Chutes & Ladders

Playing this old favorite with my young children seemed oddly familiar.

Not because I played as a child, as my parents did, but because my Professional life feels just like this game.

Chutes & Ladders subjects the player to be awarded or punished, simply because of when and where they land and the severity of their punishment or height of their reward seem clear at the outset of the game.

If you land on a space that depicts doing something wrong, say throwing rocks, then you slide down the chute to a lower spot and have to start advancing again.  We all know throwing rocks is bad, but a few spins of the arrow later, we could find ourselves right back there, throwing rocks.  Or in the case of EMS, missing too many ETT placements, giving an out of vogue medication or the like.  But even if we get it taken away and have to start again from a lower level, that penalty chute still awaits us and instead of trying to remove it completely through education and training, some systems seem content at just spinning and hoping they make it past that chute.

At the same time, climbing ladders to achieve quick gain seems a good strategy, but so much effort can be wasted if a chance spin of the arrow pushes you past that ladder and you have to continue the game slowly.

And it is not just EMS, but the fire service as well that needs to be careful when climbing.  Decades of public attention and education have led to less fires, but those that do break out are far more dangerous than before.  A new fleet of engines is a nice ladder, but not training the engineers to operate them is a big chute to slide down when the time comes and no water reaches the crews inside.

Of course they’re hoping so hard to get more than a 2 to avoid the same chute, they don’t see the bigger chute just spaces away.

It can be easy to get frustrated when sliding down a chute and your mind quickly races to avoiding that next obstacle.

Rogue Medic reminds us that in EMS one must concentrate all their efforts on the patient at hand, not the one that might get away.  This is true when engaged in patient care, but in my system, where resources are stretched thin and patients are “getting away” I have to start looking at the whole board when not on a call.  My observations about the game are not in relation to care directly, but refer to the system’s response to trends.

Getting a grant for new bags, new monitors, or finally adopting CPAP can be a big ladder towards that glimmering perfect EMS system, but we must be mindful of the chutes at the higher levels.  Just as that big ladder brought us up, big chutes can drop us back farther than we were before climbing.

Heralding CPAP while your QI program is defunded is not a success.  A good ladder, but a bigger chute.

As the game progresses my little yellow figure is constantly sliding, climbing, sliding, avoiding, and minute by minute, eventually reaching towards the finish line at the top.  The other figures on the board have the same objective, but will reach it via a different path than me, different ladders, different chutes, same excitement and frustration.

But when the green player fell the farthest possible on the game board she warned the other players, “Look out you guys, don’t land where I did,” and I was reminded why this time change in EMS will take hold.

Your spin.

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