by Charly Miller, EMT-P

This page was originally published in's January, 1999 issue.

To EFFECTIVELY use the ABCs of communication, providers must:

Development of a CONFIDENT FOUNDATION is every care provider's personal responsibility.

Confidence cannot be "taught," but the personal development of confidence is a product of EDUCATION, PRACTICE, and ATTITUDE. It is our responsibility to obtain the best initial education possible. Once operating as an emergency care provider, we must seek continuing education to stay abreast of the rapid changes in emergency care. People who complain about continuing education requirements are invariably fearful of change and sorely lacking in self-confidence. Self-confident providers are eager to learn and eager to improve their knowledge base. Self-confident providers personally profit from education.

Likewise, self-confidence requires us to practice our skills as often as possible - especially those skills we use the least often. If we don't practice rarely used skills, we cannot remain confident in our ability to respond to any and every emergency.

But, perhaps the most important way to develop self-confidence (and personal pride in the job we do) is to adopt a caring attitude - one that includes all patients.

Remember! The hero-saves-a-life emergencies seen on TV shows, only represent about 10 percent of all the emergency calls any of us will ever respond to! Certainly, we all enjoy the excitement, challenge, and adrenaline rush of handling these kinds of emergencies. But what about the 90 percent of patients we see every day? What about the coughs and colds, headaches, toothaches, minor or moderate bumps and bruises? The seizures, C-spine-painers, and all the other non-TV-fodder kinds of calls? If we can't find personal enjoyment, challenge, and a sense of accomplishment when dealing with the majority of our patients, we develop ugly attitudes. Patients don't need care providers with ugly, unhealthy attitudes. They need care providers who can provide care to all patients.

If you find yourself (or your partner) complaining about not running "good" calls, you need to rethink just what a "good" call is. Remind yourself that all calls for help are "emergencies" to the people who called for help! And, if you cared for those people, helped them feel better, then they really were "good" calls after all - weren't they?!

Yes, every EMS system has chronic patients, patients who "abuse the system." We even know these patients by name. How many "frequent flyer" names can you think of: four? Five? Maybe six? Are those patients the entirety of the 90 percent of patients that you see every day? Nope. Patients who call for your help for reasons YOU perceive as being non-emergencies are still having an "emergency" in their life. And you can profit from helping them only when you recognize that you're there to provide care to all patients.

Monkeys can be taught to manipulate all sorts of instruments and devices - but they cannot be taught to consciously exercise EMOTIONAL CONTROL.

It is normal for care providers to experience a wide range of emotions when dealing with patients. Emotions cannot be ignored, nor should we attempt to "ignore" them. But we must learn to recognize and control them. Probably the most common and most difficult emotions to control are fear and anxiety.

There are many, many different techniques for learning to control emotions and our response to them. The "best" technique is the one that works for YOU. Everyone is different. The technique I'm going to write about is the one that works for me. If it doesn't sound or feel right to you, you must search out other techniques and find the one that fits your needs: relaxation techniques, breathing techniques, meditation, or the like. Thankfully, techniques for controlling fear and anxiety (such as the one that I'll offer here) can be used to control our response to any emotion.

Fear and anxiety undermine personal confidence and interfere with personal control. Usually, our first development of fear and anxiety occurs as we are responding to an emergency call, and is based upon the dispatch information we receive. When you first begin to feel fear or anxiety, learn to just STOP! Stop your internal monologue - if that's all it takes. Or fully stop whatever you're doing and take the very few seconds required to RECOGNIZE the emotion:

"I'm afraid, I can feel it. Why am I afraid? I'm afraid I'm going to screw-up!"

Next, briefly "DEAL" with the fear of screwing up:

"I'm as educated as I can possibly be about this patient's problem. Sure, I haven't actually dealt with it before (or very often). But I can do this, I know I can!"

Then SET ASIDE the emotion:

"I don't have the time to be afraid right now. I'll take the time later. So, until this crisis is over, I'm not going to be afraid any more."


"What's the first thing this patient is likely to need me to do?" or
"What's the worst thing that could be going on with this patient?"

Mentally run through all the potential needs your patient may have. Consider what you can do to effectively respond to these needs. Now you can start moving again!

All of these steps can be accomplished as you are traveling to the emergency scene. In this way, you arrive prepared and in control of your emotions, free to successfully employ good patient communication ABCs.

Look at your watch or a clock. Go back to the previous section and time how long it takes you to calmly read it. I time it at just about one minute. That's all the time it takes for you to STOP!, RECOGNIZE the FEAR(s), "DEAL" with the FEAR(s), SET ASIDE the FEAR(s), and FOCUS on the BUSINESS AT HAND, getting back to action with a calm, confident, and effective attitude.

The investment of that one minute will increase your effectiveness - you will think more clearly, perform more precisely, and be better able to employ positive ABCs of patient communication. Your patient will vastly profit from this one minute investment. ABOVE ALL, BELIEVE IN YOURSELF! Remember; BELIEF HAS POWER. And your patient will profit from your BELIEF that you can handle this emergency.

This kind of technique is not "esoteric psycho-babble!" Sports psychologists have been doing this sort of thing, successfully, for years! Mind control techniques, picturing the goal you wish to achieve, imagining yourself achieving this goal - all of these things have been proven to be effective in improving performance.

Lastly, after developing strong self-confidence through continued education and practice, after learning to control our emotions, WE NEED TO LEARN TO SLOW DOWN!

Never, EVER RUN to an emergency! Running stimulates adrenal activity. The adrenal stimulation of running encourages only negative results and undermines our effectiveness as care providers. Running to an emergency, or being preoccupied with going FAST results in:


Certainly, the more critically injured or ill a patient is, the less they need us to run, rush, or otherwise diminish the effectiveness of our response to their emergency. WE MUST SLOW DOWN! We may walk briskly, with purpose. We may walk swiftly, with strong intent, while employing our self-talk techniques to control our emotions. But we must never, ever run - never, ever be preoccupied with "going fast!"

If you are employed by a service that requires you to run (firefighters or "cor zero" / "code blue" inhospital response teams), you must learn methods to block or vent the adrenal stimulation running produces - prior to your contact with the patient! Gather yourself together, calm yourself down, and then approach the patient using the ABCs of positive patient communication.

In the next installment of this column, we'll begin to discuss specific communication techniques for improving patient condition and prognosis - making a patient feel better simply by virtue of how we communicate with him!

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"Feedback About The Foundation of Patient Communication - Part 4"

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