I was speaking with a friend of mine recently who I had encouraged to become an EMT. She had been working the past six months for a different service, and I asked her if she was still enjoying her career choice in EMS.
Her response kind of surprised me when she said, “Yes and no.” She continued to say, “I think part of the reason I don’t like EMS is all the ‘ridiculous’ calls.” She went on to describe that she was expecting more of the “good calls,” but it seemed like all she was doing was making falls, lift assists, nausea and vomiting calls, and minor motor vehicle accidents. When I asked her what her definition of a “good call” was, she replied, “You know…the calls you see on “Chicago Fire,” “Station 19,” “911,” and “Nightwatch.’”
Regardless of the EMS service you work for, “ridiculous” calls are a part of the normal day-to-day operations, but what IS a “ridiculous” call? This is a low-acuity, high frequency call that makes up most of our call volumes. We all have low-acuity stories like the call to the house where there are four cars in the driveway, and no one wants to take grandma to the hospital.
Perhaps a call to the nursing home for the “just found” confused patient in the Alzheimer’s unit. Even the call to the patient with the flu for three days who has been prescribed antivirals, but they haven’t taken them yet because they feel so bad and now want to go to the ER. I’m sure we could come up with many more examples, but complaining about calls is not what I want to accomplish with this article.
It seems like a low-acuity call inconveniences a lot of EMS providers. These are calls that happen when we try to sit down and eat, use the restroom, or when we just got to sleep. It is a call that many of us think, “You called 911 for this?!” Some feel we are above these calls and tolerate the low-acuity calls while waiting for the higher acuity, adrenaline pumping calls.
One thing I have learned in my 18+ year career is that the “good calls” that I had once hoped for really meant that someone’s family has just been impacted by a devastating emergency that will forever change their lives. However, if we change our mindset and change the way which we think of these calls, we can truly improve our skills, clinical knowledge, our careers, and ultimately our patient outcomes and community. Remember that we are usually the first contact the patient has to the healthcare system that is already overburdened.
The calls give us the opportunity to work on our interview and assessment skills to determine the level of care our patients need so we can get them to the most appropriate level of care. So, what can we learn from the low-acuity call? What value is there in this type of call that seems to take up most of our call volume?
Behavior and Emotion
First, low-acuity calls teach us about human behavior and emotion. When someone calls 911 and asks for an ambulance, many times they are experiencing an event that they do not know how to handle. They are overwhelmed with fear, confusion, and the inability to act in a manner that can make a positive impact on their situation.
They experience an acute stress response (fight or flight) to a situation that they have not experienced or are ill equipped to handle. So, they call 911. When EMS arrives, whether you feel this way or not, we are the professionals! We have knowledge and training that they need to help bring calm to their storm.
Due to their fear and confusion, they may also have a secondary response of anger, crying, hyperventilating, irrationality, or some other emotion. Each call will be different, but eventually, we learn how to speak to people and calm them down. We learn to educate them so that they can understand what is happening and get them the help that they need.
One thing I have personally learned to tell patients is, “I will keep you updated on everything I find in my assessment. I won’t keep any secrets from you. So please don’t keep any secrets from me.”
Then I go through my assessment. I involve them by showing and explaining everything that I am finding, whether it be a blood pressure, heart rate, EKG rhythm, 12-lead, blood sugar, or anything else that is pertinent to their reason for calling 911.
Your Skills
This leads to the second point that low-acuity calls teach us. The more patient contacts we have, the more we hone the skill of assessment. We can check to see if a pulse is regular or irregular, strong or weak.
We can listen to a variety of breath sounds and begin to distinguish what is “normal” and what is “abnormal.” We can do a hands-on physical assessment to find potential deformities and abnormalities that the patient may have from either a new or old injury. If your average call volume is five calls that are low-acuity in nature, then you just gained experience in evaluating and assessing five different patients.
Some of those patients may be completely healthy and some may have a chronic illness, but you just gained experience that cannot be replicated or replaced. More importantly, you may find an acute issue that the patient may not have known about, or thought was unimportant.
When you are dispatched to your sixth call of the day, maybe that patient is having an acute respiratory, cardiac, or traumatic injury or illness. You can now apply what you learned on those previous calls and use that knowledge in assessing and treating this patient. You have just improved your assessment skills.
Sympathy and Empathy
The last point that I want to make is how low-acuity calls can teach us the difference between sympathy and empathy. Sympathy is defined as the fact or power of sharing the feelings of another, especially in sorrow or trouble. In other words, we feel sad when we see someone else feeling sad but may not have the experience that they are having.
Empathy is when we have experienced the same pain that the patient is currently experiencing. One of the calls that seems to be considered a low-acuity call in many services is back pain. When I was younger and made calls where the chief complaint was back pain, I wanted to say, “Suck it up and get on the stretcher!”
Now that I’m over the age of 50 and have experienced back pain, I have a very different view of back pain. I am very empathetic to it. Back pain can be a minor muscle strain or injury, or it could be a symptom of something far more serious, like an abdominal aortic aneurysm. Unfortunately, we may miss this high acuity finding if we do not do a complete assessment on every patient.
Putting It All Together
As we get dispatched to the variety of calls, we should approach each one asking ourselves the following questions: “What can I learn from this call/patient?” “How can I be a better provider today than I was yesterday?” “Am I missing a sign or symptom of this ‘presumed’ low-acuity call that could make this call much more serious?”
If we begin to look at the value of the low-acuity call, then we will be more prepared for the higher acuity medical or traumatic injury. As EMS professionals, we need to remember that our patient’s emergency is our emergency. It is what we either volunteer or get paid to do. We chose this profession.
It is our responsibility to meet the community, and more specifically the patient, where they are, not where we wish them to be. We need to start using every single patient contact as a learning experience to better hone our skills, knowledge, and experience. We need to see every call as a training opportunity to prepare ourselves for the upcoming high acuity, low frequency call.
We have all heard the saying by the Greek lyrical poet, Archilochus, “We don’t rise to the level of our expectations, we fall to the level of our training.” These low-acuity calls give us daily training to improve ourselves each and every shift.
The motto of the EMS Training Division for Harris County ESD48 Fire-EMS-Rescue is, “If you are failing to train, then you are training to fail.” It is time we change our mindset and ultimately our culture in how we approach the calls we make day to day.
We do this by learning to educate our patients about their emergency; we learn to be better clinicians by honing our assessment skills; and finally, we learn to be more empathetic and sympathetic to our patient’s needs. We need to remember that our job is to be the best EMS provider for our community and our patients. They deserve nothing less!
Editor’s Note: This commentary reflects the opinion of the author and does not necessarily reflect the opinions of JEMS.
