As humans we all need help from time to time. Children depend on adults for food, shelter, and clothing. Students depend on instructors and educators to relay information and knowledge. Adults depend on friends and family to support them throughout life.
As we age our need for emotional and physical support increases and decreases. However, for many of our most deprived patients, their ability to reliably depend on others for support diminishes with time. Whether families grow apart or support circles shrink, their ability to count on others gets smaller. As a result, our patients’ use of healthcare resources increases.
As healthcare professionals we find ourselves in the honored position of being exactly where patients need us the most. During times of crisis or illness, our patients depend on us. This may come in many forms, including increased utilization of acute resources or referral to our MIH/CP programs.
Many of the problems our patients encounter will be related to medical conditions. Yet the struggles of everyday life continue too: The car will still need brakes. The roof may need patching. Food may be scarce. In fact, the medical conditions our patients confront are but a fraction of the challenges they may face on a day-to-day basis. What will happen to the patient who does not have the practical plans and resources in place to meet these challenges? Unfortunately, we know these patients will have increased utilization of healthcare resources.
For us in prehospital care, that often means we invoke our inner Arnold and say, “We’ll be back.” But by ignoring the dynamic social and economic factors that contribute to the problems our patients have, we never correct their root cause. Not unlike the trauma patient who’s bleeding internally, unless we fix the root of the problem, things will continue to deteriorate.
Instead of focusing on the patient’s immediate problems, we should focus on the person as a whole. This is person-centric care. Sometimes also referred to as patient advocacy, person-centric care places the patient at the center of everything we do. We are concerned with the whole person, not just their acute medical conditions. That means digging beyond what may be a symptom to discern and help them resolve the larger problem causing it.
How can EMS providers bring more patient advocacy to their care? Here are some practical steps you can take.
Listen to Your Patients
Truly hearing your patients and reflecting on the words they use can lead to a lot of useful information. Practicing empathy is a tall order for the already-stressed EMS professional, but taking the time to listen to your patient’s challenges, acknowledging the difficulties they face, and giving yourself a chance to see the world through their perspective can be an enlightening process. Patients may not understand medical directions. They may not completely understand the discharge paperwork they were sent home with. They may be confused about who’s directing their care. Taking even a few minutes to be a reflective listener can give you a wealth of insight into the challenges your patients face and lead to a healthier patient-provider relationship.
Practicing empathy is one aspect of EMS care that is easily overlooked. Maybe you or your partner have a history of the same medical condition as your patient. Providers who have diabetes, for example, will have a natural affinity for other diabetic patients—they will intimately understand the challenges they face. This potential connection is easily overlooked during emergencies but can lead to a much deeper understanding of what’s going on with the patient and why.
Empower Your Patients
Patients often may feel like they’ve lost control over their health. When faced with a significant diagnosis or other health hurdle, patients can often feel the problem is too large for them to handle. Goal-setting for patients is critical to empowering them to handle their health. Have your patient set small, achievable, realistic goals they can attain. Perhaps it is reducing their number of calls to 9-1-1 or keeping to their medication regimen. Once patients have made one change, they can be empowered to make more.
Most important, though, remember the patient has the power. Patients are in charge of their destiny, not the healthcare system and certainly not the EMS system. Our job is to support them through the change process.
Be an Advocate
How many times have you cared for a patient who has difficulty adhering to a plan of care? Consider patients with substance use disorder. Care teams working with these patients may instruct them to abstain from the use of street drugs. But many will not, and these patients will continue to have frequent and often traumatic interactions with EMS and public safety.
Take a step back and ask how you can help these patients. Is it a matter of the right treatment plan? Does the patient even consider their use to be a problem? What can be done? Perhaps an inquiry into a local substance use disorder resource can help. What if the person just wants to talk to someone? Are you at liberty to simply have casual conversations with patients? Could a naloxone leave-behind program help?
With SUD in particular there is no easy solution. Being a patient advocate may mean stepping outside the boxes we often put ourselves in. It might mean working alongside addiction teams on days off to better appreciate the work being done. It may mean hosting a provider from the addiction teams on a shift or two to witness the work you do.
There is no ICD code for patient advocacy, and Medicare will not reimburse you for the time spent. But if you can shift one patient’s direction, would that not be sufficient cause for celebration? If you can replicate that solution and develop a protocol or procedure, now you’ve developed a whole new business line for your service. The money will follow.
Leverage Community Organizations
Community paramedic and mobile integrated healthcare programs in your area should be able to help. Do you have a referral structure in place for these programs? Can you leverage your electronic health record to automatically refer patients to the local CP, MIH, or other public health entities? Steering patients to CP/MIH teams can be a tangible way for EMS providers to get these patients the help they need. CP/MIH programs should be ready to communicate with their EMS counterparts to ensure communication gaps are filled. The referring provider should get a personal message back indicating the referral was received and is being worked on.
More broadly, do you have access to and knowledge of resources for patients in your community? Do you have phone numbers for the local homeless shelters and food banks? Do you have working relationships with crisis-response organizations? Look for the helpers: Even in communities without a large population, there are almost always organizations whose mission is to serve. Local houses of worship and community organizations typically have it in their charters to be helpful to others. Foster and leverage those relationships for access when needed.
Be a Resource
Being a community resource is something many organizations struggle with, but it can be beneficial for any EMS agency to host or support a local charity. Perhaps it’s acting as a repository for local charities that need a place to store food or blankets for the homeless. Can you dedicate some garage space to a local charity needing some space?
Contacting your local food bank and organizing a space at your station to host emergency food supplies can be a great way to not only connect EMS organizations to the community they serve but also meet the immediate needs of your patients. Needle and medication drop-off boxes can also improve your profile in the community.
Don’t be the public safety organization that’s only seen during disasters or on the evening news. Be the everyday community resource your patients so desperately need.
Work for Change
Ready to take the next step? Move into the activism space. Where is your organization with regard to the societal struggles we face today? Do you have a doctrine of nondiscrimination? Is it published and posted for all to see? How does it align with the mission, vision, and values of your organization?
If this section doesn’t make you feel uncomfortable, please do yourself a favor and think about this very clearly. This should be a real gut-check for many organizations. It takes courage to step outside your comfort zone and be critical of your work. But there are very real and practical things today’s modern EMS service can do to plug itself into the community it serves. Providers at all levels should feel empowered to exercise the needed actions on behalf of their patients. Not only will this improve your organization’s outward image in the community, but it will foster a new generation of providers who truly care for patients.
Emergency medical services is a tremendously rewarding industry to work in. We have at our disposal the opportunity to influence and change the trajectory of patients’ lives. And we often get that on a daily basis. Take full advantage of every opportunity you have to influence it.
Sidebar: Ask Tough Questions
For scholars of process improvement, this suggestion may be familiar territory: Ask the question “why?” five times.
Why did you call 9-1-1? “Because I couldn’t control my COPD.”
Why couldn’t you control your COPD? “Because my medications didn’t work.”
Why didn’t your medications work? “Because they are expired.”
Why are they expired? “Because I can’t afford to pay for new prescriptions.”
Why can’t you afford your medications? “Because I’m a school bus driver and haven’t worked since the beginning of COVID-19.”
Asking why five times may seem like a childish endeavor at first. But once you winnow down a root cause for your patient’s problem, the solution is often simple. There are many solutions to this patient’s problem. If you’re not in a position to help the patient yourself, advocate for someone else to do it. Work with the patient’s care team by establishing lines of communication with social workers, discharge planners, and care management teams so you can help close the loop with them. Even if these lines of communication are informal, they can lead to amazingly fruitful relationships.
Chip Franklin, NRP, is a community paramedic at Allegheny Health Network, Pittsburgh, Pa.