Ed's Note: Click here to order your copy of the second edition of People Care.
On the first night of EMT school, instructors usually ask things like, "Why are you here?" or "Why do you want to be an EMT?" Responses from students usually revolve around the theme of "I want to help people." The instructor typically smiles and moves on, molding minds to treat trauma patients, allergic reactions, angina--the whole list of conditions. But one condition the instructor doesn't have time to address is the human condition. It's not part of the curriculum, there's no good way to explain it, and besides, they wouldn't understand it anyway.
Once in a while, a good book comes along that becomes the compass for change. I met Thom Dick, the author of People Care, about two years ago at a speaker series the Memphis Fire Department was hosting. The lecture (really more of a journey) about taking care of people he shared with us reminded me of why, 25 years earlier, I'd said, "I want to help people." His book provides a valuable way to share that perspective--that to truly serve the human condition requires not only your best clinical skills, but the patience, understanding and compassion of a total caregiver. These are the lessons we must pass on to the providers of tomorrow.
I was able to convince the program director at Dyersburg State Community College, where I teach part-time, to include People Care as required reading for all EMT students in its multi-campus program. The reading is followed by an end-of-semester term paper in which students discuss the book. The results of these papers took me by surprise, and made me proud to have passed on to my students insights that may enable them to have long, caring careers in healthcare. What took me years to understand is, in People Care, at their fingertips.
One Student's Perspective
Joseph Stephens wants to be an EMT. He wants to take care of people, and now he knows why. From his term paper:
Caring for People
Before I read People Care, my general outlook on being an EMT was that it was all about providing medical care to people. Don't get me wrong; that's a very important part of being a caregiver. However, along with providing medical care, there are a few other aspects of being a caregiver that People Care really opened my eyes to. Some of these are sincerely treating others with respect, a genuine concern for all patients, seeing things from the patient's point of view, and being professional in both appearance and behavior.
The first aspect of care-giving I would like to address is respect. Caregivers need to sincerely treat everyone involved in a situation with respect. Starting off with introductions and asking how they would prefer to be addressed helps the patient relax and makes the caregiver seem less like a stranger. "Ma'am" and "Sir" are usually safe titles to use. Caregivers should give this consideration not only to patients but also bystanders, their coworkers and themselves. The patient isn't the only one who notices how they're being treated. Chances are they will have someone who loves them at the scene. If anyone is being treated disrespectfully, it will be noticed. A good example of this would be when responding to a cardiac arrest and the patient has a DNR order. The body still needs to be treated with respect. Comfort should also be given to the family/friends present. A caregiver needs to respect every patient and their family members as if they were their own mother, father, sister or brother. At the same time, caregivers should show just as much respect for their coworkers and first responders, such as police officers and firefighters. This should be done not only because it's the right thing to do, but also because a caregiver represents their entire ambulance service while wearing their uniform. Even though people might not notice how nice a caregiver is, they will recall how rude they were in a heartbeat!
The next aspect of care-giving that People Care made me think about is having a genuine concern for all patients. Many times a caregiver will find themselves providing care for people they wouldn't generally associate with. Every patient isn't going to be someone we would come into contact with on a daily basis. In fact, most of them won't be. The "socially acceptable" aren't the only people who find themselves in need of care. We may have to give care to criminals, drug dealers, prostitutes, homeless people and the mentally challenged. Some of these patients may become violent, angry or just flat-out rude with their caregivers. Some may even be under the influence of illegal drugs, alcohol or other foreign substances that could cause them to act crazy. They might yell, spit, bite, scratch or hit a bystander or caregiver. They are people who may be subconsciously viewed as being less than average, or not good enough.
Don't get me wrong, I like to think of all people as being equal. However, I think we're conditioned to think of ourselves as "better" than certain crowds. This book has reminded me that, as caregivers, we need to try to keep in mind that these unique patients might not have anyone who loves or cares about them. It is our job to try to fill that gap, as well as providing them with healthcare. People Care offers a good way to remind ourselves of the dignity of each person we come into contact with: "Transposition of feeling" helps us put ourselves in the patient's shoes. Seeing things from the patient's point of view is something this book reminded me to do.
I'm new to the medical field, so I don't have a lot of hands-on experience with actual patients. It's very easy to forget about what the patient feels when everything is being practiced on a plastic torso. People Care provides the reader with insight into what a caregiver might experience in real-life situations. One very important thing to remember is to see things from the patient's perspective. For instance, patients like to know what is happening with their bodies. Why do they need to have a three-inch needle stuck into their arm? Why is the caregiver putting little stickers all over their chest? Always explain each procedure and get the patient's consent before performing it. This will ease their feeling of helplessness and let them maintain a sense of control over what is happening to their body. Asking the patient what happened and finding out how they feel about the situation can help the caregiver do everything in their power to make the experience as pleasant as possible for the patient. Family members can be great sources of information when caregivers are trying to assess a situation and gain medical information regarding the patient. Sometimes the patient isn't the person who called 9-1-1, and they don't want to receive medical treatment. Being sincere in showing them respect may help keep them calm.
Professional appearance and behavior are a must in EMS, and they start with the caregiver's first responsibility: taking care of themselves. A well-balanced diet, plenty of rest and down time on off days will help a caregiver maintain a lifestyle that is healthy, as well as be able to provide the best care possible to their patients. When a caregiver is working a shift, no matter what time of the day or night it is, they must remain professional with everyone they come into contact with. Keeping a positive attitude can go a long way when providing care. It builds trust and can make the patient feel more at ease. The patient is surrounded by strangers trying to put weird things on them, and they're probably not feeling well or having a very good day. The least a caregiver can do is be nice! However, this does not mean giving false reassurance. That would be unprofessional, as well as disrespectful to the patient and their family.
My first impression of this book's title, People Care, was that it meant providing medical care to patients. Now, having read it, I think the title actually has a threefold meaning. People care refers to the medical care people receive, the genuine care and concern caregivers have for their patients, and the fact that the patients and their loved ones care about how they are treated. All of these meanings can, and should, be found within every EMS situation.
J. Harold "Jim" Logan, BS, EMT-P/IC, is a lieutenant firefighter/paramedic with the Memphis Fire Department, specializing in EMS consequence management and quality improvement. Contact him at firstname.lastname@example.org.