Interacting with the Patient, Family, Friends, and Bystanders 1.5

Interaction with the Patient

  • Overview: In emergencies, patients, family, friends, and bystanders will be in various states of mind (anxiety, fear, confusion). As an emergency medical responder (EMR), your communication shapes their experience and can alleviate fear while you gather essential information.
  • Many patients fear the ambulance ride more than the emergency itself; part of the EMR’s role is to calm them and maintain a composed demeanor throughout.

Addressing the Patient by Name and Level of Formality

  • Address the patient by their name and ask how they would like to be addressed.
  • Respect individual preferences:
    • Older adults may prefer formal names (e.g., Mr. Jones).
    • Others may prefer their first name.
  • Do not use terms of endearment (e.g., dear, honey, hon, sweetie).

Eye Contact and Body Language

  • Maintain frequent eye contact to show attentiveness and active listening.
  • Be mindful of body language and positioning to avoid appearing intimidating.
  • If the patient is seated, kneel to their level or offer to sit beside them.
  • If the patient is lying on the ground, crouch down to their level.
  • Avoid crossing your arms or adopting a closed stance; face the patient with arms at your sides to convey openness and empathy.

Communication Style: Plain Language and Honesty

  • Use common, non-technical terms; avoid medical jargon.
  • Speak clearly when questioning the patient and explain all procedures before they are performed.
  • Be completely honest: if you don’t know an answer, say so.
    • Example: If a chest pain patient asks if they are having a heart attack, tell them you won’t know until they reach a hospital.
    • Example: If asked whether it will hurt when applying a splint, acknowledge potential discomfort but commit to minimizing pain.

Listening and Documentation

  • Develop strong listening skills.
  • Write down the patient’s answers as you gather information for the patient care report (PCR) and for relay to advanced medical care.
  • If the patient is asked to repeat questions, it may indicate you aren’t paying attention.

Interaction with Family and Friends

  • Apply the same respectful techniques used with patients when talking to family and friends.
  • Explain to the patient what procedures you are performing; maintain honesty and respect.
  • If performing CPR and a family member asks if the patient will die, respond honestly: you are doing everything possible, but the situation is very serious.
  • Do not offer false hope that the patient will be fine.
  • Family and friends often have a personal connection and can be more excitable; they may flag you down on arrival.
    • Allow them to provide information, but aim to get them to a calmer state before they relay details.

Managing Family and Friends on Scene

  • Recognize there will be times you cannot fully calm a highly distressed family member, particularly in serious cases involving a child, traumatic injury, or assault.
  • They may try to interfere with treatment to remain close to their loved one.
  • Strategy: bring in another supportive person (friend, family member, first responder, or bystander) to help console while you treat.
  • This should not delay your arrival to the patient; you can coordinate this during your approach and movement toward the patient’s location.
  • Maintain a calm but authoritative voice; clearly state your name and job title to establish legitimacy and reassure your role is to help.

Interacting with Bystanders

  • Bystanders may be helpful or obstructive; treat everyone with respect and do not allow interference with assessment and treatment.
  • If a bystander was assisting before your arrival and can continue to help, assign them tasks (e.g., directing traffic, fetching a blanket) so they remain constructive rather than disruptive.
  • If there is an off-duty medical professional among the bystanders, you may request assistance, but you remain responsible for the patient until advanced care arrives.
  • You are the authority figure on the scene; take control, but do so in a way that is not coercive or unappreciative.

On-Scene Authority and Professional Demeanor

  • Your priority is to reach the patient quickly to assess and treat them, while managing bystanders and family with respect.
  • Communicate clearly who you are and what you are doing to maintain order and reassure all on scene.
  • Balance control with empathy to minimize chaos and maximize patient care.

Practical Scenarios and Practical Implications

  • Scenario: Chest pain patient asks if they are having a heart attack.
    • Response: Be honest about uncertainty and explain that confirmation requires hospital evaluation; avoid guaranteeing outcomes.
  • Scenario: A patient asks whether it will hurt during splint application.
    • Response: Acknowledge potential pain but commit to doing everything possible to minimize discomfort.
  • Practical implication: Clear, honest information reduces fear, builds trust, and helps patients and families cooperate with care.

Ethical and Real-World Considerations

  • Honesty and transparency are essential, even when the truth is difficult.
  • Do not manipulate emotions; avoid giving false assurances.
  • Respect autonomy by providing information in understandable terms and obtaining consent for procedures where feasible in the emergency context.
  • Protect patient privacy and dignity while engaging with family and bystanders.
  • Recognize emotional distress in family/friends and provide targeted support or redirect to appropriate resources when needed.