Show Your Professionalism in the First 60 Seconds

No one’s sure whether it was humorist Will Rogers or author Oscar Wilde, but both are credited with saying, “You never get a second chance to make a good first impression.” Whether it is a first date, a job interview, or your encounter with a patient on an EMS run, this is certainly true. I believe that as an EMS provider, you have 60 seconds or less to make a good, professional initial impression on each new patient and scene—and in most cases those 60 seconds will determine how well the remainder of the call will run.

Your Look

In the Los Angeles County Fire Department in the late 1960s and early ’70s, Chiefs Keith Klinger and Richard Houts were meticulous about firefighters’ uniforms, especially the newly formed paramedic/firefighter position. On every call personnel had shiny boots, uniform shirts with name tags, badge and patches, and belts with a buckle. If you watch the TV show Emergency!, paramedics John Gage and Roy DeSoto were always portrayed in uniforms reflecting such details. A professional appearance inspires confidence. If you have pride in your look, it is assumed you have pride in your skills and practice.

It’s the little things, really: Is your uniform shirt clean and tucked in? Are your boots zipped? Are they clean? Do you shine them every once in a while? Is your hair combed? Is your ID tag or name tape visible so people know your name? If you are an EMS provider on a volunteer or on-call department that responds to calls or a station from home, you may not have a full uniform, but don’t look like you just came from the beach. If you are responding to a call in flip-flops and a tank top, patients will question your professionalism. While you might be one of the best providers out there, an unkempt or unprofessional look will not inspire confidence. Step one is to look like the professional you want to be regarded as.

Your Posture

Unless you served in the military, you might have some pretty terrible posture. Long hours in ambulance seats, station couches, or hunched over laptops at desks have rounded our shoulders, slouched our lumbar spines, and made us look, well, saggy or droopy. Besides being better for your back and neck, when you stand up with better posture, you appear more confident, and it gives you a strong presence on the scene. So, shoulders and hips back and, like your mother told you, stand up straight!

Your Attitude

Admittedly, it doesn’t always feel like it after the seventh call of a 12-hour shift, but being called to someone’s aid in their moment of need is a privilege. Because they called 9-1-1, they invite us into their homes, allow us to see them in states of undress, answer some highly personal questions, and allow us to touch parts of their body few others can. If your attitude is that the patient is inconveniencing you or you’re bothered they don’t have what you’d consider an “emergency,” that will be portrayed in your nonverbal communication, and chances are that will erode trust. You might be a great provider with excellent skills, but if your attitude tacitly says, “I don’t care about you,” the patient will know.

Instead, remind yourself that your patient called you because they have an issue they cannot handle themselves and need you for assistance. While some EMS providers might be disappointed when some calls aren’t massive car wrecks or cardiac arrests, just because some calls are not your definition of an emergency doesn’t mean they’re not emergencies to someone else. Treat every patient as if it were your grandmother!

Your Approach

There’s an old saying that we never “run” in EMS. You always want to be the calmest person in the room, and if you run, you might miss some situational awareness and develop tunnel vision, neither of which is good for clear thinking. At the same time, based on dispatch information, some folks will do the “slow walk,” taking their sweet time to get out of the truck, gather their gear, and saunter into the scene.

Clearly there needs to be a balance. Your speed needs to be fast enough to show purpose but slow enough that you are clearly in control and taking the whole scene in. Use that time to survey how you might remove the patient, hazards that might be nearby, lighting needs, and other family, bystanders, or crowds to be aware of.

Your Introduction

Whenever I go to the doctor’s office, the physician walks into the room and says, “Good morning, I’m Dr. So-and-So.” By this five-word greeting, they have established a friendly baseline, and I know who is taking care of me. In EMS we should follow that same pattern: Introduce yourself and your partner(s) to the patient by name and certification or title. Next ask the patient their name and what they wish to be called. Every adult is “Mr.” or “Ms.” unless they give you permission to use their first name. Using “sir” and “ma’am” with adults as well conveys respect. Avoid nicknames and using “honey” or “sweetie”; it comes across as condescending, especially if you are younger than the patient.

When you are greeted by a server at a restaurant, they typically introduce themselves and say, “I’ll be taking care of you today.” I think we should follow that same model in EMS.

Your Initial Contact and Assessment

Active listening is a way to show people you’re engaged in the conversation. Some ways you can show active listening include demonstrating concern, paraphrasing statements back to show understanding, nonverbal cues such as nodding, eye contact, and leaning forward, and brief verbal affirmations like “I see,” “Sure,” or “I understand.” Active listening is nonjudgmental. Looking at one’s phone, laptop, clipboard, or watch while someone is talking is not active listening.

Have patience with your patients. Some, especially senior patients, may have a hard time hearing. You may need to speak up and face them. Some may have a hard time speaking or speak slowly. Some may have memory issues. Allow them to engage the way they can and show respect by giving them time to do so.

Avoid jargon and when the patient shares information, avoid judgements. Never say things like, “That was a bad idea,” “Why don’t you take better care of yourself?” or “You shouldn’t have done that.” Additionally, use plain language and avoid EMS slang and acronyms, including 10-codes and abbreviations.

You have an opportunity during your encounter to leave an impression that you care about the patient. Be curious—you should want to know more and ask questions to uncover medical and social details. Your verbal assessment and questions are just as important as your detailed physical assessment.

Final Thoughts

Most EMS calls have a 5–15-minute on-scene time. Your goal during the first 60 seconds is to project confidence, show professionalism, connect with your patient, and demonstrate caring. If you can do this in a professional way, not only will your call go well, but your patient will most likely appreciate it.

There is an old adage that students may not remember what teachers taught them, but they will remember how that teacher made them feel. In EMS, the patient may not remember the medications you gave them or the modality you provided, but they will remember the way you treated them and your first impression.

Barry Bachenheimer, EdD, NREMT/FF, has served nearly 35 years as an EMS provider and firefighter. He is a frequent contributor to EMS World.