EMS Revisited: Customer Care Part 1

EMS Revisited is an exclusive column that offers reprints of various columns and articles from our archives that are not currently available in electronic format. In the January 2003 issue of EMS Magazine (now EMS World Magazine) we began a year-long series on customer care in EMS. Here we will reprint the series in its entirety.

Customer service is a vital component of our work that can have a tremendous impact not just on individual patients, but on us and our EMS systems as well. This is the first installment in a series dealing with customer service in EMS. It will discuss the need for it, define it and examine how to provide it. Although many of us already provide excellent service to our customers, it is the author's hope that by defining and providing examples, readers will find new ways to raise their level of service to their communities even higher. For simplicity, all medical responders will be referred to as EMTs.

It used to be that if you got sick or hurt, you called the ambulance, which took you to the hospital. Today, you can probably use the ambulance and hospital of your choice. Who you choose may be based upon your "feeling" about one agency or another. Where do these feelings come from? Maybe personal experience or a recommendation, or an agency's image or advertising. You do know that after one single experience with any business, you form an opinion about them. If you walk away satisfied, you will almost certainly go back.

What makes one EMS?agency better than another? The quality of the CPR, the strength of the epi, the sharpness of the IV catheters? Let's be real:?Every ambulance crew carries virtually the same certification and equipment. Often, the biggest difference is the people: How the EMTs treat their patients and other customers has the biggest effect on how their care is perceived by the public. The public doesn't have the experience to judge us on our medical skills, but they can tell when they are treated with consideration, professionalism and respect.

What Is Customer Service?

At Sears, it probably means getting a good blender at a good price. But we are not Sears. So what, then? The first thing people expect from you is a professional level of medical care. Anyone who sees you fumbling with an IV, having trouble with your equipment or acting like you don't know what you're doing is not going to think you are a good EMT. So the first part is easy:?Just be a good EMT.

The second part can be more elusive. Good service means leaving your customers satisfied, and that means giving them what they expect, or if you can't, telling them why. What a customer wants when they call 9-1-1 is someone who can help them. If you have a delayed response, for example, that may be all they care about, even if your medical care is stellar. Take a moment to tell them, "I'm sorry it took so long to get here. We were the only unit available, and we were out of town." That shows you understand their feelings.

You and I both know that sometimes the public has unrealistic expectations. We have to be aware of any gaps that occur between what they expect and what we can do. Exceed their expectations, and your service will be perceived as excellent.

Who Is Our Customer?

Why, our patients, of course. That's pretty obvious, right? We arrive like descending angels, scoop up ill parties and get them to the hospital as quickly as possible. But what about the family member left standing in the now-empty house, looking at a pile of 4x4 wrappers, inside-out gloves and furniture moved all over the place? What about other responders who didn't even get a thank you? Aren't they customers also?

The patient's family members and friends care about the patient. They want to know what is happening and are important participants in the call. Taking a moment to speak to them can make a huge difference in how your care is perceived. Notice I say perceived. You may provide technically perfect care, but if they are confused, brushed aside or ignored, they will not appreciate your skill. Don't forget that many times, perception is reality.

Think how the family feels when you start ripping open your jump kit and pulling out supplies and equipment. Is this routine, or is it serious? You know, but they don't. This creates a lot of unnecessary anxiety for the lay person who doesn't know what we do. It's your job to tell them. Unless the patient's condition is so critical that you can't speak to family members for 60 seconds, reassure them as appropriate, or prepare them for what may be bad news.

What about the ED staff who receive your patient? Are they happy with your level of care, your report and your attitude? Isn't keeping them happy important? You bet. That makes them customers too.

Think about everyone you affect on a call: Drivers who may or may not get out of your way, other volunteer/paid responders, your coworkers, the patient, the patient's family, the patient's dog. Anyone you come into contact with while on duty, like it or not, will judge you, and not just on your medical skills. They will judge you on your appearance, behavior, attitude and driving. You have countless opportunities to make a positive impression throughout your shift. A person may not appreciate how much training it takes to identify a tension pneumothorax, but they know what unshaven looks like.

Our customers are varied. They are dispatchers, partners, patients, family members, bystanders, police officers, firefighters, volunteers, nurses, doctors, hospital registrars, 7-11 clerks, nursing home staff, ICU staff, secretaries, the driving public, the walking public, the press, our bosses--in short, everybody.

Why Is Customer Service Important?

If you already have the 9-1-1 contract, who cares? The public dials, you show up--there isn't exactly a choice. That's not strictly true. What will happen when your agency's contract is up? What if too many citizens complain? Will the city open up a bidding process? Uh-oh.

Today's EMS market is competitive. It is not unheard of for a private company to replace a public one. Providing good customer service can help secure your job.

If a nurse in a hospital or a nursing home has the choice of several agencies to call, which will be chosen? The agency with the rudest EMTs, sloppiest uniforms and dirtiest ambulances? The one that treats them and their patients the best will get the call. Holding doors for people, helping with directions, letting other drivers in, being courteous to patients who don't really need an ambulance--these are all small ways of providing good customer service. Sounds like being in Scouts, right? Well, helping people is our job. Many people would say that saving lives is our job, but anyone who has been on the street knows otherwise. Yeah, occasionally we get lucky and can make a real difference, but much of the time our calls are routine and non-emergent. So we have the choice of being constantly disappointed by the lack of patient acuity, or we can appreciate the opportunity to contribute to the welfare of our community.

Does any reader doubt that our profession is underappreciated? If we want respect (and we sure deserve it), we have to work for it. Job security, higher pay and better coverage for the public make things better for everyone. Good customer service can help us achieve these goals. When the city council votes on pay raises, what image of us do they see?

I am not minimizing clinical issues here. Being able to start an IV on a critical patient in a crumpled car is an important skill. But during the time that you're not saving lives, these other ways to provide customer service can improve your personal and professional reputations and produce vast numbers of satisfied patients. If you take this approach to your job, you will find countless ways during your shift to provide meaningful customer service. Simultaneously, by making your agency more successful, you will have better job security and the potential for higher pay, professional recognition and advancement.

How Do I Do That?

For starters, be ready. Woody Allen said, "70% of success in life is showing up." Are you showing up on time ready to go? Be rested, well-groomed and dressed in a clean, neat uniform. Have all your personal equipment in order and make sure your ambulance equipment is all set. We all know how tedious it is to check out everything on every shift, but being caught with your pants down is bad form and poor customer service.

Probably the most important element of providing good customer service is your desire to do so. If you are constantly thinking about how to improve your service, you will find countless ways to make it a habit, not a chore. Future articles will review more examples of real calls and specific things you can do and say to provide a high level of customer service in EMS.

On the Scene

Medic 7 is dispatched for an infant not breathing. The double-paramedic crew has over 15 years of combined experience, so they don't get too excited--they know they can handle it. On arrival, they grab the monitor and reach for the pedi kit. They soon realize that instead of one pedi kit and one trauma kit, they have two trauma kits (they are packaged in the same kind of tackle box). While Frank goes into the house, John starts frantically looking through the trunk, hoping they really do have a pedi kit.

About this time, the volunteer BLS ambulance arrives. Its crew has their pedi kit, so at least there is some pediatric equipment on scene. John gives up the search and enters the house to find his partner doing CPR with the patient's horrified mother looking on. The patient is three months old and looks to be a SIDS baby. Using no small amount of improvisational brilliance, they intubate with a flexible suction catheter, using a penlight and a tongue depressor. The child is transported Code 3 and pronounced at the hospital. They later learn that the patient's father is a pediatric anesthesiologist. Ouch! He was not home at the time--lucky for them. Was the outcome a result of the equipment? Probably not. But on a different call, it certainly could have been. Do you ever want to try to justify yourself in this situation? I don't. You can't provide good care without the right gear.

Paramedic and nurse Chris Hendricks has been in EMS since 1994 when he joined the Ortley Beach First Aid Squad. When he authored this article, he was a field instructor with Pridemark Paramedics Services in Boulder, CO. He now works as a paramedic and ER nurse, and serves with the Wyoming Air National Guard as a flight nurse. He will be receiving his Masters of Science in Nursing Education in summer 2011 and is a certified emergency nurse and a certified forensic nurse.