As EMS providers, we sometimes find ourselves just going through the motions of a medical call. Respond, treat, gather information, transport and get back to the station or post. How many of us break out of that mold and voluntarily take additional training because it’s interesting, provides us with an advantage and may help us better understand our patients?
Studies by leading body language experts show when individuals are tested on their ability to read and interpret non-verbal communication, those without prior training do no better than chance (approximately 50%) on the tests.1 Though emerging studies show there are individuals who do seem to have a natural ability for reading others, most people have to study and practice to become—and remain—proficient.
In August 2006, one of the FBI’s most wanted, polygamist Warren Jeffs, was captured after the SUV he was a passenger in was pulled over by a Nevada Highway Patrolman for having improper license plates. According to the patrolman, it was actually Jeffs who tipped him off. Jeffs seemed evasive, would not make eye contact with the patrolman and his visible carotid artery was pumping extremely fast.2 That led the patrolman to dig further and resulted in Jeffs’ arrest. Had this patrolman just gone through the motions and dealt with the vehicle’s driver, he may never have discovered who the passenger of the SUV really was. That’s just one example of how possessing the ability to read and interpret non-verbal communication can be a powerful tool.
Norming vs. A Quick Assessment
Some people just ooze behavioral clues, while others are aware they’re being observed and try to act as normal as possible. For those who aren’t aware just how easy they are to read, or for those who might be a danger to themselves and others, a quick assessment is probably the best way to start. People who are being deceitful and attempting to cover something up take a little more work and require some “norming.”
Norming is a way of trying to determine an individual’s baseline, or how they normally act, to better gauge their responses to specific questions and situations.1 A similar technique is used by polygraph operators when they begin their testing. However, one of the downsides to polygraph testing is that the operator usually doesn’t know the subject being tested, and because the subject knows they are under the microscope, it stands to reason they’re going to act and respond differently than they would if they didn’t know they were being evaluated. If someone close to you (family or friend) is acting a bit odd, you would notice. The reason you’d notice is because you know the person well and you know how they normally act. Considering the relatively short amount of time typically spent with a patient, EMS providers are at a disadvantage when trying to obtain information by evaluating body language. You should start any assessment with some basic, easy questions. A small sample of questions you can use includes, What is your name? How long have you lived here? What do you do for a living? Tell me what you had to eat today.
While speaking with the patient, observe their behavior not only as they reply, but as you’re asking your questions. Watch their face—do they show any expression of emotion or do they have a blank stare? Do they fidget around on the stretcher? You can also “check your math” here by saying something you both know is wrong just to see how they respond. Purposely pronounce their name wrong, repeat the wrong birthday or address back to them, mention that it’s Friday when it’s actually Wednesday. Take into account how they behave when they correct you. The patient shouldn’t have a reason to lie when they answer these questions or statements, so they shouldn’t feel uneasy answering them. Suffice it to say, the manner in which a patient responds to such simple questions or statements can serve as an indicator of how they normally act when comfortable with a question or situation. A baseline has now been established.
Now that you have a baseline, see how the patient responds to a more probing question. For example: What and how many pills did you take? Were you attempting suicide? How many drinks have you had tonight? How exactly did this injury happen? Who do you think ran the red light? If the patient behaves the same way to this type of question as they did to a norming question, chances are they’re telling you the truth about that particular question. If they behave differently, you may be on to something. When the patient responds take note of how they answer. Are their answers straightforward or do they seem long and drawn out? This is called “convince vs. convey.”1 If an individual is lying but they really want you to believe them, they’re likely to say anything to convince you of their innocence. “I know there are witnesses to the crash but I’m telling you it must have been the traffic light, it wasn’t my fault. Think about it, why would I take a chance of getting myself killed?” A person who isn’t worried about how their answer sounds because they know it’s the truth is much more likely to simply state it to you and leave it alone. They won’t feel the need to be a salesman of their own innocence.
As for physical clues, watch for tightening of the lips at the corners of the mouth, as it can be an indicator that your patient is trying to control his or her emotions.3 The muscles that control the lips are part of over 40 independent facial muscles that all fire the same way regardless of race, sex, religion, etc.3 Additionally, if you’re working on an ALS unit you have a very useful tool at your disposal: your heart monitor. While you’re asking your patient some questions, take a glance at the monitor. Do they go from a normal heart rate to tachycardic just because of your questions? How about their respiratory rate—is there a noticeable increase in response to your questions? These can be clues, but a word of caution: your heart monitor is not a polygraph machine, and any clues you get from it should only serve as additional information to help you see the bigger picture. As we all know, some medical conditions and medications can make vital signs fall out of the range we’d consider normal.
Performing a quick assessment takes far less time than norming and is a much better way to determine whether a patient poses an immediate threat to your safety. If you arrive on scene and your patient is behaving violently—physically or verbally—there isn’t much left for you to evaluate. The patient has already been pushed beyond what they can handle and you’re there because they can no longer cope. For all other call types, take in as much information as you can as quickly as you can. Asking simple questions will tell you if the patient is going to talk to you or not. Observe your patient; what is their body type? Are they physically fit? Does their body posture convey that they’re calm or does it indicate that they’re feeling uncomfortable and defensive? Hand them something, such as a pillow or blanket, to see which hand they reach with. This can tell you whether they are right or left hand dominant (very useful information) without having to worry about handing the patient something they can use as a weapon, like a pen.4 Determining whether your patient is left or right hand dominant should indicate which hand the patient is likely to use if they are going to swing at you or throw something at you. Is their personal hygiene appropriate? If a patient is in crisis, one of the first things they tend to let go is their own hygiene.
It’s worth noting patients who have been diagnosed with severe mental disorders, such as schizophrenia, may not respond or behave in ways that you would expect.5 Because these patients can be so unpredictable, attempting to digest the behavioral clues they present may be futile. Pay close attention to the other responders on scene. Are the police officers calm or are they behaving in a more “guarded” fashion? Just because a scene is determined safe to approach does not mean it will remain that way. Dispatchers can rarely give you all the information about a scene, in part because the caller may have neglected to communicate some seemingly insignificant piece of information about the patient or scene—information you would find invaluable. If police officers are escorting your patient everywhere, you should take note and pay a little closer attention than you normally would.
Learning to recognize and interpret non-verbal communication can provide EMS personnel with a unique and valuable tool to keep them safe and impart further knowledge about the patient’s behavior. Though the goal of this two-part article is to make EMS providers more aware of non-verbal communication and its potential benefits, it’s impossible for an article to encompass everything you’d need to know. It may take additional study and practice before you feel you have a firm grasp. It is highly recommended that anyone interested in learning more about this subject read through the many publications and studies authored by the individuals listed as references to this series.
1. Ekman P. Telling Lies. New York: W.W. Norton & Co., Inc., 1991.
2. CNN. Polygamist’s body language tipped off trooper, www.cnn.com/2006/LAW/08/30/jeffs.arrest/index.html.
3. Matsumoto D. Humintell, www.humintell.com.
4. Morris D. People Watching. London: Vintage, 2002.
5. Ekman P. Emotions Revealed. New York: Henry Holt and Co., 2003.
Thanks to Raphael (Ray) Barishansky who contributed to this article.
Jim Grady, EMT-B/AEMD, is logistics manager for Medstar Ambulance in Clinton Township, MI.