This article was published in JEMS, May 2018 in Kate's "Streetsense: Essential Non-Medical Field Skills
When emergencies are your everyday concern, perspective sometimes gets skewed. After a while, it's easy to imagine that every heartbeat is just waiting to wobble.
Yet somehow, the hearts in your service area take the licking of daily life and keep on ticking. And when they don't, you get the call.
Dispiriting Similarity
The challenge of a good cardiac call is something to look forward to in the mix of the requests for help from those of us at 9-1-1. Those squiggly lines on the cardiac monitor have meaning to our educated eyes.
It's interesting to parse the information, to figure out what seems to be happening, and to know how to help. Maybe the cardiac muscle is irritable or electrically blocked, or starved for oxygen. A good team of medics can do a lot for someone experiencing chest pain.
After a few thousand such cases, though, you can't help but experience a somewhat dispiriting sense of similarity from one case to the next. After all, it usually boils down to the same actions: I V, monitor, transport.
Maybe you infuse some medications or see an unusual rhythm, but even cardiac cases can come to seem routine: IV, monitor, transport.
And if you find yourself lulled by the sameness of cardiac calls, what does that say about the rest of your day, on calls that are far less demanding of your medical training and expertise?
A Fresh Approach
As alike as they may seem, no two calls are exactly the same. There are ways to maintain a fresh approach to even the most routine calls.
The patient is never the same. When the call is "chest pain, "your mental preparation may be the same as you make your way across town to the scene, but that's where the similarities end.
Nonetheless, it's remarkable how many people develop a mono:approach to patient care. This is both boring and ineffective.
Keep it fresh by infusing your bedside manner with methods of quickly and effectively achieving rapport. It starts the moment you approach the patient and assess various factors: sick? How sick? Which interpersonal strategies in your tool bag will work best?
You can gather medically related information while simultaneously reassuring the patient just by knowing (and using) the right combinations of words and nonverbal actions.
There's a lot happening quickly at cardiac emergencies, but there's always time to build in the message that the patient is the most important person in the world to you at that moment.
The relatives are never the same. Replace any tendency for judging people on the fringes of emergencies—bystanders and relatives—with a healthy dose of tolerance. They're often emotionally close to the person having the medical problem, and might need help leveling off from high levels of adrenaline. They can often provide crucial background information.
Whether a patient's relatives become your allies or not might hinge on your interpersonal skills. How quickly can you educate them on how to be helpful? The swirl of an emergency is new to them, so work politely, even when you need to be firm. They're a rightful part of the scene and warrant respect and attention.
The location and setting are never the same. Oh, the places we find ourselves! A patient might live in a three-story walk-up, at the end of a warren of hallways, in a sweet, quiet modest residence, or in the third row at the theater where they stop the performance and raise the house lights while everyone watches you handle the situation. The logistics of scene management are a constant creative opportunity! How can that ever feel routine?
You are never the same. No matter how proudly you hold yourself to high professional standards, you're human. Many factors can conspire to distract you from doing your best. Hunger, exhaustion and prejudice are just a few examples of things that can affect your work, so take time to recognize the potential for subpar performance and interrupt it before it affects hands-on care of patients.
IV, Monitor, Transport?
What you do at a cardiac call may seem routine: I V, monitor, transport. But don't let repetition generate cynicism or overconfidence.
Stay on your toes. Watch for the subtle differences in the circumstances surrounding each call.
Find new ways to improve the effectiveness of your interpersonal communication with strangers. The variety will help you enjoy the job longer, and at the same time provide ways to make their upsetting day a little better.