The sound shook the building.

It was Monday, November 12, 2001. I was working as an NYPD Police Academy instructor at Floyd Bennett Field.

It had begun as a routine morning when we heard the explosion.

We rushed to the window.

Across Jamaica Bay, thick black smoke began climbing into the sky. I saw the tail section of an aircraft falling toward the water.

“Fuck. We’re under attack again.”

It had been barely two months since September 11.

New York City was still grieving. Many of us were still trying to process what we had seen, what we had lost, and what might happen next.

There was no time to stand there wondering.

Officers began grabbing portable radios and heading toward their assigned RMPs, or Radio Motor Patrols. I started noting in the logbook who had taken each radio.

It seemed like a small detail.

It wasn’t.

When people begin moving quickly toward an incident, someone needs to know who has gone, where they might be, and how to reach them.

We headed in a convoy across the Marine Parkway Bridge toward Belle Harbor.

The smoke grew darker as we approached.

When we arrived, we found burning homes, scattered debris, frightened residents, and the unmistakable smell of jet fuel and fire.

I pulled into a driveway several blocks away using what we called combat parking. I positioned my RMP so I would have a clear path out if conditions changed.

The scene was still forming.

Information was limited.

People were moving in different directions.

A fellow officer looked at me.

“What should we do, Mike?”

I was one of the most junior officers there.

I had no supervisory rank.

But I had spent years working as a paramedic.

My EMS training took over.

Before treatment comes scene safety.

Before transport comes access.

Before people start performing individual tasks, someone needs to understand the larger problem.

Homes near the impact area were burning. Other houses remained at risk as burning embers landed across the rooftops. Residents needed to be moved away from the danger posed by the impact site.

Without hesitation, I directed my peers to begin evacuating the surrounding homes. We moved residents away from the fire and debris toward safer areas on the ocean and bay sides of the neighborhood.

We still didn’t know how many injured residents we might encounter.

We didn’t know how far the damage extended.

We needed somewhere away from the immediate scene where injured people, displaced residents, responders, and medical resources could gather.

I thought about casualty collection points.

In EMS, a casualty collection point organizes patient care away from the immediate hazard. It gives arriving resources a destination and keeps them from piling into an already dangerous scene.

I remembered the high school on Beach Channel Drive. It offered space, access, and distance from the fire.

I went there and spoke with the principal. I received permission to use the gymnasium as a temporary shelter and casualty collection point.

At that moment, it was little more than a large empty room.

A location alone doesn’t make a casualty collection point.

It needed people, medical coverage, supplies, and a connection to the larger response taking shape near the crash site.

I began making calls.

I contacted an FDNY EMS dispatcher I knew and requested ambulance resources. I asked for both BLS and ALS coverage. No ALS unit was available at that moment, but a BLS ambulance was sent.

I contacted my sergeant back at Floyd Bennett Field and asked him for the Red Cross disaster truck stationed across from our building. It carried cots, blankets, and supplies for people displaced by emergencies.

I reached out to a contact at a local hospital and asked for support from the emergency department.

One call led to another.

Within about an hour, most of the resources we needed had begun arriving.

Ambulance personnel.

Hospital support.

Cots and blankets.

Disaster supplies.

Eventually, a sergeant arrived at the school and looked around at what had been established.

Then he looked at me as I tried to leave and head back to the crash site.

“You know too much,” he said. “You’re staying here.”

It remains one of the most unusual compliments I have ever received.

He didn’t mean I knew everything. None of us fully understood the scale of what had happened yet.

The sergeant recognized that I understood how the pieces needed to fit together.

That understanding didn’t come from my police rank.

It came from my work in EMS.

I didn’t start an IV that morning.

I didn’t intubate anyone.

I didn’t place a cardiac monitor or administer medication.

Yet my EMS training influenced nearly every decision I made that day.

Scene size-up.

Hazard recognition.

Accountability.

Evacuation.

Casualty collection.

Resource requests.

Communication.

I was anticipating what people would need and thinking beyond the task directly in front of me.

Those skills don’t belong only in the back of an ambulance.

They shape how you think.

EMS teaches you to enter an unfamiliar situation, identify the immediate threats, organize limited information, and give people a clear next step.

It teaches you to reassess as conditions change and to consider what happens next while others handle what is happening now.

It also teaches you to look beyond the incident itself.

Belle Harbor was more than a crash site.

It was a neighborhood.

People had lost family members, homes, safety, and any sense of normalcy. Residents stood outside trying to understand what had happened to the place where they lived.

They needed more than police tape and emergency vehicles.

They needed shelter.

They needed information.

They needed someone to think about where they would sit, how they would stay warm, and who would help them through the next several hours.

That was part of the response too.

When newer EMTs and paramedics ask why they need to learn incident command, staging, communications, or mass-casualty operations, I think about that morning.

Most providers will respond to far more routine calls than major incidents.

That doesn’t make the preparation less important.

The major incident rarely gives you time to learn the system while it is happening.

You fall back on what you practiced.

You rely on shared language and habits built during smaller, more routine calls, when the consequences felt less severe.

Learn why casualty collection points exist.

Understand why staging keeps resources available and scenes accessible.

Practice giving clear reports, both in person and over the radio.

Know how to request help before the situation outruns the resources already there.

One day, those lessons might return in a place you never expected, like they did for me.

You might be wearing a different uniform.

You might be working outside an ambulance.

You might have no formal leadership title.

Someone might still look toward you and ask, “What should we do?”

Your answer will come from everything you took the time to learn before that moment arrived.

Author’s Note

Most of the stories I share here come directly from my life in EMS. This one comes from my years as an NYPD police officer and Police Academy instructor.

At the time of the Flight 587 crash, I was still working part-time as a paramedic. Those two parts of my professional life often overlapped, but rarely as clearly as they did on November 12, 2001.

I did not provide traditional patient care that morning. My EMS experience still shaped how I assessed the scene, anticipated needs, organized resources, and helped establish a place where care and support could occur.

That training shapes how we process uncertainty, communicate under pressure, and step forward when people need direction.

The uniform had changed.

The training had not.

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This past weekend, we treated a critically ill, unresponsive patient.

The BLS crew had already begun care when I arrived. One of their EMTs went in with me, and we worked the call together.

There was no conversation with the patient.

No smile.

No moment of recognition.

Only the work in front of us.

Assessment.

Treatment.

Movement.

The effort to give him a chance.

At some point, while gathering the information we needed, I heard his date of birth.

February 26.

My birthday.

He never knew we shared it.

We got him to the hospital alive.

Later that evening, I learned that he had died.

After the call, I shared some of the connections February 26 has gathered in my life.

The EMT listened, then made a comment that stayed with me.

With all the people and events tied to my birthday, he had never met anyone who shared his own.

His birthday was not February 26.

That was the point.

My date seemed to keep finding people.

His had remained his alone.

That observation made me think about what February 26 has come to hold.

It used to feel like a small, private thing.

My birthday.

A few messages.

Maybe coffee.

Then back to work.

This year, it had already appeared once before.

We had been called to a school gym for a student with a knee injury.

The gym felt almost calm, which seemed strange against the pain in front of us.

The young man was trying to hold himself together.

His face told us how much it hurt.

A displaced patella.

The kind of pain you do not need a monitor to recognize.

I moved into assessment mode.

Questions.

Touch.

Reassurance.

The steady rhythm experience gives us when someone is hurting.

At the same time, I was gathering information and building the chart in my head.

I turned to his uncle, who was also his guardian, and asked for the young man’s date of birth.

“February 26.”

I paused.

“February 26?”

His uncle confirmed it.

“That’s my birthday too.”

The young man smiled.

His knee did not hurt any less.

Nothing about the injury had changed.

But for a moment, he was more than a patient on a gym floor.

He was a young man with a life outside the call.

A young man with a birthday.

And we shared it.

One patient knew.

The other never did.

Both became part of what the date now means to me.

The pattern had started years earlier.

Three or four years ago, I learned that one of my regular partners and I share the same birthday.

What began as a coincidence became one more thread in a working relationship built through long shifts, repeated calls, trust, and familiarity.

Last year, a newer paramedic partner mentioned that her boyfriend shares the date too.

Then came the student in the gym.

Then the critically ill patient.

What once felt private kept appearing through the people I met and the work I did.

The easy version of this story would stop there.

A collection of birthday coincidences.

A few unexpected connections.

Something interesting to mention in conversation.

But February 26 has never stayed light for me.

The date carries names.

It carries history.

It carries loss.

I first learned about Police Officer Edward Byrne through the front page of the Daily News.

At the time, he was a young NYPD officer murdered while sitting in a marked patrol car and protecting the home of a witness.

It was a terrible story on the front page.

Later, I became a police officer.

The distance disappeared.

Officer Byrne no longer felt like someone from a newspaper.

I felt a kinship with him.

Then I realized that he had been killed on February 26.

My birthday.

The date no longer felt entirely mine.

It had become tied to service and sacrifice.

Then came 1993.

I was working as a New York City 911 paramedic, but a broken thumb had left me in a hard cast and unable to work.

On my birthday, I picked up my parents and took them to lunch.

As we drove east on the Belt Parkway, I saw NYPD Emergency Service Unit trucks racing west.

Lights and sirens.

Moving fast.

I recognized the response before I knew what had happened.

Something was wrong.

Later, I learned that a bomb had exploded beneath the World Trade Center.

The ambulance I regularly worked had responded.

I had not.

I was taking my parents to lunch while history unfolded in the other direction.

For years, I thought about what I had missed.

It took much longer to understand what I had been given.

Lunch with my parents.

Time with them on my birthday.

A memory I still carry.

Then February 26 took on another name.

Joe Braganza.

Joe was first my student.

Then he became my partner and my friend.

His influence remains.

He did not need to tell people what he stood for.

He lived it.

Joe had a way of making people look at themselves and tighten things up.

Not because they feared him.

Because they respected him.

At his wake, his nephew said something I have carried ever since.

“You can’t help but be a better person by having known Joe.”

That line described Joe.

It also left me with a question.

What do people become because they knew us?

Do they feel stronger?

More capable?

More valued?

Do we leave them better than we found them?

We do not answer those questions with a title, a résumé, or a list of accomplishments.

We answer them through how we live.

That may be what February 26 has come to hold for me.

Not one meaning.

Several.

The warmth of a young patient smiling through pain because we shared a birthday.

The quiet weight of treating another patient who never knew we shared the same date and later died.

A partner.

A newer medic’s unexpected connection.

A fallen officer.

A day of history.

A friend whose life made others better.

For much of my life, I thought a birthday was supposed to feel light.

Celebration.

Cards.

Cake.

A few calls and messages.

Experience changed that.

A career in service changes the meaning of ordinary things.

A date of birth becomes more than information for a chart.

A name becomes someone you carry.

A call becomes attached to a day on the calendar.

A sentence spoken after a patient encounter follows you home.

The EMT had never met anyone who shared his birthday.

I seem to keep meeting people connected to mine.

I once thought that made February 26 feel less personal.

Now I think the opposite.

Each person has added something to it.

The date is still my birthday.

It is also a reminder that the ordinary details we collect in this work rarely stay ordinary.

They become part of us.

And sometimes, without realizing it, we become part of someone else’s story too.

Author’s Note

Some patient details have been limited or changed to protect privacy.

This reflection grew from several unexpected connections to February 26, my birthday, including two recent patient encounters. One brought a small moment of connection. The other ended in loss.

I share this with respect for the patients, families, partners, and colleagues whose lives have become part of what this date means to me.

The piece is not about coincidence alone.

It is about how a career in service changes the meaning of ordinary things, and how the people we meet often remain with us long after the call ends.

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A recent post from my friend Roseann Reilly brought something I had neglected back into focus.

She wrote about listening inward.

Her words brought me back to the work of another good friend, Scott Bukofsky, who speaks and writes often about mindfulness.

Together, they reminded me of something simple I had not forgotten so much as neglected.

I spend a great deal of time talking about listening.

Leaders need to listen to their crews.

Providers need to listen to their patients.

Partners need to listen to each other.

We listen to words.

We listen to tone.

We watch body language.

We notice hesitation.

We pay attention to what someone says, what they might mean, and what they seem unable to say.

Sometimes the hesitation carries meaning.

Sometimes they are having a stroke.

Listening sits at the center of communication, understanding, and empathy.

Yet somewhere along the way, I had drifted from a harder form of listening.

Listening to myself.

Not my opinions.

Not the version of the story I tell when someone asks how I am doing.

The quieter signals from my own mind and body.

For nearly four decades, I have been trained to notice changes in other people.

Skin color.

Work of breathing.

Mental status.

Posture.

Movement.

The sound of a voice.

The way someone answers a simple question.

In EMS, early recognition matters.

Small changes often appear before a crisis becomes obvious.

We notice them.

We assess them.

We act and treat accordingly.

Yet when those signals come from within us, many of us wait.

We push through poor sleep.

We dismiss irritability.

We ignore tension.

We keep ourselves busy because silence feels uncomfortable.

We call emotional distance professionalism.

We call exhaustion dedication.

We call silence strength.

Sometimes it is strength.

Other times, we have given avoidance a better name.

Mindfulness asks us to stop long enough to know the difference.

I had not stopped believing in mindfulness.

I had stopped making room for it.

I was still listening outward.

I was not listening inward.

The drift was subtle.

Most drift is.

We settle into a new normal one small adjustment at a time.

You rarely wake up one morning and decide to neglect yourself.

You become busy.

Responsibilities grow.

Other people need you.

There is another shift to cover.

Another call to answer.

Another person to support.

Another problem waiting for your attention.

Listening to yourself moves to the bottom of the list.

Eventually, you stop noticing it is missing.

The problem is simple.

What we ignore does not stay private.

It enters the room with us.

Apparently, all my writing about how we show up applies to me too.

What we carry changes our tone.

It shortens our patience.

It makes a question feel like a challenge.

It makes feedback sound harsher than intended.

It makes another person carry tension they did not create.

People around us often feel what we refuse to examine.

This matters in leadership.

A leader who never listens inward risks confusing frustration with accountability.

Exhaustion starts sounding like authority.

Impatience starts looking like urgency.

Emotional distance starts feeling like professionalism.

The crew experiences the result.

They might never know where it came from.

They only know how it felt.

That is often what stays with them.

Listening to ourselves does not require hours of meditation.

It does not require a retreat.

It starts with a small pause.

Before the shift, ask yourself, “What am I bringing into the room today?”

After a difficult call, ask, “What changed in me?”

Before going home, ask, “What am I carrying with me?”

The answer might be fatigue.

Frustration.

Grief.

Anger.

It might be a sense of not feeling fully like yourself.

You cannot quite put your finger on it.

The goal is not to judge the answer.

The goal is to hear it before it begins speaking for you.

A medic who recognizes rising frustration has a chance to reset before speaking to a new EMT.

A supervisor who names exhaustion is less likely to mistake impatience for leadership.

A provider who admits a call stayed with them is more likely to speak before isolation takes root.

Self-awareness is not self-absorption.

It is part of responsible leadership.

We often teach people to watch for warning signs in others.

Changes in behavior.

Withdrawal.

Anger.

Fatigue.

Loss of interest.

A different tone.

A sense of someone no longer being themselves.

We should learn to recognize those same changes within ourselves.

Not every feeling requires an intervention.

Not every hard day signals a deeper problem.

Still, every signal deserves attention.

Mindfulness creates space between what we feel and what we do next.

Inside that space, we regain choice.

We choose our tone.

We choose whether to react or respond.

We choose whether to keep carrying something alone.

We choose whether today requires more effort or more rest.

For years, I have placed mindset alongside communication and empathy as one of The Key 3™ pillars of leadership.

This reflection reminded me of an uncomfortable truth.

Teaching something does not mean you have mastered it.

Knowing something matters does not mean you always practice it.

Experience does not remove the need to return to the basics.

Sometimes experience makes the return more important.

Roseann and Scott reminded me to return.

To pause.

To notice.

To listen before what I am carrying begins speaking for me.

We spend our careers asking other people what hurts.

Sometimes we need to ask ourselves the same question.

Then stay quiet long enough to hear the answer.

Author’s Note

My thanks to Roseann Reilly and Scott Bukofsky for the reminders that inspired this reflection and for the work they continue to share.

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On an uneventful Friday afternoon, I opened an academic paper I had written in March 2010 and found an earlier version of myself trying to prove he belonged.

I won’t call the afternoon quiet.

People in EMS know better.

A gentle rain tapped against the windows. Cars moved along the wet pavement outside. I sat at my desk at work, scrolling through my LinkedIn profile, when I stopped at the education section.

Capella University.

Master of Science.

I’m not sure why I paused there.

Perhaps it was curiosity. Perhaps it was nostalgia. Perhaps something in me wanted to look back at a part of my life I hadn’t visited in years.

So I did.

I found my graduate school capstone proposal, downloaded the PDF, and opened it.

The title page appeared first.

The Case for Distance Education in Emergency Medical Services.

Michael J. Chanat.

March 2010.

The page felt formal and distant from how I write today.

The title was precise. The formatting was proper. The language was careful.

It looked like the work of someone who wanted to be taken seriously.

In many ways, it was.

I had returned to school as an adult. I finished my undergraduate degree only two years earlier, after walking away from college when I was younger because I didn’t understand its value at the time.

Nearly two decades passed before I returned.

Life filled those years.

EMS.

Police work.

Fire service.

Paramedic work.

Teaching.

Responsibility.

Family.

Bills.

Long shifts.

Then I went back.

I didn’t return because the timing was perfect. I returned because part of me still wanted to finish what I had started.

The master’s degree was partly about credibility.

I wanted to open doors as an adjunct professor. I wanted to enter academic spaces where field experience alone wasn’t always treated as enough. I wanted others to recognize the value of what I had learned over years of caring for patients, teaching students, and working beside other emergency responders.

I also wanted to prove something to myself.

Perhaps especially to myself.

I don’t know if I would have called it imposter syndrome then. I’m not sure I had the language for it.

I knew there were rooms where I felt pressure to prove I had earned my seat.

Reading the capstone again, I saw how hard I had worked to do exactly that.

Every citation was carefully placed.

Every statement had support.

Every section followed the expected structure.

The paper didn’t sound like the stories I write today. It didn’t sound like a conversation after a call or a reflection shared over coffee. It didn’t sound like someone who had learned to trust his own voice.

It sounded like a man learning how to translate years of field experience into language an academic audience would accept.

It didn’t sound like me today.

It was still mine.

I don’t criticize the man who wrote it.

He was doing the work.

He was reading the research, building an argument, and connecting what he knew from the field with what he was learning in graduate school.

He was learning a new way to communicate.

The degree didn’t create his credibility. It gave him another way to demonstrate it.

That distinction matters to me now.

A degree adds knowledge, structure, and perspective. A title creates responsibility. A promotion gives someone authority within an organization.

None of those things marks the exact moment when growth begins.

The work often starts earlier.

The subject of the paper still mattered.

Distance education in emergency medical services.

In 2010, I was asking whether EMS education needed to move beyond the traditional classroom.

Would online or hybrid learning better serve providers who worked long shifts, raised families, missed sleep, and still needed to maintain certifications in a profession where the learning never stops?

At the time, distance education remained outside the norm for much of EMS.

Ten years later, the COVID-19 pandemic forced much of that conversation into reality.

Classes moved online.

Meetings moved online.

Continuing education moved online.

What once seemed like an alternative became the primary option almost overnight.

The pandemic proved the importance of access. It also exposed the difference between placing material online and designing education around how people learn.

Distance education became normal.

Good distance education remained a work in progress.

We still need to ask what helps providers grow and what merely checks a box.

Does the format fit the learner?

Does the material connect with the work?

Does the education respect the realities of shifts, fatigue, family responsibilities, and limited staffing?

Are we building education around the people learning, or are we expecting people to fit a system designed without them in mind?

Those questions felt familiar because the paper wasn’t only about technology or course delivery.

It was about people.

Providers trying to maintain their certifications around unpredictable schedules.

Managers trying to cover ambulances while sending people to class.

Communities still depending on those ambulances.

Students trying to grow without being worn down by the process.

Underneath the academic language, I saw the same concern I still carry today.

I also saw an earlier version of myself.

He didn’t yet write about leadership, presence, and the human moments shaping those who serve.

He didn’t have The Key 3™.

He didn’t call his ideas a framework.

He had instincts before he had language.

He was already frustrated by systems making growth harder than it needed to be.

He cared about the provider sitting through class after a long tour.

He cared about the agency struggling to keep units staffed.

He cared about the student who wanted to advance but needed a path fitting real life.

Those concerns were already present.

Then I reached the final pages.

One sentence stopped me.

I had written that distance education should be considered in contingency planning because “a good leader thinks of his people and their needs.”

A good leader.

I sat with those words.

Today, I would phrase the sentence differently.

A good leader considers their people and what they need.

The wording has changed.

The belief hasn’t.

In 2010, I wasn’t comfortable writing and speaking about leadership the way I do now.

I had led in many ways.

I had taught.

I had mentored.

I had accepted responsibility.

I had worked in positions where others looked to me for guidance.

Still, claiming the word leader felt different.

The word carried weight.

Perhaps I believed leadership belonged to someone with a higher title. Perhaps I thought I needed more proof. Perhaps I was waiting for someone else to tell me I had earned the right to use it.

Yet there it was in my own paper.

A good leader thinks of his people and their needs.

I read the sentence as the man I am today, but I felt the person I was when I wrote it.

The adult student.

The adjunct professor trying to establish credibility.

The paramedic with years behind him and plenty still ahead.

The man returning to finish something he had walked away from years earlier.

The educator trying to improve a system affecting people he cared about.

I would never force The Key 3™ onto a paper written years before I developed the framework.

Still, I recognize its roots.

How do we communicate learning in a way people understand and access?

Are we willing to rethink systems built around tradition rather than real life?

Do we consider the experiences and needs of the people affected by our decisions?

Communication.

Mindset.

Empathy.

The framework didn’t exist yet.

The concerns behind it did.

The same pattern appears throughout EMS.

A provider starts mentoring new partners before receiving the title of preceptor.

A crew member begins leading during difficult calls before earning a stripe, badge, or bar.

An instructor shapes the future of the profession before feeling comfortable calling themselves an educator.

A supervisor starts caring for the growth of others long before learning how to describe their leadership philosophy.

The role often begins before the recognition.

The values often appear before the title.

The work often starts before we feel ready to claim it.

That realization stayed with me.

Growth doesn’t always feel like growth while we are living through it.

Sometimes it feels like doubt.

Sometimes it looks like rewriting a sentence several times because we fear someone will question whether we belong.

Sometimes it means returning to school while balancing work, family, and adult responsibilities.

Sometimes it means entering a new role with years of experience and still feeling like the least qualified person in the room.

Sometimes it means learning to support an idea with research before trusting our experience enough to speak in our own voice.

One honest sentence waited inside an old paper for sixteen years before showing me where part of my work began.

I opened the PDF expecting an old assignment.

Instead, I found an earlier version of myself.

He was still unsure in some ways.

He was still trying to prove himself.

He was still learning how to express what he believed.

I don’t look back at him with embarrassment.

I look back with respect.

He returned to school while carrying the responsibilities of work, family, and adult life.

He studied.

He wrote.

He questioned.

He kept moving forward.

He was closer to the work he would later claim as his own than he understood.

The degree didn’t make me a leader.

The paper didn’t create the framework.

Both helped me put language around work already underway.

The framework came later.

The confidence came later.

My voice came later.

The concern for people was already there.

Perhaps part of your work has already started too.

Look back at something you wrote, taught, questioned, or cared deeply about earlier in your career.

What part of the leader, educator, mentor, or provider you are becoming was already present?

You might be further along than you think.

Author Bio

Mike Chanat, MS, NRP, is a paramedic, educator, speaker, and founder of Mike Chanat Leadership Development. Drawing on nearly four decades across EMS, fire service, law enforcement, and education, he helps EMS professionals and leaders grow through The Key 3™ framework of Communication, Mindset, and Empathy. He writes about leadership, presence, and the human moments shaping those who serve.

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The patient was critical, but the moment that stayed with me came after the handoff.

I was sitting in the office with my morning coffee, watching a sunny spring morning reveal itself through the window, when my Minitor VI pager shattered the quiet.

The call was for an ALS intercept.

In EMS, an intercept means a BLS ambulance is already on the way to the hospital and asks ALS to meet up with them. Sometimes the patient is critical. Sometimes they need treatment above the EMTs’ scope of practice. Sometimes the call is already moving before you ever step into it.

This was one of those calls.

A BLS crew from a neighboring town was passing through my area on the way to Good Samaritan Hospital. They pulled into my building to pick me up.

I grabbed my gear and climbed into the back.

The first thing I noticed was the 12-lead.

That impressed me.

Their agency had adopted the state’s policy on training and allowing EMTs to perform 12-lead ECGs. That may sound like a small thing, but it told me something right away. This crew had already done more than wait for ALS to show up.

The patient was lying supine on the stretcher with a non-rebreather mask in place. Oxygen was flowing at 15 liters per minute, and I could hear the steady hiss of it in the back of the ambulance.

The EMT gave me the story.

There wasn’t much.

The patient had not been feeling well. Then came a series of seizures. The crew had gathered what they could from the family, started care, and made the right decision to request ALS.

I opened her eyes with my gloved hand to assess her pupils. They were fixed in an upward gaze to the left.

I kept listening while I was getting ready to start an 18g IV in her left arm. I asked clarifying questions, trying to dig a little deeper into what we knew, what we thought we knew, and what still did not make sense.

There was also one clinical detail that made me think a little harder before moving too fast.

The driver stepped into the side door and watched for a moment.

“Do you need anything else?” she asked.

Then she asked how I wanted her to proceed to the hospital.

“Use the lights and sirens sparingly,” I told her. “Keep us moving through the traffic and the red lights, but don’t speed and don’t weave in and out. She’s critical, but she’s stable. There’s no reason to put anyone at risk.”

She nodded and went back up front.

I started the IV, drew up the Midazolam, and administered it. We checked her blood glucose to make sure that was not part of the problem. We placed her on nasal capnography. The EMT and I kept working through the call, narrowing things down as best we could with what we had. We kept reassessing her blood pressure to make sure it wasn’t climbing. It was fine.

As the medication did what it was supposed to do, the patient began to come around.

That was when the story got a little clearer.

What the family had described as “she didn’t feel well” turned out to be more specific once the patient could answer for herself. A migraine. A bad one. Lingering over the past couple of days.

That was important

Not because it changed everything.

Because it filled in the blanks.

EMS is like that sometimes, like a giant jigsaw puzzle. You start with fragments. A family gives you what they know. The crew gives you what they found. The patient cannot always speak for themselves at first. So, you work with the puzzle pieces in front of you and keep updating the picture as new information appears.

Most of my interaction was with the EMT in the back. We worked through the call together.

Questions.

Assessment.

Treatment.

Reassessment.

A little direction where it was needed.

A little reassurance where it fit.

Nothing loud.

Nothing dramatic.

Just steady.

What I did not realize was how much the driver heard.

She heard the beginning when she stepped into the back. Then, while she was driving, she continued hearing us through the intercom system tied to the rear-facing onboard camera.

The conversation carried farther than I knew.

We arrived at Good Samaritan and brought the patient inside.

The emergency department was busy. Not surprising. It had been a busy morning for everyone in the area.

We were standing just outside the patient’s room while I waited for the nurse to come out of another patient’s room so I could give her the handoff report. The driver was there for a moment before heading down the hallway to clean the stretcher and get the linens ready for the next call.

That was when she looked at me.

“Are you an instructor?”

The question did not feel random. It felt like something she had been holding onto for a few minutes.

Not casual.

Curious.

Almost like she had seen something during the ride and was trying to place it.

I remember thinking, “Where did that come from?”

It piqued my interest more than anything else. Why would she want to know that?

“I used to be,” I said. “Why?”

She said, “You communicate well.”

Three words.

You communicate well.

Then she turned and headed down the hallway.

That was it.

No long conversation.

No follow-up.

She got her answer and was gone.

I smiled anyway.

For a few seconds, I was on cloud nine.

Then the nurse stepped out of the room next door and asked, “What did you bring in?”

And just like that, the moment was over.

I gave the report the same way I had worked the call.

“We didn’t have much at first. Here’s what the crew found. Here’s what we did. She started coming around. This is what we learned after that. And here’s where she is now.”

It wasn’t fancy.

It was the truth in order.

Afterward, once things settled, I texted the president of their corps.

Most leaders hear complaints. I think they should hear the positives too.

I used their names in the actual message, but they don’t need to be named here.

They’d done good work. They recognized the need for ALS early. They got a 12-lead. They had oxygen going. They gave me what they knew without pretending they knew more than they did. They stayed involved. The driver asked how I wanted the ride handled instead of assuming.

The whole interaction felt like a crew trying to do right by a critical patient.

His reply came back almost immediately.

That stopped me for a second.

It felt good. I won’t pretend it didn’t.

But I kept coming back to the first thing she said.

Not that I moved fast.

Not that I knew what to do.

Not that the report was spot on.

You communicate well.

That stayed with me because on a call like that, effective communication can disappear inside the tasks at hand.

It sits quietly in the questions.

The tone.

The timing.

The way you ask for more information without making someone feel like they missed something.

The way you give direction without taking over the crew or the scene.

The way you explain risk without creating fear.

The way you hand over uncertainty without sounding uncertain or incompetent.

I’ve spent a lot of years teaching, mentoring, and talking about effective communication.

Still, sometimes it takes a person you have never met to show you whether it’s actually showing up where it matters.

Not in a classroom.

Not in a lecture.

Not in a post.

In the back of an ambulance, with a critical patient, a BLS crew doing their job, a driver listening through an intercom, and a short ride to the hospital.

She saw my patient care.

She watched my pace.

She observed the movement.

But what she named was communication.

After nearly four decades in EMS, that still means something to me.

Because people remember more than what we do.

They remember how we sound when the call shifts into overdrive.

And sometimes, without realizing it, that’s what they carry with them.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

A recent LinkedIn video from my dear friend Heather Younger stopped me.

She asked whether the strongest leaders are really the ones who keep bouncing back, or the ones who learn to remain steady when the pressure never stops.

Her words reminded me of the Frank-Starling principle.

For those of you outside medicine, the principle helps explain how the heart responds to increased filling.

As more blood enters the ventricle, the myocardial fibers stretch. Within a healthy range, this stretch produces a stronger contraction and greater stroke volume.

More load produces more force.

At least for a while.

The relationship has limits.

As compensation begins to fail, higher filling pressures bring congestion without producing the same increase in output.

The heart does not possess unlimited reserve.

Neither does a leader.

Perhaps leadership has its own Frank-Starling curve.

Pressure often improves performance at first.

A leader becomes more focused.

More alert.

More decisive.

They stay late.

They cover the open shift.

They take the extra call.

They answer the phone on their day off.

They step between administration and the crews.

They solve problems before anyone else knows the problems exist.

The organization sees output.

It sees commitment.

It sees strength.

What it often fails to see is compensation.

The leader is stretching to meet the demand.

Again.

And again.

And again.

In EMS, we tend to celebrate this.

We praise the supervisor who never appears tired.

We admire the chief who always has an answer.

We depend on the lieutenant who absorbs every complaint, fills every gap, fixes every mistake, and keeps the operation moving.

We call them strong.

We call them resilient.

We call them dependable.

Then we keep adding preload.

Another vacancy.

Another mandatory shift.

Another policy change.

Another conflict.

Another family complaint.

Another crew member struggling.

Another deadline.

Another request marked urgent.

The leader stretches a little more.

For a while, the contraction gets stronger.

The system rewards the increased output.

That reward becomes an expectation.

The expectation becomes the standard.

The standard becomes unsustainable.

Eventually, adding more pressure no longer produces better performance.

The leader works harder, but the return begins to flatten.

Their answers get shorter.

Their patience wears thin.

Their decisions become more reactive.

Their empathy begins to fade.

Their mindset shifts from thoughtful leadership to survival.

They remain at work, but they are no longer fully present.

We often label this burnout.

Sometimes we label it attitude.

Sometimes we label it poor leadership.

Rarely do we ask how long the person has been compensating.

The problem is not always a lack of resilience.

The problem might be an environment built around endless compensation.

Resilience still matters.

EMS demands it.

We work in uncertainty. We meet people on the worst days of their lives. We carry responsibility, urgency, grief, conflict, and constant change.

The ability to recover matters.

But recovery assumes a pause.

It assumes the pressure decreases long enough for the person to restore what was spent.

What happens when the pressure never stops?

What happens when every recovery period gets interrupted?

What happens when the leader returns to baseline only long enough to be stretched again?

This is where Heather Younger’s message about steadiness matters.

Steadiness is different from toughness.

Toughness says, “I’ll take more.”

Steadiness says, “I will remain present, clear, and intentional while I decide what this moment requires.”

Toughness absorbs.

Steadiness assesses.

Toughness often hides strain.

Steadiness recognizes it.

Toughness carries everything alone.

Steadiness knows when to distribute the load.

A steady leader is not unaffected.

A steady leader feels the pressure and chooses how to respond.

This begins with mindset.

Mindset is one of the three pillars of The Key 3™, along with communication and empathy.

In EMS leadership, mindset shapes what happens before the conversation, before the decision, and before the reaction.

A strained mindset asks:

• How do I survive this shift?

• How do I get everyone to stop complaining?

• Why does everything fall on me?

A steady mindset asks:

• What needs my attention first?

• What belongs to me?

• What belongs to someone else?

• What does this crew need from me right now?

• What support do I need before I become part of the problem?

This is not weakness.

This is self-regulation.

A leader who never pauses to examine their own condition eventually leads from depletion.

When depletion drives leadership, communication often suffers first.

• Tone sharpens.

• Listening shortens.

• Explanations disappear.

• Directions replace conversations.

The leader starts speaking at people instead of with them.

The crew notices.

• They stop bringing concerns forward.

• They protect themselves.

• They wait for the leader’s mood before deciding whether to ask for help.

This creates distance at the exact moment connection matters most.

Communication is not only about sending a message.

It is about creating enough clarity and safety for people to speak honestly.

A steady leader communicates pressure without spreading panic:

“This is a difficult week. Here is what we know.”

“We have three competing priorities. Here is what comes first.”

“I do not have every answer yet. I will update you when I do.”

“I am frustrated too, but I do not want frustration driving this decision.”

That is steadiness in practice.

Empathy also changes when a leader reaches the far end of the curve.

Empathy requires capacity.

It requires enough mental space to notice what someone else is carrying.

When leaders remain overloaded for too long, they often lose that space.

Every concern starts sounding like another demand.

Every question feels like resistance.

Every mistake feels personal.

The leader stops seeing the person and starts seeing the problem.

This does not mean the leader no longer cares.

It often means they have been stretched beyond what caring leadership requires.

Empathy does not remove accountability.

A caring conversation is a direct, respectful leadership conversation that blends clarity, accountability, and empathy.

A steady leader still addresses poor performance.

They still set expectations.

They still hold boundaries.

They still make difficult decisions.

The difference lies in how they enter the conversation.

They do not arrive flooded, defensive, or determined to win.

They arrive ready to understand, explain, and act.

At the nexus of communication, mindset, and empathy, steadiness becomes visible.

It sounds like a calm voice during conflict.

It looks like a leader who pauses before replying.

It feels like consistency when uncertainty rises.

It creates an environment where people know what to expect, even when the situation remains unpredictable.

EMS does not need leaders who pretend pressure does not affect them.

It needs leaders who understand their own pressure response.

It needs leaders who recognize when they are approaching the limits of healthy compensation.

It also needs organizations willing to stop confusing increased output with increased capacity.

A leader who keeps producing under pressure might look strong.

They might also be approaching failure.

We would never look at a struggling heart and say, “It handled the last increase in load. Give it more.”

Yet we do this with people every day.

We praise them for surviving.

Then we hand them another responsibility.

We admire their resilience.

Then we remove their recovery.

We call them indispensable.

Then we build a system where they are never allowed to step away.

That is not leadership development.

That is dependence disguised as trust.

The change begins with a different question.

Instead of asking, “How much more can this leader handle?”

Ask, “What helps this leader remain steady?”

The answer might involve:

• Clearer priorities.

• Shared responsibility.

• Protected time away.

• Honest conversations about staffing, expectations, and resources.

• Mentoring.

• Leaders admitting they need help before their performance declines.

For the individual leader, the question becomes equally direct.

Am I leading from steadiness, or am I surviving through compensation?

You might still be functioning.

You might still be meeting deadlines.

You might still be getting praise.

You might also be stretched beyond the point where more pressure creates better leadership.

Much like worsening heart failure, warning signs often appear before an obvious crisis.

The problem is that compensation can hide them.

The patient may still be talking.

The blood pressure may still appear acceptable.

The heart may still be producing enough output to meet the body’s immediate demands.

Beneath the surface, pressures may be rising.

Reserve may be narrowing.

The body may be working harder to maintain what once came more easily.

In heart failure, the body responds by increasing heart rate, constricting blood vessels, and retaining sodium and water.

For a time, those responses help preserve blood pressure and perfusion.

Over time, they also increase workload, resistance, volume, and strain.

The same responses that support short-term stability may worsen the condition when they continue unchecked.

Leadership strain often follows a similar pattern.

The leader still reports for duty.

The work still gets done.

The vacancies still get covered.

The problems still get solved.

From the outside, everything appears stable.

Inside, the cost keeps rising.

The leader sleeps less.

They withdraw more.

They stop delegating because doing the work themselves feels faster.

They check messages constantly.

They hold tighter control because letting go feels unsafe.

They push harder to maintain the appearance of normal function.

Those behaviors might keep the operation moving for a time.

They might also deepen the strain.

Like the compensating heart, the leader’s continued output does not prove the system is healthy.

It might only prove the leader is still compensating.

The warning signs are there.

• Are you becoming more reactive?

• Are you listening less?

• Are small problems creating large emotional responses?

• Are you carrying work that belongs to others?

• Are you solving every problem instead of developing the people around you?

• Are you checking messages because something needs your attention, or because you no longer know how to disengage?

• Are you treating rest as a reward instead of a requirement?

• Are your crews receiving your stress instead of your leadership?

These are not signs of personal weakness.

They are signs that sustained compensation is beginning to affect how you lead.

Mindset asks you to notice those changes before a crisis forces you to notice them.

It asks you to look honestly at your own condition.

It asks you to challenge the belief that asking for help proves you are not strong enough.

It asks you to stop measuring leadership by how much discomfort you are willing to absorb.

Communication gives you the language to name what is happening.

• “I am reaching the limit of what I can carry safely.”

• “We need to clarify which priority comes first.”

• “This responsibility needs to be shared.”

• “I need time away before my stress begins affecting my decisions.”

• “We cannot keep solving a staffing problem by exhausting the people who remain.”

Empathy reminds you to extend the same humanity toward yourself that you offer to the people you lead.

Many EMS leaders will advocate fiercely for a struggling crew member.

They will recommend rest.

They will encourage support.

They will remind others that fatigue affects judgment, mood, and performance.

Then they deny themselves the same consideration.

Empathy cannot remain something we offer only outward.

Leaders also need to recognize their own limits without shame.

This is The Key 3™ at work.

Mindset helps you recognize the strain.

Communication helps you name it and address it.

Empathy helps you respond without judgment, toward your crews and toward yourself.

The goal is not to wait for failure.

The goal is to recognize diminishing reserve early enough to change the load, seek support, reset expectations, and return to steadiness.

Sometimes that change belongs to the individual leader.

Sometimes it belongs to senior leadership.

Often, it belongs to the organization.

You cannot teach self-regulation while creating unreasonable demands.

You cannot celebrate wellness while rewarding overwork.

You cannot tell leaders to delegate while withholding adequate staffing.

You cannot praise resilience while removing every opportunity for recovery.

Steadiness requires personal responsibility.

It also requires an environment that supports it.

The goal is not to become unaffected.

The goal is to remain human without becoming unstable.

Steadiness does not require perfection.

It requires awareness.

It requires regulation.

It requires communication.

It requires support.

It requires the courage to stop proving how much you can carry.

Pressure may increase performance for a time.

No leader should be expected to compensate forever.

The strongest leader in the room might not be the one carrying the most.

It might be the one who recognizes the rising pressure, protects their remaining reserve, communicates clearly, leads with empathy, and creates the conditions for others to remain steady too.

Author’s Note

Heather Younger has been a friend, encourager, and steady source of inspiration in my leadership work.

Her recent message about steadiness connected with something I have seen throughout my clinical career. People often appear strong long after the cost of compensating has begun to rise.

Heather, thank you for continuing to challenge my thinking and for reminding leaders that strength is not always measured by how much we carry. Sometimes it is found in how we remain present, grounded, and connected while the pressure continues.

If you want to learn more about all the ways, you can create more steadiness in yourself and inside your team, go pre-order Heather’s next book, The Unshakable Team, on Amazon or wherever you buy your books. I promise, you will not be disappointed.

Mike

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I was listening recently to Mark Norris and his co-hosts on the EMS leadership podcast DAMN Good Medics. They were talking through a series of “Hot Mic” topics when one of the co-hosts shared something one of his mentors had taught him.

The mentor asked if he had said goodbye to the patient.

He had not.

The mentor corrected him.

Since then, saying goodbye became part of his practice.

As I listened, I realized something.

I do the same thing.

I do not remember when I started. I do not remember anyone in EMS teaching it to me. It was not part of my EMT class. It was not in paramedic school. No preceptor pulled me aside and told me to do it. No supervisor explained it as a best practice.

It was simply something I did.

At the end of the call, after the report, after the transfer of care, after the monitor came off and the stretcher was cleaned, I said goodbye.

Sometimes it was, “Good luck.”

Sometimes it was, “I hope you feel better.”

Sometimes it was, “Take care of yourself.”

Sometimes it was a hand on the rail, eye contact, and a simple, “Goodbye.”

It sounds small.

It is not small.

I blame my parents for it.

I blame them for a lot of things.

Being kind. Respecting people. Holding doors. Saying thank you. Living a life of service. Treating people with dignity even when nobody else is watching.

Over the years, when someone has complimented me on something like that, my usual joking response has been, “Blame my parents.”

There is truth in the joke.

Some habits come from policy. Some come from training. Some come from culture. Some come from the people who raised us before we ever touched a stretcher, wore a uniform, or answered a call.

Saying goodbye is one of those habits for me.

I have seen what it does.

A patient who looked tired suddenly smiles.

A family member standing near the bed softens for a second.

Someone who spent the last 30 to 60 minutes scared, embarrassed, angry, confused, or in pain gets one final reminder.

They were seen.

They were not only transported.

They were not only assessed.

They were not only treated.

They were cared for.

There is a difference.

I have felt the same thing when I return to an emergency department a few hours later with another patient and see someone from an earlier call still there. I check in. I ask how they are doing. I smile. They smile back.

For a moment, the relationship has an ending.

Not a dramatic one.

A human one.

EMS relationships form fast. We walk into someone’s life during a bad moment, ask personal questions, touch their body, enter their home, speak with their family, make decisions, and move them from one place to another.

Then, as quickly as we arrived, we leave.

The call ends.

The chart begins.

The radio goes off again.

The system moves on.

But the patient does not always move on as quickly.

Neither should we.

A goodbye gives shape to the encounter. It closes the loop. It reminds you the person on the stretcher was never a task, a run number, a disposition, or a bed assignment.

They were a person.

I have heard people say EMS is “just a job.”

I have heard patients described as “just a call.”

Once, I even heard someone refer to a patient as a piece of meat.

I have never forgotten it.

I also never accepted it.

If this work becomes only that, something has gone wrong.

This line of service should bring some measure of joy. It should bring fulfillment. It should bring satisfaction. Yes, it brings stress. It brings fatigue. It brings hard calls, bad days, and moments we carry longer than we expected.

But at its core, this work is still people helping people in a time of need.

That has to matter.

Saying goodbye helps me remember.

It reminds me to slow down before I leave the room.

It reminds me to look at the person, not the paperwork.

It reminds me to end the call with the same respect I tried to bring at the start.

You do not need a title to do this.

You do not need permission.

You do not need a policy.

Before you walk away, say goodbye.

Mean it.

Then carry that habit into the next call.

About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire service, and law enforcement. He writes about the calls, people, and moments that shaped his life in service, and the lessons that continue to follow him.

I arrived home from church this Sunday still thinking about the reading.

At first, I confused the Parable of the Sower with the mustard seed. A quick Gemini search helped straighten me out, so credit where credit is due.

Once I understood which reading I had heard, my thoughts moved away from farming and toward work.

More specifically, I started thinking about EMS.

In the Parable of the Sower, seed falls in several places. Some lands on the path. Some falls among rocks. Some grows among thorns. Some reaches good soil and produces a strong harvest.

The seed does not change.

The environment does.

We often talk about developing people as though success depends entirely on the individual.

Work harder.

Study more.

Be more resilient.

Improve your attitude.

Learn from the criticism.

Toughen up.

There is value in personal responsibility. Every worker owns part of their growth.

Leadership owns something too.

Leadership helps create the ground where growth takes place.

A motivated EMT might enter the profession eager to learn, serve, and belong. A new paramedic might arrive with strong clinical knowledge and a healthy respect for everything still left to learn.

Then the environment starts working on them.

A dismissive preceptor laughs at a question.

A supervisor corrects them in front of everyone.

A senior provider treats curiosity as weakness.

A mistake becomes a permanent label.

A request for help gets viewed as incompetence.

Good work receives silence. Every flaw receives an audience.

The seed might have been healthy.

The ground was not.

Some people survive those environments. They learn to keep their heads down. They stop asking questions. They protect themselves by speaking less, caring less, or trusting no one.

From the outside, leadership might call this maturity.

It might be something else.

It might be the beginning of something good getting choked out.

Toxic environments rarely destroy people in one dramatic moment. The damage often builds through repeated small experiences.

The ignored concern.

The sarcastic comment.

The uneven standard.

The leader who sees harmful behavior and says nothing.

The crew member who learns popularity matters more than integrity.

The new employee who realizes fitting in brings more protection than doing the right thing.

Thorns do not need to cover the whole field.

They only need enough room to spread.

Leaders hold responsibility for what they permit to grow.

This does not mean every workplace must feel comfortable all the time. Good soil does not remove accountability. It supports growth.

Healthy environments still include correction.

They still include high standards.

They still require difficult decisions.

They still address poor performance.

The difference lies in purpose and delivery.

Do we correct people to help them improve, or to remind them of their place?

Do we hold people accountable fairly, or only when leadership finds it convenient?

Do we invite questions, or punish anyone who exposes uncertainty?

Do we develop people, or wait for them to fail?

Good soil does not mean soft leadership.

It means intentional leadership.

People flourish where expectations remain clear, feedback remains honest, support remains available, and respect does not depend on rank.

They grow where mistakes become teaching moments instead of public entertainment.

They grow where leaders notice effort, improvement, and potential.

They grow where someone takes enough interest to say, “You are capable of more, and I will help you get there.”

Sowing matters.

Leaders sow every day.

We sow through our words.

We sow through our examples.

We sow through what we reward, ignore, challenge, and protect.

Every orientation, coaching conversation, shift briefing, evaluation, and informal interaction plants something.

The question is not whether we are sowing.

The question is what we are sowing.

Confidence or fear.

Curiosity or silence.

Accountability or blame.

Trust or self-protection.

Pride or indifference.

A leader might offer excellent training and still allow a poor culture to choke the lesson.

We might teach communication while tolerating disrespect.

We might promote resilience while exhausting people without support.

We might speak about integrity while overlooking harmful conduct from high performers.

The lesson and the environment must agree.

Otherwise, the environment wins.

Leadership also requires more than planting.

We hold responsibility for tending what grows.

New workers need guidance before problems appear.

Experienced workers need room to stretch without feeling abandoned.

Struggling workers need honest conversations before frustration turns into failure.

Strong workers need recognition, challenge, and a path forward.

People need different forms of support at different stages.

A seedling and a mature plant do not require the same care.

Neither do workers.

Some need instruction.

Some need confidence.

Some need correction.

Some need protection from an environment working against them.

Some need a leader willing to pull the weeds.

This part of leadership often proves harder than sowing.

Planting feels hopeful.

Removing what harms the field requires courage.

A leader might need to confront a respected employee whose behavior damages others.

A leader might need to challenge a long-standing tradition.

A leader might need to admit a workplace practice no longer serves the people or the mission.

A leader might need to look at poor morale and stop blaming the workers.

Sometimes the soil needs attention before anyone plants another seed.

Then comes the harvest.

Leadership discussions often focus on recruitment, training, and retention. We speak less about harvest.

Harvest does not mean extracting every ounce of productivity from a worker.

It means recognizing what has grown.

It means giving people opportunities to use their skills.

It means trusting them with greater responsibility.

It means helping them become mentors, educators, clinicians, supervisors, and leaders.

It means sharing credit when their work produces results.

A strong harvest also produces seed for the next season.

The people we develop should eventually help develop others.

A paramedic who received patience becomes a patient preceptor.

An EMT who felt safe asking questions builds the same safety for a new partner.

A supervisor who once received honest guidance learns how to guide someone else.

This is how culture changes.

One person grows, then helps improve the ground for someone else.

Leaders do more than sow.

We prepare the soil.

We protect new growth.

We remove what chokes people.

We pay attention to what is growing.

We recognize when it is time to harvest.

We also remember an uncomfortable truth.

When good people repeatedly fail to flourish, leadership should examine more than the people.

We should examine the ground.

What kind of environment have we created?

What behaviors have we allowed?

What has taken root because we failed to address it?

What potential has gone undeveloped because someone never received support?

What good workers have we lost after blaming them for failing to grow among rocks and thorns?

Leaders do not control every outcome.

People still make choices. Some resist growth. Some reject support. Some decide to leave despite our best efforts.

Leadership still owns the environment.

The worker owns the effort.

The leader owns the conditions surrounding it.

This Sunday’s reading reminded me of something simple.

The quality of the seed matters.

So does the ground.

As leaders, we hold responsibility for both what we sow and what we allow to grow around it.

The harvest will tell the story.

A Note from the Author

This is a little different from the EMS stories I usually share. It grew from a church reading that stayed with me and made me think about leadership, culture, and the environments we create for others.

The lesson reaches beyond faith and beyond EMS. I hope you find something in it that stays with you.

Mike

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We were parked on the raised median under the Gowanus when the dispatcher’s voice cut through the music.

It was Sunday morning, March 8, 1998, somewhere around 0430. My partner and I were working 32-William out of Lutheran Medical Center, sitting near 39th Street and 3rd Avenue in Brooklyn. The dashboard radio was on, tuned to WNEW-FM, 102.7. Classic rock filled the cab, low enough that we could still hear the street, but loud enough to keep us company through that strange part of the midnight tour when the city feels half-asleep and so do you.

Under the Gowanus, everything had its own feel.

Quiet. Dim. Gritty.

The sidewalks were empty. The storefronts were dark. The buildings around us were a mix of commercial spaces and apartments, all of them seeming to sleep through the hour. Every so often, a vehicle crossed overhead and the steel plates in the roadway answered with a hard, hollow sound that rolled above us and disappeared.

Then the street went quiet again.

We were relaxed, or at least as relaxed as you get on a midnight tour. Half-awake. Watching the street. Talking here and there. Joking with each other. Listening to the music. Sitting still while some part of us stayed turned toward whatever might come next.

That is how those hours work. You can be laughing with your partner one moment and reaching for the radio the next. You can feel like nothing is happening and still know the whole night can change in one sentence.

Then Richmond called us.

“32-Willie, start making your way toward Brooklyn North in the area of Nostrand and DeKalb. Sounds like a shooting at a club with multiple patients. We’re getting multiple calls on it. I’ll keep you advised.”

We weren’t assigned yet.

Not exactly.

It was more like the city was pointing us toward something before anyone had the whole picture. The incident was still on a Brooklyn North frequency, separate from our own Richmond frequency, which covered Brooklyn South and Staten Island. We were only getting what Richmond had, and that wasn’t much at the moment. A shooting. A club. Multiple patients. A situation still taking shape.

My partner looked at me.

I looked at him.

It was one of those looks you exchange after enough years in the truck together, a look that carries the whole sentence without saying much of it.

Oh boy. Here we go.

He put the ambulance in gear and started north.

No lights.

No siren.

Not yet.

That made it feel a little stranger. We were moving toward a serious job without fully being on it. Not racing. Not crawling. Just heading in the direction of something that was already bad enough to pull attention across frequencies and across the borough.

We went up 39th Street, then Fort Hamilton Parkway, then Caton Avenue, then onto Nostrand.

The streets were almost too open. A few cars here and there. An occasional MTA bus. Empty intersections. Traffic lights changing over quiet pavement. Brooklyn was asleep around us, unaware of what was unfolding just a few miles away.

Inside the cab, we didn’t say much. A few short comments passed between us as the road opened ahead.

“What do you think we’re heading into?”

“Sounds like it’s getting bigger.”

“Brooklyn North must be tied up.”

Then we let the quiet sit.

I could feel the apprehension building. Not fear. Not panic. More like the body getting ready before the mind had all the facts. That healthy edge you get when you know a call type has the potential to become more than a call. Your breathing changes a little. Your attention sharpens. The music is still playing, but you stop hearing it the same way.

Near Kings County Hospital, Richmond came back.

“There’s a shooting at the Sugar Hill Supper Club, 217 Nostrand Avenue, with a cross of DeKalb to Willoughby. Switch it over to Citywide and advise.”

That was when the night changed.

As Richmond was still talking, my partner’s right hand dropped from the steering wheel to the console. He flipped the master switch, and the ambulance came alive around us, one light after another until the red and white reflections started moving across the buildings beside us.

Storefront glass.

Parked cars.

Brick walls.

Rolled-down graffiti covered gates.

The quiet street now flashed back at us.

His hand moved to the siren knob and turned it. The first wail pushed ahead of the truck, and I sat up a little straighter without thinking about it. My partner’s face changed too. The joking was gone. His eyes stayed forward, locked on the road, and I started scanning the intersections as a second set of eyes.

That was part of the rhythm.

He drove.

I watched.

Corners. Cross streets. Parked cars. Anyone who might step off the curb. Anyone who might try to beat the light. Anything that could turn our response into another call.

Nostrand opened in front of us.

No cars in the way.

No trucks.

No one blocking the box.

Just green lights, one after another, as if the city had decided to clear a path. It’s amazing how these things seem to all come together when needed.

For a few blocks, it gave us every light.

That almost never happens.

And when it does, you wonder what you’re being cleared toward.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

Author’s note

This is Part One of a four-part series from the Sugar Hill Supper Club response. Each piece stands on its own, but together they follow one night from the first radio call to what came after.

The bottle was already sweating when he handed it to us.

Midday.

Summer of 2020.

One of those hazy, hot days where the air seemed to sit on your shoulders. Thick. Heavy. Unmoving. The kind of day where even standing still made you sweat.

My partner and I were working for Rockland Mobile Care. It was not a dramatic assignment in the way people imagine EMS. No sirens. No roadside wreckage. No frantic family waving us down from the curb.

It was a discharge from a hospital to a rehab facility.

Good Samaritan Hospital in New York to The Buckingham at Norwood in New Jersey.

The patient had survived COVID, but survival had come with a cost. An extended hospital stay. Days in bed. Weakness that settled into the muscles. Deconditioning, which is the polite clinical word for what happens when illness takes your strength and leaves you needing help to rebuild it.

That was the job.

Move the patient safely.

Protect the patient.

Protect ourselves.

Protect the next patient.

That last part had become its own job by then.

We were wearing Tyvek coveralls, Moldex N95 particulate respirators, Uline safety glasses, and Curaplex Triton Grip nitrile gloves. Full PPE. The kind of outfit that turned a routine transport into a slow-cooked lesson in endurance.

The back of the ambulance had air conditioning, but it only helped so much.

Heat still gathered under the coveralls.

Sweat still ran down your back.

The respirator still dug into your face.

By then, it was common to take the mask off and see the thin red line it left behind. Across the bridge of your nose. Along your cheeks. The outline of protection stamped into your skin.

We had gotten used to it.

Or maybe we had only gotten used to pretending we had gotten used to it.

Every call had layers now.

The patient.

The paperwork.

The equipment.

The exposure risk.

The doffing process.

The disinfecting.

The quiet thought in the back of your head about what you might carry home.

We dropped the patient off at the rehab facility and started making our way out.

Inside the suit, the heat stayed trapped. Every movement reminded you that your body wanted air and your mind wanted a break. The job was not done yet, either. Dropping the patient off did not mean clearing the call.

Not then.

There was still the ritual.

Doff carefully.

Don’t contaminate yourself.

Don’t touch your face.

Don’t rush because you are hot.

Don’t skip steps because you are tired.

Then clean the truck.

Not a quick wipe-down.

Enhanced cleaning.

The stretcher. The handrails. The bench. The walls. The cabinet handles. The monitor. The seatbelts. Anything touched. Anything breathed nearby. Anything that could become the next problem if you missed it.

It was tedious.

It was repetitive.

And missing a single step could follow you home.

We stepped outside still carrying the heat with us.

For a nanosecond, the air felt cool against my face.

Then the humidity settled back in.

My skin remembered the day.

My uniform shirt stuck to me beneath the coveralls. Sweat had already made its path down my back. The pressure from the mask still lingered on my face, even before it came off.

We were thinking about the next part.

Doffing.

Cleaning.

Resetting.

Getting ready to do it all again.

Then one of our lieutenants pulled in like he already knew what we needed.

He got out with two bottles of Orange Gatorade.

Twenty ounces each.

Pulled from an ice-filled red and white Igloo cooler.

The bottles were sweating in the heat, slick with cold water and humidity. He handed them to us after we had taken our PPE off, because none of us were careless about that. You didn’t touch something you were about to drink from with contaminated gloves. You definitely didn’t take all that risk seriously for an hour, sometimes multiple hours, and then get lazy over a bottle.

I wrapped my bare hand around it.

Cold.

Hard.

Real.

Before I even took the first sip with my parched lips, the bottle felt refreshing.

He said something close to, “Here, take these. I’ll take care of cleaning up your truck while you guys take a break for a few minutes.”

Then he went to work.

No speech.

No ceremony.

No supervisor performance.

He just opened the back of the ambulance, took the special disinfection solution we were using for COVID decon, and started spraying down the interior. Then he meticulously wiped it down.

The work we were supposed to do.

The work he did not have to do.

He was not working the truck that day. He was on the road to support crews, handle problems, take care of administrative matters, keep the operation moving.

But in that moment, he took care of us.

My partner and I stepped under an awning in the shade.

We chugged the drinks.

Not slowly.

Not politely.

The way you drink when your body has been waiting longer than you realized.

The cold traveled from my mouth down to my stomach while sweat traveled down my back under my uniform shirt. I took a few deep breaths of fresh air, or at least air that felt fresh compared to what had been trapped under the N-95 mask.

We didn’t say much.

We didn’t need to.

It was one of those quiet, understood moments you get with a partner after a hard stretch. Nothing dramatic. Nothing emotional on the outside. Just two guys standing in the shade, drinking something cold, letting the moment do what it needed to do.

The lieutenant kept working.

Pshhhttt. Pshhhttt. Pshhhttt.

Wipe. Wipe. Wipe.

Move.

Repeat.

There was something strange about watching him do it.

I felt grateful.

I felt seen.

I felt recognized for the tedious, repetitive work that had become part of every patient encounter. The work nobody outside EMS really saw. The work that did not make headlines. The work that did not look heroic.

The cleaning.

The sweating.

The second-guessing.

The checking and rechecking.

The constant mental guardrail that said, “Do this right. Do not bring this home. Do not become careless. Do not make someone else unsafe.”

Those were strange times.

Everybody said that back then.

Strange times.

It was true, but it was also too small.

The world had changed, but the calls kept coming. Patients still needed to be moved. Hospitals still needed beds. Rehab centers still needed to receive. Crews still needed to suit up, sweat through the job, peel off the layers, clean everything, write the report, and get ready for the next one.

Again.

And again.

And again.

A bottle of Gatorade didn’t fix any of that.

It definitely didn’t make the virus any less dangerous.

It didn’t make the workload lighter for more than a few minutes.

It didn’t erase the worry, the fatigue, or the strange quiet pressure that lived inside every shift. Every call.

But it did give us a pause.

And that was enough.

At least for now.

Not because of the drink alone, but because someone had noticed.

Someone saw the heat, the work, the repetition, the mental weight, and decided to remove one small burden from our shoulders.

He didn’t tell us to take care of ourselves.

He made room for us to do it.

That was the difference. That was leadership.

After he finished, there was some small talk. The kind everyone was having then. About the strange times we were living through. About how much had changed. About how everyone was getting through it the best they could.

Then the moment passed.

The truck was clean.

The bottles were empty.

We called back in service with our dispatcher.

But I still remember standing under that awning.

The cold in my hand.

The sweat down my back.

The red line on my face.

My partner beside me.

The lieutenant cleaning the truck.

And for a few minutes, we were not thinking about exposure, decon, paperwork, the next transfer, or what we might bring home to our loved ones.

For a few minutes, we stood in the shade and let our guard down.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

The smell of train metal came back first.

Tuesday, June 20, 2000.

By then, I was a full-time New York City police officer, but I had never really left EMS. I still worked as a paramedic at Lutheran Medical Center a few times a week, something I had been doing since the mid-1990s. One foot in one world. One foot in the other. Sometimes both feet back in the ambulance where I had started.

That evening, I was working with my partner on 32-William. He was driving. I was teching, which meant I was the paramedic responsible for treating the patient and writing the ambulance call reports.

We were in Brooklyn South, sitting at our cross-street location, enjoying a slice of pizza from Gina’s. The computer knew exactly where we were. That location mattered. It told the system where we were and that helped dispatch decide which assignments fell to our primary area of response, or PAR.

Then Richmond broke the silence of our radio.

We were being dispatched to a train derailment at the DeKalb Avenue subway station.

Then came the next instruction.

“Switch it to Citywide and advise them of your ETA.”

Citywide changed the feel of everything.

Citywide meant the job was big enough to pull units from all over, different divisions, different parts of the city. It meant more resources. More radios. More confusion. More ways for things to go right. More ways for them to fall apart.

As we started toward Brooklyn North, images flashed through my mind.

Other derailments I had seen splashed across front pages of local newspapers.

The chaos outside the World Trade Center after the 1993 bombing.

The Sugar Hill Club shooting.

Multiple casualty incidents have a way of imprinting themselves on you. Not as complete memories. More like fragments. Smells. Lights. Radio chatter. Faces. Blood. Movement. Noise.

My heart sped up.

I was pumped.

That may sound strange to someone outside this work, but EMS providers do not wish tragedy on anyone. We do not want people hurt. We do not want families changed forever. We do not want disaster.

But tragedy has always existed.

When it happens, we want to be the ones there to help.

We arrived to what looked like the city had cracked open.

Ambulances lined the streets. Fire engines and trucks crowded the area. Police cars were everywhere. Specialty units and supervisors from every agency filled whatever space was left. Red lights, white lights, rotating lights, strobes. Reflections bounced off commercial windows and turned the street into a moving wall of color.

Above ground, the air felt open. A light breeze moved through the block, fresh enough to remind you there was still a city outside the incident. But that freshness kept getting swallowed by diesel exhaust from idling rigs.

Engines running.

Radios blaring.

People moving with a purpose.

The scene was not as large as the 1993 World Trade Center bombing response on the West Side Highway, but it had the same feel.

Managed chaos.

That’s the phrase we use because it sounds controlled.

It’s only half true.

Chaos is still chaos.

My partner and I made our way down into the subway.

That’s where the smell hit me.

Not the smoke. Not the blood. Not the fuel.

Train metal.

A warm, stale, underground smell. Steel, dust, old cement, and subway air trapped below the street. It had a heaviness to it. The kind of smell that sticks inside your nose and waits years to return.

The train sat wrong.

Tilted.

Dark.

Stopped awkwardly, as if the whole thing had frozen in the middle of something it was never supposed to do. Doors were open. Debris everywhere. Broken glass. The platform lights made everything feel harsher than it should have.

It looked surreal.

Kind of like a movie scene, except the people were really hurt and the radios weren’t screaming rehearsed lines.

Some of the passengers were walking. Others sat on platform benches, dusty and stunned. Some had remained inside the train cars, still seated, still trying to understand what had happened. The scared and confused looks on their faces spoke volumes to what they had just gone through.

There were minor scrapes.

People holding arms.

People pointing to backs, shoulders, knees, hips.

First responders moved from person to person, asking questions, checking injuries, deciding who needed to be removed from the scene first. Some passengers were placed in stair chairs and carried from the platform to the mezzanine, then up again toward street level.

That is the thing people forget about subway work.

Nothing is easy below ground.

Every patient has to come up.

Every piece of equipment has to go down.

Every radio has to fight concrete, steel, noise, and distance.

My partner and I stayed together.

Our first job was quite simple.

Find command.

In a scene like that, you don’t freelance. You don’t wander into work because your adrenaline says move. You find who’s in charge, you get your assignment, and you become useful inside the incident command system already forming around you.

We pushed through first responders, passengers, equipment, and noise until I saw him.

The chief.

He stood with two aides near him, each holding radios, each taking notes, each passing along instructions and requests.

He wasn’t running.

He wasn’t yelling.

He wasn’t trying to prove that he was in charge.

He was standing upright, shoulders back, serious but steady. His eyes moved across the scene as if he were taking in layers the rest of us were still trying to sort through. He would look, listen, decide, then turn and give something quietly to one of his aides.

A note.

A request.

An order.

A radio message.

No wasted movement.

No performance.

He was the calm.

I had known him for years.

He knew me. He knew my partner. Our uniform patches were different, but the relationships were not new. That was important in a city where agencies could sometimes act like borders were more important than the people inside them.

I stepped toward him and extended my hand.

I addressed him with the familiarity of someone I had known for years.

The lieutenant beside him turned toward me.

His eyes cut through the noise.

For a split second, the whole scene narrowed.

The train disappeared.

The radios faded.

The injured passengers, the lights, the diesel engines above us, the dust and warm subway air, all of it slipped back.

It was just him and me.

His look said I had crossed a line.

Not with words.

With familiarity.

With comfort.

With the assumption that I had any right to walk up to a chief in the middle of a derailment and call him by his first name.

I felt small.

Diminished.

Almost dirty, in a way I still remember vividly.

We were from different agencies. Different uniforms. Different chains of command. Different cultures. In his eyes, maybe that was all he saw.

For that one second, I wondered if I had made a mistake.

Then the chief looked at me.

His serious expression softened.

He smiled.

He took my hand.

“Hi, Mike.”

Two simple words.

The lieutenant looked away.

The noise came back. The radios. The footsteps. The passengers. The smell of train metal rising from below.

I hadn’t been given an assignment yet.

But in that instant, I’d been given my place back.

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Author note

Some identifying details in these vignettes, including names, locations, timing, and select circumstances, have been changed or blended to protect privacy. The emotional truth, operational reality, and leadership lessons remain intact.

About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve

.

Sometimes the hardest part of a call is what stays unfinished after the handoff.

I kept checking.

We had brought him in during the early hours of Monday morning. By Wednesday afternoon, he was still listed in the SICU. That alone felt like something. A sign he was still in the fight. A sign that all of it, the basement, the airway, the CPR, the narrow stairs, the transport, had bought him time.

I kept asking through our EMS liaison at the hospital.

Nothing.

A week later, I stopped asking from a distance and went to the unit myself.

Sometimes the need to know does not go away. It sits with you. It follows you through other calls, other meals, other nights. Not because you think you are owed something, but because some calls do not let go cleanly. They leave unfinished emotional business behind.

When I got to the desk, I gave the clerk his name and waited while she searched.

At first, I was hopeful. Then I watched her face change.

I knew before she said it.

He had died.

It was not shock. Not really. More like the final click of something I had already begun to understand. We had done our best. The EMTs. My partner. The police officers helping us clear space, carry equipment, and get him up those stairs. We gave him a fighting chance. In the end, he still succumbed to his illness.

The clerk asked if I wanted to meet one of his nurses.

I said yes.

She introduced me as one of the providers who had brought him in.

What happened next surprised me.

I had gone there looking for an answer. What I found was something else.

Closure.

Not because the ending changed. It had not. He was still gone. But because the questions were not mine alone. I had spent days wondering what happened after we handed him off. The staff had been wondering just as much about what had happened before he reached them. We were standing on opposite sides of the same story, each holding pieces the other had never seen.

The details of that conversation belong where they should remain, among care providers. But what stays with me is the feeling of it.

The mutual curiosity.

The professional respect.

The human pull to understand how a life moved through our hands.

I had come in carrying the quiet weight of a patient whose outcome I could not stop thinking about. They had their own weight too. Different questions. Different moments. Same patient. Same unfinished thread.

And for a few minutes, that thread got tied off.

His nurse thanked me in a way I still never quite know how to receive. I have always defaulted to the same mindset. I was just doing my job. That answer still feels true to me. Yet standing there, listening to her speak, I was reminded that what feels routine to us often looks very different from the outside. She was struck by what paramedics are asked to do. What we are trained to carry. How much has to happen before the hospital ever sees the patient.

I was struck by something too.

How much hospital staff care.

How curious they are.

How much they wonder about the people who arrive in their unit with only fragments of a story attached.

The clerk and the nurse both seemed surprised that I had come back to check on him.

To me, it did not feel unusual.

It felt necessary.

Not every call ends when the stretcher crosses the threshold of the emergency department. Some stay with you. Some leave questions behind. Some make you wonder whether your effort mattered, even when the patient does not survive.

This one did.

We did not save him in the final sense.

But we gave him a chance.

We gave his nurses and doctors a patient who still had a chance.

We gave his story more time.

And in the end, even after his death, we gave one another something too often missing in this work.

A clearer picture.

A shared respect.

A measure of peace.

Closure does not always arrive the way you want.

Sometimes it arrives at a unit desk a week later, in the face of a clerk before she says a word.

Sometimes it arrives in a quiet conversation between people who cared for the same patient in different places.

Sometimes it arrives too late to change the outcome.

But it still matters.

A lot.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience across emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve

.

Some patients become so familiar that people stop seeing them. One cold afternoon in Brooklyn, that nearly happened.

One cold, misty afternoon in the 1990s, my paramedic partner and I were sent to back up a volunteer BLS crew for a man known to nearly everyone working that part of Brooklyn.

The call came in and I figured it was probably him.

He was a familiar street presence. Most of the year, you could find him on the same corner asking for money. He drank. He called 911. Passersby called 911 for him. Police did too. He was one of those people the whole area seemed to know.

Most days, there was nothing about him that looked like an emergency.

He was cold. Wet. Hungry. He wanted to get in out of the weather, get warm, maybe get a meal. He had real medical problems too, but like a lot of people living hard on the street, he spent what money he had on what got him through that day.

I never minded going for him.

Of the hundreds of street encounters I had back then, he was usually one of the pleasant ones. He would smile. He would talk. Even when he had been drinking, he was rarely nasty. If you pressed him, he was usually honest. He was a regular, but he was also a person.

By the time we got there, the BLS ambulance was already on scene.

It was one of those gray afternoons where the light was fading early and a fine mist hung in the air. Cars rolled past with that low wet sound tires make on damp pavement. The back doors of the ambulance were open. The cold air was pushing in. I could hear the heater blower running inside, trying to fight it off and losing.

The crew chief was standing at the rear doors when we walked up.

“It’s just him,” she said. “We don’t need you.”

I looked past her into the ambulance.

He was already on the stretcher. Low lights on. Another EMT seated beside him. They had clearly just loaded him. No vitals yet. No real assessment yet.

What hit me was not one thing. It was all of it at once.

He was pale. Not street pale. Sick pale. He was leaning forward, breathing through pursed lips, his chest rising and falling with effort. His respirations were fast and shallow, upper twenties at least. His eyes were closed. His lips were dry. He looked tired in the way people look when breathing itself is wearing them down.

I felt a snap of irritation.

“He looks sick,” I said.

The crew chief gave it right back, dismissive, like I was missing the obvious.

“It’s just him. You can take a cancel. We don’t need you.”

Outside, the traffic noise drowned most of it out. But when I stepped up into the back of the ambulance, close enough to reach him, I could hear it. High-pitched wheezing. Wet, coarse noise under it. He opened his eyes when I spoke to him, confused for a second, maybe because he was already in an ambulance, but there was trust in the look too. He knew me. He knew my voice. He answered in single words and nods. His shoulders were slumped forward. He looked weak. Almost defeated, which is a hard thing to say about a man hardened by the street.

His usual smile was gone.

That more than anything told me this was different.

I reached down, unbuckled the stretcher, and the metallic pop of the buckle changed the call at once. From reputation to patient. From assumption to assessment.

“You don’t look so good today,” I said. “Come with me so we can get you some help.”

I slid my gloved hand under his arm and guided him forward. He was a little heavy, the way sick people get when even moving feels like too much work. He came along with coaxing, bent forward, still working to breathe.

I helped him down the bumper step and onto the street. His feet shuffled as we made the short walk, maybe fifteen or twenty steps, to our ambulance. The mist clung to his damp overcoat. The air was dank. Cars kept sliding past with that wet road hiss. I remember the smell of his jacket as much as anything. Damp wool, street wear, body odor, not overpowering, only the smell of a man living outside too much and bathing too little.

He wore a long tan jacket, a gray sweater, a wool cap, dirty jeans smudged from sleeping where he could.

By the time I got him to our truck, my partner was already in the back, on the same page without needing a word. She had the nebulizer set up, oxygen ready, and the stretcher prepared.

“Yeah, he’s sick,” she said. “I can’t believe they were trying to cancel us.”

That was all that needed to be said.

We got him settled. Nebulizer with oxygen first. In those days we did not have pulse oximetry with us. We looked. We listened. We put hands on the patient.

He did not fight the mask. He was too tired for that. I had to coach him.

Slow, deep breaths. Hold it. Let the medicine get in.

At first, he kept slipping back into shallow breathing. I would coach him again. He would try. After a few rounds, he started to get it. The only sounds in the back were the hiss of the nebulizer and the ambulance blower after we turned the heat up to push back against his damp clothes and the cold he had come in with.

His hands were cool from outside. His forehead was warm when I checked it with the back of my gloved hand.

When I listened to his lungs, the picture sharpened. High-pitched wheezes. Wet, coarse rhonchi. Diminished at the bases. He was not putting on a show. He was not working an angle. He was sick.

My partner spiked the IV bag while I got the line in. We did what needed to be done.

I happened to be back in that emergency department the next day and asked what became of him.

He had been admitted to intensive care with severe pneumonia.

He stayed in the hospital for a while.

What has stayed with me all these years is not the diagnosis. It is how close he came to being treated like a nuisance instead of a patient.

People talk about the patient who cries wolf.

Maybe.

But sometimes familiarity becomes its own kind of blindness. You hear the name, you know the corner, you think you know the story, and you stop looking.

That is what bothered me then, and it still bothers me now.

How easy it is to dismiss someone.

How quickly a reputation can outrank a basic assessment.

How three words can flatten a human being.

It’s just him.

That day, it was not just him.

It was a sick old man in a damp coat, breathing hard in the cold, with no smile on his face.

Someone finally noticed.

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Author’s note: This vignette draws from repeated encounters with a familiar street patient. Identifying details, including name, location, timing, and select circumstances, have been changed or blended to protect privacy. The emotional truth and operational reality remain intact.

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience across emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

By then, I knew her.

Or at least I thought I did.

For six months, maybe eight, working midnights as a rookie paramedic in Brooklyn, I had picked her up more than a dozen times. She was usually only a few blocks from the same area, sometimes one side of 5th Avenue, sometimes the other, but never far. On that night, she was in front of the bank on the corner at 8202 5th Avenue.

To us, she was Rose.

That was never meant to be cruel. It was the kind of nickname that starts in EMS the way nicknames often do. She almost always had a bottle of Wild Irish Rose either in her jacket pocket or lying on the sidewalk near where she landed. So, on my paper Ambulance Call Reports (ACR), with my BIC pen, I would block print the following...

First Name: ROSE

Last Name: UNKNOWN

Address: UNDOMICILED

I had done it more than once and never gave it much thought.

Then one night in the emergency department, I handed the hospital copy of the ACR to the clerk to register her, and she looked at me and said,

“You know her name isn’t Rose, right?”

That caught me off guard. She said,

“Her name is Margaret.”

Then she gave me an address. A few blocks away. Close enough that it hit me right then that no matter where we found her, she was never really all that far from home.

That stayed with me.

So, the next time we got sent for her, I already knew something I had not known before.

It was on the cooler side. Late fall, maybe. She was lying on the sidewalk in front of the bank, curled onto her left side in a loose fetal position. She had on an ivory bubble jacket, dirty and stained from too many encounters with the ground. On her head was a pink hand-knit hat pulled down over mousey brown, greasy hair.

She looked like she usually did.

Smiling in that loose, alcohol-softened way I had come to recognize. Eyes heavy. Half-closed. That familiar look of someone too drunk to care much where she had ended up.

On the earlier calls, she never made things easy.

If we tried to help her up, she would wiggle, resist, swat a hand away, make us work for every inch of movement. My partner and I, sometimes with a pair of cops helping, would each take an extremity, lift her up onto the stretcher, and get the seatbelts across her fast before she rolled right back off.

That was the routine.

That night I walked up and said,

“Margaret, we need to get you to the hospital. You can’t stay out here on the street.”

Her face changed.

The smile got bigger, yes.

But that wasn’t the part that hit me.

Her eyes opened wide.

Not the usual half-lidded, squinty look. Not the expression the alcohol wore for her on most nights. They opened wide like something real had cut through the fog.

It was the look of, you know me.

Then came the part I had never seen before.

She started trying to get up.

No swatting.

No wiggling away.

No fighting the help.

Just a smile, maybe a little giggle, and an effort to rise.

My partner and I stood on either side of her, each putting an arm under hers to help her up and steady her. Her legs were weak and wobbly from the drinking, but she accepted the help. She let us guide her to the stretcher. She sat down without a struggle.

That was the moment.

Not some dramatic save.

Not some big speech.

Not a miracle.

Just one woman on a Brooklyn sidewalk, in a dirty jacket and pink hat, letting us help her because for once she knew we knew who she was.

Once she was seated, even her body language felt different. Softer. More vulnerable. Comfortable in a way she never had before. She no longer felt like a burden being managed. She felt like someone accepting help from people she trusted.

I still think about how small the difference was.

One word.

Not medicine.

Not force.

Not persuasion.

Just the right name.

This job teaches you shorthand. Some of it is useful. Some of it helps you survive the repetition of long nights, familiar corners, and repeat patients you think you know. But every now and then, the shorthand gets in the way.

Rose was shorthand.

Margaret was her name.

And on that cool night in Brooklyn, the difference between the two changed the whole call.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

I have told this story more times than I can count.

I have told it to other first responders.

I have told it to family.

I have told it to friends.

I have told it to people I had only recently met.

It usually comes out in conversation when we start talking about the World Trade Center, 9/11, service, timing, purpose, or the strange way life sometimes places us exactly where we are supposed to be, even when we do not understand it at the time.

For years, I thought this story was about what I missed.

Now, I think it may be about why I am still here.

That shift took time.

It took years.

It took watching history unfold from the wrong side of the response.

Twice.

February 1993

The first time was February 1993.

By then, I had been a full-time New York City 911 paramedic for a few years. I was working out of Lutheran Medical Center in Brooklyn. I was young. I was eager. I loved the job.

I lived in Brooklyn at the time.

It was Presidents’ Day weekend, and some friends and I had decided to head up to Ulster County to ski at Belleayre Mountain over the long weekend.

It was a great weekend.

Until it wasn’t.

Somewhere along the way, I broke my left thumb at the base.

It was bad enough to need a hard cast. That meant no ambulance work for a little while.

I was bummed out at first. I was young and wanted to work. But after the first disappointment passed, I thought there might be a small upside.

A few weeks off.

Some rest.

A chance to catch up on television shows I had recorded on VHS tapes.

My birthday was coming the following week too, so I figured I would take my parents out for lunch. Something simple. Something normal.

On Friday, February 26, 1993, I picked up my parents a little before noon.

We were going to Randazzo’s Clam Bar on Emmons Avenue in Sheepshead Bay.

I remember getting on the Belt Parkway eastbound.

Somewhere around 12:20 or 12:30 in the afternoon, as we were heading east, I saw several Adam cars going the other way.

Lights and sirens.

Moving fast.

Adam cars were the smaller NYPD Emergency Service Unit trucks. As a paramedic, I was used to seeing them at barricaded EDPs and pin jobs.

An EDP was an emotionally disturbed person. A pin job was a crash where someone was trapped in a vehicle and needed extrication.

I saw those ESU trucks racing westbound and thought to myself, Wow, there must be a great pin job somewhere.

Then I kept driving.

That was it.

I did not give it another thought.

My parents and I had lunch.

We sat down.

We ate.

We talked.

Nothing about my birthday or that lunch felt historic.

Nothing about that drive felt like a dividing line.

When lunch was over, I dropped my parents back off at their house. Then I went to meet my girlfriend at the time at her apartment.

When I got there, she asked me what I thought about the bombing at the World Trade Center.

I remember looking at her and saying, “What are you talking about?”

She said there had been an explosion at the World Trade Center.

Then she turned on the television.

There were some disruptions. Some of the channels had poor picture quality. But once the news came on, I saw what so many other people saw that day.

Emergency vehicles everywhere.

West Street packed with police cars, fire apparatus, ambulances, and command vehicles.

Smoke.

Confusion.

The World Trade Center.

The same emergency response I had seen racing westbound while I was taking my parents to lunch.

In the days that followed, I spoke with some of my peers.

That was when I learned that the ambulance I was usually assigned to had responded to the explosion.

My regular truck had gone.

I had not.

I was home because of a broken thumb in a cast.

As a young paramedic, that bothered me.

It bothered me more than I admitted at the time.

I felt like I had missed the job of the century.

That may sound strange to someone outside emergency services.

It may even sound wrong.

We do not wish harm on anyone.

We do not hope for tragedy.

We do not want people hurt, trapped, burned, scared, bleeding, dying, or calling for help on the worst day of their lives.

But when that day comes, we want to be there.

That is part of the calling.

That is part of the work.

We train for the bad days.

We build skills for the bad days.

We learn how to stay calm, how to assess, how to treat, how to move, how to communicate, and how to help when everything around us is falling apart.

When you are having your worst day, we hope to have the privilege of making it a little less bad.

That was how I saw it then.

That is still how I see it now.

So, 1993 stayed with me.

I went on with my career.

I kept working.

I kept serving.

But in the back of my mind, there was always this thought.

I missed it.

I missed my chance to help.

I missed the big one.

I did not know then that the World Trade Center would come back into my life again.

Eight Years Later

Eight years later, I was no longer only a paramedic.

It was June of 2001.

I was an NYPD police officer assigned as an instructor at the Police Academy Driver Training Unit. EVOC.

Emergency Vehicle Operator Course.

I was still working part-time as a paramedic at Lutheran Medical Center.

By then, I had married the love of my life, Mary Kay.

We had started a family.

We were building a life together.

We had been in our home in Locust Valley for about three years. Like many young families, we had work to do. Boxes still to unpack. Rooms to reclaim.

Our dining room had been unusable since we moved in.

It had become the place where boxes went when we did not know where else to put them.

Mary Kay and I finally had a plan.

The last week in June, Mary Kay, my mother-in-law, and I would all take vacation from our jobs.

My mother-in-law would come stay with us and help watch our infant son.

Mary Kay and I would tackle the boxes.

We were finally going to get the dining room back.

Monday morning came.

We were sitting around the breakfast table, talking about the day and the week ahead.

Then I felt something in my chest.

It was not exactly pain.

It was not exactly discomfort.

It was a twinge.

Something strange.

Something that did not belong.

I walked upstairs to get ready.

As I moved around, the feeling got worse.

I made the decision to tell Mary Kay.

Then I made the decision to go to the hospital.

That decision started three days of testing.

At the end of those three days, doctors found a coronary artery occlusion.

I needed a stent.

That was not part of our plan for the week.

The dining room boxes were going to wait.

My recovery began.

I was placed on medical leave.

I started the process of rehabilitation and follow-up appointments.

As the summer unfolded, I was scheduled to return to full duty on Monday, September 10, 2001.

I was ready.

Or at least I thought I was.

That Sunday evening, September 9, I went to a coworker and friend’s 40th birthday celebration.

While I was there, I started to feel something familiar in my chest.

That same kind of feeling.

That same concern.

I left the party and went to the emergency room.

I was admitted.

On Monday, September 10, my cardiologist and I talked about what might be happening.

There was concern about a possible re-occlusion.

At the time, I had received one of the last types of stents that did not have the newer coating to help prevent re-occlusion.

I had missed that cutting-edge technology by a few months.

My doctor said we would repeat a nuclear stress test Tuesday morning.

We would see what it showed.

My appointment was scheduled for 9:00 a.m.

Tuesday morning came.

September 11, 2001.

I woke up around 7:00 a.m. in the CCU at Glen Cove Hospital.

The coronary care unit.

I had breakfast.

My morning vital signs were checked.

My blood was drawn.

I took my morning medications.

Then a transporter came with a wheelchair and brought me down to Nuclear Medicine.

It was about 8:55 a.m.

I remember being rolled into the waiting area.

There was a television on.

People were gathered around it.

They were talking about a small Cessna that had crashed into the World Trade Center.

That was what people were saying in those first moments.

A small plane.

A terrible accident.

I looked at the screen.

I looked at the damage.

I looked at the shape of the impact.

And something in me said no.

That’s not a Cessna.

My experience as a paramedic told me no.

My experience as a police officer told me no.

A small Cessna would not have done that.

In my mind, I thought a Cessna would have splattered like a bug hitting a windshield at highway speed.

This was different.

This was bigger.

This was something else.

Then, as we watched live television, the second plane hit the South Tower.

2 World Trade Center.

I did not think.

I reacted.

I shouted, “Fuck! We’re at war!”

Everyone looked at me.

No one said anything.

A moment earlier, there had been chatter.

Speculation.

People trying to understand what they were seeing.

After the second plane hit, the room went silent.

Faces changed.

Mouths opened.

Jaws dropped.

The look of confusion became the look of horror.

People began to understand what I had just blurted out.

This was not an accident.

This was not a small plane.

The first aircraft had not been a Cessna.

It was a full airliner.

So was the second.

We were under attack.

And I was sitting in a wheelchair in Nuclear Medicine.

Again.

I was away from where I thought I should be.

Again.

The day kept moving, even though everything had changed.

I got my scan.

The test happened while history unfolded.

Eventually, I was returned to my bed.

My doctor came to see me.

The news kept coming.

The towers had collapsed.

I was in a hospital bed, hearing words I could not fully process.

The towers had collapsed.

Even now, I do not think that sentence makes sense to anyone who knew those buildings.

They were too big.

Too present.

Too much a part of the skyline.

Too much a part of New York.

Too much a part of us.

Later that afternoon, a fellow officer called me from Ground Zero.

His name was Danny.

We had a long conversation, but one line is the one I remember.

He and I were both police officers.

But he was not talking about my police skills.

He was talking about my paramedic skills.

He knew what I brought to a scene.

He knew what I could do.

And he knew they needed people who could do it.

That hit me hard.

It still does.

I had spent years thinking about 1993 and how I had missed the job of the century.

Now I was missing something even bigger.

The call of a lifetime.

The call of the century.

The call of the millennium.

Whatever words I used in my head at the time, the feeling was the same.

I should have been there.

My unit had been mobilized to perform perimeter security at The Pile.

If I had not been in the hospital, I would have been with them.

My doctor knew it too.

At some point, my primary care physician checked in with me. She had the results of the testing.

The pain had not been caused by a re-occlusion.

It was Prinzmetal angina, also known as vasospastic angina.

A spasm of the coronary artery.

Not another blockage.

That was good news.

Then she asked me a question.

“If you weren’t here, would you be there?”

I told her yes.

There was no hesitation.

Danny’s phone call had already proved it.

That was where my unit was.

That was where I would have been.

She looked at me and said, “I’m glad you had chest pain.”

It was an odd thing to hear.

It was also one of the most honest things anyone said to me in those days.

She was not wishing me pain.

She was not being cruel.

She was not minimizing anything.

She was grateful that something had kept me away.

Two weeks later, when I saw her in her office for a follow-up visit, she apologized for saying it.

I told her there was no need.

I understood what she meant.

She was glad I was alive.

She was glad I had not been there.

At the time, I understood her words.

But I did not fully accept them yet.

Not deep down.

Because the responder in me still felt helpless.

I had watched the attacks from a hospital.

I had heard the reports from a bed.

I had spoken to a friend who was there.

I had been told my skills were needed.

And I had not been able to go.

As the weeks unfolded, I heard stories from fellow officers who had been there that morning and in the days after.

I heard how things went down.

I heard what they saw.

I heard what they smelled.

I heard what they carried with them.

There are things people bring home from scenes like that, even when they do not know they brought them home.

One night, I remember sitting up in bed with Mary Kay.

We were watching a tribute to the fallen.

Names.

Faces.

Stories.

Lives.

My wife had tears in her eyes.

She looked at the television and said, “If you’d been there that day, you’d probably be one of those dead yahoos.”

That was Mary Kay.

Plain.

Honest.

Loving.

Direct.

She knew me.

She knew my passion for helping people.

She knew my dedication to the job.

She knew my pull toward service.

She knew if I had been there, I would have gone where I thought I was needed.

Not because I was fearless.

Not because I was special.

Not because I was trying to be a hero.

Because that was the work.

Because that was who I was.

Her words echoed what my doctor had said a few weeks earlier.

I’m glad you had chest pain.

If you’d been there, you might not be here.

Still, in those weeks, I kept asking myself the same questions.

Why wasn’t I there?

What was my purpose?

What was my why?

I would eventually return to work in October, but only in a light-duty capacity.

I went to Ground Zero in person once in October and again in November.

I was not there on September 11.

I was not there for the collapse.

I was not there for the first hours.

But I did stand there afterward.

I saw the destruction.

I smelled it.

I felt the sorrow.

There was a weight there that is hard to explain.

It was more than wreckage.

It was more than twisted steel.

It was more than smoke and dust.

It was absence.

Thousands of lives gone.

Families broken.

Departments grieving.

A city wounded.

A country changed.

And around it all were responders still working.

Still searching.

Still standing watch.

Still doing what responders do.

I carried a strange mix of emotions.

Grief.

Gratitude.

Guilt.

Pride.

Frustration.

Helplessness.

Purpose.

All of it lived together.

That may be hard to understand unless you have done this kind of work.

You feel grateful to be alive.

You feel guilty that others are not.

You feel relieved that you were spared.

You feel ashamed that part of you wishes you had been there.

You know better than to say that too loudly.

But it is there.

Not because you wanted anyone hurt.

Because you wanted to help.

There is a difference.

A big one.

What I Understand Now

For a long time, I thought I had missed the World Trade Center twice.

In 1993, a broken thumb kept me away.

In 2001, chest pain kept me away.

The first time, I thought I had missed the job of the century.

The second time, I thought I had missed the call of a lifetime.

Now, after all these years, I see it differently.

That is not something I say lightly.

And I do not say it in a way that makes my life worth more than anyone else’s.

It is not.

The people who died that day mattered.

The people who died years later from World Trade Center-related illnesses mattered.

The firefighters, police officers, EMS providers, construction workers, volunteers, and others who breathed that air, worked that pile, searched that site, and paid for it later mattered.

Some were people I knew.

Many were people I never met.

Over the years, I have watched thousands of first responders and recovery workers die from cancers and other illnesses connected to that work.

That changes the way you understand survival.

It changes how you look back.

It changes the story.

When I was younger, I saw myself as the guy who missed the big job.

Now I see myself as someone who was spared from something I did not understand yet.

I was not meant to die in 1993.

I was not meant to die in 2001.

I believe that with deep conviction.

Maybe someone else needed me later.

Maybe someone still does.

Maybe the purpose was a patient I treated.

Maybe it was a new EMT I encouraged.

Maybe it was a paramedic I mentored.

Maybe it was a coworker I listened to when they were hurting.

Maybe it was my family.

Maybe it was a student.

Maybe it is someone I have not met yet.

Maybe it is someone who will read something I write and feel less alone.

I don’t know.

I don’t get to know all of it.

That may be the hardest part.

We like answers.

We like clean lines.

We like to know why things happen.

Most of life does not work that way.

Sometimes we only see pieces.

A broken thumb.

A lunch with your parents.

ESU trucks racing the other way.

A television in an apartment.

A blocked artery.

A hospital bed.

A wheelchair.

A second plane.

A phone call from Ground Zero.

A doctor saying she was glad you had chest pain.

A wife crying in bed, telling you that you might have been one of the dead.

At the time, those moments did not feel connected.

Now they do.

I have work left to do.

That is what I believe.

I am still here for a reason.

That reason may not be dramatic.

It may not be public.

It may not come with lights, sirens, smoke, cameras, or history.

It may come in a quiet conversation.

It may come in a classroom.

It may come in the front seat of an ambulance.

It may come at a kitchen table.

It may come through something I write.

It may come through one sentence said to the right person at the right time.

That is enough.

I used to think the extraordinary moments were the big ones.

The calls everyone talks about.

The ones on the news.

The ones that become history.

But maybe my friend Barry was right when he reminded me that much of what I considered ordinary was extraordinary to others.

And maybe Scott was right too, when he wrote about the small moments that rarely seem remarkable while we are living them.

Maybe what we call ordinary is often anything but ordinary.

A lunch with your parents.

A wife who knows your heart.

A doctor grateful you are alive.

A friend calling from the pile because he knows what you would have brought to the scene.

A life spared.

A purpose unfinished.

I have told this story many times.

For years, I told it as the story of two days I missed.

Now I think it is the story of two days I was kept away.

And because I was kept away, I am still here.

Still serving.

Still teaching.

Still learning.

Still trying to help.

Still waiting for the next person I am meant to reach.

By word or by deed.

One call.

One conversation.

One moment at a time.

About the Author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire service, and law enforcement. He writes about the calls, people, and moments that shaped his life in service, and the lessons that continue to follow him.

A Note of Thanks

This piece began after reading Scott Bukofsky’s Substack reflection, “For the Days We Get,” written for the day after Memorial Day. His words about the small moments we often call ordinary, but later understand as extraordinary, brought this story back to me in a different way. I’m grateful for the reminder, and for the push it gave me to finally write this down.

“He’s a bad asthmatic,” my partner said as we headed to the call. “Last week we had to hit him with Epi when we walked through the door. We dumped the whole protocol. Mag drip and all.”

It’s just after midnight.

That was not what you want to hear while responding to a male caller complaining of difficulty breathing.

It raised the stakes before we ever got there. This was going to be legit. This was going to be a job where we would have to work.

When we pulled up, the first thing that felt off was how calm everything looked.

No porch light on. No front door open. No one outside waving us in.

A cop at the door asked if we had the same address, he did. We were all trying to verify. Rockland EMS and the police dispatcher both tried calling back. No answer. We kept knocking.

A woman finally came to the door looking genuinely surprised. She said she had not called. That threw all of us off. Wrong address? Prank call? At this hour?

She called out for her husband. No answer.

Then she went downstairs. No rush. Matter of fact. Nothing about it felt urgent, almost like this had happened before.

When she came back up, everything changed.

“I don’t think he’s breathing,” she said, her voice breaking.

The look on her face said the rest. Dismay. Disbelief. Frantic, choppy movement. Not knowing whether to turn this way or that. Not knowing what to say or where to go.

She led us downstairs.

It was her first. Then my partner. Then the female EMT. Then me. Then the male EMT and the officer behind us. The staircase was tight, steep, narrow, and cluttered with piled-up items. As I sized it up coming down, I remember saying to myself, “Oh boy, this is going to be fun.”

Not funny. Just the kind of dry line you say in your own head when you already know the room is going to fight you.

The basement hit all at once.

Pet dander in the air. Dim incandescent light. Stacks of belongings everywhere. My nose starting to get stuffy. Limited space. The kind of environment we used to try to recreate in school for students because you knew one day they would get stuck in a place exactly like this and have to make it work.

We found him sprawled across the bed.

The first thing that hit me was the color. Purple. Cyanotic all over. Not the look of someone struggling to breathe. Not even the look of a really sick asthmatic still fighting for air. This was a flaccid, lifeless body. The hissing nebulizer was still in his open hand. His inhaler was on the floor. The TV was on, playing something about the Chicago mob and Al Capone.

My first move was not dramatic. It was practical. I looked left, right, and behind me trying to figure out where I could even put the LifePak 15 down.

Because the room was that cramped.

My partner was first in because the stairs forced us into single file. He went right to the patient, checked the carotid, and in the same breath started directing the room.

“Begin chest compressions.”

The female EMT went to work immediately.

“We need to move some of this out of the way and get him on the floor.”

No raised voice. No panic. No over-talking. Just calm, simple directions.

We cleared enough space and got him onto the floor so we could work him on something firm. He took the head. I knew my role and went for IV access. I asked the officer to put his flashlight over my shoulder so I could see the patient’s hand better.

As I was getting the line, my partner said, “Let’s get some Epi on board.”

Again, calm. Clear. Direct.

We were all seasoned enough to know what had to happen next. This BLS crew had worked serious calls before. I had worked with them before too. Nobody was flailing. The room had a groove, and everyone was in synch.

He intubated him in that basement. First attempt in spite of the less-than-ideal alignment and having to be up on his knees. I started the IV and got fluids going. Got the monitor pads on. Asystole. Flatline. No cardiac activity at all. We put the LUCAS on and got to work.

The TV kept playing.

We never found the remote, and even if we had, nobody had time to care. The room was too disheveled to expect easy order from it. Our priority was the recently dead man on the floor.

At some point, the rhythm changed. My partner charged the monitor and defibrillated him. Then we kept moving. CPR. Medications. Reassessment.

The real shift did not come with the shock itself. It came when we checked again and saw a rhythm that could and should perfuse.

He was at the head checking the carotid and having trouble feeling it. Being closest to the wrist, I went for the radial. Not the preferred location for a pulse check in a cardiac arrest situation, but the one I could get to fastest.

I felt it.

Bounding.

He was back.

And that was when the room changed in a whole new way.

Not celebration. Not relief.

The earlier “Oh boy,” now coming to fruition.

Because now we did not only have a basement arrest. We had a living, unstable patient in a cramped, cluttered room with a steep, narrow staircase and a pile of equipment that all had to come back out with us.

I started handing nonessential gear to the officers to take upstairs and get it out of our way. We needed more hands, and we were going to need them fast. We had called for additional police officers to help get him and the equipment out.

That was the next problem. Keep him alive. Get him out.

We moved him upstairs, got him outside, and onto the stretcher.

As the police officers and EMTs were loading him into the ambulance, my partner said he might need pressors for his blood pressure. He was already thinking ahead.

I knew he could draw them up, mix them, and give them himself. That was not the issue. The issue was the weight of everything else already sitting on him. Fresh post-arrest patient. Airway. Hemodynamics. Possibility of rearresting. The kind of cognitive load that grows fast in the back of a moving ambulance.

So, I asked, “Do you want to take it in double ALS?”

He said, “Sure.”

We both climbed in.

In the bright fluorescent light of the ambulance, I could finally see him clearly. The patient was pink again. Not healthy. Not safe. Still critical. But no longer that purple, lifeless man on the bed in the basement.

The female EMT was across from my partner on the BVM, ventilating through the endotracheal tube. I was at the head in the captain’s chair. My partner was on the crew bench, calm and focused, comfortable in his own skin.

Then the EMT said, “I think he’s gagging.”

My partner answered right away. “That’s a good thing. It means there’s some intact neurological function.”

She looked relieved. She said she had never seen that before.

Then his eyes opened.

At first the blinking was slow. Then his eyes started moving around, as if he were trying to take in what was happening or what had happened to him. The eye movement was purposeful.

That was the turn.

This was no longer us going through the motions on a futile call. This was no longer just a perfusing rhythm on a monitor. We had actually done something. We had made a difference.

As the gagging continued, my partner was already reaching for the Versed. Humane. Appropriate. The next right move without anyone having to tell him.

The EMT had more questions. Was that normal? What about the heart rate? My partner kept explaining as he went. Teaching. Reassuring. Leading.

I mostly faded into the background with the occasional nod while he handled the patient and the conversation at the same time.

He called the ED and gave a steady, competent report over the cellphone.

Only after that, with a slight look of surprise at himself, he said this was his first cardiac arrest as a paramedic.

That made the whole thing even better to me.

He had seen arrests before. As a youth squad member. As an EMT. As a paramedic student. But this one was his first for real, and he was carrying himself like he had already been there.

A little later, after the report was given and the back of the ambulance had settled into that rare moment where you realize the call has turned in your favor, some praise got passed around.

That was when I downplayed my part and said, “I’m just here as your emotional support paramedic. This is all about you.”

Everyone laughed.

And it was.

At the hospital, he never lost the room.

Doctors, nurses, respiratory therapy, registrar. Questions coming from different directions, almost on top of each other. He stayed cool. Kept the details organized. Directed his voice where it needed to go. Controlled the flow instead of getting pulled apart by it.

A lot of people can work during the action and then come apart during the handoff. He did not.

He brought the patient in alive. Pink again. Eyes opening. Gag reflex intact. Sick enough to go straight into the SICU. The last we heard, he was admitted.

Then we stepped back outside into the ambulance bay.

The air was crisp and cool. One of the nurses was out there on break with a cigarette, probably taking her own breath after the excitement, we had brought in. We started cleaning the equipment and putting everything back together for the next call. Always at the ready.

That was when it hit me most.

The feeling that we had just pulled off something rare.

Not every pulse back turns into this. Not every post-arrest patient keeps it through the stairs, the stretcher, the ambulance, the ride, and the handoff. Not many get admitted.

As we were cleaning up, the female EMT asked her partner, “What do you think is better, delivering a baby or getting a save?”

The conversation rolled from there while we reset our gear and got things back in order. I do not remember every line of it. It was one of those autopilot crew conversations that just happens in passing after a call like that. But I remember where we landed.

A true save like this one rocks.

And standing there in the cool air of that ambulance bay, putting things back in order for the next run, I felt the pride and the privilege of both. Being part of a team that had pulled off something rare. And watching a newly minted paramedic lead the kind of save you never forget.

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Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve

By then, the end was finally starting to feel close.

Not close enough to relax. Not close enough to coast. But close enough to feel it.

I was about four weeks out from the original course final, the New York State certification exam, and the New York City REMAC exam. I only had a few clinical ride-alongs left. We were deep into review mode in paramedic class, close enough to the finish line to see it, but still far enough away to know you could trip before you got there.

That summer, I would stop by the Brooklyn College EMS office just before lunch to see a friend.

She was a fellow volunteer, an EMT, and one of the people helping hold the place together during the quieter summer stretch. Her research class met in the mornings, and by the time I got there, it was often just the two of us in the office.

I usually sat behind the dispatcher’s desk, where I would have been signed in anyway during those summer sessions. The desk was handmade, mahogany-stained wood, with a raised far end that gave a little separation between the person behind it and the rest of the room. In front of me were the things that always lived there. The clipboard with the call receiving form. The open logbook, front and center. The dispatcher’s handset within reach.

She sat a few feet away in the body of the room. Close enough to help. Far enough that it still felt like its own kind of test.

The room had its own summer personality.

Heavy air. Stifling, even with the window open. The shade drawn to cut the glare. A fan on the right edge of the desk, whirling and oscillating, sweeping brief bursts of air across me that did little except remind me how hard the room was fighting the heat. The fluorescent lights hummed overhead. Campus itself was mostly quiet that time of year, so the room never had much outside noise to compete with. When I paused to think, the silence was broken mostly by the fan and the lights.

And by my own frustration.

We had a deal.

I wasn’t getting ice cream from the nearby Häagen-Dazs until I could recite the NYC REMAC pediatric protocols by heart, word for word, without prompting.

It was playful, but it was also real.

There was no actual enforcement, of course. No contract. No consequence beyond my own integrity. If I wanted to go get ice cream anyway, no one was going to stop me. But that was never the point. The deal only worked if it meant something. And it meant something because I needed it to.

At the start of our sessions, I would hand her the small protocol booklet we had been given in class. It was the 1987 version. Pocket-sized. Color printed. Water-resistant pages with little icons at the top that matched the protocol. Ours were still pristine then, prized in a way only people from that era of EMS education would fully understand. Older versions had been typed and Xeroxed on full-sized paper. This felt like something you had earned by making it that far. Mine had my name written neatly in blue block letters on the inside front cover, sharp against the white, the way I had learned years earlier in a technical drawing class.

She would flip through to a random page while I waited in silence.

I never saw the protocol itself. Only the cover or back cover in her hands.

Then she would look up and say something like, “Okay. Give me pediatric anaphylaxis.”

And I would either start blurting it out if I knew it.

Or say, “Uhhh...” if I didn’t.

Back then, memorization was the job before the job.

You were expected to know it cold. On the tests, there were no little aids to save you. No quick check. No safety glance at a card or screen. If you wanted to pass, you carried the words in your head. Every dose. Every route. Every detail that could turn dangerous if you got lazy with it.

The pediatric protocols felt like their own test inside the larger one.

Weight-based dosing has a way of sharpening your attention. So do decimal points. The difference between 0.01 mg/kg IV or IO and 0.1 mg/kg down the ET tube was not academic to me. It felt heavy. The same medication could mean different things depending on how it was given, and that made recall harder. You weren’t only memorizing words. You were trying to organize pressure in your head.

Most days, she would quiz me on one protocol until I had it clean.

Later, once I had more of them down, she’d jump around on me. Rapid-fire. Different protocols. Different routes. Different details. She might say, “What’s the dose of X in the Y protocol?” Difficulty built as recollection improved. It was a simple method, but it worked.

She was patient with me.

That mattered.

As an EMT at the time, she did not necessarily understand every line I was reciting or every reason one phrase mattered more than another, so there was never that edge of frustration that can creep in when someone thinks you should know it already. She was not there to judge me. She was there to help me get there. Sometimes she would offer a hint, just enough to prod my recall without giving me the answer. Just enough to keep me moving.

I can still picture myself in those moments when I got stuck.

Eyes rolling up and to the left. Brows pulling down. Lips tightened. Looking, I am sure, like someone trying to drag a fact back into the room by force of will alone. At times I felt real frustration, especially when I thought I should have had it and didn’t.

When I hit a real roadblock, I would ask for the booklet back. Sometimes I wouldn’t even ask. I would simply extend my arm toward her and she would know. She’d hand it back, and I would mumble the words under my breath, sometimes repeating a section more than once, trying to rebuild the sequence in my head.

Then I’d hand it back.

And we would start again from the top.

Always from the top.

That was the understanding.

Because this was not only about remembering a dose. Lives depended on knowing it cold, top to bottom, including the parts where I might have to call medical control and paint the picture clearly enough for a physician to trust what I was asking for. What the scene looked like. What the patient looked like. What I found. What I had done. What worked. What didn’t. What I wanted permission to do next. Confidence mattered as much as the image.

So, I kept chasing the words until they were mine.

That was the rhythm of those summer afternoons.

She would ask.

I would start.

Sometimes I would get a little momentum.

Sometimes I would stall out halfway through and fight for the next line.

The fan would keep turning.

The lights would keep humming.

The room would stay hot.

And Häagen-Dazs would stay just out of reach until I got it right.

Every now and then, someone would come in needing help. Once, it was someone with a splinter in a hand from one of the staircase banisters. In an instant, we would shift from relaxed study mode to business mode. Patient care came first. We handled what needed handling, the way we were there to do. Then the room would settle again, and she would reopen the booklet or look back up at me and say, “Okay, where were we?”

And we were right back in it.

It was such a small ritual.

And it meant everything to me.

Because beneath the ice cream and the teasing and the summer heat, there was something much bigger going on. I was on the long road to getting my card. Every clinical. Every review session. Every protocol I forced myself to own. It was all part of becoming the kind of paramedic I was trying to become.

Eventually, I would get one right cleanly.

No prompt.

No rescue.

No circling back.

And when I did, she’d smile and give me exactly what I had been waiting for.

“Good, let’s go.”

She was as eager for a cup as I was.

We would close up shop the way we were supposed to. Sign off the air. Notify security. Sign out.

M. Chanat, #637 signing out as Dispatcher.

G. Zarrin, signing out as Med-1.

Then came the click of the switch as the lights went off, and the sound of the dark brown steel door pulling shut behind us, the big blue Star of Life on it catching the last of the hallway light.

That was the real changeover.

Literally and figuratively.

A few minutes later, a couple of blocks down and across from Boylan Hall, the work was done, the deal was honored, and the sight that made it real was not the first bite.

It was watching the scoop of Rum Raisin drop into a waffle bowl.

That was the signal.

That was the deal.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve

.

We had come back to the office between calls to restock.

Business as usual.

It was probably early afternoon. No later than two. The hospital hallway outside was busy in the way hospitals always are. People moving with purpose. Staff coming and going. Doors opening and closing. Phones ringing somewhere out of sight. Nothing about the day felt unusual. Nothing hinted that, in a matter of moments, I would walk out feeling like my life had shifted.

Then I was told the supervisor wanted to see me.

I did not know why.

That short walk across the hall could not have been more than ten feet. Door to door, it was nothing. In my head, it stretched into something much longer. My mind started doing what minds do when they are handed uncertainty and no facts. It filled in blanks. It searched for trouble. It ran ahead of reality.

I did not know then that this kind of what-if thinking is normal. I only knew that the walk felt a lot longer than it was.

I stepped inside.

The office itself was small and unassuming. There were ambulance call reports spread across the desk, the usual paperwork waiting to be reviewed and processed before being filed away. It looked like a working supervisor’s office, not some grand place where life-changing moments were supposed to happen.

He was seated behind the desk in a high-backed office chair, upright but relaxed. Shirt and tie, as always, though the collar was open and the tie slightly loosened. He had that same approachable look he always carried. Warm. Welcoming. The kind of person who did not need to raise his voice or harden his face for you to understand when something mattered.

My nervousness did not come from him.

It came from the office.

From his title.

From being called in and not knowing why.

Then he smiled, looked at me through his glasses, and in a soft voice said something close to this.

“Michael, how would you like to work here after you get your card?”

For a second, my mind lagged behind reality.

From the start, those units felt like the kind of place I hoped I might one day belong. Even back when I was only an EMT student, there was something about the people there that stayed with me. The paramedics I had the privilege of riding with and learning from were welcoming, knowledgeable, generous with what they knew, and the kind of people you would trust with your own family. They had the kind of character and demeanor I respected deeply. I already felt at home there, even before I had any official reason to.

And now the supervisor was asking if I wanted to work there.

It is hard to describe a moment like that without flattening it.

For a moment, I just sat there, surprised and thrilled, trying to catch up to what I had just heard. I am sure there was a pause before I answered. A beat where the question hung in the air and I tried to make sure I had heard it right.

Then came the only answer that made sense.

Yes.

Probably not a polished yes. Probably something more emphatic than that. Something closer to the kind of yes that comes out when joy beats composure by a step or two.

He told me to go to Human Resources and fill out an application.

Even then, there was a small part of me that felt nervous. I did not think I showed it, but I felt it. I trusted his guidance and did exactly what he said. That trust mattered more than I understood at the time. Back then, I only knew that someone I respected had opened a door and told me where to walk next.

So I walked.

The first trip across the hall had felt like an eternity.

The second felt like I was floating.

I was on cloud nine. There was a bounce in my step. I probably smiled the whole way there. I replayed his words in my head over and over as I walked, still trying to absorb the fact that this place I admired, this place where I already felt welcomed, had just made room for me in a real and official way.

When I got to Human Resources, there was a friendly woman there. I told her who I was. The supervisor had already called ahead. He had even anticipated the question about my certification and told me what to say when it came up, that he had a copy and would bring it over.

She accepted that and simply kept processing the application.

No friction.

No interrogation.

No stumbling.

Just the quiet confirmation that I was expected.

I can still picture the light in that office. It was a sunny day, and the beams coming through warmed the room. That warmth matched the moment. It matched the feeling.

I was standing there in navy uniform pants and a plain white student shirt with an EMT patch on it. No agency identifiers. No sign yet that I belonged to anyone. Just a student ID clipped to my left epaulet.

But that afternoon, it felt real.

Not because I had never been welcomed there before. I had. That was part of what made the moment so powerful. I had already felt the trust, the kindness, the sense of belonging.

This was different.

This made it official.

A few steps across the hall.

One question.

And a future I did not see coming.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve.

I was sitting at the desk at the station, checking work emails, when the phone rang.

Routine.

My partner was in the next room, at the station tablet, finishing the call log. I had already written the report in my head. The call had been simple. A psychiatric transport from a state facility in our primary response area to the local receiving hospital. Nothing dramatic. Nothing especially memorable. The kind of call you do, document, and move on from.

I picked up the phone.

“Hey Mike, the hospital found a gun on our psych patient.”

I remember blurting out, “WHAT?”

Not because he sounded panicked. He didn’t. His voice was matter-of-fact, steady, professional. There was disbelief in it, but no accusation. No heat. Just the kind of tone people use when they are trying to say something out loud that still does not fully make sense to them.

He repeated it.

The hospital had found a gun on the patient.

And just like that, the call I had already mentally filed away came roaring back to life.

A little while earlier, my paramedic partner and I had responded first in the fly car. We were waiting for the BLS ambulance to arrive for the actual transport. The patient had gone voluntarily to the clinic for help. He had stopped taking his prescribed medication a few weeks earlier and felt himself starting to unravel. A friend had noticed changes and pushed him to go in.

We were escorted inside by the facility’s peace officers and brought to a small office. The doctor had already been sitting with the patient for over an hour, interviewing him at close range. When we walked in, the patient was pacing a little, anxious, maybe restless, but nothing about him felt alarming. He was cooperative. He answered questions. He did not present as combative, threatening, or out of control.

My partner and I did what we always did. We took in the room. We spoke with the doctor. We spoke with the patient. We gathered the information we needed to decide whether this needed ALS involvement or whether BLS could handle the transport safely and appropriately.

It looked straightforward.

The BLS crew arrived. We shared the doctor’s findings and our own. They were comfortable taking the patient on their own. We were comfortable with that too. No need for sedation. No need for extra hands. No need for us to continue in.

The patient left with them.

We went back in service.

That should have been the end of it.

Instead, I was now sitting at a desk, phone in hand, feeling my stomach drop as the BLS chief filled in the rest.

The transport itself had been uneventful. No struggle. No sudden behavior change. No clue that anything was wrong. They arrived at the emergency department, gave report to the triage nurse, and were directed to bring the patient into the secure psychiatric holding area. To get there, the patient had to pass through a metal detector and sally port.

That was when the alarm sounded.

Security wanded him, patted him down, and found a handgun concealed in his waistband under his clothing and bulky winter outerwear.

A handgun.

Not a knife clipped in plain sight. Not something half hidden and easily guessed at if only we had looked harder. A concealed handgun. Hidden well enough that neither the doctor, nor the peace officers, nor my partner and I, nor the BLS crew had any reason to suspect it was there.

I sat there in disbelief, listening, replaying the call in my head in real time. The office. The pacing. The questions. The calm. The handoff. The complete ordinariness of it all.

Then came the wave that hit hardest.

Not embarrassment.

Not defensiveness.

Horror.

The horror of what could have unfolded.

The doctor had spent more than an hour sitting within arm’s reach of this man. We had stood with him, questioned him, assessed him, and moved him through what felt like a routine process. The BLS crew had transported him without incident. Everyone had done what made sense based on what was in front of them.

And still, a loaded truth had ridden quietly underneath the whole call.

I remember feeling grateful for the phone call.

That might sound strange, but I was.

The chief did not call to place blame. He called because we had a good relationship, because information mattered, and because a near miss only teaches you something if it gets shared. It was a professional courtesy, but it was more than that. It was one agency making sure another agency understood how close ordinary had come to becoming something else.

When I got off the phone, the room felt different.

The station was the same. The desk was the same. My partner was still nearby finishing up the routine work that follows routine calls. But nothing felt routine anymore.

By that point in my career, I had already seen more than enough to know better. Long before EMS, I had learned as a police officer that complacency kills. It was drilled into us. You hear it enough and, early on, you carry it with you. Then the years go by. You get experienced. You get comfortable. You do thousands of calls that turn out exactly the way they seem they will. And without announcing itself, complacency starts to blend in with confidence.

That day, I saw that in myself.

Not because I had ignored some glaring warning sign. There wasn’t one. Not because someone had been careless or reckless. They weren’t. I saw it because I had let routine soften a truth that should never go soft.

Routine is never routine.

Not fully.

Not in this job.

As a lieutenant, I went back to the facility and spoke with the head of security, one of the state peace officers. By then, he had already been made aware of what happened. I wanted to make sure the information had been shared all the way through and that a process discussion followed. I wanted something useful to come out of a call that could have gone in a much darker direction.

That was the last I heard directly about it. What I do remember is that pat downs started happening regularly after that when transport was required. State police and local police were brought into the conversation too, in line with the safety concern. A gap had been exposed, and people moved to close it.

That mattered.

But the bigger change for me happened quieter than that.

It happened in my own head.

That call reminded me that scene safety and personal safety are not boxes you check at the start of a call and then forget once the patient seems cooperative. They are not habits you get to retire because a scene feels familiar, or because the patient is polite, or because the doctor is calm, or because the transport sounds straightforward.

They have to stay alive in your mind.

The call was over.

Then came the call after the call.

And that was the one that stayed with me.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve

By the time we had them on the living room floor, the room was already full.

Not crowded in the way people think of crowded. Small apartment. Third floor walk-up. Sometime after midnight. Hardwood floors. A couch pushed too close to the wall. A lamp still on. The kind of room built for ordinary nights, not this one.

The child was eleven.

My paramedic partner was at the head of the patient getting ready to secure the airway by way of endotracheal intubation. The two EMTs from the BLS crew were moving with us, opening equipment, handing over what was needed, doing the work that keeps a resuscitation moving. I was coordinating and taking charge of the scene. Trying to keep the room narrow in my mind even if it felt wide to everyone else.

Mom stood off to one side with tears in her eyes, looking like her body had not yet caught up to what was happening in front of her. Dad was flushed, agitated, bouncing between panic and anger the way people do when the worst thing they can imagine is happening in their own home and right in front of them. He wanted action he could recognize. Movement. Urgency. A stretcher in motion. An ambulance pulling away fast enough to make him believe something was changing.

What he was seeing instead was us on the floor.

He looked at all of us working around his son and said what many people in that moment would say.

“Get him to the hospital. Why are you wasting time?”

I understood why he asked it.

To most people, the hospital is where care happens. The ambulance is what gets you there. The scene is the delay before the real treatment starts. They do not see what we see. They do not know what can be done in the field and what has to be done right here, right now, before the ambulance ever starts rolling.

That misunderstanding is not stupidity. It is distance. Most people never have to know what paramedics are capable of in the worst minutes of a life. They think of transport first. They think of sirens first. They think speed means help.

Sometimes speed matters.

But on calls like this, sequence matters more.

These are low-frequency, high-risk calls. Pediatric arrests. Status epilepticus. Children who go from sick to critical so fast that the room itself seems to tilt. Calls that test everybody. The family. The crew. The training. The ability to stay inside the next right thing instead of getting swallowed by the whole picture.

That is where panic waits for you.

Not always in the loudest form. Sometimes it comes dressed as urgency. Hurry up. Move faster. Get out of here. Do something. It reaches for the crew from the outside, and if you let it, it starts growing on the inside too.

That is why your approach has to already be there before the call ever comes in.

Thoroughly and methodically.

Not because the call is calm. It is not.

Not because the family is calm. They should not be.

Not because you feel calm. You might not.

You do it thoroughly and methodically because that is what grounds you when the room is fighting hard against order.

My partner stayed focused at the head, managing the airway, ventilating, keeping attention on what mattered there. The EMTs moved in step, one helping us with the resuscitation, one helping create a little bit of space around the family while still keeping eyes and ears on the room. We assessed what needed to be assessed. We treated what needed to be treated. We relied on the basics because the basics are not small on a call like this. Basics are the frame the rest of the care hangs on.

Airway. Breathing. Circulation. Rhythm. Access. Medications. Reassessment.

No wasted movement. No frantic improvisation. No chasing panic.

Methodical does not mean slow.

It means deliberate.

It means you do not skip steps because the room is loud.

It means you do not let someone else’s fear rush you past the science.

It means you narrow possibilities by assessing thoroughly and treating intentionally instead of reacting to noise.

Mom’s voice kept cutting through in pieces.

“Why is this happening?”

“Why?”

There are questions families ask in moments like this that do not have answers anyone in the room can give them. Not then. Sometimes not ever. They are not really asking for an explanation in the medical sense. They are asking because their world has broken open and language is all they have left.

One of the EMTs turned toward her while my partner and I stayed with the child and said,

“You’re experiencing a completely normal reaction to a very abnormal event.”

It was the right thing to say.

Not polished. Not dramatic. Not false reassurance.

Just honest.

Families do not need us to outtalk the moment. They need us to steady it. They need to know that their fear is seen and that their reaction is not wrong. Compassion does not pull us away from the medicine. It is part of the medicine. The art of these calls sits right alongside the science. You cannot do one and neglect the other.

Dad was still keyed up, still wanting motion, still looking at the door as if that was where rescue lived.

“Get him to the hospital.”

“Why are you still here?”

I looked at him and gave him the truest answer I had.

“His best chance of survival is to do these things right here and now.”

That line did not come from a script. It came from experience. From understanding that in calls like this, the floor becomes the emergency room before the ambulance ever becomes transportation. We were not standing around. We were not wasting time. We were doing everything that had to be done where it had to be done first.

People outside the profession sometimes imagine prehospital care as a bridge between home and hospital. A ride. A handoff. A delay before the experts take over.

But this is part of the expert care.

This matters.

What we do in those first minutes matters. How we assess matters. How we ventilate matters. How we organize the room matters. How we communicate matters. Whether we let ourselves get dragged into panic matters. Whether we remember the family while we work matters.

Especially with children.

Especially when the room is telling you to move before the patient is ready to move.

I have had more than one call like this. Different homes. Different children. Different endings. Some were seizures. Some were arrests. Different symptoms. Different parents. Different neighborhoods. But the lesson keeps returning to the same place.

If your everyday approach is sloppy, panic will expose it.

If your everyday approach is thorough and methodical, stress will fall back onto training.

That is what gets you through.

Not bravado.

Not volume.

Not pretending you are untouched by what is happening.

You get through by trusting your process. You get through by relying on the basics. You get through by leading the room instead of letting the room lead you. You get through by remembering that low-frequency calls do not require a new version of you. They require the same disciplined version of you, now under more pressure.

And while all of that is happening, you never forget the family.

Never.

They may not remember every intervention. They may not understand every decision in the moment. But they will remember your tone. They will remember whether someone saw them. They will remember whether the room felt abandoned to chaos or held together by calm hands and clear voices.

That matters too.

So, when the call comes in and the stress hits fast, do not make the mistake of thinking you need to become frantic to match the moment.

You do not.

You need to become more disciplined.

More deliberate.

More grounded in what you already know.

Thoroughly and methodically.

Because in that apartment, on that floor, in the worst moment of that family’s life, their child’s best chance of survival is to do these things right here and now.

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About the author

Mike Chanat is a paramedic, leader, and educator with nearly four decades of experience in emergency medical services, fire, and law enforcement. He writes about leadership, presence, and the human moments that shape those who serve