Exclusives, Patient Care, Trauma

Engaging Bystanders of Potentially Traumatic Events

Pictured above is a 4×6 card distributed to bystanders of potentially traumatic events by the Colerain Township Department of Fire and EMS in Ohio.  The two-sided card was created after identifying the need to better engage bystanders of potentially traumatic events. The Colerain Township PTE witness card has a QR code that links individuals to the Centers for Disease Control and Prevention’s “Coping with a Traumatic Event” document. Other organizations implementing similar PTE cards, such as McLean County Area EMS System in Illinois, link individuals to local resources. (Photo provided by Shane Packer)

A 50-year-old male suddenly collapses in aisle five at the local grocery store after experiencing sudden cardiac arrest. Other people shopping in that same aisle, some with children, unexpectedly find themselves in an intensely stressful situation that they have never witnessed before. Some may be in disbelief and freeze. Some will check on the patient but may be scared and hesitant to begin CPR.

Fire, EMS and law enforcement all come rushing in, cramming into the store’s aisle to take over CPR and begin patient care. Individuals that began CPR, some without any sort of CPR training, stand back to watch the events continue to unfold. Shock may set in with some bystanders. Others may begin to question if they did the right thing by beginning (or not beginning) CPR. Fire and EMS personnel continue to work the cardiac arrest. They may even have a crew member serving as a family liaison, gathering information and comforting the family, if applicable. 

The crew moves the patient to the medic unit for transport while the engine company returns to quarters. It’s all part of normal daily operations for fire and EMS agencies across the country. Meanwhile, at the grocery store, at least a dozen employees and shoppers are left with many questions and feeling a wide range of emotions.

Most likely, they will never find out what happened to the patient. Some of the bystanders may not know how to process what they just experienced. There is an opportunity for improved customer service that many of us are likely missing. We need to take a moment to recognize any pain, fear or confusion of the other individuals involved in the incident may be experiencing. 

This type of incident can be a potentially traumatic event (PTE) for bystanders. Other PTE examples include motor vehicle collisions with serious injury or death, incidents involving children, or any incident where bystanders are left with a sense of horror or feeling helpless. What may be the routine call for us as firefighters and paramedics, it is far from ordinary for the rest of the world that does not work in emergency services.

We have made significant progress in recent years acknowledging the stressors of our profession and developing peer-support programs. Those same stressors apply to the bystander. It can have a longer lasting negative impact because they’re not trained or mentally prepared for these types of situations. While we are not behavioral health experts, we can help PTE bystanders understand the symptoms of PTSD, and point them in the right direction if they need help. 

I was first introduced to fire and ems customer service as an 18-year-old volunteer listening to then-Millville, Ohio fire chief talk about “Mrs. Smith”. Fresh out of high school and clueless as to where my fire service journey would take me, I initially thought poor “Mrs. Smith” lived down the road and had terrible luck. Like so many other chiefs, he was instilling customer service values and setting expectations for how we treat people. We’ve done a great job setting expectations to treat Mrs. Smith and her family with mutual respect and compassion. We need to take this commitment of excellence in customer service and apply it to the other individuals near Mrs. Smith during her emergency.

When we think of customer stabilization, we need to remember that there is more than one customer on scene. We all set expectations of providing first-class customer service to our patients and their family members. We need to build on that culture and mindset to remember the bystanders of a potentially traumatic event; especially individuals that provided assistance prior to our arrival. While a crew may rush in and quickly transport a patient, there is likely an engine company or other unit still on scene.

Take that opportunity to engage bystanders. This is an opportunity for us as public servants to address some of those initial emotions or questions PTE bystanders may have. Patient care and incident stabilization will always be the first priority, but remember that we are here to serve all residents and guests of our communities.

Colerain Township Department of Fire and EMS responded to several of these potentially traumatic events in the summer of 2017. We realized there were missed opportunities for improved customer service, ensuring everyone we encountered on PTE scenes were alright. The department created a PTE witness card to distribute to bystanders. The card is a physical reminder to our personnel to remember the bystanders. We did not have much experience talking to bystanders about PTSD and traumatic events. The card is an ice breaker to begin that conversation. It begins with a simple thank you for taking the time to help someone in need prior to our arrival.

The conversation continues to explain that these events can have negative and lingering effects on people.  This can provide comfort and reassurance to the individual when they know that they did the right thing and that we sometimes struggle with these events as well. Our PTE witness card has a QR code that links them to a document from the Centers for Disease Control and Prevention for coping with a traumatic event. This is another example where we as prehospital care providers act as navigators, helping connect people to the appropriate resources. While the card is a small and simple concept, it sends a loud and clear message of empathy and mutual respect. 

A card is just one way that you can send the message that you are thinking of everyone involved in a potentially traumatic event. We have also sent follow-up letters and posted messages on our social media sites. A recent Facebook post discussing potential bystander PTSD from a fatal MVC on the interstate reached over 25 thousand people in 24 hours.

You do not need a card or resource packet to improve customer service for everyone involved in a potentially traumatic event. Saying thank you and a brief conversation before returning to quarters can go a long way. No matter the approach you take, remember when you’re done taking care of “Mrs. Smith,” check on those that were near her because it is the right thing to do.