Our job is to help treat whatever it is ailing our patient. The problem, oftentimes, is treating a patient means using tools not found in an EMS kit or paramedic textbook.
Compassion and empathy are key requirements in this field where many calls are successfully handled with not just skills but a friendly face and an understanding of suffering.
It takes more
The amount of skills learned by an EMT or paramedic are numerous and varied. Acting with relative autonomy out in the field, away from doctors, nurses or supervisors, EMS providers have to rely on their understanding of cause and effect, recognition of an injury or illness, muscle memory to perform skills, and the ability to identify the possible problem and provide a suitable treatment plan. Usually this is all done within minutes, sometimes seconds, of getting to the scene and evaluating the patient.
Most calls first responders are dispatched to require a tactful interweaving of both a learned skill set, i.e. starting IVs, intubation, 12-lead ECG interpretation, and more along with a mixture of something that perhaps cannot be taught: concern and sympathy.
It is these latter two qualities that I believe are just as important, if not more so, than the retention of facts and muscle memory.
Of course calls vary.
For instance, if a patient is in cardiac arrest, time is of the essence if we want to get our patient’s heart beating again. Learned skills therefore, become a focal point for the paramedic and human emotion tends to take a temporary back seat. This is of course necessary to accomplish the task at hand. Cardiac algorithms and drug dosages sometimes become the only thing between life and death.
Sometimes the implementation of these skills works … but unfortunately, most times it doesn’t.
The prehospital survival rate of resuscitating someone back to life is unfortunately, pretty bleak. According to a report published in 2015 by the National Institute of Medicine, out of an approximate 395,000 reported cardiac arrests that occurred outside of a hospital setting, less than 6 percent survived.
For the first responder that responds to a cardiac arrest, a tremendous amount of importance is placed on skill sets and critical thinking in order to facilitate the best chance for a successful outcome: the resuscitation of the patient.
But so does compassion
However, cardiac arrest calls, thankfully, are not the most common calls EMS run on.
First responders need to remember that when someone decides to dial 911, chances are whatever they are facing, at least in their mind, is a true emergency.
For example, I remember being on shift with the fire department I worked for in Santa Fe, New Mexico. I was scheduled to be on the ambulance, which was fine with me, as I had fallen in love with the medical side of my profession.
At noon, a call came in for us to respond to an elderly lady complaining to 911 of having suffered a penetrating eye injury. No further information.
We got the dispatch and on the way to the call, I made a mental inventory of how I was going to treat such an emergency: Stabilize the penetrating object in place, cover the unaffected eye to prevent bilateral movement, rapid transport, etc…
As with all information I receive from dispatch, I immediately began to hope for the best and prepare for the worst. En route to the call, I could tell my partner, another seasoned paramedic, was going over many of the same scenarios in his mind.
When it comes to EMS, nobody wants to be taken by surprise.
Once on scene, I felt confident that both my partner and I had mentally prepared ourselves for whatever we might face. We leapt out of the truck ready to spring into action. However, what we were faced with was something I hadn’t expected.
My patient was an 85 year-old female who called 911 because she had misplaced her glasses and accidentally poked herself in the eye while searching for them.
My partner and I looked at each other. I could instantly see the deflated look on his face as the adrenaline drained out of his body.
“Is this why we were called out here? To find this lady’s glasses?” Our patient overheard my partner.
I remember being so upset at my partner.
After a quick primary survey, we saw no obvious life threats. I asked my partner to take the medical bags we had carried in back to the ambulance and said I would complete the paperwork, a deal my partner couldn’t pass up.
Once my partner had left, I began to focus on my patient. Her name was Ruth. She had worn glasses since an early age growing up in Israel. Both her parents were killed at Auschwitz, and she grew up with relatives who sent her to New York when she was 15.
She had no family in Santa Fe. Her husband had died 20 years earlier in New York. She moved out to New Mexico to be close to her kids … both of whom had also since died.
She loved to watch old Universal monster movies, Dracula being her favorite, as it was one of the first she ever saw in a theater. We both smiled at my similar appreciation for ghoulish cinema.
By spending the time to sit and speak with her, I was able to learn more about her – from her mental health to the conditions of her home. She was remarkably mentally fit and most certainly able to take care of herself. Her house was clean. Her refrigerator well stocked with food, and aside from a small, half-smoked cigar, a habit she picked up from her late husband, there was no sign of any unhealthy habits.
Once calm, I lent new eyes to her current problem. I located her glasses in the kitchen near an open loaf of bread. I surveyed the eye she had poked to look for any obvious abrasions or injury. Finding none, I took her vital signs, which were normal, and asked her if she wanted to go to the hospital.
Grateful to have her glasses back on her face and her eye not damaged, she said no. I smiled and started to gather up my things, when she grabbed my hand and looked me straight in the eye and said, “Thank you for listening to me.”
I responded that it truly was my pleasure to help her and thanked her as well.
The whole call must have taken only 15 to 20 minutes. But at least for me, this call that took place about 15 years ago, has become a lifelong lesson.
Connecting with the patient
Skills can be learned. With enough time, starting an IV, performing CPR or intubating can be taught to practically anyone.
But taking the time to sit with and show genuine concern for a patient’s problem, no matter how minor or insignificant it may seem, is something much harder to teach, if it can be taught at all.
However, it’s that feeling of connecting to my patients that has gotten me through some rough patches in my EMS career, one that has lasted nearly 18 years in the field.
EMS is an emotionally tough profession to be in. It takes a toll. Tempering it with a genuine intrinsic sense of accomplishment by helping patients, regardless of whether there are actual life threats involved, can make a position in the profession more than a transient career stop on the way to a new job.
Paul Serino is an 18-year Nationally Registered Paramedic and a faculty member with the St. Petersburg College EMS Program. If you have any questions or would like further information about the program, please contact him at: email@example.com