EMS Revisited is an exclusive column that offers reprints of various columns and articles from our archives that are not currently available in electronic format. In the January 2003 issue of EMS Magazine (now EMS World Magazine) we began a year-long series on customer care in EMS. Here we will reprint the series in its entirety.
I'll never forget the time when, as a paramedic student, I was about to start an IV, and as I reached to stabilize the vein, my patient saw the needle and jerked his arm away. "What do you think you're doing?" he cried. I hadn't bothered to tell him I was going to start an IV. I was so focused on getting everything right, I left out that small detail. Quite possibly, you've had a similar experience. We can all recite our treatment protocols cold, but our patients don't share that knowledge. Let your patients know what you are doing and why. Taking the time to explain procedures can greatly reduce their anxiety.
While you don't want the call to turn into a mini CE, explaining about a medical condition will help a patient understand what's going on. It is fear of the unknown that scares people the most. Keep it basic, but your patient will 1) see how professional you are and 2) begin to make sense of all the ECG patches, IVs and other treatments.
Some patients blindly trust that whatever you're doing is the right thing. Others question everything. Remember that you are there to help them. Don't treat them as if they are getting in the way of their own treatment (even if they are). Tell them, "I want to tell you what I think is going on." Educate them to your plan of treatment.
Go out of your way to inform patients about what they can expect when they get to the ED. Will they be "treated and streeted" in 10 minutes? Do they think they're going to die? Will they be admitted? Answer their questions as honestly as you can. You can go a long way to allay their worst fears.
If a patient is having an MI, for example, tell him you think he is having a heart attack, but the good news is that you're taking him to an excellent heart hospital and many patients who have heart attacks leave the hospital just fine. Whew! He may think all MI patients die.
Do the same for a patient's family members. Let them know what you think is wrong with the patient and explain your treatments. This is especially true if you're treating on scene. People might be upset that you are not initiating transport. Tell them, "We're doing exactly what they would be doing in the ED, and we want to start that treatment right now."
Respect any patients who do not want treatment--such as an IV, for example. Nicely explain the reason you want to start one, and inform them of possible consequences of refusing. If they are competent, don't get upset--continue to treat them with respect. Not everyone will agree with you or do what you want in life. It's their decision, and if they're properly informed, they knowingly accept the risks. You might inquire why they don't want it. If they have a specific reason, you may be able to tell them why they needn't worry.
Sometimes we find ourselves talking either above our patients' heads or down to them. It is important to constantly reassess their level of understanding and body language and adjust your vocabulary accordingly. If a patient looks confused, maybe he isn't following you--slow down and simplify. Or perhaps a patient impatiently rolls his eyes. You are insulting his intelligence--speed it up.
Unless your patient identifies himself as a medical professional, avoid using medical terms. Don't use diaphoretic when sweaty works just as well. Address a patient's concerns with patience and compassion.
Be forthright when your assessment or treatment will be uncomfortable or painful. If you have to move a patient with multiple fractures, for example, tell him it will hurt a lot. Explain why you need to move him and apologize in advance. Pain control should always be considered when a patient is in pain. It may be entirely appropriate to start an IV and give pain meds prior to moving or splinting a painful fracture. Your patient will appreciate it.