By: Rabbi Howard A Cohen (Deputy Chief, ret.) AFM Virtual Training Coordinator

As first responders we are required to absorb an overwhelming quantity of data.  As good as our intentions are to remember all that we are taught, the reality is that we forget details.  This is why constant reviewing, drilling and periodic recertification is so important.  Even with doing our best to keep our skills sharp and our knowledge base current, the reality is that we cannot possibly be experts in every situation we might encounter in the course of work.  For example, though we may have a solid understanding of basic first aid principles, we are not doctors and therefore are limited to the extent that we can help a patient in the field.  Even if we were trained to the level of a medical doctor, in the field far removed from a hospital facility, we would still be limited with what can do.  We do not work in controlled environments or under ideal conditions.  No matter what the situation or our skill level, our response is always on a spectrum that moves from the ideal to the real.

Every three years I re-certify as a wilderness first responder.  Every three years I’m embarrassed to admit how much I’ve forgotten.  Although I wish my memory was such that I was better at calling up a lot of details and data that I rarely ever use, I don’t worry about it.  Why? Early on in my first responder career I was taught two important lessons.  The first lesson is that an emergency response in the field will always be somewhere on the spectrum from the ideal to the real.  As emergency responders we do the best that we can with the tools and knowledge that we have on the scene. This is what it means to move from the ideal to the real.  Remember, as first responders, our objective is keep the patient alive long enough to get to advanced medical care.  It is not our job, nor do we have the skills, to fix or heal patients.  Our job is to stabilize, comfort, and transport our patients.

To do our job well as first responders we do not need a medical education. This brings me to the second important lesson I have learned in my career as a first responder:  Pay special attention to the three big systems: circulatory, neurological and respiratory and do whatever you can do to keep them functioning.  The vast majority of injuries to people are not life threatening.  However, any significant trauma to one or more the three big systems has a high probability of being life threatening.  If a person is bleeding, stop the bleeding.  You do not need to know how to suture.  You do not need to know how long to keep pressure on an open wound.  You only need to know that you have to “plug” the hole where the bleeding is coming from.  If your patient is not breathing you don’t need to know how to do a tracheotomy.  You just need to know what to do to open her airway because if you can’t get your patient breathing she will die.  Ideal to the real.  Remember, it is not our job, nor do we have the skills, to fix or heal patients.  Our job is to keep them alive and as comfortable as possible as we get them to advanced medical care.

As first responders we will always strive to respond with the very best of our abilities.  That’s what we do.  However, the reality is that we are generalists trained to respond to a mind boggling variety of emergency situations that always happen under less than ideal conditions.  Ideally, we might want to respond in a certain way, in reality, the situation and our knowledge level will determine our response.  Therefore, it is important to remember that emergency medical responses in the field always fall somewhere on the ideal to real spectrum. Our goal is to do the best that we can with the tools and knowledge we have on the scene.

About the author:

Howard joined the fire service in 2001 to serve as chaplain of his local fire department. Twenty years later he retired as his department's deputy chief.  Howard planned to join Africa Fire Mission on a trip to Zambia but Covid interrupted those plans. He has since traveled twice to Kenya with AFM. He is regular AFM blog contributor and webinar instructor. Outside of the fire service, Howard serves as rabbi to Congregation Shirat Hayam in Duxbury MA. He also has a leadership and mental fitness coaching practice called code3leadershipcoaching.