TIMELESS TACTICAL TRUTHS by Phoenix Fire Chief  (Ret.) Alan Brunacini

The very worst emergency plan is no plan (the next worst is two plans).

The only safe emergency scene assumption is to assume the worst.

If you have lots of ideas, you need lots of resources.

Safe paramedics are smart paramedics.

Emergencies give the test just ahead of the lesson.

Never confuse repeat calls for routine calls; the same basic elements are present at every call--there are no routine calls.

First rule of exits: if you go to get in, you need to have a way out.

You can't save anyone when you are a victim.

You can fool the spectators, but you can't fool the players.

All bleeding stops eventually.

Trust safety, not luck (luck makes you dumb).

Something is wrong if you keep inheriting bad situations.

Playing catch up on an emergency scene is an old female dog.

When you're having problems, take on a partner to share them.

Complicated operations are generally screwed up operations. - KISS

Losing your temper generally represents the incipient stage of rectal-cranial inversion.

Good procedures are so simple you don't need to write them down to remember them or use a dictionary to understand them.

Keep working on the basics- most of us are not advanced enough to make advanced mistakes.

Be careful of the guys who close their eyes when they open their mouths.

Educational times are not always fun times.

The fewer parts of the plan, the fewer things can get screwed up.

The number of faults in an operation is in direct proportion to the number of viewers; the intelligence of the viewers is in direct proportion to how late they arrive.

The weight of a patient increases in direct proportion to the number of floors up they are located. That weight increases expotentially in relation to the reduction in space available to access that patient.

You gotta have a plan before you can revise it .

Experience and education are like oregano- they must be mixed with a lot of other stuff to be good.

It difficult to get a little excited.

The treatment for screwed- up situations: education, training, reflection, and getting to do it again.

Be careful of people who attach status to knowing things you don't.

Never is a long time.

Standard management cycle: procedures- training- execution- critiquing- revising and back around.

Paramedics who are tough enough to eat nails and spit ambulances will generally become extremely fragile when mistakes occur.

Manage procedures- lead people.

If you think training is expensive, check out the cost of ignorance.

What dies, never returns.

Some days on the ambulance the best it gets is so- so.

Don't ever develop a plan that is so smart you can't explain it to the people who have to carry it out.

When you lose your head, the next thing is your ass.

If you can't control yourself, you can't control anything else.

Take the process seriously- not yourself.

The things that lead up to accidents happen slowly- the accident happens fast.

Always take care of the people who are trying to make you look good (and make it as easy as possible for them to do so).

Hope for the best- plan for the worst.

Most big screwed- up situations start with one small out-of- balance step in the wrong direction- be careful of confusion snow balls that start rolling downhill.

The more seniority a screw up gets, the harder it is to fix- this applies to both the on-scene operations and unfortunately paramedics.

Considering what was going on at the time a decision was made will many times effectively refocus 20/20 hindsight.

Repeat, ongoing business can become tactical aesthetic that produces a paramedic sucker punch: like twenty 26A1 and nothing calls at the same residence, setting you up for the 26A1 that turns out to be a 9E1.

The incident commander must always initiate and move toward correct action. He must also be prepared and capable of stopping incorrect, unsafe action- he absolutely cannot live with a bad situation.

The incident commander who will not disagree with a decision or countermand [and change] an order, should stay home and watch it all on TV.

They generally don't call EMS because someone did something smart.

If you are not suited up to play, stay at home.

Every emergency contains a discrete number of decisions- they can be made either by the paramedic or the emergency.

Do not think you are communicating just because you are talking.

Don't take it personal when someone dies. It's not your fault we are not immortal.

Most of the time at an EMS call, the first five minutes are worth the next 30 minutes.

When someone screws up, always ask the standard question, "Who taught him how to do it?"

The longer you wait to make a decision, the fewer options you will have.

The incident commander must be careful of what he says in difficult situations- off hand, dumb command comments are like aluminum beer cans- they last forever in the environment.

Basic EMS call frequency axiom: the farther you are from the last one, the closer you are to the next one.

The incident commander must always be able to separate what is a hope from what is a plan.

If a fire is an emergency to firefighters, who would you call? The sanitation folks are never surprised when they find trash in the trash cans. We should not act surprised when we encounter a fire.

The more routine decisions the paramedic makes before the call, the more time he will have to make critical decisions during the call.

The most important call is the next one.

Life isn't made up of only good runs (life is not perfect).

Know when to leave well enough alone.

Sometimes there's no time better than the present. Instructions are most effective when they are understood.

Beware of the Chief that is trying to run the fire before he gets there.