Quality Corner: The Art and Science of Being Nice Part 2

This is the second part in a series on being nice in EMS. In the first part, Joe Hayes used a previous call to illustrate the art of being nice as an EMS provider. In this part, Hayes describes how being nice can affect a patient's level of stress and what changes that has on their body. Part one can be found here.

Last month, I used a call of mine to illustrate the art of being nice as an EMS provider. This month, we will review the science of being nice.

People who call 9-1-1, with rare exception, have legitimate medical concerns if not an outright medical emergency. The calls may be routine for those of us who respond to them regularly, but in the minds of most people who call 9-1-1, it’s an emergency. If the nature of the call itself were not enough to create anxiety and apprehension on the part of the caller, the fact that the patient is typically either themselves or a loved one will. In fact, the greatest of all stressors of an emergency call is undoubtedly the personal involvement.

We in EMS have the advantage of arriving on the scene after the intensity of the sentinel event is over.

I once had an EMT partner who was solid and unshakable through some of the most horrific trauma calls I’ve ever been on, back in a time before air bags and seat-belt usage was as universal as it is today. I had rarely seen such panic in anyone’s eyes as one Saturday morning when an EMT came running into the ambulance bay with his eight-year-old son in his arms screaming for help.

The fact he was so frightened made me frightened momentarily. Quickly realizing medical emergencies don’t fix themselves, I reverted to my rescuer mentality. I saw his son was conscious and breathing, seemingly aware of his surroundings and surprisingly calm. So, I took a deep breath and asked what the problem was. The nature of the call ended up being a laceration on the sole of his son’s foot from stepping on a piece of glass.

At first I thought the EMT was playing a joke on us, and I started to crack a smile. Then I realized the look of terror on his face was genuine. My next impulse was to bust on him for losing control and panicking like a rookie. Fortunately, I just as quickly realized he needed some assurance, just like the friends and families of so many of the patients we treated. Besides, there would be plenty of time to razz him over this later. For now there was a job to do and he was part of the job.

Most patients we encounter will have some degree of anxiety ranging from mild concern to total fear for their lives. In many cases we recognize that while these patients may require medical treatment, it is manageable and not the life and death emergency they’re imagining. Taking a moment to reassure your patient may be the most important and appreciated thing you can do for them.

After many years in EMS I’ve come to realize the importance of going out of my way to project a caring attitude towards my patient and their family. I also try to establish as much of a personal relationship with my patient as time and circumstance permit.

You can tell a lot about a person from the home they live in, and EMS providers have a unique opportunity over most others in health care of seeing the patient’s natural habitat. Needless to say, there are a lot of advantages to this; observing their general living condition along with any potential hazards, and the décor of their home as well. Yes, you can tell a lot about a person based on the décor of their home, such as what their interests and passions are.

Once  the priority diagnostics and interventions are complete, I try to engage my patients in casual conversation based on clues of personal interest I’ve seen in their home; whether memorabilia on the wall or books in the coffee table. Talking about the fate of the local sports team is easy enough for most people. Additionally, most patients older than sixty lived in a time of almost universal military service. Many display pictures or trinkets of their service or wear hats, shirts or jackets with their branch of service, ship or unit on it, just waiting for someone to ask about it.  

After you get a good conversation going with a patient, take a peek at the cardiac monitor. You’ll frequently notice the patient’s heart rate has decreased as they relax and sometimes even temporarily forget their problems. I’ve gotten so good at this, there have actually been times when the patient seemed disappointed when the ambulance ride was over and we arrived at the hospital.

And this is the science of being nice: If you can calm a patient down or assure them they are in good hands and being well taken care, you can many times significantly lessen their anxiety and help them relax. As a result, their heart rates will generally decrease a bit, resulting in a decrease in workload on the heart.  Any degree of lessened stress and workload on the heart is good for anyone, but better yet for a sick person.

You’re of course never going to convert a V-fib with your niceness, but you do have the capacity to positively affect the psychological and to some small degree the hemodynamic wellbeing of your patients by nothing more than simply being nice. 

Joe Hayes, NREMT-P, is deputy chief of the Bucks County Rescue Squad in Bristol, PA, and a staff medic at Central Bucks Ambulance in Doylestown. He serves as the quality coordinator for both of these midsize third-service agencies in Southeastern Pennsylvania. Contact Joe at jhayestpc@gmail.com.