The Four Cs of Care

Patient care from both sides of the stretcher


A.J. Heightman, MPA, EMT-P | | From the January 2008 Issue | Monday, July 6, 2009

EMS providers are often the worst patients. We don’t like people pokingus with needles and placing tubes in our orifices. The thought of being intubated, having someone cannulate fluid pathways, or probe, cut and repair our body organs, is way outside our EMS Zen level.

I’ve been preparing physically and mentally for gastric bypass surgery for the past nine months, and I thought I’d reflect on what’s been going through my mind, particularly these past two weeks before being wheeled into the operating room. First, I’ve learned a tremendous amount about myself, the psychology of obesity, nutrition, the weight management staff and my surgeon.

Along the way, I learned that dieting doesn’t always work; that sugar, soda, white stuff (e.g., pasta, bread, cream sauces and greasy foods) can kill you; and that inadequate rest, genetic factors and stress all play a role in weight gain.

I’ve also learned that the people who specialize in weight management are passionate about what they do and really care about their patients. You can’t say that about everybody we interface with in EMS. Many just want to work until the stroke of four, and they grumble if they’re sent on a late call or a patient care issue demands a little extra time.

But the most important outcome of this long process to have bypass surgery was the opportunity to contemplate the care that will be rendered to me and the realization of how much I rely on my caregivers to be careful, compassionate, clean and competent—the four Cs. I also had a moment of self-reflection: Did I do everything I could for the patients I cared for in the past?

As a young pup, my dad mentored me to realize that the most important treatment tools we possess are our personality, demeanor, compassion and sincerity. Our patients don’t know us. They trust that we’re competent, that we’ll explain our every action, and that we’ll do our best to relieve their pain and keep them as stable and comfortable as possible. Those are powerful objectives that I’m sure we don’t always accomplish.

My nephew was recently involved in a head-on collision. The EMS crew backboarded him and left him in the ED on the board, where he remained (with minor injuries) forthree hours. Most of his subsequent pain was caused by lying on that board, not the collision.

During my pre-admission testing, the hospital staff told me that I would be kept as comfortable and warm as possible throughout my operation. See the difference in approach?

Trust (and first impressions) play a big role in a patient’s attitude and stress level. It became a central focus of my mental preparations the past two weeks. I had to trust that the team caring for me possessed the same enthusiasm, commitment to excellence and desire for success as my surgeon. In the prehospital arena, an EMS team leader has to instill this in the patient and their family members in the first 30 seconds of the call.

I had to trust that my OR team would tube me correctly, place me in an unconscious state and maintain my physiological status for three hours without any loss of concentration or critical errors. You have to do the same, making sure the ET tube stays free of dirt and other debris from the roadway or living room rug that will cause your patient to get a respiratory infection, catch pneumonia and die. It’s an enormous responsibility

we all have.

Keep the four Cs in mind whenever you’re with a patient, particularly those who are unconscious and trusting you with their lives.

Five Objectives for Careful, Compassionate, Clean & Competent Patient Care

  1. Patients have a desire (and right) to know what’s happening to them.

    Introduce yourself and start a good rapport early on.

    Explain everything you’re doing to (and for) them.
  2. Treat unconscious and conscious patients the same.

    Always assume the unconscious patient can hear you;

    they often can.

    Be gentle and take great care not to cause or exacerbate injuries.

    Be aware that unconscious patients can’t feel or correct a poorly positioned, trapped or snagged body part.
  3. Remember that all patients have fears.

    Listen to them.

    Respect them.

    Allay them.
  4. Pain (physical and emotional) is unacceptable.

    Don’t cause either one unnecessarily.

    Seek its source, battle it like an incipient fire and extinguish it—before it escalates out of control.

    Treat pain like it’s an injury, not just a symptom.
  5. The prehospital arena is full of contaminants and germs.

    Constantly look for and fight off this unseen enemy.

    Keep your equipment as clean and neat as an OR tray.

    Make a habit of ensuring clean zones and sterile fields. JEMS

For more from A.J., go to:

Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Patient Care, Patient Management, Jems From the Editor

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A.J. Heightman, MPA, EMT-P

JEMS Editor-in-Chief A.J. Heightman, MPA, EMT-P, has a background as an EMS director and EMS operations director. He specializes in MCI management.


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