Life On One Level

There is a story told in EMS educational circles about the instructor who wanted to provide his class with a dose of real empathy. When students showed up for class one day, some were given eyeglasses to wear that were smeared with Vaseline; others were handed cotton balls and instructed to pack them in their ears. Some students' hands were splinted at odd angles with tongue depressors, and latex gloves pulled over them, while others were asked to put on shoes with balls of tin foil tossed inside. The last few to arrive were given wet Depends and told to put them on.

With everyone somewhat situated, class began. Within minutes, the class had turned into a fiasco. The students with glasses complained that they couldn't see the instructor's notes on the blackboard, while those with cotton balls in their ears heard virtually nothing the instructor was saying, and kept repeating, "What's that?" or "Huh?" Those with splinted hands/fingers complained they couldn't hold their pens to take notes, and the tin foil people said they couldn't focus on class because their feet hurt. Those who got to wear the wet Depends were just plain unhappy.

What message had been delivered to these students? A serious dose of empathy, as they experienced what it is like to step outside their life and live with a vision or hearing impairment, rheumatoid arthritis of the hands, corns and bunions on the feet, or incontinence. As the story goes, many of the students said that this was one of the most powerful learning experiences of the entire class.

Yet, there is another patient group that wasn't included in this event-those who are bedridden or who spend most, if not all, of their waking hours either sitting or Posey-belted into a wheelchair. As the graying of America continues, EMS providers can expect to see increasing numbers of patients in assisted living or extended-care facilities, some of whom are confined to their bed or wheelchair. What can we do to facilitate a better patient care experience for this group of patients?

First, we need to modify our approach to communicating. With this group of patients, good communication begins with changing your physical position. Whether it involves sitting on your drug box, taking a seat in a chair or simply kneeling down next to the patient, the bottom line here is that you need to get down to eye level with the patient. Do you really think it is appropriate to stand and talk down to bedridden patients while their field of vision is filled with your belt buckle, zipper, portable radio and side pouch?

Once at eye level, shaking the patient's hand as you introduce yourself and your partner, and possibly even continuing to hold it as you begin to gather the patient history, further communicates that you truly care.

Then there is the matter of doing the extra things that can make them a little more comfortable. Do you ever have those days when you don't have to work and you just don't feel like getting out of bed? Assuming you do, you probably choose to lie around for an extra hour or two. However, at some point, you begin to feel differently. Even with a quality mattress under you, that bed just isn't comfortable anymore, so you decide to get up. Unfortunately for these patients, simply deciding to get up and out of bed or out of the wheelchair isn't an option, so they remain uncomfortable-frequently because they don't have the strength or ability to reposition themselves and must wait for a caregiver to do it for them…if and when that happens.

Take a proactive approach and ask your patients what you can do to make them more comfortable during transport. For the bedridden, just sitting upright will often do the trick.

In other situations, patients may have sore spots on their hips, buttocks, elbows or shoulders from being in one position in the bed or being Posey-belted to the wheelchair. Creative use of pillows, towels and blankets can go a long way toward alleviating the problem. It's about trial and error and communicating: "How does that feel there? Let me know when I find the right spot. Is there anywhere else that's bothering you?" It really isn't that hard. You just have to take the initiative to ask.

Finally, do your best to add an extra dose of empathy and caring during the entire call. Being uncomfortable and unable to do anything about it by yourself is a miserable situation. If you really don't think so, rent a wheelchair on one of your days off and spend the whole day in it. In short order, you will find what life at one level is like.

These patients are every bit as important as any other patient in our care. Make no mistake-appropriate communications, better comfort and an extra dose of caring may well be some of the most meaningful care you ever render. Until next month…