rapport

[rocket]

rap�port

Pronunciation: ra-'pOr, r&-, -'por

Function: noun

Etymology: French, from rapporter to bring back, refer, from Old French raporter to bring back, from re- + aporter to bring, from Latin apportare, from ad- ad- + portare to carry -- more at FARE

: RELATION; especially : relation marked by harmony, conformity, accord, or affinity

Hi all, just a quick survey for the group at large.

As an EMS provider, how much of a priority do you make out of establishing a good rapport with your patient and/or the patient's family during the call?

It's not the sort of thing that gets documented on the PCR. It's not an intervention that will make the difference between life and death. It's not a skill that is part of any EMS training curriculum (as far as I know). It doesn't seem to be a hot topic of discussion among providers.

Yet it's one of the things that all providers incorporate into patient care. It's the part of treatment that is not covered by protocols and hence is our opportunity to have autonomous control over one aspect of the patient contact experience.

One of my local (and very well respected) EMS supervisors tells a great story of working a full arrest during a large dinner party at a local banquet facility. As his crew worked the patient this supervisory medic worked with the patient's family and helped defuse the calamity that might have erupted given the conditions. As the medic tells it, most of the dinner guests assumed that "our dear friend who had the heart attack was very lucky! The people who showed up to help him were obviously friends of his family based on the way they were talking to his close relatives!"

I've seen an intoxicated, combative MVA patient refuse and resist all treatment...even when ordered to be compliant by on-scene police....until the right EMS provider showed up and made that breakthrough. That wild animal that needed 5 men to get him onto the backboard turned into a docile patient....one who allowed (and consequently recieved) a much more detailed physical exam.

On that note I've also seen good rapport between an EMS provider and a grumpy ER charge nurse take the turnover of patient care away from an exercise in frustration to one where everyone gets along and learns something.

It seems that rapport is an important but often unsung aspect of what we do. How much of a priority do you give it in your everyday practice? Is it right up there with the ABC's? Do you try to establish it with any (conscious) patient right from the get-go?

Are there any "tricks" you can share in regard to building that relationship with your patient/patient's family?

Thanks!

-Trevor

[JakeEMTP]

Interesting topic Rocket, kudo's.

Depend on the severity of the call ( of course, it always comes down to this ) we/I always try and establish some sort of rapport with the pt and their family. I think it helps reassure the family and pt if you seem confident, not cocky ( can I say cocky here? ), and use a friendly voice instead of a authoritative one. Yes, as EMS providers, we need to be in charge of the situation. That being said, I find if you act in the manner I mentioned, the call seems to go smoother, the pt is a little more relaxed and so is their family. It's not always the case but seems to be more than 50% of the time.

Being relatively new to EMS, I haven't worked a situation as you described yet so it would be hard for me to speculate how I would handle it. All scenes are different, but your supervisor obviously handled this particular call correctly.

To develop a rapport is an acquired skill that comes with experience. If one is comfortable with their skills then rapport should come easier to them. Introverted people of course will have a harder time acquiring this skill. I have also noticed that introverts have a harder time with assessment. But that is another topic.

[FireGirl911]

To develop a rapport is an acquired skill that comes with experience. If one is comfortable with their skills then rapport should come easier to them. Introverted people of course will have a harder time acquiring this skill. I have also noticed that introverts have a harder time with assessment. But that is another topic.

This is a great topic!

Here's my take on it:

I too believe that we have a huge effect on how the event will play out, based on our ability to interact with everyone involved. By presenting one's self as approachable, confident, and trustworthy, we facilitate a more tranquil environment, which allows us to focus on the care of the patient.

By creating a sense of trust with the patient and their family, they trust us with information and access that we would not have otherwise. This is why EMS/Fire are usually welcomed into someone's home with open arms. This is why mothers hand us their babies. This is why we are asked to attend funerals.

It is a bond we create with the community we serve, and by doing this we make our own jobs easier and more meaningful.

I agree that this is not a skill that comes easy for everyone. I also agree that as a provider's skill set becomes stronger, they find it easier to focus on rapport. I think that for many, they have the potential to interact at this level, but at the beginning of their career they are still focused on the mechanics of patient care. They are focused on integrating their learned behavior. Once they assimilate their skills, the performance of those skills comes easier, and they can relax and allow themself to focus on the human side of patient care.

[Eydawn]

Working with kids a lot of the time in the scouts, rapport is definitely high up on my list. If I can't get the kid to calm down, I'm going to have issues with treatment efficacy... not to mention a screaming kiddo on my hands, yuck!

Working EMS, rapport makes a lot of difference. Some people are hard to establish a rapport with, others are easy.. but once you've got it, they're more likely to tell you information they might not have otherwise... some people are ashamed of certain medical conditions or possible issues (pregnancy) and don't really mention it, but if they trust you, they're more likely to bring it up without you having to fish so hard.

Wendy

NREMT-B

CO EMT-B

MI EMT-B

[hfdff422]

I personally am an introvert when it comes to dealing with new people, but when it comes to patient contact the professional drive takes over. I always introduce myself to patients (who are concious) and ask them what happened and what their name is. I then try to use cues from that initial contact to dictate how I handle the situation. If someone is or may become combative I treat them with empathy. If someone is scared or nervous I will act very confident but use a quiter tone of voice. Our main objective is to ensure proper patient care which can only be achieved if we get as accurate of a history as possible, and then become their advocate in the ER. That is why I am against wearing badges, it will automatically put a barrier between you and a patient who may be in legal trouble or even a woman who has been abused by her husband.

[AZCEP]

The more critical the situation, the less likely I am to do a lot of talking to family. I will tell them just enough so they know what is going on, and what I am going to do, but I won't leave them with a warm, fuzzy feeling about it.

[AnthonyM83]

Great topic!

I just went to a seminar that had a lot to do with effects of gaining rapport from people in emergency situations and am reading the book, The Worst is Over by Judith Prager which addresses the topic.

Since I'm not actively working in EMS, I haven't gotten a chance to practice too much, but in general gaining quick rapport with someone helps people trust you and let you direct them or give them advice.

I feel showing you understand their situation and that you're treating them as a human being is very important. I've had people work on me like I wasn't even there...it sucks to go through any medical problem feeling alone.

Two examples:

When I had my wisdom teeth taken out, there were two nurses and the dentist paying close attention to me. One nuse monitored the screens, the other stood behind me with her hands on my shoulders, the dentist who had explained each step gave me the mask and did the IV. They kept asking how I was feeling and telling me what they were doing (switching gases, putting in IV, giving new med). At one point, I started feeling REALLY bad which started making me feel extremely anxious. I felt like getting up and running out, but the nurse kept talking to me and even running her hands through my hair (the human touch helped so much) and the doctor noticed my facial expression and asked how I was. I told him I feeling really bad and he said that was really common right before going under and that it'd go away.... those two things instantly calmed me down and while I felt physically bad I knew I'd be okay.

Another is yesterday when a 6 yro at work was hit by teather ball during a game. She instantly went down to her knees and started crying hard. I put my drink down and went down to one knee to be on her level, sat her on my bent knee, and told her:

Me: "Oh, I bet that's hurting. It sucks to be hit by a ball, but as you sit here I bet you can feel it start getting better already. Sometimes that happens in sports. It can be kinda violent, huh?"

Her: Yeah!

Me: Are you going to keep playing?

Her: No way!

Me: "But that's part of the game, I guess (<--to tentatively introduce an idea)...you get hit hard, but then it gets better, and you jump right in. It always impresses me how sports players get taken down, but they force themselves to go back in, and then they're fine"

I was recalling all the psych/soc stuff about girls always being babied when they fell and guys are told to get back on their feet, but thought I might've gone too far, but she instantly looked up with this super determined face and said, "You know what? I'm going back in!" She wasn't instantly happy and she was tense like it still hurt a bit, so I know the pain was real, but I think it completely changed the course of outcome for her. It was no longer about how badly she was injured, but about how she was going to keep playing. I've seen bigger boys her age get hit with similar force and sob for awhile and even decide to just sit and watch for the rest of the recess.

I really believe this can change the course of recovery and outlook in pre-hospital and hospital settings, just psychologically or emotionally. You have to show you understand what they're going through so that they'll listen to you, then give them a way to think about the injury.

Compare

Medic1: Wow, you're a total mess (heard doctor in my clinical rotations say this). Guess you'll be out for awhile, there, huh? (even if meant in kidding friendly way)

Medic2: Okay, let's see how we can take care of you so you can start getting better

Doctor1: It's going to be quite awhile before you'll be on your feet again, Mr. Jones, so take it easy.

Doctor2: "When you get home, be careful not to overdo it, even though you'll be feeling better faster than you thought."

It just kinda sets the tone for recovery. It can also set the tone for the interaction at the scene of a 911 call.

[ToledoEMT]

Anthony... Great post!

I was really impressed with the way you expressed yourself... It made me really think about how I say things. With every patient in general, but especially with kids. In EMS and while I'm off duty. I have two kids.

Also, I want your dentist. I just recently had a bad experience with mine.

Take care,

April

[cosgrojo]

Patient and family rapport are, in my mind, the most important factor in EMS. I love the fact that this topic has been brought up, and only a little jealous that I haven't thought of it! :oops:

The human brain is the most influential and powerful organ in the body. Whatever the ailment (within physical reason) the mind can be utilised to dull the pain, relax the body, and make patient care easier. If you, as a provider, are able to break through the mental barrier that many patients erect and make a connection with them, then you have just enacted the single greatest intervention. A relaxed and trusting patient allows you assess the patient in a controlled manner. It also allows you greater scope because the patient trusts you enough to allow you to assess and treat to your full capacity.

Example:

3-4 years ago.... Myself and a Medic partner are responding in a very rural township for an 18 y/o female with shortness of breath. When we get there the volunteer fire monkeys are all ready there. The young lady is laying on the floor with her legs drawn up. There are 5 fire fighters in full bunker gear hovering over her, yelling at her all at the same time, and trying to shove 15 lpm o2 via non-rebreather. This is doing nothing but causing her to breath with short, shallow, rapid breaths with excessory muscle use.

My medic partner sizes up the situation immediately and orders all the fire-monkeys out of the room. I start talking to the patient and get some vitals and try and help her take deeper breaths. The medic gets the story from her parents..... boyfriend problems.... anxiety attack. Mind you I am a very green EMT without the complete understanding of these situations, and my rapport with patients so far has been during stable nursing home transfers. After the medic got the story, he immediately came over to the patient, removed the O2 and calmly and appropriately talked the patient off the proverbial ledge. Between the residence and the hospital the patient was breathing normally, having full conversations with my partner and feeling better about her situation just because the medic made a connection with her and was able to treat the patient without "treating" the patient. The fire guys were going by the Shortness of breath protocol without taking into account the patient.

This is the kind of call that rapport IS the treatment, not just a pleasant interaction that allows for better care, but it is the care. I think that we get too much tunnel vision. Treating the protocols and not the patients. Rapport and making a connection are paramount to good care.

Ways to get rapport:

1. Never lie to a patient. Even old demented patients can tell when you lie to them. Never get caught lying to them, you just ruined their trust, and you will never get it back.

2. Don't get tunnell vision. We get reports from family, staff, and patients to get an idea of what is going on. Big picture information, so you can treat the patient appropriately. Don't just treat the patient, treat the situation as well.

3. Be yourself. When it comes down to it, people know when you are being fake. People have a natural ability to sense this kind of stuff and it shows in their interaction. If you are not good and building rapport, try and work on it, but don't change your fundamental makeup, it is too telling.

4. Be empathetic. It may be trite, but it's true, unless you've walked a mile in another's shoes.... blah blah blah. We all know this.

Those were my thoughts.... again, great topic.

[cosgrojo]

Nobody has anything to add to this topic? I'm very surprised.... huh.