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Patient Care

Impressions Are Everything

As prehospital professionals, we are constantly reminded that our non-verbal actions often speak louder than words. We are always representing not only our agency and our systems, but our profession as well. While it is quite easy for us to speak about the “hard skills” which we use to save lives—CPR, endotracheal intubation, cardioversion, specific medications, etc.—it is quite another to speak about and demonstrate the “soft skills” which we use to make an impact in the lives of our patients and their families. Soft skills include our compassion, tenderness, ability to listen and selflessness.

The impact of the soft skills prehospital professionals use never struck closer to home than it did this past year, when my family had the need to request EMS for assistance—twice. The differences between these two experiences have altered the way I practice and teach patient care.

The first occurred last summer, when my 91-year-old grandmother fell at her retirement community in Milwaukee, WI, injuring her leg and face. Aid was quickly requested and a Paratech ambulance responded within just a few minutes. When an elderly individual, like my grandmother, falls onto cement it’s easy to argue that there is potential for a spinal column injury. However, my grandmother only complained about right knee pain. Rather than placing her on a longboard, the EMTs who cared for her found a position of comfort and padded her knees with pillows, in lieu of laying them flat. While this small gesture was likely a passing thought for a crew who may complete 15 transports in 24 hours, this small gesture of increased comfort made all the difference to the grandmother of a paramedic. In the emergency department she was diagnosed with fractures to her right patella and right orbital bones. Neither required surgical intervention, although her right leg would need to remain immobilized in a straight position for several weeks. Her emergency department physician elected to send her home via ambulance, as she was going to need assistance getting back into her bed (she lives independently). A Paratech ambulance was again requested for her transport and she still speaks about the transport today. By the time she arrived at home, she had been at the ED for 5 hours and missed dinner. She didn’t want to go to bed and requested to be assisted to the couch. Before leaving, the crew took the time to get her food from her refrigerator and heat it, and poured her a small glass of wine (her request). The impact of this interaction has cemented in my grandmother’s mind that these extra gestures are how all prehospital professionals act. Every time we speak she brings up these two crews and reminds me how wonderful they were to her.

A few months after my grandmother’s experiences, my sister phoned 9-1-1 from her New England home. My otherwise healthy 11-month-old nephew suddenly became pale, extremely lethargic and had a glazed look over his eyes. After calling 9-1-1 she called me; 20 minutes later an ambulance arrived. She lives in a major metropolitan area on the East Coast and there is a firehouse six blocks away. When the crew finally arrived they never assessed my nephew, never took off his jacket, and never listened to his lungs or even checked a blood glucose level. Even though he was now acting close to normal, he was still lethargic. All the crew fixated on was my sister going to her car, a block away, and getting his car seat. While I am thankful they do want children transported in an appropriate safety device, the impression my sister was given was that the crew was more concerned about the ride four blocks to the children’s hospital than my nephew’s health. What impression did this leave on my sister and brother-in-law? EMS takes too long to arrive and doesn’t assess or do anything for their patients.

My family’s experiences have taught me two valuable lessons. First, the small things do matter, especially on the non-emergency calls. The extra few minutes we take to increase a patient’s comfort, whether it’s padding their sores, adjusting the heat/air conditioning, getting them a glass of water or turning on their TV, can make all the difference in the world. These actions show our human and caring side and tell the patient and their families they’re important. Second, only we know what we’re thinking and a 9-1-1 call is often a first-time experience for patients and their families. They’re worried and our actions can belittle their worries if we don’t acknowledge that they’re real. Sometimes when we rush, we portray that we don’t care and that we aren’t listening. Always take the time to hear the whole story and assess the patient. After listening to their stories, explain what you want to do—and not do—for the patient. For example, tell them, “Your pulse, respirations and blood pressure are all normal right now so I’m not going to put you on the heart monitor unless you begin to feel weak again.” Simple explanations communicate that you have a plan, and it makes all the difference in in the world!

Kevin T. Collopy, BA, FP-C, CCEMT-P, NREMT-P, WEMT, is an educator, e-learning content developer and author of numerous articles and textbook chapters. He is also the performance improvement coordinator for Vitalink/Airlink in Wilmington, NC, and a lead instructor for Wilderness Medical Associates. Contact him at kcollopy@colgatealumni.org.

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