Education

I would argue the communication link between Emergency Medical Service (hereafter EMS) providers and patients is not a topic that garners a great deal of formal attention. Academically, EMS providers are taught about the various forms of consent, how to best communicate with those who have hearing impairments, the polar ends of the aged (the very young and the very old), as well as tips and tricks to overcome a plethora of language barriers experienced in the field.

Formal education in the field of emergency services is often brief and focused.  There is an overwhelming need to educate individuals who are entering the this field across a broad array topics so they may assess and rapidly act upon foundational knowledge.   The implicit understanding is that true skill development will be subsequently expanded and refined through field training and experience.

If a department has a strong continuing education program, EMS providers may obtain some formalized training related patient consent or improved report writing.  This training often falls under two categories.  While valid and justifiable, I believe EMS providers are missing a critical opportunity.

  • Legal based training focuses on protecting the agency and provider from liability if and when a patient refuses care before later experiencing further medical complications. This lens tells providers which “boxes” must to be checked to safely allow a patient to refuse medical care.
  • Financial based training (often offered by EMS billing companies) focus on teaching providers key words to document within patient narratives to satisfy the “medically necessity treatment” threshold to improve the likelihood that insurance companies will pay subsequent claims ultimately generating operational revenue.

Placing patient care as the primary focus of an EMS agency should mean both tasks would be inherently accomplished.  However, we need to apply a medical lens rather than a traditional prescriptive problem/solution focus upon our practice of emergency medicine.

Upon reviewing research related to the link between overall positive patient outcomes in the presence of effective physician communication skills (Ha, Anat, & Longnecker, 2010; King & Hoppe, 2013; Rodin, et al., 2009), I am quite interested in formally studying this matter further.  Rapid patient care occurs in Emergency Departments nationwide, however a team of providers and established systems exist within a structured environment which helps support achieving such lofty goals.  Robust structured systems afford the opportunity for checks and balances, luxuries that are simply not possible in a dynamic field-based environment.  However we don’t know what we don’t know at this point.

Now, make no mistake.  EMS personnel are trained to deliver excellent emergent medical care, and they do so quite well- each and every day.  These providers operate within streamlined decision processes and protocols, using equipment that is arranged for rapid access by personnel who instinctively (muscle memory) know where to find supplies, often without ever taking their eyes off their patient.  Well operating EMS services are highly structured.  Crews often work seamlessly while one provider is gathering patient histories while forming an initial assessment, as the partner is actively taking steps to implement a care plan.  The assessment is rapid and focused, just as it should be.  Providers are trained to navigate through the noise of the environment (figurative and literal) and circumstances to get to the important aspects of whatever is occurring or contributing to the situation.  Further, EMS protocols are designed with the express intent to limit harm with the complete realization and acknowledgement, that information is limited and constraints do exist.  Care is provided in transit where advance skills take over upon arrival at emergency rooms.

But there is more to consider.

  • EMS providers operate in formal positions of authority innately granted by a public who ascribes personal liberty to responders based on tradition, respect, and trust.
  • Implied authority exists.  EMS is commonly provided and often delivered through a fire-based system where various statutory authority empowers public safety providers in ways no other caregiver is.  Additionally, EMS providers operate alongside law enforcement.  First responders are often categorized as Type-A personalities because the nature of the job attracts individuals who take charge and take action.  These characteristics are necessary as providers must rapidly select among a variety of options and rapidly implement necessary actions for the preservation of safety and security of both the public and responder.

A sober assessment of current practice can bring about positive change.  For example, permission to administer care is often assumed.  The rational exists that since the individual called 911, that person has made a determination that an emergency exits, and they want to go to the hospital.  The entire system is set up to provide emergent care and transport the patient rapidly to the hospital.  In an effort to provide swift care and save time, it is my experience that EMS providers infrequently offer an explanation of what they are doing as they are doing it, or more often the explanation lags just behind the care that was just immediately provided.

The example above offers an opportunity to explore how the patient-provider relationship could be enhanced within the emergency setting.

  • Studies by King & Hoppe (2013) and others have found that physician providers overestimate their ability to effectively communicate with their patients. Further, poor communication or the inability to overcome communication barriers leads to negative patient satisfaction or improper diagnosis, leaving patients frustrated and possibly grieved (Ha, Anat, & Longnecker, 2010).
  • Research shows that patients desire a setting where they are informed, and able to participate in the decisions that impact their personal health and well-being (King & Hoppe, 2013).
  • Additionally, physician providers who do not, or are unable to connect with their patients demonstrate low levels of empathy which often causes the patient greater distress or distrust (Ha, Anat, & Longnecker, 2010).  The presence of physician respect enhances patient outcomes and stabilizes patient emotions (Flickinger, et al., 2001).

With over 25 years providing emergency medical care, I have little doubt that these same principles and practices would positively affect patient and EMS provider relations as well.  One cannot assume that such connections are similar or significant.  Therefore, a formal study of this matter is warranted.  As indicated above, significant differences exist in the field compared to the controlled environment found in the emergency room, further justifying the need for formal study to effectively quantify and qualify each.

Works Cited

Flickinger, T. E., Saha, S., Roter, D., Korthuis, P. T., Sharp, V., Cohn, J., . . . Beach, M. C. (2001). Respecting patients is associated with more patient-centered communication behaviors in clinical encounters. Patient Educ Couns, 250-255.

Ha, J. F., Anat, D. S., & Longnecker, N. (2010). Doctor-patient communication: A review. The Ochsner Journal, 10:38-43.

King, A., & Hoppe, R. B. (2013). “Best practice” for patient-centered communication: A narrative review. Journal of Graduate Medical Education, 385-393.

Rodin, G., Zimmermann, C., Mayer, C., Howell, D., Katz, M., Sussman, J., . . . Brouwers, M. (2009). Clinician-patient communication: Evidence-based recommendations to guide practice in cancer. Current Oncology, 42-49.

The Oxford Dictionary of English defines a hobby as “an activity done regularly in one’s leisure time for pleasure.”  When someone considers what hobbies are, most often think of things like running, hunting, computer gaming, playing basketball or something similar.  The idea of pursuing educational degrees as a pastime is not something that would be ranked among the top one hundred people surveyed and revealed during an episode of Family Feud.

Most people have hobbies.  Many of those interests come with quite hefty price tags.  The thing I love to do most in my spare time, the thing I’d rather do more than anything else at any given moment- is to learn something new.  Certainly, one can learn much among a wide array of topics by exploring the local library or even the internet.  That type of study is incomplete.  Education is not just about filling your head with new information.  The key, and most importantly to this discussion- the pleasure, arises from the application of these new discoveries in real-life scenarios where one can make a difference.

It wasn’t until late high-school years that I found a few classes that I even cared about.  Classes involving governance, the legal system and civics, as well as a few electives such as art and then human physiology which paired well with my then hobby of serving my local fire department as a Fire Explorer resonated well with me.  I have always loved serving those who are in need and am especially drawn to rapid-paced environments that provide significant challenges.  It is no wonder why I found myself drawn to the fire service.   Fast forward to Paramedic school, where the science and art of medicine intersected, and I was hooked into a profession that I wasn’t sure was for me.

The idea of learning something (and even mastering a skill) and relying upon that level of knowledge for ‘life’ is an idea that is foreign to me.  This is likely a side-effect of the constant need to learn more faced by those in the fire-service who understand there is a constant need to be better prepared for the next challenge faced during the next emergency, where those who know more than I do may not be there because of absence, multiple calls, or simple attrition.  After all, the longer we are around- the sooner we become ‘the old timers’ even when we fail to recognize who we are until it is pointed out to us.

Advancing to senior ranks early in my career only worsened the drive I felt to be prepared for even bigger problems, that I knew I didn’t know anything about.  The breadth of needed knowledge in fire administration far exceeds the ins and outs of the fire service.  The end result is that I have continued to learn, in both structured and unstructured environments- constantly.  Public Administration encompasses and even broader array of knowledge providing a wealth of opportunity to put the various components of business, economics, politics, policy, legislation and more in conjunction with well-established emergency service principles in a meaningful way.  I recognize that I am blessed to be in a position where all of my interests intersect both personally and professionally, but the arrival as such as place has only occurred with hard work and significant investment concerted professional and personal effort.

I was never one to ‘enjoy’ school in any way, shape or form.  However, there is something to be said about pursuing a course of study through a structured course of learning.  As my pursuit through higher education has continued now to the doctoral level, I have learned that I do not have the self-discipline to pursue courses of study into areas that I do not inherently agree with.  Beyond the boundary of comfort is where one (who has an open mind to new ideas) discovers new insight that quickly leads to discovery.  This area of personal growth stems from understanding and wisdom when disparate topics are synthesized in new ways.  In order not to be foolish, we must discuss and debate these ideas.  Part of that evaluation includes subjecting oneself to criticism and challenge.  Hereto the process is can be quite enjoyable- and educational.  The difference in theory and application is critical.  In order to verify what we think we know, we must ultimately place these ideas and concepts into practice.  Next, there must be an objectively evaluation of the results.

Education is an activity, just like any other hobby.  The journey is just as much a part of the process as the ability to act upon what one has learned.  Too often the goal is thought to be a grade or certificate at the end of the process.  This is where the traditional idea of education fails the student.  It is the pursuit of knowledge, one that should never end at graduation, that is both fulfilling and rewarding.  Who knows, somewhere along the line we might even be better off as a society if we could effectively shift our concept of education from chore to enjoyment and ultimately fulfillment.

I’d love to know your story and your thoughts.  Please comment below and let’s further the educational process of bettering our world!

-Jw

Jonathan M. Westendorf holds a Master of Public Administration from the University of Southern California and is a Doctor of Public Administration candidate at West Chester University in Pennsylvania.  Interests include a variety of public policy challenges including erasing the stigma associated with the opioid epidemic.  Additionaly, Westendorf is a Fire & EMS Chief for over 18-years, and is currently the 1st Vice-President of the Ohio Fire Chiefs’ Association and Legislative Committe Chair.