Tools with multiple uses are more economical than those with single functions. The manner by which an individual conducts him or herself in EMS is no different. Another way to think about this: Situational awareness is the intersection of provider safety and personal connection. Being cognizant of your surroundings, when providing medical assistance in disparate situations, is a must! But beyond staying heads up for danger, scanning the environment offers clues about the person. (Here I purposely did not use the term “patient.” This post is about the personal and human connection, as well as the potential of humans to pose threats.)
It begins with scene size-up or “the windshield survey.”
Soaking in details about the scene on approach of the home, places of work or recreation might reveal peril unreported to dispatch (animals, violence, unstable buildings). However, looking at the home can indicate interests, ability for self-care, etc. Businesses or offices shed light on profession and expertise. A baseball diamond or Frisbee golf course may hint at what kind of injury awaits.
Often homeowners hang signs brandishing their names. “Welcome. John and Jane Doe”. Using this information during patient contact allows the provider to establish orientation to self. For me, matching the name offered by a patient to the one on the sign has resulted in preventing an error caused by those who use their middle name or nickname. Furthermore, it is respectful to note during patient transfer that William prefers to be called Bill.
It may not be necessary to clinical care, but perhaps knowing the patient is visiting is important. Realization that the person is from elsewhere prepares providers. Records may not be readily available; they may feel uncomfortable being away from home during their medical emergency; and EMS providers will have to make suggestions for hospitals. Furthermore, out-of-town visitors may not be on their regular schedule and have missed medications or been less strict in diet.
Judging a book by its cover.
Yes, contra to the maxim cautioning book readers not to cast away books based on cover artwork, for EMS, outside environments can foreshadow interior conditions. Thick black smoke billowing out of a back window of a home, is highly correlated to a raging fire inside. Bags of empty beer cans or a porch strewn with empty whisky bottles signify a resident with an alcohol problem. Unfortunately, where there is alcohol usually an agitated or apathetic person is encountered. In either case, effort may be needed in extricating the person out of the home. Time can be saved by mentally mapping the path to and from the patient. Additionally, family demanding the patient be taken to treatment may become aggressive. On the other hand, the abuser of alcohol may have finally descended to rock bottom. Concerned family or friends can be used to encourage cooperation.
Paying special attention to others (family, friends, neighbors, bystanders) on scene can be lifesaving. Primarily, if there is violence or abusive words between the patient and others, asking law enforcement to intervene. Relocating to the ambulance early can literally save the responders’ lives. But, as mentioned above, assessing relationships between parties on scene, goodwill on part of family (spouse, adult children, parents) or trusted caretakers can be leveraged. It is preferable to reason with the unreasonable using emotions of those who care. The alternative is finding justification for a health and welfare hold signed by police. Of course such a tool should be reserved for those in imminent danger, not against those making unwise but fully informed medical decisions. For doing so could incite violence.
Other benefits.
Being optimally aware of every environment feeds tidbits of information to responders; some important, some not. I pay attention to photographs, paperwork, random things stuck to refrigerators under magnets. I spy these items to gain insight to the patient. Many partners have been surprised by some of my questions. They didn’t see the Veteran’s Affair magazine in a pile of papers; walls were not scanned to see a novelty “Key to the City” from the local Chamber of Commerce; newspaper clippings of significant events were missed; or patients or family using technically medical terms were ignored, hinting at a medical background. While I do not do anything special, at times I feel like the character Shawn Spencer (James Roday) from the humorous detective show Psych. In the show, Shawn solves mysteries as he divines clues from the environment while pretending to be psychic. The reality is, Shawn was trained to be observant by his police detective father (Corbin Bernsen).
Knowledge gained from paraphernalia can be used as an icebreaker. A smiling gentleman seen in a photo standing next to a Kenworth, might enjoy talking about his journeys. I love to hear about favorite cities from over-the-road truckers. In my area, it is not uncommon to find an elderly patient relocated to an urban assisted living apartment from a rural farmstead. Farmers are a different breed; they’d prefer to finish the chore they started before their arm was shredded by the PTO shaft. Typically with this population, near their favorite chair is a bird’s eye photograph of their former farm. I’ve learned much about what is grown in this state and what it takes to be a successful grower. However, looping back to scene safety, guns and stubbornness are hallmarks of this culture. The latter is usually the issue, but the former shall never be dismissed.
Enhancing your practice.
For new or generally introverted providers, recognizing what is important to patients offers ways to connect. Rather than burying one’s nose in electronic charting or sticking to robotic clinical questions, sprinkle in conversation about their past. Make a human connection. When situations do not call for many interventions, fill time with talk generated from something you saw in his or her house. During times that call for more cares en route, small talk from the same sources of information can reveal seemingly unrelated causes or distract a patient, reducing pain and anxiety. Beyond this, listening to their interest will instill trust because you are making a personal connection.
This last point is important to me. I love hearing about other careers. If I were not in EMS I have no idea what I would be doing. My curiosity knows no bounds; I would like to try every job for at least one day. It is easier to discuss a shared hobby; but refrain from drawing attention to yourself. After all, they are your patient – the focus of the encounter. Yet, because I ask and listen to stories about other peoples’ careers and experiences, I can make informed conversation, which lends credibility. Being capable to express genuine interest conveys mastery and empathy. My standard operating procedure is to treat everyone with respect; respect becomes more genuine when honoring former mayors, retired Chief Medical Officers of major health systems, stay-at-home moms, a nonjudgmental ear to a homeless person, or commiserating with the unemployed. I have cared for a patient involved with development of the atomic bomb and a contractor who, in the ’90s and ’00s, singlehandedly travelled the country and painted nearly every location of a nationwide retailer. I’ve learned if someone has no middle name, there’s a good chance they are from a family of over ten and “my parents just ran out of names.” These are backgrounds not usually blurted out by patients; rather they are teased out through conversation.
Conclusion.
Being observant, otherwise known as situation awareness, serves two important functions to the EMS provider. First, it helps keep team members safe. Situational awareness translates into early detection; any opportunity to mitigate threats when signs of potential dangers are observed is good. Being mindful of ways to evacuate can increase chances of survival. Second, eyeballing memorabilia, mail and personal affects provide fodder for conversation. Inquiring about their career or hobby creates a personal connection that can add legitimacy to your pitch to transport them.
Of course, nothing is absolute. A docile person can be triggered. The absence of a threat does not exclude the chance violence may develop. And even the shared experiences of a hobby or hometown will not change the mind of a stubborn person. But they both lend themselves to good safety and clinical practices.