Speaking of Emergencies

You all know what to do as EMS providers, but it can be so hard to know precisely what to say. In this four-part series, we’re going to explore the power of the spoken word during medical emergencies. We’ll talk not only about the concept of “Verbal First Aid” but about problems that come up in the field when you’re face to face with patients.

In my talks around the country on Verbal First Aid, providers always ask me questions like, “What do we say when we’re on scene and a child is coding and their mother is literally inconsolable? What do we say to a man whose right hand is barely attached?” I’m here to help you with that.

Though the situations are difficult, the answer is based on one simple principle — what we say can harm or heal. In 1987, the American Academy of Orthopedic Surgeons stated, “During periods of great stress, words that seem immaterial or are uttered in jest might become fixed in the patient’s mind and cause them untold harm.”

The premise is simple. You’ve all experienced it in your own lives. Two people meet for the first time and within 30 seconds and the exchange of a few words, they’re crying, laughing or reaching for their blood pressure medication. It’s no different to say that with 30 seconds and a few words, we can lower blood pressure, relieve pain and calm a nervous heart — even save a life.

Words generate images. Images generate thoughts. And those thoughts translate immediately into physiologic processes. We are what we see in our minds what we think. Words, the ones you say and the ones you hear, drive those thoughts like a conductor drives a train.

The Original Study
In 1976, M. Erik Wright, MD, PhD, took two groups of paramedics and conducted a simple study based on a radical notion at the time: the environment of treatment begins upon first contact.

One group was taught a special protocol and the other was not. The experimental group was instructed to separate the patient from the crowd, keep their conversations to a minimum (and as positive as possible), and recite this short paragraph to the patient, whether or not they were conscious:

“The worst is over. We’re taking you to the hospital. Everything is being made ready. Let your body concentrate on repairing itself and feeling secure. Let your heart, your blood vessels, everything, bring themselves into a state of preserving your life. Bleed just enough so as to cleanse the wound, and let the blood vessels close down so that your life is preserved. Your body weight, your body heat, everything, is being maintained. Things are being made ready at the hospital for you. We’re getting there as quickly and safely as possible. You’re now in a safe position. The worst is over.”

The experiment was so successful that, during the training, the paramedics themselves became the proselytizers, and they were scared they would skew the results. Not only did more patients from the experimental group arrive alive at the hospital, they recovered and went home faster.

The Healing Process
When you feel upset, you start the healing process by talking to someone — maybe a pastor, priest, rabbi, friend or relative. Why choose that person? How does it help you heal? There are two basic reasons:

  1. How that person listens: They have respect for us and confidence in themselves. They pace our feelings in both verbal and non-verbal ways. They’re truly listening.
  2. How that person talks: They speak firmly, kindly, convincingly and empathically. They have authority. We know they’re on our side. They have the confidence and ability to lead us with words to wellness. So, if they tell us that the wound has been cleaned, and we can now stop the bleeding, we believe it and can do it (I’ve seen it).

EMS professionals using Verbal First Aid do both — they can pace their patients and soothe their anxiety, as well as lead them to wellness with carefully chosen language.

Words in Action
When we’re frightened, shocked, confused, hurt, worried or wounded, we go into “altered” or “trance” states. In these moments, we’re highly focused or dissociated and very suggestible. We become literal and highly sensitive to what is being said to us or around us.

The price for not using Verbal First Aid can be high. A colleague of mine at Nyack Hospital back in New York told me a story: a paramedic arrived at the home of a hypoglycemic patient that had called EMS many times before. He was unconscious as his wife complained about his “rotten, lazy” attitude, assuming he heard nothing. Mistakenly, one of the medics joined in with the wife, calling him “a pain.” When he awoke, he screamed, “I heard that! I’m going to kill you!”

The rewards for using Verbal First Aid, however, can be great. Awhile back I was in Albuquerque doing some shopping and walked into a store. The woman at the cashier was pale, clammy, and had a look of sheer panic on her face. I approached her right away and asked if she was alright. She said, “I don’t know. My chest hurts. I can’t breathe well,” she panted. I looked around. The other people in the store were leaving, obviously scared by her situation and not sure what to do. I put my things down and came around to the back of the counter. I called 9-1-1 and asked her to sit down and lean forward a little. I began pacing her breathing, slowly leading her to a less frantic respiration rate. She said she was scared she was having a heart attack. It seemed a distinct possibility. So, I told her that her heart was the strongest muscle in her body and that it had served her well and could continue to do so now. She began to relax.

When the medics arrived, they moved calmly, spoke very little and said what they had to softly and compassionately. They didn’t joke around or dramatize the situation. They addressed her by name. One medic even offered to close up the store for her, so she wouldn’t have to worry about it.

Conclusion
Verbal First Aid helps you know what to say when you need it most, when every moment and every word counts. Sometimes, as the Albuquerque medics showed, the right thing is to say less and let your presence project a calm, confident authority that allows the patient to relax, knowing they’re in good care.

I would like to hear your stories — what worked, what didn’t. And I’m interested in your questions. If you’ve ever been in a situation that left you a bit speechless, tell me about it. I’m here to help you and encourage you in all you do.

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