It’s been about 20 years since my first workshop on therapeutic communication with a small volunteer firehouse, and I still get the same questions at my seminars: “What do I say when there’s nothing to say?” or “How can I be reassuring when the situation looks pretty grim?”
For instance, I received the following two comments regarding my mostrecent article:
Nate Dionne from Greenville County (S.C.) EMS asked:
As an EMT in a 9-1-1 system, I often find myself at a loss for words in certain situations. I have been in this field for just over two years now and still haven’t the slightest idea what to say when a family member asks me “Is he going to be alright?” as I’m doing compressions on a cardiac arrest patient. Often my partner or a supervisor (who often back us up on arrests) saves the day and says something, but nothing seems to be very encouraging after we’ve had a patient in asystole after multiple shocks and rounds of CPR. I know there are no magic words that will instantly put the family at ease, but if you had any advice for situations like this, I would really appreciate it.
Randell Allan Weinberg, EMT-B, FF, asked:
I have been an EMT since 2001 and am just about ready to graduate from paramedic school. I obviously still have a lot to learn and will never have all the answers to every call I run. I found (as an EMT) the more I knew about a patient’s condition(s), the better I could communicate with them, that it’s our job as prehospital providers to be able to explain their condition to them and answer as many of their questions as possible. We’re taught in our training programs that we need to tell the patient everything we’re doing or going to do in the next few minutes (assessment and treatment). I have this part down pretty well.
It’s when they ask if they’re going to die or how the injury/illness will affect the rest of their life. We never want to lie to the patient and give them false reassurance, but just telling someone “We are doing everything we can for you” seems to be a brush off, or it implies that we don’t want to answer the question because the answer is not going to be good.
I found the paragraph about what the medics were taught in the experiment to be a better approach. I’m looking forward to reading the rest of this series.
Here’s my response to Nate, Randell and you other interested EMS providers out there:
Those really are the hardest moments. And, Nate, it sounds as if when you’re doing the work, you’re not feeling terribly encouraged yourself given the “multiple shocks and rounds of CPR.”
First, we don’t want to get caught in a situation where the patient’s condition appears to be deteriorating rapidly and family members are panicking next to the patient or getting in the way of our work. If family members are around, one of our primary tasks is to ask them to move off to the side where they are not interfering with any of our work to save the person’s life.
You can accomplish this by two simple methods: 1) Designate a team member as the person responsible for calming and securing the patient’s friends and/or family, and 2) Distract the family or friend by utilization. Keep them busy and involved in the process of helping peripherally. This doesn’t mean you would ask a civilian to participate in any delicate or professional procedures. It can mean, however, that you might ask the family member or friend to tell you about the patient. Are they aware of any medical history? What are the patient’s hobbies? Where do they work?
If you’re alone by some chance, have the friend or family member be useful in some other way: Have them direct traffic and/or bystanders away from the scene if you’re outside, bring a blanket or pillow from another room if you’re in a home, or compile a list or basket of the patient’s medications for transfer to the hospital.
One of the worst things for a family member or friend is watching someone they love get hurt and feeling utterly powerless to do anything to stop it. At the very least, you as a first responder have an arsenal of tools at your disposal. The more you can give the family member to do (within legal and ethical parameters), the better.
The Big Question
Eventually, though, the dreaded question will be asked: “Is he going to be alright?”
It has been my experience that people know when things are quite serious, even if they don’t understand what is happening or why. Fudging the facts, placating a person who’s already in pain, or simply not dealing with it can make us appear callous, uncaring or incompetent.
What to say, then? Keep it simple. Keep it compassionate. Keep the family member involved. Here’s an example of what to say during a cardiac arrest call:
“Right now, your loved one is getting CPR. We’ve seen a lot of people receive CPR all the way to the hospital where they can get more intensive care, and they pull through. Can you help us by answering a few questions?”
The family member or friend will nod yes.
“Good. Has he ever had heart problems before?” (Give them time to answer, then keep the conversation going.) “Do you know when? How was his recovery then?”
When you’re done with that line of question, you can assign “tasks.”
“You could really help us by making a list of all his medications or pulling the bottles from the medicine cabinet.”
If they say no or you’re in a situation that doesn’t lend itself to that, ask:
“Can you help us by making a list of things he’ll need in the hospital, his doctors, and (if a friend) his family members?”
Now, if the patient is clearly not responding, and you and your partner can’t hide your deep concern, when the friend or family member asks, “Is he gonna be all right?” you can honestly and comfortably say the following:
“We’re giving him CPR right now, and we’re gonna keep going until we get him to the hospital where he can get more intensive care. In the meantime, you can help us by holding his hand and talking to him gently. Even though his eyes are closed, he can hear you. And even though he’s not moving right now, he can feel you. Let him know you’re with him. Let him know you care about him and that he’s being taken to the hospital. Let him know we’re taking the best possible care of him and so are you. Can you do that?”
A nod or movement toward the victim is the sign you’re looking for.
When It’s the Patient Questioning
What if the patient is the one who’s asking whether he’s going to be all right? When providingVerbal First Aid,we always want to put our and the patient’s focus where there’s potential for healing:
“Well, you’re speaking to me, and that’s a pretty good sign right there. How about I ask you some questions to see what else is going on ” (And then at that point you lead the patient’s focus to parts of his body or to functions that seem to be working properly.)
As far as how an illness or injury will affect a person’s life, the truth is that it’s impossible for us to assess that. None of us know the full impact of our actions or what’s in store for us. But we can reassure and inspire one another with stories of success and unbeatable spirit.
You can share stories that reassure without offering false promises. It’s not a denial of the obvious you’re dealing with a serious situation. But it allows everyone there to play a part in the hope of healing.
Please send us your stories, questions or comments. We want to hear from you.