Operations, Patient Care, Rescue & Vehicle Extrication, Training

Ease Patient’s Fear for Better Care

Issue 8 and Volume 35.

Everybody’s scared of something, sometime. It turns out that’s not a bad thing, Life-Saver. Of course, some people are irrationally fearful. But for most, fear is more like good sense. It prompts them to moderate their contact with everything from tall, shaky ladders to wrong-way traffic.

Just out of curiosity, I Googled the term “fear” and got 186,000,000 hits on the first try. That seemed odd, because I have never found it referenced in any EMS text. Nor have I ever heard anybody mention it in any class or seminar I have ever taken.

The public seems to readily understand its importance, but our teachers don’t seem to give it much thought. Yet, we learn quickly in the field that fear is a focal element of every emergency. (I believe, more than that, it’s a component of all suffering.)

It’s hard to communicate with sick people who are scared, until you get them past their fear. Even if they’re violent because they’re scared, that’s good news. Unlike almost any other impediment to communication, fear is an adversary you can overcome. Try the following techniques.

“We’ve got ya.” I can’t begin to tell you how handy that expression is  when somebody’s scared. It assures people they’re in good hands, and it works just as well to soothe kids being extricated from cars as it does to calm little old men being carried down stairs.

“Don’t be afraid.” Some experts say it’s not wise to tell people how to feel, and that’s probably truest in the early stages of bereavement. But this doesn’t hurt anybody. And many people, especially kids, really don’t know how to feel after something awful happens to them. I think this small reassurance is helpful to most. Try combining it with the preceding suggestion.

Touch doesn’t work for everybody, because some people don’t like to be touched. (They’ll recoil visibly if they don’t.) But it works for most, especially kids—who may do everything from reaching for your hand to just smiling when you pat ’em on the shoulder or hug ’em.

Body language (especially your eye contact and your tone of voice) speaks constantly to people who are scared. In fact, it means more to most of them than the things you say. As busy as you are sometimes, don’t overlook the importance of these mechanisms for telling someone you appreciate their predicament, and you’re determined to mitigate it. (Don’t forget to smile!)

Visible evidence of physical protection is more important than anything to people who have been assaulted. Emphasize this throughout your contact with them; it’s what they need from you more than anything else.

Explanation. One common cause of fear is inexperience—for instance, with pain that’s unlike anything we’ve ever felt. The same is true of shortness of breath, or maybe a first-ever seizure. Sometimes you can alleviate the fear that comes with those emergencies by simply telling people what you think has happened, what you’re doing about it and why that’s likely to help.

Pain relief. Fear also happens when we’re about to experience something we have dealt with in the past—like kidney stones or the manipulation of a broken bone. Those are situations when it’s good to pull the drug card. Even if you don’t carry meds, let the patient know you appreciate their fear, will anticipate it and will do everything you can at your destination to facilitate their relief.

Speaking of pain relief, I think the word “patient” needs to go away. It’s an archaic term for inept, impotent, passive, horizontal people, tended by echelons of vertical professionals, with doctors and insurance executives waaay up there at the tippy-top. We’re not omnipotent, but I think sick people shouldn’t have to be patient about anything we can fix.

8. Address people’s fear for their loved ones! That kind of fear can be the most profound of all. If you find a sick person is focused on somebody like that, you can do a lot to relieve their anxiety by addressing everything you say to both of them, almost as though they’re both sick. Whatever you do, try not to unnecessarily separate them.

9. Physical comfort is another thing that really hasn’t had much attention in our education. Too bad, because it matters to sick people at least as much as good medicine. A paramedic once told me that there were two things that didn’t belong in his ambulance: pillows and blankets.

I can’t help thinking they did. He probably did not. JEMS

This article originally appeared in August 2010 JEMS as “We’ve Got Ya’: Getting people past their fear.”