True or False?

Posted by: Polak187

True or False? - 12/10/03 01:06 PM

In the survival situation, leader of the group should act at all the time like he knows exactly what he is doing (even if he doesn't) and never ever ask for opinion or help from others since that can undermine his position.

What you guys think?

Matt
Posted by: garrett

Re: True or False? - 12/10/03 01:36 PM

I would say true and false. If a group scenario presents itself, there will always be a natural leader who will rise to the top and take control, whether he wants to or not. Whoever that is, he does need to remain calm, coo,l and collected. Even if he has no clue where he is in the world, he still needs to look as though he knows the area like the back of his hand. This will have a calming effect on those around him and will put them at ease. Fear is the mind killer.

BUT, one should never refuse the advice of others. Unless it is totally out to lunch, most people have something good to add to the situation. Your postion wont be undermined by asking for and listening to the advice of someone else.

I have never been in a real survival situation, but I am a Marine and have spent quite a bit of time in situations where I really had no clue what was going on, but if I let that show, I would have upset the Marines around me and caused stupid mistakes. I always ask for the advice of those around me, but in the end, I am the one who is paid to make the decisions.

So to wrap it up, true and false. A surival leader needs to have an air of being in control, but it never hurts to ask for help, and it wont undermine your position.

Garrett
Posted by: Anonymous

Re: True or False? - 12/10/03 01:39 PM

Leader needs to maintain lead and command but must be humble enough to acknowledge that he isn't expert in all skills needed. If there are others with better specialist skills work of that nature should be delegated to them. The FEMA Incident-Command training courses make clear one rather successful approach to this problem.

There is the incident management aspect and the ongoing survival management issues. For example if there is a plane crash / ship-wreck in which one of the crew survives then the crew member with highest rank is naturally expected to become the leader. They should accept this responsibility gladly and immediately. They may not have the best medical training in the group. First act that they should take is a skills inventory of the group. The person with the best medical training should be put in charge of dealing with traumas. The person with the best outdoors training / experience should be put in charge of shelter, warmth, orienteering. In issues of resource contention between groups / individuals the leader should be judge / arbiter / leader. The leader should not meddle in issues that have been delegated and should not accept any questioning of his / her authority and leadership. By delegating to the greater skill in specialities the leader properly empowers those who may naturally become his opponents and instead makes them his allies. Also, in a true emergency, this delegation will keep such individuals engaged and too busy with their speciality to bother with trying to direct the group as a whole. The leaders role is more of a coordination role than a boss role.

Without such leadership tragic mistakes may happen. If there is a lot of trauma and everyone gets involved in dealing with trauma because it is impressive then you may stabilize more patients and then lose everyone because no-one was bothering to build a fire and erect a shelter. Allow the most medically skilled to apply triage and provide him with as many helpers as he can direct while reserving enough man-power and expertise to erect a tarp, dig a snow-cave, etc to move the wounded into as quickly as possible. The leader needs to be aware of all aspects of the scenario and needs of the group but not so involved in accomplishing anyone of these needs that they lose perspective.
Posted by: Anonymous

Re: True or False? - 12/10/03 01:57 PM

Well ... no. Some guy back in the late 1930s tried doing it like that, he had bad hair and a tacky mustache, and look how HE ended up - badly barbecued after gulping down some cyanide.
About the only situation you will find in modern times where that might apply is in the captain of a naval vessel, "master alone before God" and all of that.
Otherwise, I tend to adhere to the philosophy, "An expert is someone who knows when to call in the experts."
Posted by: ratstr

Re: True or False? - 12/10/03 02:18 PM

Leadership issue is never black and white. And your question is on the very grey side. A good leader is the one who knows how to listen and who knows how to convince the team members. If you ask your team members and respect their answers they will bond to you further. Specially ask the the questions with answers already known by you and complete their sentences before they do. Asking questions on regular basis will get your team members accustomed to it. This is good when you need to ask a vital question for your decisions they will think it is part of the regular. They will not be suprised. Some specially directed questions will help you on your leadership as they lead your team members into supporting your decisions.

The worst thing is a team member challenging you. You can prevent this by asking him lots of questions.

You should be concerned but not emotional, alert but not excited, quick but not hasty and if you add a reasonable plan on this than no one questions your decisions.
When your decisions are undermined it is very dangerous. If you make your team members part of the decision they do not undermine themselves:) You should have sharp diplomatic skills for that and diplomacy is the ability to tell a person to go to hell in such a way that he looks forward to the trip <img src="images/graemlins/smile.gif" alt="" />

Burak



Posted by: Anonymous

Re: True or False? - 12/10/03 03:04 PM

No one has all the answers and pretending that one does will lead to withdrawel and possible resentment from other potential contributors. Not a good idea in a team effort at any time, military situations aside.
Asking for input, evaluating it and forming a decision or action plan are attributes of a good leader.

Good leaders are not the ones with all the right answers, but more the ones with the right questions and the ability to put the answers into an action plan to be implementd as needed.
Posted by: Anonymous

Re: True or False? - 12/10/03 03:08 PM

Having said, this, I am in a strong believer in my father's philosophy of "It ain't gonna get done if we stand here looking at it, let's go!"
"When total confusion reins, someone has to TAKE CHARGE to get things moving in the right direction."

A good leader knows when to lead and when to manage.

Posted by: Polak187

Re: True or False? - 12/10/03 03:14 PM

I was asking for a reason that we had this conversation yesterday about member of our team who even if in doubt will choose the course of action. It may not be the best choice and sometimes even risky than other choices but there is no waiting time or indecisivness. He never asks about stuff even if team memebers are younger and sometimes better trained. In his eyes any leader who asks jeopardises his leadership position.

I want to lead or follow, it means no difference to me but lately I've been put on the spot many times where I had to take over. I'm always open to suggestions and take course of action that assures safety of my team (partner), bystanders and victims. I have no problem with people voicing their opinions. I'm firm when it comes to orders but I give them out after they are tought over. I never give order just to give it so people get occupied sometimes in sensless work. I just want to be a good leader and advice given by by the older guy didn't sound too kosher.

Matt
Posted by: Anonymous

Re: True or False? - 12/10/03 03:24 PM

I think difficulty arises when a decison is made, direction/orders are given, and someone starts to question them. THAT is a problem, not with the leader, but with the person who will not take direction.
The difference might be how questions to the directions are posed; in front of the group, victims, etc, and the attitude used.

80% of a problem can be the way it is voiced and not the problem itself.
Posted by: Anonymous

Re: True or False? - 12/10/03 03:37 PM

seeming indecisive and uncertain will jeopardize your authority as a leader. Whether that is displayed by asking questions or by simply hesitation in the face of urgent need. There are times and situations that require immediate action and if you are to maintain leadership through means other than rank then you will have to be seen as acting in those situations. To stop and evaluate, plan, discuss, hold a meeting, attempt to attain a consensus at a time like that will get you disrespect if not revolt. The leader should have enough experience to deserve the position of leadership. If they do then they will have an action response to urgent situations. Certainly techniques are being refined all the time and someone with the latest training may have some techniques that are better - that doesn't take into account the need to maintain a central point of authority and direction in an emergency situation. Better that everyone is following ONE plan than that any one individual is using the BEST technique. (within limits of the protocols and standard of care). If you find any individual who is using out-dated technique or sloppy practice that is something that needs to be addressed - but not at the scene. At the scene everyone does their best - indians stay indians and chiefs stay chiefs. If the indian spots bad technique or sloppy practice by the chief they should immediately bring it to the attention of the individual after the incident and if that isn't well received then the issue will need to be escalated. It is often possible to raise such issues non-confrontationally by asking the leader to teach you why and under what circumstances they prefer the older techniques to the newer ones. Sometimes simply asking the question will cause the individual to reconsider their practice. Don't expect them to do anything other than justify their actions in the conversation. But if you thank them for their time and expertise and let things drop you might find that they behave differently next time.

Never, Never, Never undermine the Incident command. If necessary to save a life that has been tiraged into your responsability you may consider disobeying silently - even that is fraught with difficulty because not only are patients triaged but also are supplies and if your disobedience uses supplies needed elsewhere you may have caused more harm than good in the bigger picture.
Posted by: Anonymous

Re: True or False? - 12/10/03 03:52 PM

The responses are interesting.
Some of us look at it as a "group survival" situation and some have turned it into an accident scene.
Both soliciting different "needs/demands" of the leader as well as liability and urgency in action/response.

No such thing as a black and white answer.


Posted by: ratstr

Re: True or False? - 12/10/03 04:01 PM

I strongly suggest he reads the story of HMS Bounty <img src="images/graemlins/smile.gif" alt="" />

Burak
Posted by: paramedicpete

Re: True or False? - 12/10/03 05:23 PM

Having just taken Integrated Crew Source Management, I can tell you “they” are stressing the use of all on-scene personnel, regardless of the number of years of experience one might have behind them. Although, like most things in the Fire Service/EMS, progress is often tempered/hampered by tradition, there is an effort (at least the theory is being promoted) to utilize crews to their fullest potential. So if an IC or chief line office is truly progressive, they will seek the advice (when and where appropriate) of the “newest” member of the team, who hopefully still has all those “new” techniques still in the short term memory banks and can recall them at will. However, the newest and greatest techniques must be balanced with real world experiences and the need to make rapid and decisive decisions. The fire/accident/rescue scene is not necessarily the place to start discussing them, which is why we take continuing education and conduct training drills, this is the place to explore and experiment with new ideas and techniques. Having been in both situations, both as the IC/Operations officer and as a lower man on the totem pole, I can tell you I prefer a leader who will make a decision right or wrong, but will seek the advice of others as the scene unfolds and make adjustments to accommodate either changing conditions or recognizes the original plan was not the best course of action. Personally, as a Paramedic, I or my partner are often the ones who are “in charge” of the patient or the EMS aspect of the scene, I prefer it, when the BLS crew takes the initiative to implement those aspects of patient care that they are responsible for, instead of waiting for me to tell them what to do. Often my mind is directed towards assimilating all of the information (nature of the call, patient condition, history, vital signs, resources, etc.) to decide upon a course of action and do so within the first few minutes of the call. Being in charge is not easy, often one must act upon experience and gut instinct, which hopefully is based upon extensive education and training. The bottom line – it is a TEAM effort that will lead to the best outcome. Pete
Posted by: Anonymous

Re: True or False? - 12/10/03 07:02 PM

For example:

It was a simple BLS call for a slip and fall with possible head injury. Myself (EMT-B), the crew chief (EMT-I) arrived on scene in the ambulance, Extra un called EMT-P arrived in personal vehicle and Duty EMT-P arrived by personal vehicle. Pt was sitting and alert with visible brusing to forhead and thigh. Stated he had fallen when the top of a stair he was installing gave-way beneath him dropping him on a pile of lumber on concrete slab. Bystanders report brief moments of Loss of Consciousness. Pt wants to refuse service and starts walking around to "shake it off". With strong persuasion from Extra paramedic(pt's friend) Pt accepts transport. PROBLEM STARTS HERE. Extra paramedic starts to take control of scene and orders standing long board application. Pt is 6'11" tall. Duty chief is only EMT-I and Duty Paramedic has already triaged down. Luckily our duty chief is a strong personality and simply ignores the Extra and we get out the stretcher and have the Pt lie down on the long board. In this case the protocols state to avoid bending the spine if there is any chance of compromise so - standing long board application. Problem is that that works fine with a patient that is approximately the size of the long-board and not at all with a patient who is a full foot taller than the board. The chief didn't have the learn'in of the paramedic and hadn't been to school as recently but he knew what would be possible.
Posted by: billvann

Re: True or False? - 12/10/03 07:45 PM

There seens to be two very different scenarios being discussed here. The accident scene with professionals on-site and the true ad hoc emergency. With regards to the accident scene, which upon further clarification was the main intent of your original message, the comments about addressing the issues during training makes sense. You may be relutant to do so during training to avoid "rockin' the boat," but that's the exact time in which to hammer out the process. Who knows, behaps the old hand will learn how to be a better leader in the process.

With regards to a true emergency situation, the question of leadership is much more fuzzy. Skater's Dad's philosophy, "It ain't gonna get done if we stand here looking at it, let's go!" rings tru with my experience. I tell the senior scouts in my troop that the first step in leadership is raising your hand when the need arises. Time and time again, I've been in situations where the leaders are the ones willing to step forward. A 'good' leader is one who knows his or her skills and limitation and is willing to seek help and delegate accordingly. In a true survival situation you have the added dynamic that the innocent bystanders are not just casual observers, but may actually be in danger themselves. Hence fear and panic become inflencers in the descision process. Add pain, hunger and cold into the mix and the leader has a handful. The STOP pricipal still applies. Except now the other members of the party become part of the mix. Part of Observe is to identify skill sets and assess or triage the mental state of the other members and to Plan accordingly, including them into the solution. That won't solve every problem, but it's a constructive start.

Interesting concept, group servival dynamics. we should perhaps reread Chris' account on the Channel islands. There the non-leaders were indifferent towards his leadership as they were not aware of the true peril of their situation. By quietly taking the steps he knew were correct, he eventual became the defacto leader without much question. What if they paniced and went off on their own regardless of his leadership. Well "you can lead a horse ..."

Ultimately, if you prepare and practice, and are willing to step forward in time of need, I beleive most folks will see your confidence and success (provided you've practiced) and will follow with out question.
Posted by: paramedicpete

Re: True or False? - 12/10/03 08:03 PM

My rule is never to second-guess the decision making of another provider if I was not on the scene and involved directly with the call, so I will not comment on whom is right or wrong. Each jurisdiction may have a different mechanism for implementing “who is to be in charge”, I can only tell you how, in general things are handled around here. All of our ambulances are BLS and are associated with a Volunteer Fire and/or Rescue Company, staffed either by volunteers or a combination of volunteers and career staff. We do not have a county fire department but do have a Department of Fire/Rescue Services (DFRS), mainly for the direction of career staff. Officers under DFRS do not have any official operational authority, but may serve in that capacity until a line/duty office of one of the first-due companies is on the scene. The Line/Duty Officer may allow the DFRS officer to continue to be IC if they deem the individual has things well in control and the call is proceeding smoothly. However, due to the way the laws are written for the fire service in our area, the Line/Duty Officer actually has the legal authority and responsibly for the call. All of our ALS units are chase vehicles, scattered around the county and are under the direction of the Department of Fire/Rescues Services, we have gone from a 100% volunteer staff of about 20-30 CRT/EMT-I and EMT-Ps to 95 % career staffing. There are many reasons for the shift, which I will not go into here. If the call is dispatched ALS or upgraded to ALS, the on scene 1st due ALS unit medic (can be an CRT/EMT-I or EMT-P) has the authority for patient care directing requests for additional resources through the Line/Duty Officer who has IC. If the incident requires additional medic units, generally an ALS Duty Officer will also respond to direct the call. If I were to show up to a call “off duty”, I would be expected to handle the call until a medic unit arrived on scene, the on duty ALS provider can elect to take over the call or if they feel the call is proceeding smoothly and I have the time and can transport with the patient, allow me to handle the call.

Without second guessing how your call proceeded and they was still some concern of not boarding the patient while standing, due to his size, could you have used a collar with a K.E.D.s device to initially stabilize the neck and back, until the patient was to place onto the stretcher?

Pete
Posted by: Anonymous

Re: True or False? - 12/10/03 08:06 PM

Quote:
80% of a problem can be the way it is voiced and not the problem itself.


I think you struck the nail on the head here. Diplomacy goes hand in hand with both leadership and being in a subordinate position. If you are in a situation where you see an error being made, a simple nudge or quiet, constructive comment will go farther than an outright slam. If the intended audience is alert and receptive you will get your point across and not step on their toes.

As an example, I once worked with a paramedic who was fresh out of school and had no previous ALS experience. Out of confusion (or stress) he would mix up the leads on the heart monitor and then try and figure out the odd looking rythm on the screen. The way I would correct him would be to say something like "Why don't we try switching the black and white leads to see if that gives a better picture". This would clue him into the error and he would be thankful for my input. It was a lot better than saying "What are you, a moron? You can't even get your wires straight?"

Another thing to consider is that you may have bystanders and family members about who are expecting professionalism. Seeing crewmembers squabbling doesn't promote a good public image or boost confidence.


Chris

Posted by: paramedicpete

Re: True or False? - 12/10/03 08:15 PM

One thing I did fail to mention is that if the on-duty ALS provider is a CRT/EMT-I, and I as an EMT-P turn patient care over to that individual, I can be held legally responsible (both civilly and criminally) for patient abandonment, if the call were to head south. The same thing would be true if I were to down grade the call to BLS and turned patient care over to the BLS crew and the patient took a turn for the worse or I failed to recognize a life-threatening condition. Pete
Posted by: paramedicpete

Re: True or False? - 12/10/03 08:30 PM

It is not only the "fresh"/new providers who can make a mistake, even seasoned individuals, who for many reasons can overlook the obvious. The way you handled the “correction” is to be applauded. Unfortunately many ALS providers are afflicted with the “I am GOD” syndrome and “never” make mistakes. The same method you used to “correct” an oversight would be well employed by many ALS providers who treat BLS personnel like idiots. A gentle reminder or whisper can do a lot to foster relationships between varying levels of EMS providers. Although, I must admit, I have gotten somewhat verbal when I have to constantly remind the BLS provider to continue with ventilations instead of watching me. Pete
Posted by: Anonymous

Re: True or False? - 12/10/03 09:26 PM

All good points. And yes we did collar the pt before having them lay on the long board. The Ked + lb presents some packaging problems and removing the ked after boarding is all around a bad thing.

In our jurisdiction the ALS is also a chase vehicle and at their discretion will ride along or not. Practice here is for the ALS to always arrive on-scene in consultative capacity. If the Paramedic takes pt care at all they must ride along. Commonly they will stand back as the call is assessed by the B or I. At first indication of shock or other serious situation they will step in and commit to the call. I am not versed on the protocols from med control on the guidelines for "triaging the call down to the BLS team" There must be something in the Standing Orders for that.
Posted by: Anonymous

Re: True or False? - 12/10/03 09:29 PM

See the paramedic. See the paramedic save the patient! See the EMT. See the EMT save the Paramedic's career! It is a team thing!

Paramedics save lives. EMT's save Paramedics.
Posted by: MartinFocazio

Re: True or False? - 12/10/03 10:30 PM

Absolutely not. The leader needs to be the one to draw out ideas, help get them implemented and NOT be the person who is blindly moving forward to keep up appearances. The best idea to survive may not be the leader's own idea - but the leader needs to recognize and capitlaize on the ideas that will work.
Posted by: Anonymous

Re: True or False? - 12/11/03 12:49 AM

To the open minded individual, you taught so many things in the way you handled this situation.
You most likely earned the lifelong respect of an individual who will go on to help others and most likely save lives. What a sense of accomplishment.

"Humility is not a sign of weakness, it is a sign of wisdom."
Where have I heard that before?

Posted by: Polak187

Re: True or False? - 12/11/03 01:01 PM

Just a question of curiosity...

You guys remove KED after transfer to the long board?

Matt
Posted by: Anonymous

Re: True or False? - 12/11/03 01:35 PM

Absolutely not! Didn't apply KED because we intended to board. We applied the collar while pt was standing and then had pt sit / lie on board on stretcher then strapped him in.
Posted by: Polak187

Re: True or False? - 12/11/03 01:56 PM

Oh I just re-read your post and realized I skiped two words that explained everything. I need coffee. Lots of it <img src="images/graemlins/smile.gif" alt="" /> Sorry I had a lot fo work last nigth with flu transports.

Matt