Assertive Inquiry in EMS: A Lifesaving Communication Tool for Tactical Medics

Assertive inquiry isn’t just a communication tool—it’s a lifesaving practice. By combining clear, confident observations with open-ended questions, providers at every level can voice concerns, clarify priorities, and keep patients safe in dynamic, high-pressure environments

In the high-stakes world of EMS, especially Tactical EMS, communication can mean the difference between life and death. Misunderstandings, egos, and tunnel vision can all create dangerous blind spots in decision-making.

This is where **Assertive Inquiry** comes into play—a powerful tool that blends clear, assertive communication with curiosity-driven questioning. For EMS providers, it offers a structured approach to voicing concerns, asking critical questions, and improving team coordination under pressure. For Tactical Medics, assertive inquiry becomes even more crucial, as the dynamic and often chaotic nature of tactical scenes requires precision, situational awareness, and trust among team members.

In this post, we’ll explore the origins of assertive inquiry, its application in EMS, and how it can save lives in Tactical EMS operations. We’ll also provide actionable tips to help you incorporate this tool into your practice.

The Background and Genesis of Assertive Inquiry

Assertive inquiry is a communication method that finds its roots in leadership, crisis management, and negotiation strategies. It was designed to bridge the gap between stating a perspective (assertiveness) and seeking to understand others (inquiry). It works by balancing two components:

Assertiveness: Clearly and confidently stating what you observe, believe, or need.

Inquiry: Asking open-ended, non-confrontational questions to gain additional information or perspectives.

Assertive inquiry thrives in environments where quick, accurate decisions must be made. Instead of assuming authority or being overly passive, it encourages providers to share their observations while remaining open to input.

For EMS providers, this tool directly supports the foundational principles of **crew resource management** (CRM), used in aviation and healthcare to reduce errors through clear, respectful communication.

Assertive Inquiry in EMS: Speaking Up at Every Level

EMS is inherently hierarchical. You may have an EMT-B working alongside a Paramedic or a Paramedic working with a Physician on a critical call. While this structure allows for clear roles, it can also create communication barriers, particularly when a lower-level provider sees something a higher-level provider does not.

In these situations, assertive inquiry allows team members to voice concerns without appearing disrespectful or confrontational. It ensures that every provider, regardless of their title, can contribute to patient care decisions effectively.

Example Scenario 1:

An EMT-B assisting a Paramedic notices that a patient’s breathing sounds are absent on one side.

• Passive: “I’m not sure, but it might be a pneumothorax?” (Lacks clarity and confidence.)

• Aggressive: “You’re missing a pneumothorax! We need to decompress now!” (Accusatory and confrontational.)

• Assertive Inquiry: “I don’t hear breath sounds on the left side, and I’m seeing tracheal deviation. Could this be a tension pneumothorax?” (Clear, direct, and invites discussion.)

  
  

This approach frames the concern clearly while inviting the Paramedic to consider the observation without feeling attacked.

Example Scenario 2:

A Trauma Team is rushing to treat a multi-system trauma patient, but the EMS crew—who has been caring for the patient—needs to relay critical information before transferring care.

• Passive: “Uh, we have some details, but it looks like you’re all set.” (Not clear or confident.)

• Aggressive: “Stop what you’re doing! You need to listen to me right now!” (Disruptive and confrontational.)

• Assertive Inquiry: “We’ve been managing this patient and have critical information to share, including a mechanism of injury and suspected internal bleeding. Can we take 30 seconds to relay these details before you proceed?” (Direct, clear, and respectful of their focus.)

This method ensures vital pre-hospital information is communicated effectively while respecting the urgency of the trauma team’s work.

Assertive Inquiry in Tactical EMS: Critical Communication Under Fire

In Tactical EMS, the stakes are even higher. Medics operate in environments where chaos, risk, and split-second decisions are the norm. Team members may have competing priorities—securing a scene, neutralizing threats, or evacuating casualties—which can lead to conflict or missed details.

Assertive inquiry becomes a tactical medic’s tool for cutting through the noise. It enables you to advocate for patient care while respecting the operational priorities of law enforcement or other tactical personnel.

1. Clarifying Priorities in Dynamic Scenes

Tactical Medics often face scenarios where their medical priorities conflict with the tactical operation. Assertive inquiry allows you to raise concerns clearly without disrupting the chain of command.

Example:

A critically injured officer is lying in an unsecured hot zone.

Assertive Inquiry: “I’m concerned about the officer’s condition. He’s losing radial pulses, and we’re running out of time to manage shock. Can we discuss a way to move him to cover safely while maintaining your tactical priorities?”

This phrasing identifies your concern, presents clinical reasoning, and invites collaboration without undermining the tactical team’s authority.

2. Breaking Tunnel Vision

Stress causes tunnel vision, and no one is immune. Tactical situations can lock teams into one plan, even as conditions change. Assertive inquiry helps redirect focus to overlooked details.

Example:

A team leader is focused on maintaining a defensive position due to an active shooter, but you notice two injured team members deteriorating quickly.

Assertive Inquiry: “We’re holding a solid defensive position, but I’m seeing two team members with significant injuries. Could a hasty fallback to a cold zone allow us to address their injuries while maintaining safety?”

Here, you present your observation about the injuries and propose an alternative that respects the team leader’s tactical priorities while addressing the immediate medical concerns.

3. Managing Conflicting Opinions

Assertive inquiry is invaluable when you disagree with a teammate’s assessment but need to avoid escalation. Tactical Medics often face this when working alongside other clinicians, team leaders, supervisors, or even fellow team members.

Example:

Your partner wants to focus on an airway, but you believe the patient’s bleeding is the greater threat.

Assertive Inquiry: “I see the airway is a concern, but I’m also noticing rapid blood loss. Could the bleeding be the priority here to avoid losing the airway altogether?”

This phrasing keeps the conversation focused on patient care and invites your partner to reconsider priorities without challenging their judgment directly.

Practical Implementation of Assertive Inquiry in Tactical EMS

1. Train Regularly:

Assertive inquiry must be practiced in order to become second nature. Incorporate it into tactical training, using realistic scenarios where medics must balance medical urgency with operational demands.

2. Simulate High-Stress Environments:

Create training exercises that mimic real-world stress, such as active shooter drills or prolonged field care scenarios. Encourage medics to use assertive inquiry to communicate clearly during decision-making moments.

3. Create a Culture of Psychological Safety:

Teams that trust each other are more likely to embrace assertive inquiry. Leaders must foster an environment where all team members’ observations are valued, regardless of rank.

4. Use Briefings and Debriefings:

Before missions, establish a framework for communication. During debriefs, review moments where assertive inquiry was used effectively or could have been applied better.

5. Develop Key Phrases:

Provide tactical medics with ready-made phrases to fall back on during stress, such as:

• “I’m concerned about...”

• I’m seeing/hearing...”

• “Can we discuss an alternative approach?”

6. Learn to Persist Respectfully:

If your concern is dismissed but the risk remains, escalate while staying calm and professional:

“I still see a major concern here. Can we stop and reassess before we move forward?”

Conclusion: Assertive Inquiry Saves Lives

In EMS, and especially in Tactical EMS, assertive inquiry is not just a communication tool—it’s a lifesaving practice. By combining clear, confident observations with open-ended questions, providers at every level can voice concerns, clarify priorities, and keep patients safe in dynamic, high-pressure environments.

For Tactical Medics, assertive inquiry allows you to balance medical urgency with operational priorities, ensuring that no critical details are overlooked. It’s about fostering a culture of **collaboration, clarity, and respect** where every voice matters, and every observation counts.

In the chaos of a tactical scene or a critical call, assertive inquiry gives you the tools to speak up effectively and ask the right questions when it matters most. Practice it. Refine it. Use it. Because in EMS, clear communication isn’t just about being heard—it’s about saving lives.

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Case Scenarios: Practicing Assertive Inquiry

Below are four scenarios—two in EMS and two in Tactical EMS. For each, consider how you would employ assertive inquiry. Follow these steps:

1. Identify the critical observation or concern.

2. Phrase your statement clearly and respectfully.

3. Use an open-ended question to invite collaboration or action.

Case 1: EMS

You arrive at a scene where a Paramedic is managing a patient with altered mental status. You notice the patient has cool, clammy skin and tachycardia, which suggests hypoglycemia, but the Paramedic is preparing to intubate.

Case 2: EMS

A flight crew is preparing for a rapid “scoop and run” of a trauma patient with severe facial trauma and airway compromise. You recognize that the patient is on the verge of losing their airway entirely and likely requires a cricothyrotomy before flight. The flight crew appears focused on getting airborne quickly and has not assessed the airway situation thoroughly.

Case 3: Tactical EMS

During a high-risk warrant service, an officer with a leg injury is being ignored as the team focuses on securing a barricaded suspect. You recognize signs of compartment syndrome developing.

Case 4: Tactical EMS

In an active shooter response, a team leader wants to keep pushing forward, but you notice one of the team members is showing signs of heat exhaustion and may become a liability.

Case 5: EMS

You are the new flight nurse, one day out of field training, preparing for a 30-minute flight to a scene call. The pilot is confident in proceeding but has not done an in-depth weather review. Your smartphone app shows a major thunderstorm system moving in that could complicate the flight and pose serious safety risks.

Your Task:

For each scenario, write down:

• What you would observe and state clearly.

• The question you would ask to guide the team to action.

Reflect on your responses and consider how assertive inquiry could change the outcome of each case. Practicing these situations will help you develop the confidence and skill to use assertive inquiry effectively in the field.