“Bravo 300, respond to 123 E. Main St. for an 80-year-old female dementia patient, non-emergency transport, family riding along, to Shady Acres Nursing Home.”
After grabbing a quick lunch, you and your partner head for the address. Upon arrival, you back the ambulance into the driveway of a nice, middle-class home in the middle of suburbia. The two of you carry the stretcher inside and are met in the entryway by the 50-something daughter of the patient, who fills you in on the patient’s status. As you enter the family room, you find the patient in a hospital-style bed; you also notice a man, who appears to be a little younger than the patient’s daughter, sitting on the couch. He looks toward you, moves over a little and continues staring out the window. You think nothing of him as you move to slide the patient over to the stretcher. As soon as you touch the patient, the man sitting on the couch comes unglued, flailing his arms around, screaming and getting in the daughter’s face. As you try to get a handle on things you learn the man is the patient’s son and the daughter holds the patient’s power of attorney. The daughter set up the transport and the son clearly does not agree with his sister. As you move toward the door with your loaded stretcher, the son steps in your path, locks the door and menacingly remarks, “You guys aren’t going anywhere with my mother!” Now what? Could this situation have been predicted and avoided?
Anthropologist Ray Birdwhistell, PhD, a leader in body language interpretation who coined the term “kinesics,” states, “The isolation of gestures and the attempt to understand them lead to the most important findings in kinesic research. This original study of gestures gave the first indication that kinesic structure is parallel to language structure. By the study of gestures in context, it became clear that the kinesic system has forms which are astonishingly like words in language.”1
It’s estimated non-verbal communication accounts for 60%–80% of a typical conversation. Unfortunately, years of myths have led to major misconceptions about non-verbal communication. Sometime in the 1970s, so-called body language experts claimed if a person looked up and to the right when asked a question, they were lying.2 That is not necessarily true. Another misconception was if a person could not initiate or maintain eye contact for longer than a few seconds, they were lying.2 In 1985, industry-leading psychologist Paul Ekman, PhD, and his team conducted ground-breaking research that effectively busted these and other body language myths, while at the same time rewriting the proverbial book on the interpretation of emotions and facial micro-expressions.3 One certainty that this research helped to prove was that there is not any one singular motion or action that acts as a guarantee that someone is being deceitful.4 Those who are proficient in the use of non-verbal communication understand that indicators of deception are best discovered by taking into account a combination of whole body language and facial micro-expressions.
Females may have an advantage over males, as it is widely believed by body language experts that women are inherently better at interpreting body language than men. Experts like psychologist Katherine Benziger, PhD, have published breakthrough studies and testing showing the detailed inner workings of the male vs. female brains. This research compares and contrasts not only the left and right sides of the brain, but also the frontal and basal sections, as it relates to a particular area of the brain having natural dominance over whether an individual is a thinker, more inclined to be intuitive, uses feelings more often than others, or allows sensations to get to them through the day.5
Being a powerful observer is a life skill that can be especially helpful to those in the EMS field. In order to really observe behavior and interact with an individual, normal and easy questions have to make way for deeper, probing questions. When asking a probing question, whether to a patient, family member or colleague, be as interested in what they don’t say (sometimes, more so) than what comes out of their mouth. Anyone can lie, but very few people even know what body language is or how it’s used, let alone how to mask their own. In asking that difficult question, simultaneously scan the person’s face and body. Look for sudden, subtle changes in their face, as well as changes in body posture. Be sure to look for specific “tells” that the question hit a nerve and the subject may be lying in their reply. These can include, but are not limited to, the following:
Head and Face
The skin may appear sweaty or flushed in certain areas. The whole face may go red or certain spots, such as the neck, may start to become blotchy as the “flushing” goes up the neck and into the face. This is common if a person feels embarrassed or angry with the question or situation. The skin may also become pale if a person is scared or shocked. The pupils may dilate or the eyes may dart around nervously. Too much or too little eye contact throughout the exchange can be very telling. Be cautious here though; sometimes when an individual breaks eye contact and looks away, into the air or down at the table, it might just be a sign that their brain made the switch from internal to external thinking—internal thinking being more personal and contemplative, utilized when taking in and analyzing information or strategies, and external being more recollective.4 An example of external thinking is the individual who might be trying to clearly visualize an image or statistic in their mind and finding it difficult to do while maintaining eye contact. A father makes eye contact with his son when asking him if he passed his English test, the son maintains eye contact while answering “yes.” However, when the father asks the son which of the essay-style test questions was the most difficult, the son may have to break eye contact and look away so he can try to visualize the question, word-for-word, as he “reads” it back to his father, in reply.
Along with the eyes, the eyebrows and mouth tend to work together to demonstrate emotion. With true happiness, the eyes become almost squinted and crow’s feet can be easily spotted at the outer edges of the eyelids. The teeth and sometimes the gums become visible as the mouth opens wider than normal. A true smile is different than a social smile where the mouth stays closed and the corners of the mouth pull up only slightly. With a social smile, there is very little involvement of the other facial muscles. True smiles typically last between one and three seconds.6 Anything longer or shorter may be a fake appeasement or patronizing smile. Anger shows wrinkling of the forehead and narrowing of the eyebrows.6 The mouth may be tightly closed and tense or open with teeth bared in a “rage” sign. Although the topic is about non-verbal communication, the tone and quality of the voice must also be taken into consideration. Listen for inflection (changes in tone). Stuttering or tripping on words, along with shakiness in the voice, can be a key indication of nervousness.4 This can be attributed to an individual being unsure how to reply with a believable answer, so they do their best to convince you, and in turn, themselves, that they are telling you the truth.4 The more they feel they’ve convinced you, the less nervous they may feel. This will be discussed further in part 2 of this article.
Look for sudden defensive posturing, such as arms or legs being crossed. By themselves, the arms and legs being crossed should not be interpreted as a dead giveaway because the individual may just be cold or happen to like crossing their legs when they sit down.4 Observe their feet; we tend to point our feet in the direction we wish to go. If someone just wants to get away and not have a conversation, their feet may very well stay pointed toward the door or another escape route. The belly button can work in the same manner as the feet. Body language expert Janine Driver, CEO of The Body Language Institute and author of the book You Say More Than You Think, recommends using the “Belly Button Rule” to help determine whether an individual is interested in the person they are interacting with by observing which way their belly button is facing.7 We face our belly button toward the person in whom we are most interested. If someone is “squared up” with another individual and their belly button is pointed at him or her, it is a good indication they are interested in that person or what they are saying. If they see that person as a threat, it may be seen as a way of keeping the individual in front of them and in their sights. If they angle their belly button away, it should be considered a sign of disinterest or trying to end the conversation quickly. This is especially true if they simultaneously turn their shoulder away, exposing their back. Nothing says, “I don't care,” like giving someone the cold shoulder.
The hands may not seem relevant, but they definitely provide their own clues. Some people like to talk with their hands and use many illustrators as a way of communicating. When the hands are open with the palms facing up, it is generally seen as a sign of openness. In anger, the hands may be clenched into fists. If the entire hand is stuffed a pocket, it may be a way of signaling a person feels uncomfortable. Keeping the hands cupped behind the back can be seen as a sign of confidence and comfort, since the individual is not subconsciously protecting the vital organs in the front of their body.8
The study of body language and detecting lies is considered a learned technique. Paramedics are taught how to intubate a patient in class, but true proficiency in this skill comes with practice, experience and studying the literature. Body language interpretation is no different. Experienced EMS providers tend to go with their gut, which just might be an early sign that they’re picking up non-verbal clues.
As EMS providers, we get lied to for a living—it comes with the territory. Maybe a patient is embellishing the severity of their pain so the paramedic will administer more pain medication. Or it could be a patient involved in an accident not being 100% truthful about the amount of alcohol they consumed. Or their intentions may be of a more sinister nature, such as a suicidal or homicidal patient professing that they’ll behave on the way to the hospital and certainly would never think of harming the nice paramedic or themselves.
Let’s return to the aforementioned call and the son’s confrontation.
You carefully approach the son and try to defuse the situation by explaining the rules you are required to follow in regard to transport options and power of attorney issues. You scan the vicinity for anything that could be used as a weapon, while trying to determine whether the son is truly a threat or simply very emotional at the moment. You offer to get your supervisor involved to help the son out, explaining that you have to step outside to call on the radio because the signal in the home is very weak. Once outside, you radio dispatch for police assistance and request a supervisor come to the residence.
It’s possible this confrontation could have been predicted. This call actually happened to me. Knowing what I know now, I should have seen it coming. Upon arrival to the scene, the son was very despondent, and refused to make eye contact or acknowledge EMS. He had his feet angled toward the door, his face was red, he could not focus or sit still, and he kept his back to us. The signs were definitely there, we just didn’t know to look for them.
There is definite value in learning to detect deception and understanding body language is a powerful tool. Not only will it further an EMS provider’s understanding of a patient, it may also help ensure the safety of the ambulance crew—and personal safety should be a primary concern for every EMS provider.
1. Birdwhistell RL. Kinesics and Context. Philadelphia: University of Pennsylvania Press, 1970.
2. Navarro J. What Every Body Is Saying. New York: Harper Collins, 2008.
3. Ekman P. Emotions Revealed. New York: Henry Holt and Co., 2003.
4. Ekman P. Telling Lies. New York: W.W. Norton & Co., Inc., 1991.
5. Benziger, Dr. Katherine. Benziger. 2011. 15 September 2011. http://www.benziger.org/
6. Matsumoto D. Humintell, www.humintell.com.
7. Driver J. You Say More Than You Think. New York: Crown Publishers, 2010.
8. Morris D. People Watching. London: Vintage, 2002.
Jim Grady, EMT-B/AEMD, is logistics manager for Medstar Ambulance in Clinton Township, MI.