Honoring Those Who Say "I'm Possible"

“We were the first ambulance on the scene,“ said Carlos. “When the call came over the officer’s radio and we heard the gun fire, we took off after him. We arrived in minutes. We heard the gun fire up close now and saw people running but saw only one victim.”  The victim, a man later named “Patient No. 1,” collapsed after suffering two bullet wounds to his abdomen. Carlos immediately treated him to control the bleeding and, after surveying the scene for others, he and Joshua delivered him to the ER within minutes. Carlos’s words to the staff there: “I think you’re going to have a bunch of people coming in.”

The ER where Carlos and Joshua took Patient No. 1, Orlando Regional Medical Center, is only four blocks from Pulse. The team made the round trip in 15 minutes. Other ambulances were being held back due to the danger. The streets were flooded at this point. “That’s when we started seeing the big, big injuries — the people whose injuries were extremely critical and needed to be off the scene,” Carlos recounted. “We saw injuries we’d only read about. Joshua and I participate in national EMS competitions. Typically, the final event is a mass-casualty event designed to test what you’re made of. Our last competition before Pulse? Active shooter.”

“The patient that stands out most for me is a man who I talk to almost every day now,” Carlos shared. “We’ve become really close. When we found him he was hyperventilating, pale, had no distal pulse, and then passed out. I searched everywhere for the wound. I finally found it on his back between his shoulder blades. I didn’t have an occlusive dressing so I improvised. I used a defib pad! Once I had the wound covered, I decompressed both lungs. The patient’s chest looked full of air, and I was sure one of his lungs had collapsed. I just didn’t know which one, and there wasn’t time to think about it.” 

As Joshua recounted, “Carlos just — bam! — stuck two needles in the chest, and I saw the guy take a huge gasp of air. A double-needle decompression — that’s something someone might do once in their entire career!” Carlos added, “Joshua and I train to compete. That kind of training gives you a muscle memory and drive to do everything right the first time.” Ironically, Carlos and Joshua don’t regularly work together. Joshua emphasized, “It was such a crazy coincidence that we were together. I’d asked to be at that station because I heard Carlos was coming in. We hadn’t worked together in four years.” The Carlos-Joshua team transported and saved 13 patients that early morning.

Carlos’s and Joshua’s story illustrates how simulation is being used to instill a mindset that makes preparedness the cornerstone of patient safety. The training and competitions in which Carlos and Joshua are national champions center on simulation. The National Council of State Boards of Nursing (NCSNB) now recommends that simulation can be used to replace up to 50% of required clinical hours. Across healthcare, simulation is being used, not only to teach clinical skills, but to teach critical thinking, leadership, and teamwork skills. It is even being used to teach stress management. These are all the skills exhibited by Carlos and Joshua. “Simulate twice, act once,” is becoming an axiom for training to save lives.

We extend our sincerest respect, admiration, and gratitude to Carlos (right) and Joshua (left) for their acts of valor. We would also like to thank those in simulation who are dedicated to training people like them to achieve zero preventable harm—a goal that Carlos and Joshua pursued relentlessly without thought of self. By their own account, if it were not for their simulation-based training, they would not have been able to think as clearly and act as decisively as they did that morning. You are examples to all of us in the simulation and patient safety community of what it means to look at the impossible and reply back, “I’m possible.”