First Responders & First Responses
Patients may have waited anxiously for hours, so they’re highly observant for our first responses in words, facial expression and body language.
Working as a paramedic, medic, EMT, prehospital care provider or any other type of first responder differs vastly from any other role in those first seconds or minutes of arrival. In most medical-based experiences, every patient prepares themselves to enter the patient care domain, whereas, unique to emergency services, we have to enter theirs.
It may sound like stating the obvious, but as with most things in life, the obvious aspects can easily go unnoticed, so picture the following scenarios to spot the difference between a patient approaching us and us approaching them.
Scenario One
A young man wakes one morning, feeling quite unwell with severe, lower right sided abdominal pain.
He tries everything he can think of to ease it through position, antacids, food, water, a long soak in the bath.
After looking up his symptoms online, he's more concerned and calls a few family members to canvas opinion.
Each advises him to go to the emergency department because he's feeling worse as time passes and has begun to vomit.
His uncle calls around to pick him up and they drive to the hospital, talking about the options and what to expect on arrival.
They park their vehicle, pay for a ticket and walk towards the main doors, taking in their surroundings and the new environment.
While standing in the queue to be booked in and triaged, they figure out how the system works and see the different processes in play.
By the time the patient is called through to be assessed, he feels less daunted as he notices how staff interact in normal, everyday ways.
Human factors are recognisable to him, even if the foreign surroundings are not, so he has prepared himself to settle in and go with the flow.
Scenario Two
A young man wakes one morning, feeling quite unwell with severe, lower right sided abdominal pain.
He tries everything he can think of to ease it through position, antacids, food, water, a long soak in the bath.
After looking up his symptoms online, he's more concerned and calls a few family members to canvas opinion.
Each advises him to go to the emergency department because he's feeling worse as time passes and has begun to vomit.
No relatives are available with a car and he's in too much pain to drive himself, so he dials emergency services for assistance.
While waiting for an ambulance, anxiety climbs along with the pain and discomfort, he has never been in this situation before.
No idea what to expect from the care providers or what their roles are and what they do other than brief snippets he's seen on TV.
Will they be able to take the pain away? How much will it cost? Where will they park? How will they get him into the ambulance?
Do they fix him up and leave him at home? Will they be disgusted at his untidy house? Is he going to be judged by his surroundings?
The questions are endless and the longer he waits, the more worried he becomes about how it's all going to play out.
Prehospital emergency calls take all perceived control away from the patient and leave them anxiously awaiting that first point of contact.
For this reason, we see all manner of unexpected reactions on our arrival. Frantic waving from the street, even when we're right there and have clearly identified the location. Aggressive directions on where to park or what we'll need to bring in with us. Abrasive answers to initial questioning. This doesn't fit with the meek, welcoming, appreciative reception we trained for in scenarios. All that practice in carrying our bags, introducing ourselves then launching into questions, consent and treatment goes out of the window in a flash. We weren't taught to deal with hurdles in our way other than aggression or intoxication related calls. If people are out of their comfort zone and calling for help, why would they behave in ways that seem defensive or bossy or stand-offish? It makes no sense. Or does it?
Being out of the comfort zone is key. Humans like to be in control of their surroundings so they can feel safe and secure. If patients and their loved ones are visiting a doctor's office, a hospital or a clinic, they'll take comfort items with them. A bag of belongings, mobile phone or electronic device, a book, maybe headphones. They'll dress in clothes that make them feel presentable and can choose how they may be perceived. They accept the unfamiliar as they arrive and seek out things that are recognisable, so that they feel less out of their depth.
But, just like our first few months in an ambulance, heading towards each scene with a nervous feeling about the unexpected awaiting our arrival, patients and their loved ones may feel the same from the other side. How can they maintain a sense of control and order? Perhaps by frantic waving so that they feel like a useful participant. Maybe by directing us where to park and what to bring in. Being defensive and stand-offish is possibly their natural reaction to being fearful and this increases with our direct and instant questioning. Just as often, they will provide the welcoming and appreciative reception expected. No matter how they respond as we step out of our vehicles, we can rest assured that the majority will be uncomfortable, anxious and therefore highly observant of our initial words, body language and facial expressions.
As first responders, our first responses to every patient and family member on arrival can set the scene in good, bad or ugly ways.
Unlike our healthcare counterparts, based in static structures where others enter their domain, no matter how many thousands of calls we have run in our time, we enter a new domain every single time. So what can we do? Remembering one simple thing may make all of the difference.
Picturing a patient's anxiety climbing with the kilometres we cross in reaching them can make ourselves more mindful of mannerisms. It's not always as easy as it sounds, I know. Feeling fatigued after endless calls through a tough night shift. Attending a low acuity job just minutes after clearing from an emotionally charged sudden death. Organisational culture stressors creeping into the ambulance and changing the mood. Challenging crew dynamics. Whichever factors come into play, it's up to us to do our best to start each call with a clean slate and recognise that our first response is the first impression and first impressions count.
If we're abrasive, apathetic or aggressive in our initial reactions on arrival, we'll have to work much harder to gain trust from that point onwards and, let's face it, none of us want to make the job any more difficult than necessary.
On this first day of a brand new year, maybe it's a good place to start in terms of reflective practice. If first impressions count for so much, then our first responses as first responders may make all the difference in providing first class care and career satisfaction.
Thanks for reading.
Tammie
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