Streetsense Revisited: It’s Still About Communication, Safety, and Control

In 1996 paramedic and author Kate Dernocoeur wrote a seminal book for EMS providers called Streetsense. In this work she outlined three important skills providers need to develop beyond their medical training to be effective practitioners: communication, safety, and control. The book has endured for 22 years, with a fourth edition about to published, because of sage advice in these areas.

Communication

Dernocoeur’s major point in this section is that EMS is about working with other human beings and helping folks who (at that moment, at least) cannot help themselves. She calls this the “human component,” and it requires understanding oneself as well as how others react. The book gives effective suggestions for reading people, such as using a patient’s facial or body gestures to predict what they might do. It emphasizes treating all patients with respect and dignity and sharing the essential elements of compassion: feeling others’ emotions and a desire to help ease their pain. Good communication is a lost art these days in EMS, where we need to look up from our phones, tablets, laptops, and cardiac monitors to really communicate with our patients using good eye contact, nonverbal listening cues, and body positioning with a focus on safety and scene awareness.

“The goal in the emergency care arena is to obtain a lot of information quickly. Part of the art of EMS is gathering a good, reliable history from both the patient and bystanders. As Stuart Harris, an ED physician at Harvard, says, 'The patient history is the diagnostic engine of medicine.' It really matters to do this accurately, efficiently, and thoroughly…

“A good interview usually progresses from the general to the specific. It’s like drawing a picture. An artist sketches a framework on the page before putting in the details, and so should you. You need an outline; this is why it helps to begin with the chief complaint.”

The book further dissects communication challenges such as dealing with death and dying, showing empathy for survivors, and understanding that even the toughest EMS providers are affected by death. Dernocoeur expands on challenging communication situations like religious and cultural differences, children, gangs, the elderly, fakers, frequent fliers, and the disabled. The key to dealing with all these situations is demonstrating pride in what you do, having a professional appearance and demeanor, possessing a service orientation, using good manners, being a team player, and looking to defuse rather than escalate conflict.

Safety

Scene safety is the first thing providers are taught in EMT school. Dernocoeur breaks down four areas for developing good “street sense”: before the call, on the scene, in the ambulance, and dealing with weapons.

Before a call she reminds us to check our equipment and vehicles. While en route there is the importance of driving defensively and approaching scenes safely (e.g., shutting off lights and sirens a block away and turning off interior lights so as to not announce your presence to the whole neighborhood). She emphasizes checking your mirrors for oncoming cars before exiting your vehicle, knocking on the outside edges of doors so your full body mass is not in front of them, and never having a patient or obstruction between you and the exit. In the book she gives additional tips for safety equipment, restraining patients, and how to escape if grabbed.

Control

Control refers to management, whether it’s yourself, the scene, or risks. Dernocoeur gives suggestions for how providers can be aware of and respond to stress to avoid burnout. She additionally discusses how to reduce legal risks, which balances self-awareness, an awareness of others, and tying the two together with clear and effective communication, verbal, nonverbal, and written. She also spends a great deal of time talking about setting up a scene for success—she calls it “scene choreography,” or running your scene with smoothness and style. This requires a levelheaded awareness of time—knowing when to slow down and when to rush, and the appropriate times for both depending on the patient and scene.

The Book

The new edition of Streetsense will be out in 2019. When the book was first written, often only two partners would be on an EMS scene. Now, with the expansion of EMS, there are often first responders, BLS, ALS, and others involved. Regardless of the numbers, we are all on the same team and need to use street sense. Further, our body of knowledge has increased. For example, the term active shooter wasn’t in the lexicon in 1996 but is an important part of EMS training today.

When asked what has changed in Streetsense over the years, Dernocouer says, “So much is the same, and yet so much has changed. Social media is among the biggest changes; we cannot operate in anonymity anymore, and this is probably good! It underlines more than ever the need for field personnel to learn and use the skills of customer service, diplomacy, patience, tolerance, and everything it takes to look the part. When one of us does something the public views as insensitive or inappropriate, we all suffer—nowadays to the point of being attacked. This is a new(ish) thing and one that concerns me greatly because it seems so random sometimes. If anything, I find it gratifying to see the emphasis on personal safety, but I also see field providers missing opportunities to practice situational awareness. Be careful out there! And remember to take some of your best selves home again.”

Final Lessons

There is a hidden blessing and benefit to being an EMS provider that is not taught in EMT or medic school. Dernocoeur writes, “EMS providers have a unique opportunity to live life better and more fully as a result of the things they see out on the streets. No one else is a witness to life as unplanned and as unrehearsed as we are…because of these we are bestowed precious lessons about life without having to live the tragedies ourselves. We can live our lives differently in hopes of avoiding the same mistakes or misfortunes.”

For more see https://katedernocoeur.com/.

Barry A. Bachenheimer, EdD, FF/EMT, is a career educator and university professor, as well as a firefighter and member of the technical-rescue team with the Roseland (N.J.) Fire Department and an EMT with the South Orange (N.J.) Rescue Squad. With an emergency services career of more than 30 years, he frequently serves as an instructor for both departments. He is also co-owner of Jump Bag Training Company, LLC. Reach him at barry@jumpbagtraining.com.