There are moments at conferences that take you completely by surprise — not because of where they’re listed in the program, but because of the power and authenticity of what unfolds in the room. That was the case with “The Great Affect,” delivered by Liz Harney, EMS lead CDI specialist for Baptist Healthcare in Georgetown, Kentucky.
Tucked away in a second-floor classroom, this session was, without exaggeration, the keynote I didn’t know I needed. The power of Harney’s delivery, the beauty of her message and the emotional resonance of her story held the audience rapt. For me, it was the best session I’ve attended in years.
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The forgotten domain
Harney’s message began where many EMS education discussions rarely go — the affective domain. EMS education traditionally focuses on two pillars:
- Cognitive (what we know)
- Psychomotor (what we do)
These are the skills and knowledge we can test, grade and measure.
But Harney made a compelling case that the third domain — affective — is the missing cornerstone of well-rounded paramedic education.
The affective domain encompasses everything that shapes the human side of patient care:
- Values
- Empathy
- Communication
- Professionalism
- Self-awareness
As Harney reminded the room, “We have built entire systems around what’s easiest to grade. But just because empathy and presence are harder to quantify, doesn’t mean they’re optional.”
From the heart of a patient turned paramedic
If her words on affective education were powerful, her personal story was transformational. Harney recounted the day she overdosed in a hotel room — the day she nearly became another statistic.
When EMS arrived, she was met with judgment and disgust from most responders. But one paramedic treated her differently. That medic knelt down, looked her in the eyes, and spoke to her, not about her. She showed compassion, presence and humanity — qualities that transcended clinical skill.
“That paramedic,” Harney said, “made me feel like I mattered. She gave me hope when I had none.” That moment became the catalyst for Harney’s recovery and her entry into EMS. “I wanted to be just like her,” she shared, “to pay it back.” Now 10 years sober, she teaches others that emotional intelligence isn’t a soft skill — it’s a survival skill.
Why it matters
Harney framed the affective domain as both a professional responsibility and a protective factor. Emotional intelligence isn’t just about being kind — it’s about being effective, resilient and safe. Research supports this: higher emotional intelligence correlates with lower burnout, better teamwork, safer clinical decisions and improved patient outcomes.
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“EMS is demanding,” Harney said. “Not just cognitively, not just physically, but emotionally. If we’re only teaching our students what to do, but never how to be, we’re failing them.”
Her message hit home for educators and field providers alike. She called for a shift in EMS culture — away from stoicism and suppression, toward openness and emotional literacy. “In some EMS circles, showing emotion is still seen as weakness,” she said. “We act like we’re made of Teflon. But we’re not. And pretending that we are is why we break.”
Teaching the intangibles
Harney didn’t just deliver philosophy — she delivered a playbook. Her strategies for building affective competency were practical, powerful and proven in her own programs.
- Case studies with heart: Go beyond the “34-year-old male found intoxicated on a park bench.” Ask students, “What was your first thought?” “What emotion did you feel?” “How could that affect your care?”
- Reflective journals: Not a “dear diary,” but structured reflection prompts — “When did you feel unsure of yourself this week?” “What shifted your view of a patient?”
- Group decisions: Transform individual experiences into shared resilience. “When students share vulnerability,” Harney said, “it becomes strength.”
- Simulation with emotion: Every skill scenario should have an emotional dimension — an anxious patient, a distressed family member, an angry bystander.
- Clinical rotations with intention: Her program requires students to spend time in treatment facilities for people recovering from substance use disorder. “You can’t teach empathy from a PowerPoint,” she said. “It has to be felt to be understood.”
The outcomes, Harney shared, were extraordinary. “You could see a light come on,” she said. “Students came away changed — more human, more understanding. And they carried that back to their services. The ripple effect is real.”
Modeling matters
Perhaps the most poignant message came near the end of Harney’s session: educators and preceptors must model the behaviors they want students to learn. “If we say ‘empathy matters,’” Harney said, “but don’t reflect it in our own actions, students will know.” She urged leaders to create psychological safety in their classrooms and field programs — places where students can talk about mistakes, burnout or emotional struggle without fear of ridicule.
Compassion fatigue, she warned, is real — but it’s not an excuse. “Our frustration cannot become someone else’s shame,” she said. “The patient on the other end of that call doesn’t know you’re burned out — they only know how you make them feel.”
A call to action
In the end, Harney’s message was simple but profound: the affective domain is not optional. It is as essential to EMS education as airway management or pharmacology. “We’re not just preparing students to pass a test,” she concluded. “We’re teaching them how to stay present in someone’s worst moment — how to carry the emotional weight of this job without being crushed by it.”
Her words lingered long after the applause faded. This wasn’t just a lecture on pedagogy; it was a lesson on humanity. And as one audience member whispered on the way out, “This session didn’t just make me a better educator — it made me a better person.”
Bottom line: Liz Harney’s “The Great Affect” was more than a presentation — it was a reminder of why we do what we do. In a profession often defined by procedures and protocols, she brought us back to the power of presence, empathy and emotional connection. The affective domain isn’t an add-on. It’s the heart of EMS.
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