Have you ever walked away from a call or transport wondering what more you could have done? Perhaps it was a suspected hip fracture in an elderly woman. Yes, you managed her pain to the limit of your protocols with medications, good splinting techniques and gentle handling, but you still ended up delivering an anxious, pain-ridden woman to the hospital.
Many will tell you that our pain-management protocols are not aggressive enough, but changing the written protocols aren’t the only solution. What more can you do during that ambulance ride?
Managing patient pain or anxiety during transport is not always about drugs or what written protocols allow. Sometimes it’s about just spending time with your patients, listening to them and helping them to relax.
There’s a missing protocol skill—one that isn’t taught in school or even in the back of the rig during your training ridealongs. It’s the skill of conversation. It’s something that many would say you either have or you don’t. It’s been called a gift as if it’s something you have no control over. “You know Johnny, he has a gift for gab.” This, of course, is untrue. It’s a skill, like any other, and it’s one that the really good EMS providers make look natural and easy.
The good news is that being a good conversationalist is a skill you can acquire and make your own with little practice and effort.
Being able to start a conversation is a proven method of patient management and helps reduce anxiety and pain through distraction. According to some studies, pain can be reduced by up to 25% by distraction alone.1 There are certainly times when an initial dose of morphine or fentanyl can’t do that well.
The reduction in pain occurs because distraction has the ability to actually change the physiological response of pain transmission in the spinal cord.2 It’s as if when the brain doesn’t have to think about it, some of the pain signals don’t get processed at all. For children especially, research has shown that interactive distraction is far better at managing pain and anxiety than passive distraction or other forms of passing the time.3 This means that engaging someone in a conversation is far better than just having them listen to people talk or look out the back window of an ambulance, watching the world go by on the way to the hospital.
Adding to Your Toolkit
Not sure you’re the type of person who can just strike up a conversation? Given the proper tools, you can start conversations on a variety of topics that will last the entire ambulance ride. When you use these tools to interact with your patients verbally, they will serve you just as well as the ones used for taking vital signs and listening to lung sounds. You can make having conversations with your patients and their family members in the back of the ambulance as easy as taking a pulse. All you need is a little practice.
The process starts as soon as you arrive in the patient’s home or on the scene. You approach and introduce yourself by name and title, and confidently announce that you are there to help out. You don’t make promises you can’t keep, you just smile and give gentle assurance that you are going to do everything you can do. You assess the situation, determine your diagnosis, treatment and interventions, and then you head off to the hospital with the patient. Now, on the way to the hospital, as you begin your secondary assessment, pull out your conversation toolkit and use it to help pass the time, relax and reassure your patient.
EMS Conversation Toolkit:
1. Kids/Grandkids/Family: Every parent and grandparent I’ve ever met loves to talk about their kids and grandkids. Aunts and uncles will chatter on about their favorite nieces and nephews. Kids will talk about their siblings. Family is central to many of our lives, so use this to get the patient talking and ask questions to further the conversation. Where do the kids go to school or college? What’s their favorite sport or subject of study?
2. Work/Hobbies: People don’t live in a vacuum. Everyone does something. They work, they play, they do many things. Find out what those things are and inquire about them. How long have they worked at the office? Did they always want to be a chef? What is their favorite thing about collecting antiques? You might be surprised with the answer just by asking, “What do you do for fun?” I once got an eye-opening lesson on the challenges of a pole dancing class. You just have to ask.
3. Community: Folks come from somewhere. Maybe they’ve lived in the community for their whole life or they’re just passing through, but they have a home, a place they grew up and a history. “How long have you lived in the county/city?” “Where did you grow up?” “Is your hometown anything like it is here?” Be inquisitive and carry on the conversation.
4. Vacation Spots: People have their favorite vacation destinations and they’re pretty passionate about them. Often you can meld this conversation starter in with the one on family since many families vacation together. “I’ve still got to decide on a vacation spot for my family this year, have any recommendations?” You might just find your next family vacation spot through one of these conversations.
5. TV Shows: Nearly everyone watches television. TV shows are the fodder for water-cooler discussions and conversations in every workplace, so find out what your patient watches. “Do you watch reality TV shows?” “What’s your favorite show?” “Do you think this season is as good as past seasons?” Dig in. You might find, as I once did, that even 90-year-old women think Sheldon from “The Big Bang Theory” is hilarious.
6. Sports/Current Events: Here in the Baltimore area, there is one conversation for the last few months about which almost everyone has something to say: “How about them Ravens?” Winning the Super Bowl will do that to a community, but all of us have some sports team or current event that we could talk about. If your patient has a favorite team, get them to educate you on what their prospects are in the upcoming season. You don’t have to know much about it, just be honest about your ignorance and let them teach you something.
7. Favorite Foods/Restaurants: We all have to eat, and even in our mobile lives on the ambulance, we haven’t tried all of the food joints in the area. Ask what their favorite food is, especially for kids. Ask where they go for dinner and why they like it. Tell them you’ve been looking for a good place to take your significant other for dinner and ask for a recommendation. Share your thoughts about local cuisine and what the nearby diners make best. You might come up with someplace new for you and your partner to try for lunch on the way back to the station.
8. Shopping/Gadgets/Computers: At holiday time especially, I ask folks if they’ve got all of their shopping done. But it’s also a good conversation starter, especially for young adults. Ask them what kind of phone they have and why they like it. Do they have a favorite app or game they play? Share yours. I learned about “Doodle Jump” from a patient and I’ve lost many hours playing that game since. Who knows, you might give them something new to download and play while they wait in the ER for treatment.
9. Social Media: Got Facebook or Twitter? I haven’t met anyone yet who doesn’t have some opinion on the benefits or blunders surrounding social media. Not since the CB radio craze of the ’70s has something brought so many people together via an electronic device. Ask the question and you might find out that you have @TweetinGrannie_65 in the back of your ambulance with you. It’s a great opportunity to tell people about your service’s social media outreach, too.
10. Weather: When all else fails, use this ancient, time-honored conversation starter and talk about the weather. “Hot enough for you?” That line has started many a conversation for me. If nothing else, it gets you to turn the heat or air conditioning in the back of the unit to a comfortable temperature for the patient. In my area (a farming community), the weather is of more importance than most. Sometimes, you might have an avid gardener on the stretcher. Don’t discount the value of this one.
I hope these tips give you the confidence to bring conversation and distraction techniques into your EMS toolkit for patient treatment. It only takes a little work on your part and the skill can be parlayed into other areas of your personal and professional life. Become a better communicator to become a better EMT or paramedic.
1. Bowers E. (June 27, 2011). Managing chronic pain: a cognitive-behavioral therapy approach. In WebMD. Retrieved May 15, 2013 from www.WebMD.com/pain-management/features/cognitive-behavioral.
2. Sprenger C, Eippert F, Finsterbusch J, et al. Attention modulates spinal cord responses to pain. Current Biology, 2012;22(110),1019–1022.
3. Wohlheiter K, Dahlquist L. Interactive versus passive distraction for acute pain management in young children.Journal of Pediatric Psychology, 2012;38(2),202–212.