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Category: EMS Operations

Topic: Therapeutic Communication

Level: EMT

24 minute read

Effective Communication Factors
  1. Introductions
  2. Privacy
  3. Minimize interruptions/distractions

INTRODUCTIONS can go a long way in facilitating effective communication with patients and family members. EMS professionals should always introduce themselves and their partners and team members, when applicable, and follow by allowing or requesting that the patient introduce himself/herself.

PRIVACY: During each patient encounter, the EMS professional should always uphold the greatest level of patient privacy and minimize interruptions of any kind, especially that of the physical environment.

DISTRACTIONS: Lighting, noises and outside interference, distracting equipment, distance, and a difference in height between the EMS professional and the patient are all easily corrected and should be applied effectively.

EMS professionals may take notes to remember pertinent information.

DOs & DON'Ts: Several techniques can be employed to facilitate effective questioning and interviewing. 

Control of the interview is facilitated by the following: 

  • The EMS professional should always choose a language the patient understands. 
  • Use the correct type of questions, including open-ended questions and closed or direct questions.
  • Ask one question at a time.

Hazards of poor interviewing include

  • providing false assurance or reassurance to the patient,
  • making it seem as though the EMS professionals are giving advice,
  • asking leading or biased questions,
  • talking too much,
  • interrupting, and
  • using “why” questions that deter from the underlying issue.

Interviewing Techniques

Nonverbal skills such as the posture and gestures of the interviewer and patient often impact patient interviewing, and should be adjusted and corrected accordingly.

Gestures such as specific facial expressions, eye contact, tone and volume of voice, and physical touch are all tools that can be utilized to effectively improve patient interviewing, but also have the power to greatly disrupt the patient-provider relationship if performed incorrectly.

Some patients will have an issue succumbing to the authority of an EMS professional, and in this case, the EMS professional's bedside manner should be adapted to make the patient as comfortable as possible. It is important to always remember that EMS professionals are often seeing people in their worst moments when emotions are high.


Verbal Defusing Strategies

When interviewing a hostile patient, it is important that the EMS professional build rapport with the patient to earn trust prior to performing treatments or care. The EMS professional should always maintain a professional and non-threatening demeanor. To develop patient rapport, the EMS professional should always attempt to put the patient at ease and put himself/herself at ease, as well.


Family Presence Issues

All patients should be allowed the highest level of personal privacy, even from other family members on-scene. Often patients of all ages will feel embarrassed or fear of being completely honest with EMS professionals in view or earshot of family members. (Example: questions about sexual activity or possible pregnancy for a young girl in front of her parents.)

It is the EMS professionals duty to uphold the privacy of all patients, but facilitate the acquirement of information as well, so it may be necessary to request the patient’s family members on-scene leave momentarily to give the EMS professional and the patient privacy.

In the event that privacy is not easily gained, the EMS professional should wait to question the patient in more detail in the privacy of the ambulance, away from family members. EMS professionals should always follow department policies regarding the EMS professional’s response to these situations and to family preferences.


Communications Adjustment Strategies

Communication strategies should be adjusted for

  • age-appropriateness,
  • stage of development,
  • patients with special needs (i.e., hearing-impaired patients), and
  • differing cultures.

ETHNOCENTRISM: defined as the evaluation of other cultures according to preconceptions originating in the standards and customs of one’s own culture.

CULTURAL IMPOSITION: defined as the tendency of a person or group to impose their values and patterns of behavior onto other persons.

CULTURE: Transcultural considerations require that the EMS professional introduce himself/herself and what he/she wants to be called. It is important to remember that both the EMS professional and the patient will bring cultural stereotypes to a professional relationship.

  • SPACE: Space is a big cultural issue that requires knowledge, and correct action to avoid offending patients, of different cultures.

EMS professionals should be aware of intimate zones, in which they are physically too close to a patient of any culture. Adequate personal, social, and public distance should always be maintained. Many cultures are very aware of varieties of space constraints and many other potentially offendable issues.

Each person within a specified culture accepts the "sick role" in different ways and nonverbal communication that it is in the culture of the EMS professional may be perceived differently by the patient.

  • DIRECT EYE CONTACT: Asians, Native Americans, Indochinese, and Arabs may consider direct eye contact impolite or aggressive.
  • TOUCH: As well as space and nonverbal considerations, many cultures can perceive touch as an offending communication mechanism. EMS professionals should never touch a patient without consent and should always adhere to the patient's customary cultural beliefs and practices, when applicable, practical, and possible.
  • LANGUAGE: EMS professionals should always keep in mind that language barriers may prevent understanding between patient and EMS professional.

Radio Communications

The communication process and components that allow EMS professionals to communicate effectively with dispatch, medical control, and other healthcare professionals include the radio system.

ENCODING: The digital radio system includes the encoding of a message so it can only be received by the intended party, the actual verbal message itself, the decoding of the received message at the receiver, and any feedback in the form of a return encoded message.


Patient Responses

Patients may react in many different ways to attempts at communication from EMS professionals, requiring thoughtful action on the EMS professional's part to continue building a strong and trusting professional relationship. EMS professionals will respond to patients' specific or general responses in several different ways as well.

Specific types of responses that may be encountered and utilized from either side include

  • facilitation,
  • silence,
  • reflection,
  • empathy,
  • clarification,
  • confrontation,
  • interpretation,
  • explanation, and
  • summary.

FACILITATION: the tendency for people to perform differently when in the presence of others than when alone.

A patient that is suspected of facilitating should be interviewed away from other people when possible.

SILENCE: when a patient or EMS professional does not respond at all--usually a defense mechanism--but may be due to an underlying medical condition.

REFLECTION: when a person applies serious thought a concern.

EMPATHY: the ability of a patient or EMS professional to understand and share to feelings of another.

CLARIFICATION: the act of making a statement or situation less confused and more easily comprehensible.

CONFRONTATION: an open but direct conflict of opposing ideas.

INTERPRETATION: the action of explaining the meaning of something.

EXPLANATION: providing a reason or justification for an action or belief.

SUMMARY: providing a brief statement or account of the main points of something.


Information Acquirement Strategies

In many situations on EMS calls, patients or patients’ family members may be reluctant to share pertinent information. An effective EMS professional will still be able to obtain needed information on complaints even through their resistance and defense mechanisms, shifting focus, and distractions.


Unfortunately, some patients will be unmotivated to talk to EMS professionals, even though most patients are more than willing and very eager to speak with medical personnel when there is a medical concern.

In the event that patients are unwilling to talk to EMS professionals, the EMS provider should start the interview in the normal manner with an introduction, followed by attempting to use open-ended questions. As always, EMS professionals should provide positive feedback and make sure the patient understands the questions.

When more information is needed, the EMS professional should continue to ask questions and provide necessary special accommodation such as language line or other interpretation services.

Specific situations in which special interviewing techniques will be required of the EMS professional include

  • when patients are under the influence of street drugs or alcohol,
  • during communication with elderly patients, and
  • during communication with pediatric patients.

UNDER THE INFLUENCE: When an EMS professional has encountered a patient who is under the influence of street drugs or alcohol, every attempt should be made to keep the patient calm and cooperative, but not at the risk of personal harm to the EMS professional.

If ever in doubt, the EMS professional should request law enforcement prior to continuing with patient interviewing or patient care.

GERIATRIC: Communication with elderly patients can require that the EMS professional obtain the patient's assisting devices for them, such as glasses, hearing aids, or walkers due to the potential for a visual deficit, auditory deficit, and the need for assistance during walking.

PEDIATRIC: Communication with pediatric patients should utilize the parent or caregiver of the patient whenever possible and requires the EMS professional to use clear explanations.