Sponsored by Binder Lift
By Shawna Renga for EMS1 BrandFocus
“Training for uncertainty [is] facilitated by keeping one’s focus directly on the individual patient, not on idealized stereotypes.” – Kenneth Ludmerer, American medical historian
Much of what we do in EMS is centered on problem-solving through uncertainty. No two patients present exactly the same, and the chaos and variability of the out-of-hospital environment demands a level of adaptation that is unique in the healthcare setting.
Knowing what to do when feeling uncertain was recognized as a key problem in medical education as early as the 1930s [1]. How can we act with conviction and confidence during patient interactions when faced with scenarios that don’t fit the mold of our training? How can we mask our uncertainty in front of our patients, asking them to trust our actions and believe in our decisions?
Patient satisfaction has always been important in EMS, but it may have even more impact in years to come. Medicare reimbursement amounts may be tied to overall patient satisfaction in the future, making it all the more important for providers to focus clearly on our patients’ emotional state while we provide care.
Prepare for a variety of patient scenarios
Some scenarios demand in-the-moment problem solving to address a situation that is truly out of the ordinary. These scenarios require providers to function at a high level while under stress, and they can be particularly taxing on the mental health of responders.
These “big sick” situations are when we connect with our education, experience and knowledge to deliver a patient care experience that is likely to provide the best outcome for everyone involved. However, these “big sick” situations are not the majority of what we do in EMS, and uncertainty often affects situations that need not be difficult.
By preparing and training for these less critical scenarios, we remove the uncertainty and save our mental, physical and emotional resources for the situations that truly demand our top performance.
Consider patient comfort and dignity
The initial move of a patient is often one of the first times we, as healthcare providers, ask a patient to put their trust in us. We promise that we won’t let them fall, that they aren’t too heavy for us to lift and that they are safe in our hands. And yet for many patients, that initial move may be nerve-wracking, frightening or embarrassing.
Many EMS departments use outdated or improvised lifting techniques that have been passed down from previous generations, and we don’t often think about how these improvisations affect the patient’s comfort and trust in our abilities.
Imagine a patient who has fallen in his garage. He weighs 375 pounds and has managed to land in an awkward position, wedged between the car and the garage wall. He is trapped, scared and having a bit of trouble breathing due to the position he is in.
Or perhaps you are caring for a geriatric patient who has slipped in the bathtub and is unable to get up and out of the small space with her own limited strength.
With only two providers, how do you quickly lift and move these patients while protecting their dignity during the process? How can you avoid communicating uncertainty to these patients, causing them to question your ability as a provider?
Think of our patient stuck in his garage. What might he feel as he watches a pair of EMS providers, or a group of firefighters, strategize about how to lift him safely? There’s an inherent loss of dignity for the patient when providers improvise in this way, as we are communicating that the patient’s size is causing a problem and making things difficult for us. These initial moments can directly influence the patient’s confidence in our ability to perform more invasive procedures en route to the hospital.
Consider what can be done to eliminate these common negative aspects of an initial patient interaction. Perhaps you and your partner agree to avoid strategizing about challenging patient moves in front of the patient. Better yet, spend some time discussing past cases where the initial lift could have gone better and attempt to implement new strategies on the next call.
Throughout every call, consider the interaction from the patient’s perspective, and how your actions may be affecting their overall trust in you as a provider. These are small changes to implement, yet they can have significant impact on patient satisfaction.
Use the right tools for the job
It is equally as important to ensure that you have the equipment necessary to protect yourself and your patient through the initial patient move. The Binder Lift, a vest-like device with multiple handles, can be put on the patient quickly and allows providers to smoothly lift someone who is in an awkward position.
Using specialized equipment like the Binder Lift establishes the professionalism of the provider and starts the process of building trust with the patient. The Binder Lift allows providers to move with confidence and decisiveness right from the start of the patient interaction.
Without the patient’s trust, it can be very challenging to deliver appropriate care. The patient who questions every action, refuses aspects of treatment, or is otherwise “difficult” may very well just be lacking in trust for their provider.
It is a common misconception that the fact we are EMTs, paramedics and firefighters means that people will inherently trust us with their care. In fact, our position of authority as public safety providers might cause an initial lack of trust in the people we serve. Regardless of whether we have the patient’s trust from the outset, EMS providers should be actively working to gain and maintain the trust of those under our care.
References
1. Ludmerer, K. M. (1999) Time to Heal: American Medical Education from the Turn of the Century to the Era of Managed Care. New York: Oxford University Press.
About the Author
Shawna Renga, AS, NREMT-P, currently works as an instructor for the United States Coast Guard Medical Support Services School in Petaluma, California, providing EMT training for helicopter rescue swimmers and Coast Guard corpsmen. She also works part-time for a private ambulance company and lives with her husband and two sons in Sausalito.