My Superintendent sure knows how to keep me humble. We had a good meeting tonight, and just ran through a bunch of different scenarios, I got mostly trauma, until the last one, where I got thrown a difficult scenario, people-skill-wise.
First aid courses, be it OFA3, EMR, AMFR, all teach good first aid skills. You get drilled with protocols on medical and trauma cases so that eventually you can read it like the back of your hand. The more seriously injured the patient, the “easier” it is protocol-wise. Everything is written down step by step in black and white on what you have to do: Unresponsive pt, based on MOI need to take D-spine, ensure airway-put in OPA, not breathing, so assist, circulation not present start CPR and attach pads and AED… and the list rolls on. Sometimes, the not so easy cases are the ones that really don’t involve any injuries. It involve people skills. Skills in negotiating with uncooperative patients, potentially hostile patients, basically patients that just give you a hard time. I find that sometimes we get so focused on “first aid” when responding to a call and in training that when we get patients like these, it’s like being thrown a curve ball and we lose our rhythm.
It all comes down to practice, practice, practice and experience. I understand that first aid classes are meant to teach first aid skills and therefore, pretty much all practice scenarios are based on such. However, I feel that by taking that approach, many classes are neglecting practicing and teaching challenging scenarios that involve honing people skills, and dealing with and negotiating with challenging patients. These skills are just as vital as first aid skills and very practical in the real world. I believe more of these types of scenarios need to be incorporated into classes.
Scenario (based on SJA protocols):
Patient comes up to you with a friend who’s had alcohol and therefore can’t drive, asking if you can give them a ride to N. Van hospital for his insulin. Your division is covering the Abbotsford Airshow event and you can only transport to the First Aid Post or to the Field Hospital. You start your primary, but the patient becomes uncooperative and insists on being taken to the N. Van hospital. Patient refuses to disclose their SAMPLE history, and becomes quite angry (potentially hostile), standing up and cursing, calling you liars, and insisting on being transported to N. Van hospital and not to the field hospital or anywhere else. His friend starts hitting on your partner, not making the situation any better. From the information you were able to gather, the patient is stable but hasn’t taken his insulin since yesterday.
Some useful things to keep in mind for this situation:
1. Don’t crowd (may aggravate/increase anxiety of the patient). Consider the positioning of you and your partner(s)
2. Separate the friend and the patient if it’s making the scenario complicated (if the patient isn’t cooperative, perhaps your partner can get information from the friend)
3. Know which attendant is in charge, let him/her do the talking, allowing the patient to have one focus instead of multiple
4. Don’t be afraid to be firm and raise your voice when needed
5. Express your sympathy and understanding of the patient’s situation (ie. “I understand that you’re anxious and need your insulin but…”)
6. Provide options for the patient, give them some control of the situation (ie. you can either refuse to cooperate and stay here or you can cooperate and we can transport you to the field hospital where you can take your insulin. Which would you like to do?)
7. Try reasoning with the patient (ie. we can’t transport you to N. Van because we’re assigned specifically to cover this event. Also, if we do transport you to N. Van, and others get hurt, we’ll be lacking resources to help them.)
8. Talk to their friend to see if they can convince the patient to accept care.
9. If patient still refuses to cooperate, then make sure they understand the risks of not accepting care (of course make sure they’re competent and is an adult) and have the patient sign a refusal. If they refuse to sign a refusal form, have their friend or witness sign.
10. If you can’t provide the care for the pt, perhaps others can, consider your resources (PD, Security, Staff at the events).
11. Beware and constantly assess the possibility of the patient turning hostile. Consider calling PD, or security for assistance. Safety’s first.