Crisis Management for Paramedics Week 1 Fundamentals of Communication & Therapeutic Approach Fundamentals of Communication & Therapeutic Approach Concepts of Crisis & Stress Concepts of Crisis & Stress

Service You all stated you want to help people and that you are people persons...so here is your chance to “shine” You all stated you want to help people and that you are people persons...so here is your chance to “shine” Patients deserve our best efforts at service – they are the reason we exist Patients deserve our best efforts at service – they are the reason we exist What the “S” in EMS stands for What the “S” in EMS stands for

Effective Communication External Factors External Factors –Look the part of a professional –Pay attention to you appearance –Inspire respect

Consider the following: How does communication occur? How does communication occur? What are the components of communication What are the components of communication How do we as care givers attempt to communicate with people in crisis and what can hinder the communication How do we as care givers attempt to communicate with people in crisis and what can hinder the communication

Communication Therapeutic Approach What is communication? The exchange of common symbols The exchange of common symbols Written, spoken, signing and body language Written, spoken, signing and body language Basic elements: the sender, the message and the receiver Basic elements: the sender, the message and the receiver

Verbal Verbal Voice quality, diction, pitch, rate of speech and volume Body language Body language Provide your undivided attention Provide your undivided attention LISTEN LISTEN

Successful communication occurs if, by way of the response, the sender believes that the message was received accurately

Effective listening An active skill An active skill Requires complete attention Requires complete attention Focus on the messenger Focus on the messenger Never finish the other person’s sentence Never finish the other person’s sentence Do not consider your response until the other person has finished speaking Do not consider your response until the other person has finished speaking Requires practice!! ** Requires practice!! **

Remember: A good communicator needs patience and flexibility!

Trust and Rapport There is a certain amount of trust implied in being a paramedic There is a certain amount of trust implied in being a paramedic You need to earn the trust You need to earn the trust First you establish the trust, then the rapport follows. First you establish the trust, then the rapport follows. With good rapport the person you are helping will follow your lead With good rapport the person you are helping will follow your lead

Developing Rapport Introduce yourself and your partner Introduce yourself and your partner Address the patient formally – Mr., Mrs., etc. Address the patient formally – Mr., Mrs., etc. Use the patient’s name ** Use the patient’s name ** Get to the level of the patient Get to the level of the patient Use a professional but compassionate tone of voice Use a professional but compassionate tone of voice Explain what you are doing and why Explain what you are doing and why

Nonverbal communication skills Eye contact Eye contact Touch and Gentleness Touch and Gentleness Posture Posture Demeanour/Smile Demeanour/Smile Important to look at your patient’s body language Important to look at your patient’s body language

Eye contact Can be a very powerful source of effective communication Can be a very powerful source of effective communication –Take your sunglasses off!! Can be very important in tense or difficult situations Can be very important in tense or difficult situations Remember, eye contact means the patient is looking at you! Remember, eye contact means the patient is looking at you!

Compassionate touch The holding of a hand, touch of an arm or shoulder The holding of a hand, touch of an arm or shoulder May be awkward at first – watch for response May be awkward at first – watch for response May help to calm the patient May help to calm the patient Be careful to touch appropriately – consider the patient’s age, gender, cultural background and current setting Be careful to touch appropriately – consider the patient’s age, gender, cultural background and current setting

Posture Gestures, mannerisms and postures by which a person communicates with others Gestures, mannerisms and postures by which a person communicates with others Includes distance between you and the patient, whether you are at eye level or not and your stance Includes distance between you and the patient, whether you are at eye level or not and your stance

Demeanour & Therapeutic Smile Pleasant demeanour absolutely necessary when you are dealing with people in crisis – they need to feel safe and assured that you can help Pleasant demeanour absolutely necessary when you are dealing with people in crisis – they need to feel safe and assured that you can help Smile – can send the message that all will be well but consider the crisis Smile – can send the message that all will be well but consider the crisis

Interviewing Techniques

Questioning Use open-ended questions Use open-ended questions Use closed questions only when necessary Use closed questions only when necessary Ask only one question at a time Ask only one question at a time Listen to the patient’s complete response before asking the next question Listen to the patient’s complete response before asking the next question Use language the patient can understand Use language the patient can understand Do not ask leading questions Do not ask leading questions

Payoff Questions Have you felt like this before? Have you felt like this before? Have you been upset about anything lately? Have you been upset about anything lately? Are you afraid of someone? [save this one for the privacy of the ambulance] Are you afraid of someone? [save this one for the privacy of the ambulance] Have you been thinking about hurting yourself? Have you been thinking about hurting yourself? What happened the last time you felt this way? What happened the last time you felt this way?

Strategies to Elicit Useful Responses to Questions Facilitate the response Facilitate the response Be quiet - never miss a good opportunity to shut up Be quiet - never miss a good opportunity to shut up Clarify the response Clarify the response Redirect the response Redirect the response Interpret the response Interpret the response Simplify and summarize the response Simplify and summarize the response

Common Interviewing Errors Assume Nothing Assume Nothing Giving Medical advice Giving Medical advice Providing false hope Providing false hope Assuming excessive authority Assuming excessive authority Sidestepping the truth Sidestepping the truth Distancing yourself from patients as people Distancing yourself from patients as people

Assessing Mental Status Observing the patient Appropriate Humour Appropriate Humour Timing of Responses to Questions Timing of Responses to Questions Memory Memory Ability to obey simple Commands Ability to obey simple Commands

Unique interview situations People who are unmotivated to talk People who are unmotivated to talk People who are hostile People who are hostile People who are very old OR very young People who are very old OR very young People who live with special challenges People who live with special challenges Cross cultural communications Cross cultural communications –Manners, gestures and body language –Cultural sensitivity and cultural diversity

How does failure to communicate occur? Prejudice – do not paint all with the same brush Prejudice – do not paint all with the same brush Lack of empathy Lack of empathy Lack of Privacy Lack of Privacy External distractions External distractions Internal Distractions Internal Distractions