What the FBI taught me about patient interactions. Part 1

(For any in the law enforcement community, do not worry, I will not be releasing any sensitive information. I would never want to aid someone committing a crime.)

The FBI along with ICE allowed a few of us in the EMS community to participate in a joint training on Hostage negotiation. During the training I was amazed at how much the training we were going through related to some of our everyday patient interactions. They made it very realistic and proved that just like dispatching it is a job I would never want.

Cranky patients that don’t want to cooperate? No, we never have those right? Patients in an extreme anxiety state getting aggressive? Never seen one of those right?

Now let me start by saying I do believe in scene safety, I think it is very important to always maintain a secure scene as best we can. I also know it is not always possible. So here are a few of the things they showed us that we really should keep inside our heads:

1) In a shouting match sometimes the whisper is loudest.

We were not told to actually whisper, but we were told that in most cases where a patient began to scream actually lowering your tone and loudness could make the other person stop and listen. I have had to do this with schizophrenics as well as my son when he walked out and found his pet dog dead in our backyard.

This doesn’t work all the time, and sometimes when it does it’s only after multiple attempts. The trick here is having enough self control to not respond in the same manner that we are being talked to. Trying to remember that our job is not judge, jury and not even Medicare fraud officers. Our job is patient care. Too many times I’ve heard stories on how a patient was “shown” not to call the ambulance for minor complaints with how they were treated or treatment that was done. (Did that patient really need that 14 gauge cath?) This is not what we are here for, and yea there is much we could do to improve systems and resource management, but don’t do it while wearing the uniform and manning a truck that means safety and care to so many.

“The sign of an intelligent people is their ability to control their emotions by the application of reason.”- (unknown source )

We don’t need paper bags to control a hyperventilating patient, we coach them down. We may have to restrain a schizophrenic patient, it doesn’t mean we berate them for making us struggle with them.

I have seen greatness in EMS. I have seen competent medics calm a severe CHF patient as they ready the CPAP machine and apply it. I have also seen a prone restrained patient get growled to by a medic in front of his superiors and nursing staff at the ER and everyone laughed.

Did that in any way help with patient care?

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