To practice compassion in EMS, do the small things well

The curse of a busy EMS career is that compassion is the skill that erodes while all the rest become stronger with constant practice.

"Put your heart aside. Duty comes first. But when fulfilling your duty, put your heart into it. It helps." — St. Josemaria Escrivá

Escrivá, the founder of Opus Dei, was a Spanish priest canonized by Pope John Paul in 2002. While much myth and misinformation about him and his organization persists in books and movies, Escrivá believed that all humans are called to holiness, and that the path to sanctity lies in good works.

Regardless of your religious beliefs or lack thereof, there is a lesson in there for us as EMS providers. I don't need to tell any EMT that caring for others is its own reward. None of us are in it for the money or recognition. But in the course of your career, time and toil have a way of eroding our commitment to excellence, until we find ourselves simply doing our duty, going through the motions.

Call it burnout, or simply complacency, but eventually it affects us all, and we forget what an honor it is to care for other people. Some of us cultivate it as part of our professional ethos, emblazoned on tee shirts and bumper stickers that say, "EMS: Paid to save your ass not kiss it."

We're told to cultivate professional distance in our careers, to sympathize but not empathize, that objectivity helps us maintain the focus needed to render lifesaving care when the world has turned to chaos around us.

But when that emotional wall of professional distance keeps us from connecting with the other 75 percent of the people we serve, it diminishes us as caregivers. It keeps us from being our best. We go from being committed to EMS, to merely being involved in its delivery.

We convince ourselves that we are superior medics because we can work a resuscitation in our sleep, or we can fall down a flight of stairs and accidentally intubate five people on the way down.

We might brag about our system's aggressive protocols, or cardiac arrest survival rates and response times, as if those things are the true measure of an EMS system. And truly, those things are worthy of being measured, and we should emulate the practices of those who do it well.

But, as it is in many organizations, the benchmarks most often measured are the ones that are easy to measure. The soft skills are far harder to quantify, and often more valuable. Ultimately, the only people impressed by our cardiac arrest survival rates and intubation prowess are other EMT's. Our patients are the ones who value the soft skills, and chief among those is compassion.

In his book, 'People Care,' Thom Dick points out that prompt, skilled and professional emergency care is what we owe to all our patients. It's expected. It's our job. But compassion is our gift to them, and like all gifts, bestowing it rewards the giver as much as the recipient.

"We must combine the toughness of the serpent and the softness of the dove, a tough mind and a tender heart." — Dr. Martin Luther King, Jr.

The curse of a busy EMS career is that compassion is the skill that erodes while all the rest become stronger with constant practice. And make no mistake, compassion is a skill. If you don't use it, you lose it.

So how do we practice compassion?

The first and biggest step is to make sure you do the little things well. Remember back to your first ridealong when you were a bit lost as to what to do on the scene, and all you could think to do was hold the patient's hand and offer reassurance while the more experienced EMT's rendered care?

Do more of that.

You'd be surprised how much difference it makes, and how much easier it gets the more you do it. And the hidden benefit is, attention to those little details often pay dividends elsewhere. Many of those systems that boast clinical excellence are able to do so because they do the small things well, too.

Those few extra seconds of preoxygenation and preparation of equipment often make the difference between a successful intubation and an unsuccessful one, or the coordination between crewmembers to assure that there is minimal interruption in chest compressions make the difference between ROSC and a dead patient.

And those extra few moments to fetch a pillow or reassure frightened family members often make the difference between a positive impression of EMS and a negative one.

Author and pop psychotherapist Richard Carlson told us in his book, "Don't sweat the small stuff… and it's all small stuff." That's excellent advice to prevent little details from overtaking our lives, and letting perfectionism create unnecessary stress. There is truth in the statement that perfect is the enemy of the good.

But it's also true that the people who shine at any EMS agency are those who do sweat the small stuff.

It shows they care.

About the author

Kelly Grayson, NRP, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 24 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is president of the Louisiana Society of EMS Educators and a board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. Kelly's books are available on his author page at You can follow him on Twitter (@AmboDriver) or Facebook, or email him at Kelly is a member of the EMS1 Editorial Advisory Board.

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  2. EMS Education
  3. EMS Management
  4. EMS Training

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