Professionalism: What We Say

What we say...
by Adam Thompson, EMT-P

I have been reading quite a bit lately, in EMS trade journals, about professionalism in our industry. A couple of the articles have really stuck with me, and made me think. Sometimes in our illustrious profession, we begin to make the motions without even thinking about what we are doing. This may be a result of experience and confidence, and indicates assertiveness. For instance, you respond to a patient complaining of atraumatic chest pain, you ask if they are allergic to aspirin or if they have any bleeding disorders, then you administer the medication. This probably use to take you a bit longer to do, but after doing it so many times, you can do it without even thinking. This development, however, may be a little too disconnecting. What I mean by that, is the relationship between you and your patient.


Think about your training labs in EMT and paramedic school. How do we first practice our prehospital skills. The use of training mannequins has become almost universal. We shock them, splint them, chest decompress them, crich them, and intubate them. Not once, did we have to introduce ourself to these inanimate objects, or ask for permission to perform procedures on them. There has been advancements, and they even have Sim-men hat even talk back, but they are still a far cry from the real thing.

Now think about running a bad call. An unconscious patient, whether it be as a result from a traumatic event, or cardiac arrest. Do you still treat these patients as if they are mannequins in training lab? I'm sure you're not kicking them to check for arousal, like you may have done to rescue annie, but do you let it set in that you are dealing with a real person? If you're like most of us, probably not. We tend to disconnect ourselves from the reality, and severity of situations like these as a coping mechanism. Psychologically, no one could deal with the storm of emotions that would arise from getting too involved on every call.

The problem with the above method of coping, is that it is only beneficial with a patient that can't comprehend what is going on. With our everyday patients, it is better to treat them like people. I know this sounds pretty basic, but I think it may be overlooked more often than not.


One of the most important phrases to be said on a call is "hello, how are you, what is your name?", a nice follow up to this is "my name is ___ and I am your EMT/paramedic". This simple greeting does so much. Next I would say something like "so what brings us here today" and follow it up with "well I am here with some of the best in the business, and we are going to make sure everything is going to be okay". Is everything going to be okay? Maybe not, and I know what the texts say about false reassurance, but so what? I don't think it has harmed a single person to try and put them at ease. In fact, if you are on scene with someone having the big one, a reduction in stress could result in a reduction of morbidity. While greeting the patient with these phrases, you may want to hold their wrist. You may put them at ease even more, while obtaining a few vital signs (ie. pulse rate, rhythm, & quality, skin condition & temperature).

I don't expect that any of this information is shockingly new to anyone reading this. It may, however awaken at least one reader who has, maybe, let their empathy fade over time. I have to constantly remind myself about this.


Well, medically-ignorant, not ignorant-ignorant; most of them anyhow. This is extremely important to remember. We know the medical phrases, they don't. We know most medical conditions in more depth than they do. We have seen more people with many more pathologies than they have.

So because of this, what comes out of our mouths is immensely important. It is very possible that they called 911 because they were scared and had no idea what to do. They expect a professional to show up and tell them what to do. When you show up on scene, you are an expert in the opinion of your patient, until you open your mouth. It is your job to keep them thinking you know everything there is to know, even if you don't. If you start out by using a variation of one of the phrases I made mention to above, you are on the right track to keep their confidence.

Don't make your patient's feel dumb. This is something I commonly see, "so you took your insulin and you didn't eat anything?", or "you have a fever, why didn't you try taking Tylenol?", or "if you take anti-inflammatories on an empty stomach, you are going to have belly pain.". Say those phrases with a condescending, patronizing undertone to get the full effect. If you don't want to run needless calls, get a new job. They are inevitable, and allow us a chance to educate, not punish our patients customers. Don't get me wrong, I have my moments of frustration. They easily fade away when I consider the unemployed alternative.


We know our patients are medically-ignorant, and that they probably called us out of fear. It is then easy to assume that the decision to go to the hospital for further treatment is most often predicted by what we say and how we say it. I would venture say that over 90% of our patients are going to go to the hospital or refuse transport based on what we tell them. The rest probably didn't call us themselves anyhow.

Don't believe me? Put yourself in the shoes of the patient and think about how you would respond to the following questions:

- So, do you want to go to the hospital for this by ambulance?

- Since I'm not exactly certain there isn't something more serious going on, why don't we go to the hospital and get this checked out to put your mind at ease?

I think it is safe to say that the first question would most likely get you a signature and a wave while the second may get you a transport.

There are a ton of these phrases that we have all learned to use; hopefully in the right way. It is important not to abuse this power that our patients give us. I'm not saying to talk every person you come across into being transported, just be careful to not talk them out of a transport. It is always easier to explain why you did than why you didn't.


- Say "your welcome", or "my pleasure"
- Avoid the giggles (laughing on scene may be construed as immaturity)
- Always explain the consequences of refusing transport
- Keep the bystanders (eavesdroppers) in mind when treating the unconscious patient
- Avoid the medical terminology (one of the first lessons taught)
- Use welcoming body language. Open arms, eye-level stance.
- Talk to the less severe patients during transport. I like to ask where they are from or what they did for work, it is easy to bury your face in your PCR and just watch the monitor. Holding a conversation with the patient may clue you into a change in symptomatology such as breathing patterns or neuro-deficits like short-term amnesia.
- Wish the patient well before leaving the hospital. First and last impressions are important.


Shaggy said...

Very good. Sometimes I have to remind myself of these things as I have let my empathy fade, as you put it. Sometimes it is easy to understand how EMS providers get to this point, expecially when you are doing about 8-10 calls in a 12 hour shift, and many of them you just want to slap someone. But if you put it in perspective you are a healthcare provider and they are calling you because they cannot, for whatever reason, get medical advice from anyone else, then it should make you feel more compassionate, and more important. The problem, Adam, is many EMS folks see themselves simply as high teck glorified EMERGENCY ambulance attendants and drivers. Not only that, they have been beat down into believing that enough to tell people they cannot offer advise, only they are there to TRANSPORT people who NEED EMS. We believe that we are not educated, trained, or qualified to give obvious advise, instructions or referrals. Are we abused? Yes, many times, and I think we should take the time to educate people. The frustration is where people intentionally abuse the system, are aware you know it, and just don't care. I am still grappling with how to handle these folks.

Adam Thompson, EMT-P said...

Well Shaggy,

I believe we absolutely offer medical advise. It may not be to the extent of what we could offer if they loosened the chains, but it is advise.

I understand, believe me do I understand, how taxing the EMS abusers may be. Just try not to sweat it. If you get frustrated, you increase stress. if you laugh it off and have a good time running the needless calls, you increase longevity. I believe there are more needless calls to come with less retribution. A public option for healthcare is inevitable, and it will increase our call volume. Whether you are for or against socialized healthcare doesn't matter. We are bound to be busier. We are bound to be busier running calls on more people that would have driven themselves to a clinic in the past. The fear of the bill (whether they paid it in the past or not), will be gone. So I say again, don't sweat these calls.

Being busy is a good thing. I bet there are some realtors, construction workers, and investors out there that wished they were busy. Yea, no one signs up to run the unimportant calls, but that's the gig Shaggy, you know that. And every once in a while, we get that unique chance to truly help someone.

I know my glass seems half full. I am an optimist. It is the only way to get through this job with a smile. It is too easy to complain. Consider it a challenge.

Shaggy said...

I actually believe if we had a national health insurance, we could in fact, decrease our transports. How or why? We would be paid regardless of transport or not. I mean, if we treat and release, or prevent a patient from increasing healthcare costs by not taking them to the hospital for something not warranted, there would be a reward. The governing bodies who would regulate the insurance would rather pay us NOT to transport as it would be in their best interest. I also think that with a national plan, there would be more triaging of services, and this could begin with calls to 911.
We may not have to wait for healthcare reform to do that. If the economy does not improve, and EMS agencies need to make cuts, there will be less crews to take calls, and 911 centers will be forced to triage their calls a little more. That's just my take on it.
I am in favor of loosening our reigns, and we have to be the ones to force change. That could be by taking the initiative and educating patients and giving alternatives to transport, even if it takes a call to their PCP, cardiologist, or local hospital ortho clinic to make an outpatient appointment. You would be surprised how much influence you can make in stetting change.

Adam Thompson, EMT-P said...

Shaggy I would agree except we believe in evidence right? Socialized healthcare has been tried. You don't have to travel far to see the strain it puts on a system. Boston has some of the longest wait times in ERs in the country. I have transported Canadians that say the purchase their own insurance because they are likely to be seen faster than with the public option provided by the Canadian government.

Imagine a country with only Medicaid. I don't want to express my opinion too much on the topic, because politics bring out the worst in people. I have researched places that have socialized healthcare. What has been tried just doesn't look good.

Shaggy said...

Ah, the socialized medicine argument. At EMSVillage, ALL of the Canadians and others across both ponds swear by their national health plans and rebuke our propaganda against them. They still seem to be working there without a single industrialized country thinking of dismantling them, though many realized they have to cut back as too many people take advantage of the system. In the UK, they triage their calls at 911 and EMS can act as gatekeepers. Up North, the Canadians are just now realizing they need a similar triaging system, especially when they have ambulance crews waiting, no lie, up to 6 hours in an ED waiting to hand off their patient. They also don't have EMTALA laws.
Medicaid is jamming us up because of lack of adequate compensation and the medicaid clients abusing the system.
I think the whole system needs revamped, but, we will not see that happen. At least not for a long time until the healthcare infrastructure starts to break down more.
Why are we discussing this here? Sorry about that.