Just the Right Distance

   This month in BTB, we'll look at one of the greatest challenges in EMS: maintaining the right distance from your patients. While you might think I mean physical distance, that would be an errant assumption. What I am actually speaking about is "emotional distance," or more specifically, the problems that come with being either too close or too far away from your patients.

When You Get Too Close

   The vast majority of the EMS workforce in the United States consists of EMT-Bs, and roughly 80% of them are volunteers. Many of those folks live and work in small towns, often for services that run 500 or fewer calls per year. One of the unique aspects of working in these rural settings is that it is common to know most, if not all, of your patients by their first name. There's no doubt when you get out of the rig, head over to the car that has become one with a telephone pole, and you recognize the driver as being a neighbor, things move along quickly and smoothly when the first words out of your mouth are, "Well, hey there Larry. Looks like you bagged a keeper pole tonight." Most would agree that having that pre-existing relationship is an advantage. However, this scenario is not without a downside. Let's say Larry has been critically injured and, in spite of the best efforts of the EMS team and ED staff, Larry doesn't survive.

   While it is certainly important to be "friendly" to all of our patients, there is clearly significant emotional risk associated with being "friends." Under these circumstances, the hurt comes home to roost quickly and painfully. It's never easy to bury one of our patients, but it is far more painful to bury one of your friends. When you are too close, these events extract a huge emotional price from the responders.

When You Are Too Far Away

   By comparison with the previous scenario, let's say you work in a large urban center. In that venue, there's a good chance you might run calls all year and never have a patient you know by first name. Under these circumstances, you need to make contact with the patient and start the process of getting connected to them, thus making patient assessment move much slower. Once again, let's say the outcome is a bad one, and the patient dies. There is far less emotional impact on the EMS team, because it wasn't loss of a friend or loved one.

   With this scenario, the emotional impact is lessened because you aren't too close. Once again, the "far away" venue is not without its downside. As you put more emotional distance between you and a patient, at some point he or she ceases to be a patient and morphs into a situation or condition. Think how many times you've heard a provider say something like, "Man, you should have seen the gunshot we just worked," or "We just worked a nasty head-on grinder over on the interstate." Truth be known, they didn't just work a gunshot. They worked a 16-year-old boy who was shot in a crack cocaine deal gone bad. That so-called head-on was a drunk driver who passed out, drifted over the center line and wiped out a mom, dad and their two kids. In both cases, we are talking about people, not conditions (gunshots) or situations (car crash).

   The challenge I referred to earlier is one you face every time you roll out on a call: maintaining the right emotional distance. Unfortunately, neither I nor anyone else can tell you exactly what the right emotional distance is. It is something each and every EMS provider has to figure out on his or her own.

   Never lose sight of the fact that we are in the people business. As such, we should never get so emotionally distant from our patients that we lose the humanity of our medicine. By the same right, if you stay too close to your patients, your heart will be ripped out of your chest over and over. In that setting, you won't last long as your emotional bank account gets overdrawn repeatedly. At some point, you'll just give up and simply walk away from EMS.

   Maintaining the right emotional distance from your patients truly takes conscious thought and far more effort than you might imagine. But expending that time and energy, as I see it, delivers huge returns on your investment. With just the right emotional distance, you can have a long and healthy career, and continue to provide the compassionate care each and every one of our patients deserves. With the wrong distance, your EMS experience will either be someone doing a job with no real connection to the patients, or someone who is emotionally bankrupt after having been sucked dry. Neither leads to a positive outcome relative to the time you will spend in prehospital medicine.

   Until next month…

   Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of EMS Magazine's editorial advisory board.