From NCEMSF: Your Words Matter

How can EMS providers best communicate with people in extreme distress?

This was the central question posed by Bram Duffee, PhD, EMT-P, during his talk Patient Interview: Nocebic and Hypnotic Language, held Saturday afternoon Feb. 22, 2025 during the National Collegiate EMS Foundation annual conference in Pittsburgh.

Duffee is a full-time paramedic based in Houston and the host of the podcast "EMS Research with Professor Bram." He holds faculty positions at Kennesaw State University and the First Responder Behavioral Health Institute. Duffee also authored two books on communication, including the latest, Hypnotic Communication in Emergency Medical Settings: For Life-saving and Therapeutic Outcomes.

Duffee’s interest in the patient interview was shaped early on by a call with an older gentleman with chest pain who refused to go to the hospital despite Duffee’s clinical observations and urging. The man died, leading Duffee to seek to understand what could have gone differently in that encounter to save the man’s life.

Patients in extreme distress enter a mental state akin to hypnosis, explained Duffee. They focus their attention in a way that activates physical and mental responses differently than they could under normal circumstances. With this knowledge, EMS providers can take advantage of this mental state for better care, Duffee postulated.

Think about how you can enter this hypnotic state, Duffee advised. Rather than asking patients general questions such as “Do you have health problems?”—which they may not be able to articulate—be specific: “Do you have lung problems? Are you diabetic? Do you have a history of heart problems?”

Duffee finds it helpful to repeat the phrase “The worst is over” to patients in distress, in order for them to enter a state of relaxation. He may have them visualize their body beginning to heal itself.

Duffee highlighted research by psychiatrist Erik Wright in the 1970s that found that patient outcomes were directly correlated with paramedics’ behaviors including reciting a specific paragraph on their way to the hospital.

Further tips: Make a good first impression—look patients in the eye when you introduce yourself. Emphasize the patient’s role in the patient-provider partnership.

Protect patients from outside negative information and build a rapport. Watch what you say on scene. Don’t talk about how tired, hungry or overworked you are, even quietly to your colleagues. Body language is important as well.

It’s not always what you say, but how you say it, Duffee continued. Open-ended questions about what patients are feeling can be better than “How intense is your pain?”—which can make a patient focus on just their pain or dire consequences. Do your best to separate hysterical and fearful bystanders from the patient, which can exacerbate fear and pain.

Instead of symptom-focused language—“you’re not dizzy anymore”—spin your phrasing to be positive: “You should start to feel more clear-headed.” Rather than “You won’t be crying anymore,” try “You should start feeling a whole lot better.”

Ten years from now, there will be changes in how EMS communicates with patients on scene, Duffee concluded. “People’s impressions of us matter.”