I was fortunate enough to be able to assist at a motor vehicle accident a while ago where we had two patients both classified priority two/yellow coded according to the standard triage model. However, this scene was one of those where things didn’t work in the way we planned. As per the report, one gentleman was pulled from the vehicle and robbed before we arrived on the scene.
Now here is the problem. Patients have rights and one of the fundamental rights streaming from the South African constitution to the patient bill of rights is their safety.
Now for most that had the privileged of obtaining a tertiary education, would have heard of or seen the name Maslow. Abraham Maslow was an American psychologist who developed a pyramid (Maslow’s Hierarchy) to explain the basic psychological needs humans have that need to be fulfilled for a person to be happy and/or motivated. It has five tiers starting at the bottom and ending at the top. The bottom is the most important.
So, how does this apply to a patient or an emergency scene? Is there a direct correlation between the hierarchy and the treatment rendered to the patient or is there an adjustment that can be considered when we look at a patient? Because, from a practical perspective, a “happy” patient is a calm patient and a calm patient is progressive to the enhancement of their current condition.
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It is therefore imperative that the emergency responder considers the hierarchy when attending to the patient.
1. Physiological Needs. The emergency responder has very little direct control of the items listed in the image loaded above. There are, however, steps that the emergency responder could take that would establish this base of the hierarchy.
a. Physiological needs like air, food and water could be established by the emergency responder through the provision of IV fluids (if required), oxygen (if required), and the required medications or drugs for the patient’s condition. Even the opening of a window may achieve the need for the “fresh air” the patient may want.
b. Sociological needs like clothing, shelter and sleep could be addressed by the ER through the provision of blankets and the security of a pre-established area like a clinic or ambulance.
2. Safety Needs. In this regard, the ER does have some degree of influence concerning the patient and the scene.
a. Personal Security and Property. The ER should maintain an environment that the patient could regard as a “safe zone” as best they can. This will include crowd management, road safety, access control, etc. The establishment of a limited access scene would bring a decline in the macro factors that may negatively influence the patient’s emotional standing. The secondary is the patient’s property that the ER could assist with by ensuring that all the patient’s important possessions (cell phone, wallet, ID, etc ) are present, accounted for and the patient knows where it is at all times.
b. Health and Resources. The patient is made aware of their available choices would place them in the position to make certain decisions and establish the groundwork for the regaining of control of their life.
3. Love and Belonging. This may be a difficult need for the ER to address as it deals with interpersonal connections. It is found that where there are established connections the degree of trust is higher.
a. Friendship and intimacy. Ideally, the ER should be emotionally uninvolved with the patient and should definitely not be involved intimately with the patient.
b. Sense of connection. The ER can establish a great sense of connection with the patient to fulfill this need through casual conversation and treating the patient for shock. Finding a common interest with the patient is a great way to create a rapport
c. Family. “Is there anyone I can call for you?” is a question that is both beneficial to the patient and the ER. It will allow the ER to monitor signs of memory loss and provide an additional line of communication for further information. It will further ensure the patient’s need is met through contact with the chosen person.
4. Esteem. The ER can have a tremendous function in fulfilling this role for the patient by applying a fair amount of interpersonal skills and psychology.
a. Self Esteem, respect, and status could be concreted in the manner that the ER addresses the patient. A term like “Mister,” “Sir” or “Ms” would address all three of these elements with the patient combined with the tone that the patient is spoken to being of a respectful nature.
b. Recognition, strength, and freedom for the patient are secured through terms of encouragement and motivation. “You are doing great!” now and then would go a long way!
5. Self-Actualisation. This is a complicated element to address as it fundamentally deals with self-enhancement and personal growth. The ER can play the role of that annoying practitioner that over-explains and breaks the patient’s condition down into a long-winded physiological class, which would allow the patient to gain additional knowledge. But the patent would probably not be in the mindset to care too much about educational enhancement but rather health enhancement. It is with this in mind that I would suggest that the self-actualisation element s replaced with a support element.
a. The provision of support on any level that the patient would require would aid in all four of the previous elements. Support does not necessarily mean doing things for the patient but could also refer to actions that will allow the patient to do things for themselves. The ER could consider providing patients with relevant information and allow them to make the necessary choices from there. The ER should be respectful and supportive of these decisions. In this, I am at no point stating that the patient should be given the choice of how much glucose or morphine they should get, or whether a traction splint is truly necessary. But information on nearest hospitals and the pros and cons of said hospitals would be a great example.
It is with this in mind that wish to propose an amended Hierarchy of needs related to the person in the emergency.
The format herein is laid out to meet a duel function:
The first concern is with the stabilization of the patient’s condition thus ensuring the best possible rate of survival before the other needs of the patient.
The second concern is with the overall needs of the patient from a psychological perspective aligned with Maslow’s Hierarchy to the best of his or her ability.
