rapport

[Star09]

I got to see the fruits of my efforts to gain a patients trust. We were called out to a woman in resp. distress. She was scared of anything medical - to the point where she was combative and tried to refuse to go to the hospital. She wouldn't tolerate the NRB and actually managed to land a flailing hand across my face.

I firmly asked her to look at me. I managed to get eye contact with her and I told her that I knew she was scared, but that we were going to do our best to help her if she would let us. I added that it had hurt when she had hit me and I asked her to relax because I didn't think she really wanted to hurt me. She nodded in understanding, but you could tell she was still really freaked out. On the way to the hospital I explained everything I needed to do in excruciatingly thorough detail before doing it. I convinced her to hold the NRB herself.

Arriving at the hospital was another struggle and I ended up remaining with her and holding her hand throughout the exam. I would explain what the nurses were going to do and if was the same or different than what I'd done in the ambulance. It was a long night and I didn't know at the time how comfortable I had made her.

We got called out to her again a few weeks later. I was actually a third on the ambulance that night, so my two partners went in before me and I brought the stretcher. I came in and she was freaking out again. But as soon as she saw me she calmed right down. They began taking her out to the ambulance while I packed up the kit and she actually got upset because she thought I wasn't going with them. I rode in the back with her and she was fine. She let us do whatever we needed to, she took the O2 without hesitation, and answered all of our questions.

It was really neat to see her improve so much in her attitude with us. That experience sticks with me now when I'm dealing with my patients.

[Arachne]

In addition to what's been mentioned already, I've found that addressing the patients' practical concerns can help to gain their cooperation and trust. Elderly people are afraid they won't be able to get home after release from the hospital, or they're afraid they'll be sent to a nursing home. Kids are afraid of needles. Teenagers are afraid that their parents or the police will find out they were drinking/using drugs. Some female assault victims are nervous about transport with a male EMT. People are worried about leaving their pets alone if they don't know how long they'll be in the hospital. It may not always be obvious what they're really afraid of, but if you can figure it out or ask something like, "Is there something else that's concerning you?", it can go a long way in building that rapport with them and getting them to work with you.

[Sassafras]

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.

I've never had an issue arise because I wear a (small) badge. Never.

[Patch]

I don't care what anybody believes. NO BADGES. The U.S.A. can do what they want. I don't ever want to wear a badge with the only exception being a formal dress uniform. If I want a badge I'll go to Depot in Regina and get a gun to go along with it.

[Patch]

Empathy, empathy, empathy.

This will get you past barriers and will improve your communication greatly. I believe we must regard peoples minds with as much detail as we afford their bodies.

[AnthonyM83]

One thing that can REALLY help is putting your hand on someone's shoulder or upper arm and telling them the worst is over. They had us do this with the person sitting next to us at a seminar I went to recently and it was surprisingly reassuring. It's almost like a buddy giving you this reassuring hand and telling you it's all going to be okay. It's very human.

Going to the hospital can be a very scary and lonely experience, especially for older people. Imagine if something happened to you. You'd want to call your spouse, parent, family member, or friend right away. You'd want to tell someoen. A lot of older people have no one else left. No one to call and they're going to be alone in that bed the whole time. You can see the fear and worry in their eyes as they're rolled out to the ambulance. Even if you're surrounded by professionals working on you and asking you medical questions, you can still feel completely alone. Having one person on the team talk to YOU as a person and just go through it WITH you really helps.

[hfdff422]

As long as you are confident that the worst is over, often with medical patients they could easily get worse despite your best efforts.

[t_pritchard06]

yeah..thats true..i just got done reading the book "The Know-It-All: One Man's Humble Quest To Become The Smartest Man In The World"...and he gave me my new motto in life: sometimes right, sometimes wrong, always certain...

as long as youre certain, you can do anything

[rat115]

I agree that this is a great topic to be brought up. It's something that all EMS, fire and LEO have to deal with.

Just last week, I went on a call for a female pt who had had a seizure. We arrived on scene to find the pt was just coming around to the point that she could talk to us. (And I found that the family is part of my church community.) My partner on the call was very focused on the pt and tended to only speek to the family when he needed information. I started asking questions while he was treating her and I was helping him. He was so preoccupied about getting her into the ambulance that he didn't realize that he had not put the cot into the load position and started to get rude with me on scene. I swapped places with him so that he could see that there was a problem. Then, I asked him to move the cot back from the ambulance and tried putting the cot into load since at that time I wasn't sure what the exact problem was. I then quietly told him what the problem was by saying that "the cot wasn't all the way into the load position." The family was standing there the entire time. I double checked if they were going to ride in the ambulance or take their vehicle.

When we arrived at the hospital and were gettign off of the elevator to the ER, the pt started into a grand mal. We got her into a room and onto a bed. Got the treatment started with the nurses and docs. The mother was very upset. I moved back because there were so many people around the bed that we were about to step all over eachother and went over and talked to the mom. I gave her something to focus on besides being scared for her developmentally delayed (28 y/o) daughter. I asked her about the past history of her seizures more in depth and other information about recent behavior and changes in the pt's life. I was able to get some extra information AND keep the mom calm.

I've noticed that in the area that I work in rapport is very important. I think sometimes it's more so here than it may be in the city where you know that you're not going to know the people who are on the ambulance. Being a small town, you know a lot of the families and pts. Those that you don't know will ask who you are, how long you've been in town, who you're related to and any of a dozen other questions to feel that they know you. Then, you know that there's a high chance that you're going to see the pt again somewhere around town.