Are Prehospital Acts Of Kindness Losing Their Magic?
Unexpectedly switching up the scene to focus on helpful additions used to be a handy trick in every paramedic’s toolkit (Image from Unsplash)
Paramedics are well known for compassion towards patients and most of us have gone out of our way to go above and beyond at some point. Everyone loves a story about the acts of kindness we get to provide in such a privileged position. Patients and their families talk about small gestures for decades, remembering how it made them feel at the time. First responders fondly recall those moments of adding value and feeling appreciated, too.
From cleaning an elderly patient’s bathroom so they don’t come home to a gastrointestinal mess, to ensuring the palliative patient’s final journey involves a detour that takes in one last sunset. Or getting an injured groom to the altar (albeit by stretcher) en route to the emergency department, to dropping a lonely pet somewhere safe after their human is hospitalised.
We do these things because we’re naturally inclined, because we enjoy the feeling it gives us and because we care. It may also simply be in everyone’s best interests in helping to get the job done. Just as reassuring words roll off the tongue, acts of assistance come to mind and make all the difference on scene.
The motivation behind it may purely be practical, like the lady who slipped and fractured both wrists while colouring her hair. My colleague and I rinsed out the dye and towel dried her locks, once analgesia and splints were organised. We all laughed together about the specialised salon service, but in reality, the only other option would have been a severely burnt scalp if we’d just let it be.
Perhaps it’s something sad that plucks at the heartstrings and makes it impossible to leave behind, like the damage caused by a collapsed husband in a beautifully tended garden. There was no way anyone on scene would have slept that night if we hadn’t cleared away broken pots, propped up squashed flowers and raked the soil flat before leaving. Any thought of his widow being confronted by the debris after losing her life partner was much easier to wipe from the mind after wiping it from reality.
More often than not, it’s merely a case of obvious need. Dropped groceries beginning to melt in the hot sun? Into the fridge before transport. A dog left home alone? Fill up the water and food bowls as we leave. Elderly patient back into bed, uninjured after a fall? A cup of cocoa while the paperwork is completed, so they settle safe and sound into slumber.
We feel the warm glow, they feel cared for, the paramedic profession remains valued as a whole and ambulance service bills are paid without protest.
Everyone wins.
But what happens when it becomes a commercialised craving for kudos?
Reality TV shows play a big part in educating the general public about prehospital care. Overall understanding of paramedic practice has improved enormously. An increasing number of patients now know that clinical competence comes included with the package, rather than balk at a cost comparison between ambulances and Ubers as a method of transport. Stoic stalwarts are becoming more likely to call when they suffer a STEMI, rather than putting it off until it’s too late. Bystanders are growing to relish the thought of CPR and saving a life now that the concept is less foreign and frightening. Kids are keener than ever to interact inside an ambulance that’s familiar to those they see in their lounge room daily.
Along with increased insight, however, comes expectation.
Patients rarely used to anticipate or even imagine private acts of kindness on top of professional clinical care. Suddenly switching up the scene to focus on helpful additions was (and still is, when unexpected) a handy trick in every paramedic’s toolkit.
That gravely ill patient, reluctant to be transported, may be more easily convinced when a chore that cannot wait is completed for them. A stressed and strung out mental health crisis may be alleviated purely by practical assistance, without need for clinical or pharmacological intervention. Those cups of tea and sandwiches that settle a diabetic hypo, or stave off starvation in young children with injured parents, can make or break a day.
But those memorable moments that first responders have been sharing with patients since the dawn of prehospital time are at risk of losing their magic.
So heavily publicised, all surprise is slipping away.
So widely promoted, evidence exists that expectations abound.
Questions now come up on scene about the kindest things we’ve ever done. Jokes and banter about when laundry will be folded, or how long until dinner become more commonplace. Smartphone footage of thoughtful gestures is uploaded to social media by patients and loved ones, like those “captured in the wild” scenes used to be in the early days of nature documentaries. Bystanders look for it, wait for it and hope for it, that moment of delight when the kindness card trumps the common clinical.
Ambulance services build public relations based on the goodwill of their frontline clinicians. A small number of paramedics photograph or film their acts of kindness, sharing them far and wide for the whole world to see. Online groups with casts of thousands exist to collaborate, confer and congratulate both givers and receivers on gestures that bring smiles during times of crisis.
The more attention we seek through reality shows, organisational PR driven social media platforms and self-promotion of good deeds done, the more attention we gain for doing so. Now that it’s becoming something to hope for or even expect, like an encore at the end of a magician’s stage show, we’re going to disappoint a whole lot of people by failing to meet their expectations.
Educate them to expect professionalism.
Encourage them to anticipate a high standard of patient care.
Enlighten them in understanding what clinical excellence looks like on scene.
But elevating their focus to automatically anticipate random acts of kindness from healthcare providers through every long shift, with minimal or no breaks, in all weathers, trying circumstances, continually changing environments, in and out of moving vehicles, without security and creature comforts while under the pressure of KPIs, documentation demands, organisational protocols, regulatory guidelines and media scrutiny is unrealistic and unreasonable.
Not every patient expects, needs or deserves additional generosity over and above compassionate, competent and professional prehospital care. The more we publicise these acts, the more they become an expected part of the service and the less value they bring. Where does this leave us when we have no magic tricks left to turn any patient’s terrible day into a slightly less painful memory?
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Tammie.
