Have EMS Acronyms outlived their usefulness?

2009-10-15-acronym-of-dignity

 I teach a class for EMS ‘Dinosaurs’ working with Gen X and Millennials in the EMS workplace.Because the focus is mostly towards understanding the value of long-term providers, there is typically a large contingent of ‘Dinosaurs’ among the attendees.

Jurassic EMS

Some version of this complaint comes up every time.

“These new EMT’s don’t want to talk to patients. They keep their nose in the computer and expect machines to tell them what they need to know.

 Can you teach compassion? Because they don’t seem to care about people.

They just want to * do stuff *.”

Take away the computer, and you have the what used to be called “clipboard” EMT’s back in the day.

A clipboard EMT would awkwardly approach a patient, stand at a safe distance and rattle off a series of interrogation style questions while scribbling the answers down on the ubiquitous metal clipboard/runform box found on all ambulances.

“What is your chief complaint? Past pertinent medical history? What was your last oral intake?”

This verbiage does nothing to create a connection between EMT and patient, and often fails to even elicit a meaningful response. Because normal people don’t talk that way.

For years, EMT students have been taught to memorize acronyms.

 SAMPLE, OPQRST, FAST, SMART, AVPU, DCAPBTLS, ABC, CPR, BSI.

I used to keep a book of them. EMS love their abbreviations, acronyms, and slang terms.

They are the Pig Latin of the profession, something EMS insiders understand.

dumb EMS acronyms

But are acronyms helpful? Or do they encourage rote memorization and parroting instead of critical thinking?  Even worse, do they discourage compassionate, meaningful conversation with patients?

The first thing every victim wants to hear from a rescuer is reassurance.

In his book “People Care”, Thom Dick reminds us :

“Patients don’t care how much you know until they know how much you care.”

 PDCHMYKUTKHMYC is not an acronym for a reason.

Acronyms have no heart, no soul, no passion. They are simply tools of task management.

epic-fail-photos-acronym-fail

Is it time to stop teaching them and focus on substance, and understanding?

My partner Kelly Grayson admonishes students who gripe about studying medical terminology, explaining the importance of understanding and using the language of their professional correctly, for a multitude of reasons. Continuum of care when turning over patients to other healthcare professionals. Clarity in documentation. Representing EMS as more than “ambulance drivers”.

He is correct of course, and without question, every EMS provider should be capable of identifying body parts and systems using medical terminology, appropriately characterize and describe injuries and illness, and even know the correct names of relevant equipment and associated parts.

Turn the thingy on” doesn’t fly when you need to direct someone helping with suction or oxygen administration.

But when it comes to direct patient care, we need to rethink how we teach assessment and history taking, and focus on the fact that we deal with anxious, frightened human beings, not simply disease processes and victims of bodily of injury.

In the past, most ‘clipboard’ EMT’s eventually became comfortable with talking to patients as the newness of the job wore off, and everyday life experience chatting with strangers meshed with the patient assessment process. Increasingly this is no longer the case. We are well into the second generation of Americans raised in a culture stressing stranger danger”,good touch-bad touch”, and the importance of respect for “personal space”.

personal-space-dilbert

The internet, smart phones, and artificial intelligence have also created a society where some young people are as uncomfortable with making eye contact, starting a conversation and laying a comforting hand on a stranger as the older generation is with texting and technology.

personal space clipart

In today’s society, in a world stressing cognitive offloading, is the emphasis on memorization tools such as acronyms obsolete?

Or should we be focusing instead on just providing a script without them, and practicing the kind of role playing that will achieve the result we want: A calm, reassuring, focused interview which results in extracting the answers needed to provide the best possible patient care.

Something like this:

“ Hi, I’m Nancy with XYZ small town ambulance, and I’m here to help you.

Can you tell me your full name? Do you prefer Susan, or Mrs. Smith?

(If not obvious) How can I help? What happened that caused you to call 911?

How are you feeling right now? Can you describe it?

 Is anything else bothering you, or hurting? Is your stomach upset?

 Does anything make it worse, or better? When did this start?

 What were you doing when this happened?

 Has this ever happened before? What happened then?

 Did you see a doctor? Were you prescribed medication? Have you been taking it as prescribed?

Do you take any other medicine, or vitamins, or supplements? What do you take them for?

 Have you ever had a bad reaction to medicine? What happened?

Do you have any allergies? What kind of reaction do you have when you (eat, touch ,or are exposed) to it?

 What have you been able to eat or drink today? When?

Mrs. Smith, my partner and I are going to do our best to take care of you and make you as comfortable as possible today.

 I think we should take you to St Something hospital. Is that what you want?

 Can we call anyone for you?

Here is what will happen next. “

Learning to effectively converse makes more sense than memorizing a bunch of letters and trying to remember what they mean. And when the answers to these questions are entered into check boxes in today’s ePCRs, the language is easily converted to standard healthcare terminology.  Most programs even have a 3-dimensional rotating diagram of the human body. All that is necessary is to point and click and your ‘broken ankle’ easily becomes a “deformity/swelling of the right medial malleolus”.

epcr body pic

Compounding the communication problem is the chapter in EMT textbooks which stresses formality, and strongly discourages any language that may be considered disrespectful or condescending to a patient. While there is no question that the message contained in this section is important, the interpretation has become entirely too rigid in a world that has become increasingly casual.

For some EMTs, it might seem safer to say as little as possible rather than make a mistake. But the ability to build trust and provide comfort depends greatly on the perceived sincerity of the caregiver. This is where education, mentoring and careful observation of various cultures, ethnicities, and generational differences become a critical part of the patient experience.

 

Here is how I would rewrite that section:

 When addressing a patient, and depending on the circumstances and nature of the call – Sir, Ma’am, Hun, Baby, Sweetie, Mr., Mrs, Miss, Doctor, Professor, brother, Bro, sister, dude, kiddo, and maybe even dumbass can all be appropriate ways to address a patient.

A good example of this is watching the interaction between EMS and the people of New Orleans in the A&E series ‘Nightwatch’.

 Patients generally do not know or care whether you are an ambulance driver, EMT, Paramedic, firefighter, volunteer or career provider. If they refer to your rank or position inaccurately -get over it.

ambulance driver meme

Kindness and respect are universally understood. Make sure you always sincerely demonstrate both.

Be yourself, with this caveat: Your sexual preference, religious persuasion -or lack thereof- or political opinion has zero place in the conversation. If the patient chooses to share his thoughts on any of these, your response is simply neutral or supportive.

 If you cannot practice EMS without being kind, or openly expressing or passing judgment, find a different career. EMS is not a good fit for you.

 We need to think about softening our teaching and mentoring style to put the humanity back in patient care.

Developing empathetic and confident EMT’s requires a mentor to personally demonstrate, and acknowledge proficiency of soft skills in others.

Soft skills are indicative of emotional intelligence, one of the characteristics that separate a good technician from a great healthcare provider. Very few people who enter the field of EMS  actually lack empathy or compassion. But fear or discomfort with doing or saying the wrong thing can cause those lacking confidences to retreat to their comfort zone, and in today’s world that is often technology.

epcr writing

I have seen students, new graduates, and volunteers who don’t run a lot of calls struggle to go down that imaginary checklist in their head, trying not to miss a letter from an acronym, meanwhile losing focus on the person in front of them. And so their eye goes to the pulse oximeter, and their hands go to the Toughbook. Because that is their comfort zone.

So to answer my Dinosaur’s question-

No, I don’t think you can teach compassion. But you should expect that most people, including young EMTs, have it until proven otherwise. Teach them how to be comfortable in a stranger’s personal space.   Confidence and soft skills are an inherent part of the knowledge capital owned by most of you tribal elders.Pass it on.

 Be patient. Demonstrate how a kind word and a soft touch provide reassurance and point out how Mrs. Smith responds. Because she is nothing like Rescue Annie or Sim Man.

And maybe, after you have said ‘Goodbye, feel better soon ma’am” to Mrs. Smith, your partner will help you figure out how to navigate that damn ePCR.

good dinosaur