Compassion and skill: Mindfulness in EMS
Being thoughtful is the key to success in EMS training, providing compassionate care and setting priorities
By Bill Miller
"Thoughtfulness will get you everywhere."
This mantra, on occasion uttered by my dad, carried him far in life without a college degree or specialized training, and I think it is the North Star for many of us involved in EMS. Definitions for thoughtfulness include characterized by careful and reasoned thinking; and showing careful consideration for the needs of others.
While it seems obvious that we need to be thoughtful and attentive to what we are doing and to be considerate of the needs of others, I'd like to focus on three areas where I think we all could improve in being more thoughtful.
1. Teaching, training, orienting and supervising employees
In order to cultivate thoughtfulness in the workplace, we must try to think about our coworkers; how they learn and what makes them tick. I have been lucky to work with some terrific trainers, teachers, supervisors and administrators, but over the years, I have noticed a few people in these roles who act more like drill sergeants at boot camp than thoughtful mentors and colleagues.
I am not talking about serious emergency situations where order and the chain of command are essential, but rather about the daily doing and learning. People who exhibit pushy, domineering or insensitive behavior toward their fellow EMTs and paramedics are not teaching them how to love emergency medicine. Instead, they may be squashing their coworker's individuality and initiative by using demeaning labels and viewpoints.
I can recall hearing some trainees in orientation called derogatory terms or hearing a paramedic who was small in stature and who looked young being called "kid." It can be difficult to take time and energy to think about our employees and coworkers – trying to understand what moves them and what they need to take the next step. Making this effort can make for a more personal and honest environment which enables learning, can help to build confidence and can foster contentment in the workforce.
2. Helping people who are broken in mind and spirit
Assisting people who are down and out is an everyday occurrence in EMS and seems to have increased greatly with the opioid crisis and the cuts in medical assistance (in some states). Many healthcare professionals have developed a resentment towards people who are overdosing or those who use the hospital emergency department as a primary care system (and take an ambulance to do so).
Hopefully, we can do a little educating with our patients about priorities and resource options, but we can also look at the situation as a chance to better understand what other people are going through.
Greg Boyle, a Jesuit priest who has worked with gang members in Los Angeles for over 25 years, has an approach to seeing others in a different light: "Here is what we seek: a compassion that can stand in awe at what the poor have to carry rather than stand in judgment at how they carry it."
How do we come to understand a 37-year-old who just got out of 10 days of Detox and is found down after drinking a pint or two of whiskey? What do we know about him? Can we imagine what his childhood was like?
In writing about developing this sense of understanding and compassion, Boyle recalls a line from a Black Spiritual: "God looks beyond our fault and sees our need." This can be a life-long quest for many of us and, in a sense, we are lucky to get lots of opportunities to practice.
I always remind new hires who are disappointed at missing an IV, that we only get proficient at something by doing it over and over. We have many opportunities to improve our understanding of people who are different and learn how to better communicate with them. This is skill we need to learn to be better healthcare workers and better human beings.
One way to care for people who are troubled and distraught is to be mindful of the tone and volume of our voices. Occasionally I am struck by a coworker who is almost yelling at a patient, "What drugs did you take?" or "Which did you use, heroin or fentanyl?" or "Sit down here and don't move," in a tone so jarring that I am taken aback.
In general, I think that the louder a patient talks or the more troubled and distraught a patient is, the lower our voices should be. Of course, there are exceptions to this – such as when we need to be firm with an uncooperative patient – but even then, we can be firm and direct without yelling at the patient.
Steve Whitehead, in one of his "Remember Two Things" videos, advises asking distraught patients, "How can I help you?" rather than yelling at them to "calm down!" I know that when I feel upset or unsettled, being told to calm down does not help me to feel comforted or cared for. Having someone attempt to understand and allow me to state what is going on is more consoling and can help me take the next step. Being thoughtful really helps, but it takes practice and patience, particularly when we feel rushed by the stressful situation.
3. Set priorities for EMS success
Being thoughtful is crucial in our daily and long-term planning. I personally have found that all of EMS can be boiled down to two priorities:
- Always strive for compassionate and skillful patient care.
- Get the truck ready for the next shift.
Compassion and skill; we need them both. Asthma patients could get all the kindness and understanding in the world, but if they don't get the right treatment, all is lost. At the same time, we could provide the 100% right treatment for our asthma patients but still not be able to "connect" to enable them to feel comfortable enough to tell us what else is going on – or to trust us when we say that going to the ED is what they really need.
I work for two ambulance services and am fortunate that both have good medical directors who have written solid protocols. These guidelines, in my mind, not only help us know what to do but also help us to identify what is going on. Good protocols can help us to give careful and considerate attention to the patient's signs and symptoms. Reviewing these operating procedures and pursuing ongoing education can help us to learn how to apply careful, reasoned thinking to the patient's situation. The best paramedics and EMTs I have worked with are able to think through a situation and identify what options they have. This is a real skill!
Developing compassion is a less measurable quality and is more difficult to articulate. I think it takes honesty, imagination and a willingness to communicate. Ask yourself:
- How would I feel in this or that situation?
- What might this patient's life be like?
- How can I connect with this person to create a positive and comfortable exchange of information?
In the past, I have often leaned on automatic, habitual questions and responses – probably because they don’t require as much thinking. Don't get me wrong, I am really grateful for reminders such as the SAMPLE and OPQRST mnemonics – they really help us remember important areas to cover during our patient assessments. But can I work at gathering information in a way that the patient knows I am talking to another human being and not just rattling off my list? Can I give the patient the courtesy of really trying to listen to their responses?
This can be challenging if they give too much information or drift off topic. And it's even more challenging with our time constraints – particularly if the patient’s condition is serious or our system is overloaded. Learning how to re-focus the patient and move things along is an art in itself.
You may chuckle when I tack on getting the ambulance ready for the next shift as a major priority, but it is very important. Without our equipment and supplies, the only thing we can readily do to treat patient is to start compressions!
Those of us on the street are just the "tip of the pencil" and we have a whole line of support systems behind us (such as supply, maintenance, communications, administration, etc.) which enable us to do what we do. We can keep that link solid by ensuring the ambulance is stocked, clean and ready to go for those who come after us.
It's a major responsibility for the crews who have to clean and re-supply their own ambulances. At shift change, the incoming crew may get a call as they walk in the door and then be so busy they don't get back to their supply lockers for the rest of the day. Do they have what they need? I am amazed and disappointed when I walk into work and the crew getting off only then begins to think about what shape the truck is in or what supplies the next shift might need.
The hard work of thinking can help in our training employees, showing compassion and in being mindful of our priorities. I sometimes have to remind myself that the benefits of being thoughtful far outweigh the effort, because being thoughtful will take us where we want to go. "Thoughtfulness will get you everywhere." Thanks, dad!
About the author
Bill Miller has been a paramedic for over 18 years and currently works for two ambulance services in a busy, urban area.