenaline-fueled spectacle you see on TV. Sometimes, the most heroic thing a medic can do isn’t a flashy procedure – it’s hitting the mental brakes. And it turns out, the science backs up what the old-timers have known for years.
We’ve all seen them, maybe even been one early on: the “Skills Junky.” They’re eager, full of textbook knowledge, and itching to use every tool in the bag. They see a challenging call and their first thought is the “blade” – the needle, the tube, the shock. But here’s the rub: that rush to do can lead straight into the traps our own brains set for us. Researchers call them cognitive biases, things like “anchoring,” where you latch onto the first piece of information, or “premature closure,” where you decide on a diagnosis before you’ve got all the facts (Patenotte & Darby, 2023; Tory, 2022). Add the intense stress of a critical call, which we know can impair memory and decision-making (LeBlanc et al., 2012), and you’ve got a recipe for tunnel vision. I remember a young partner, sharp as a tack, but so focused on getting an IV in a crashing patient that he almost missed the subtle signs of a tension pneumothorax. He saw the “low BP” anchor and went straight for fluids, forgetting to look at the whole picture.
Then you’ve got the other side of the coin: the “Wise Medic.” They walk into a chaotic scene, and it’s like they have a built-in dimmer switch for the panic. They move with purpose, but not haste. They listen. They look. They think. They have excellent situational awareness, constantly scanning and interpreting the environment, not just the patient (EMS1, 2024). They employ critical thinking, questioning assumptions and evaluating information before acting (JEMS, 2020). These medics understand what researchers call Dual Process Theory – that we have both fast, intuitive thinking (System 1) and slow, analytical thinking (System 2) (Murdoch, 2019). While experience builds good intuition, the wise medic knows when to slow down and engage System 2, especially when things don’t quite add up.
I’ll never forget a multi-car pileup on I-45. It was pure chaos. But our senior medic, Maria, took a beat. She didn’t rush to the loudest patient. She stood back, directed her team, performed quick, deliberate assessments, and identified the quiet, critically injured patient tucked away in a crumpled sedan. Her calm, methodical approach, her ability to filter noise and prioritize, undoubtedly saved a life that day. That wasn’t luck; it was practiced wisdom.
So, what separates the wise medic from the skills junky? It boils down to a few key things, all supported by research:
- Superior Diagnostic Reasoning: They prioritize a thorough assessment, actively fighting cognitive biases. They engage in true clinical reasoning, understanding it’s a complex skill built on education and reflective experience (BMC Med Educ, 2023).
- Calm Under Pressure: They manage their cognitive load, preventing the mental overload that leads to errors under stress (LeBlanc et al., 2005). They know that panic is contagious, but so is calm.
- Judicious Use of Interventions: They understand that every procedure has risks. They weigh the benefits against those risks, using interventions as targeted tools, not a shotgun blast. They value doing the right thing over just doing something.
- Strong Team Communication: Wise medics are often great leaders and followers. They communicate clearly, listen actively, and value their partner’s input, recognizing the importance of human factors in team performance (Summers, 2010).
- Long-Term Resilience: By approaching the job thoughtfully and managing stress, they avoid the burnout that plagues so many. They understand it’s a marathon, and you can’t sprint the whole way.
It’s not all life-and-death drama, either. Sometimes the lesson comes with a laugh. I remember a call for a “man down” in a park. My eager young partner was ready to deploy every diagnostic tool known to man. We roll up, and there’s a fella snoozing soundly on a bench, a half-eaten picnic beside him. He woke up, looked at my wide-eyed partner, and grumbled, “Can’t a man enjoy a nap without an interrogation?” It was a lighthearted reminder: sometimes, the best assessment tool is a simple, “Sir, are you okay?”
The bottom line is this: EMS is a thinking person’s game. The skills are crucial, yes, but they’re just tools. The real craft lies in judgment, in critical thinking, and in the wisdom to know when to hit the brakes. To all the new folks coming up: find those wise medics. Watch them. Learn from them. Practice not just your skills, but your thinking – engage in deliberate practice (Sentio University; PubMed, 2021) to refine both. Don’t chase the adrenaline; chase the understanding. Because in this line of work, slowing down often means you’re actually getting ahead – and taking your patient with you, safely.
Stay safe out there. And remember: Brakes before blades.
References:
- BMC Medical Education. (2023). Clinical reasoning in undergraduate paramedicine: utilisation of a script concordance test.
- EMS1. (2024). Situational awareness: Your primary weapon in violence prevention.
- JEMS (Journal of Emergency Medical Services). (2020). Traits of a Critical Thinking Paramedic.
- Keene, T. (2024). Dispatch information affects diagnosis in paramedics: An experimental study of applied dual-process theory. (OSF Preprints).
- LeBlanc, V. R., et al. (2005). The Impact of Stress on Paramedic Performance During Simulated Critical Events. Prehospital and Disaster Medicine.
- LeBlanc, V. R., et al. (2012). Paramedic performance in stressful simulated scenarios: The impact of cognitive load. Prehospital Emergency Care.
- Murdoch, S. (2019). Clinical decision-making and its place in paramedic practice. Paramedic Practice.
- Paramedic Flash. (2025). What You Should Know About Situational Awareness in EMS.
- Patenotte, P., & Darby, I. (2023). Cognitive biases and their effects on practice: a case study reflection. Journal of Paramedic Practice.
- PubMed. (2021). Deliberate practice and mastery learning in resuscitation education: A scoping review.
- Sentio University. What is Deliberate Practice?
- Summers, A. (2010). Human factors within paramedic practice: the forgotten paradigm. Paramedic Practice.
- Tory, D. S. (2022). Paramedic decision-making and the influence of bias: a case study. Paramedic Practice.