When were you last strapped to a stretcher with cervical spine stabilization in place?
What experience do you have in being wheeled out of a building on a carry chair?
Have you ever watched medical professionals preparing equipment and felt scared?
Something that we may not do often enough is put ourselves in the patient’s position, quite literally, to gain an understanding of how they may feel during our interactions and interventions.
In years gone by, this happened more often in EMS training. We may have been instructed to lay on the stretcher and be wheeled up and down bumpy pathways. It may have been compulsory that we sat in a carry chair, whilst it was manhandled down a stairway. There may have been a time that we agreed to be strapped into full spinal precautions and carried into the ambulance. Perhaps we were placed on the stretcher and then driven at speed so that we could experience the sensation of sudden braking during transport.
Due to an increase in EMS students, as well as health and safety awareness, however, many of these experiences no longer exist and, at best, they are extremely limited in their occurrence. Whether we’ve had the pleasure (or in most cases displeasure) of putting ourselves in the patient’s place or not becomes less relevant over time, as we become more and more used to everyday ambulance equipment throughout our careers.
So, what’s the big deal, we’re careful and thoughtful, aren’t we?
Most of us are, or at least we want to be, but how can we know if we haven’t been in the patient’s shoes?
Here are four things to forewarn your patients about to increase their comfort and compliance:
1. Weather
Imagine what it feels like to be lying supine, on a stretcher, being wheeled out towards the ambulance with rain pouring onto your face. Or strong wind whipping up the blankets and compromising your dignity. Perhaps you’re blinded by bright sunlight, or a dust storm fills your mouth and nose.
If we haven’t experienced this for ourselves, the familiarity of our working environment can cause us to discount the value in explaining to a patient what the weather may be like outside before leaving the comfort of their surroundings. Perhaps we don’t realize that they can’t see or hear us whilst we steer them towards the ambulance, because of inclement weather, their attempts to block rain and dust by closing their eyes, the noisy wheels, or the wind buffeting around them.
Once we do notice, it becomes glaringly obvious and we can easily overcome most issues by developing a habit of explaining beforehand, leaning into the patient’s line of sight often, placing a reassuring hand on their arm occasionally and finding ways to ensure comfort, and avoid fear, where possible.
2. Immobilization
Picture some of the calls where spinal precautions have been utilized and the patient’s line of sight is immediately restricted, to solely what is immediately in front of them. In cases where an extrication device or cutting equipment is necessary, intense noise and terror now add to a minimal field of vision. Femur traction splints may be placed but in a supine position, the patient has no idea what’s happening.
Even if we have tried and tested all of the devices as part of our training, when we’re under pressure to manage the patient’s clinical needs, apply the necessary equipment, manage scene safety, resourcing, medications, transport and a multitude of other vital considerations, despite our best intentions, it can be easy to forget that our patient needs to be informed, step by step.
The more we do this, the more success we may have in connecting with our patients, keeping them calm and still, and more actively involved in assisting with their own needs. Before we apply immobilization or splinting, perhaps an extra 30 seconds of clear explanation will make all the difference in having the patient respond efficiently to instructions. This may prove vital to the success of some interventions. En route to the emergency department, positioning ourselves where the patient can see us automatically aids in ensuring minimal movement in suspected cervical spine injuries.
While we may take precautionary equipment for granted, it’s important to bear in mind that we already understand its potential benefits to the patient. If our patient is uninformed, frightened, feeling alone and unable to see or hear clearly, they are likely to require more reassurance, more active management that takes away from their other priorities and potentially, more medication, if they feel less in control of the pain and fear caused by their situation.
3. The wobbles
Visualize every piece of carrying equipment that we have available to us and imagine how unfamiliar, unsafe and insecure every patient we carry may feel as a result of its use. Now we know that we only drop patients on Tuesdays, or at least that’s what many of us joke, but the recipient of our care generally has no idea. All jokes aside, we really do know that this is a rare occurrence, but when patients find themselves at the mercy of those carrying them, unless they are informed about how it is expected to feel, they are likely to experience sudden terror.
They may reach out, attempt to move or react in some other way that compromises everyone’s safety. Almost every single piece of carrying equipment wobbles. No matter how sturdy the structure may be, or how strong and fit the operators, the acts of carrying, wheeling and manoeuvring inherently involve wobbling, sliding, bumps, rattles and worse.
The patient strapped into a carry chair may feel relatively comfortable while it’s rolling along an even pathway, under the firm guidance of a competent paramedic’s hands. The moment that chair is tipped backwards to manage steps or lifting, however, without being forewarned, they will likely assume that it is falling and that they’re going to fall with it. Being encapsulated within a vacuum mattress, spinal immobilization harness or flexible carrying device is disorientating at the best of times and requires the patient to relinquish control completely, for their safety and ours.
Expecting such trust without explaining the procedure may be unreasonable. Each time a patient lies on a stretcher, they can feel every wobble, every bump, every twist and turn through the stretcher movements towards the ambulance, while being loaded and secured into the vehicle, through road, air or water transportation and then once again upon reaching their destination.
While some of this discomfort and disorientation is unavoidable, perhaps we can be vigilant in remembering that this may be the first time for many patients. We have the ability, therefore, to arm them with realistic expectations of what is normal, so that their fears are immediately reduced.
4. Interventions
As with all of this equipment, our treatment bags, cardiac monitors, ambulance contents and assessment tools become as familiar as the furniture in our homes – at least to us. Not, however, to our patients. With the advent of countless television shows and movies depicting paramedic practice, we have to contend with not only the fear of the unknown but the new, additional fear of the incorrect.
The simple acts of drawing up normal saline into plastic syringes for irrigation or medication for oral administration and intranasal atomizer use, may instantly make our patient think that they are about to receive an injection, causing them unnecessary stress. If they do require an injection or perhaps intravenous access, the patient may not realize that we will discuss the procedure with them and gain their consent. A fearful adult or a terrified child may be picturing movie scenes of interventions occurring unexpectedly, or even against their will. Unravelling ECG electrodes and applying them to a patient’s chest may make them nervous about being defibrillated accidentally, unless we explain what we’re doing, and why.
Not only does talking through upcoming interventions help to allay our patient’s fears and keep them informed, but it can also aid in keeping us on track as we verbalize our plans, maintain our systematic approaches and become less likely to miss a vital step.
Overall, in every situation, the human sympathetic nervous system relies upon our heightened senses of hearing, sight, touch and smell when we’re in a fearful situation. With this in mind, for our patients, when circumstances force them to rely upon paramedics, they’re hardwired to be hyper-aware of everything going on around them. Part of our role, therefore, may be in helping to return some sense of control, with minimal extra effort, simply through our words and a little empathy.
Think for a moment about how each of us communicates with our patients. Are we proactive in giving a heads-up overview of what the patient is about to experience, or do we forget to give it much thought because the job has become a matter of routine?
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