Coping Strategies
Bunslinger asked:
Those harrowing nasties you mentioned.. how DO you deal with them? What’s your coping strategy..?
In fact, how do you deal with the shouty ones who don’t like being told “no you can’t have an ambulance”?
The “harrowing nasties” are in fact much easier to deal with than the timewasters. While I’m on a call, if the patient is unconscious or suspended, I try not to allow myself to think of the patient as a person at all - they are just a resus Annie and this is a training exercise. Better still, this is an episode of Casualty and we’re making it up as we go along. In my head, no-one is beyond hope until the death certificate is written, so there’s no point in anyone getting upset. There’s a procedure to follow. Two breaths, fifteen pumps. Two breaths, fifteen pumps. Keep going, we’re almost there. You’re doing really well. Two breaths, fifteen pumps…
Road Traffic Accidents and other gory accidents are not as bad to deal with as they sound, even though the events themselves can be quite horrific. For instance, once I took a call about a motorcyclist who had hit a pillar in a tunnel and been separated from his head by several metres. Another time a woman had been caught under the wheels of the lorry and, in the words of the caller “was in pieces all the way down the road”. The reason these aren’t so bad is because the caller is just a bystander, not a hysterical relative, so again it’s easy not to think of the patient as a person. It sounds horrible to say I don’t treat patients like people, but the truth is, if I did, I’d go mad and I’d not be able to do my job. Of course, this only applies to dead/dying/unconscious patients - if they’re reasonably stable then my fabulous interpersonal skills and milk of human kindness come flooding back! (Right up until the moment they tell me they’re calling for a toothache).
After work, the best method I’ve found of dealing with nasties is this blog! Writing things down is a good way of getting them out of your system. Another thing I’ve learned is that you must not under any circumstances torture yourself thinking “what if I did this or that?” There’s been a couple of calls where I did worry - for instance, I thought should have recognised this patient’s agonal breathing quicker, and I still don’t know how this panic attack resulted in a dead body. Talking to the crews helps, or to other people in the room.
The shouty rude timewasters (and the shouty rude people who have a genuine need for an ambulance for that matter, though for some reason these are rarer), on the other hand, still have the capacity to interfere with my sanity despite my best efforts to eradicate them from my brain. You are kind of limited in what you can say to them, because you are of course not allowed to be rude and you are also not allowed to say “you can’t have an ambulance” or point them in the direction of the nearest cab firm/pharmacy etc (a policy I have to say I do not entirely agree with). This means you are so busy biting your tongue that the shouty rude person can take over the conversation a bit and you also end up suffering from esprit d’escalier, in other words, thinking of something you could have said which would have put them in their place without breaking any rules halfway through the next call.
The best way of coping with these calls is making a note of their ticket numbers and checking back in a couple of hours time to find they got a call back from TAS telling them that they were wasting our time and needed to see a GP, or even better, got an ambulance accompanied by a stern looking police officer who proceeded to lecture them on being abusive and threatening towards control room staff. That’ll teach ‘em.
on September 19th, 2006 at 12:55 pm
Yes, blogging helps. But then there is the trickyness of doing it without upsetting/being discovered by employers, colleagues, patients, relatives etc. In my line of business this is almost a showstopper.
on September 19th, 2006 at 2:28 pm
Yeah, I do worry about that too. Even though I do all the patient confidentiality changes and then some so no-one could work out who I’m talking about, the callers would still be able to recognise themselves. But so far I’ve had no complaints. I figure that if I’m writing about someone who did something good, or simply describing an emergency, then I should write in a way I would find acceptable if it were me being discussed — sensitively and tastefully. I still use humour even when describing the most horrible situations, but I hope I know where to draw the line. As for those posts describing people who did something bad, they might feel a bit peturbed if they read this blog and recognised themselves, but perhaps they’d learn from it!
on September 19th, 2006 at 3:25 pm
2 rescue breaths to 30 compressions surely? Or have you not moved to the new protocols?
on September 19th, 2006 at 3:43 pm
Do you still get a high proportion of hoax calls as well as timewasters and harrowing nasties? I say ’still’, as it seems that when I were a lad, not a week went by without our being forced to watch a badly-made video detailing the horrific evils of hoax calling and its consequences.
on September 19th, 2006 at 3:53 pm
Alex: the crews have moved over, but we haven’t. Actually, most of the time we do compression-only CPR, but that didn’t sound right in this post!
SCW: yes, we do. Not as many as the timewasters, but still enough to make me want to kill them all. Trouble is, there’s nothing we can do — even if I know it’s a hoax (which I usually do) I still have to pretend to believe them. Really frustrating…
on September 20th, 2006 at 11:57 pm
I find the shouty rude ones a bit of a pain because it is always about 2 hours later when I think of the sharp witty comment that would have completely deflated them and make the vow never to be nasty ever again. Some hope.
on September 22nd, 2006 at 1:57 am
hi there, hope i not intruding. its 2am, post night shift and my body refuses to believe its time for bed. im sure ya know what i mean. i work in central and west region ambulance control, in south west wales, and i somehow trawled across your site while surfing the net. just wanted to say that to those asking about coping strategies and how you deal with it, the simple response is that after your first 1000 angry ones, you kinda get used to it. the only thing that gets to me now is the paediatric arrests, i dont think i’ll ever be able to take one of those without getting a bit upset, but everything else becomes common practise really.
on September 25th, 2006 at 8:36 am
Not much time - internet cafe in maurituis - wooo!
Thanks for the answers Mark, will read when I get home
Alison
on September 27th, 2006 at 12:05 am
Right, now I am home and not being charged silly money per minute..
Thank you for answering my questions
This whole “it’s not a person” attitude seems to be pretty much universal. My dad was an RAF medic in ww2 and his strategy was pretty much word-for-word what you’ve described.. he went to horrible scenes (for example the plane that had crashed into a tree - they found intestines decorating the tree) and he says he thought of the bodies as “just rubbish, used up - there’s no person there, and if they’re not dead they’re usually so close that they have no idea what you’re doing to them anyway”.
I can cope with shouty people (having done callcentre work and retail work you get immune to it) and I can cope with pressure, but could I ever be that detatched..? I’m really not sure. I like to think that I can be fairly efficient and on occasion, ruthless when I have to be.. but that’s different.
on September 17th, 2007 at 11:23 pm
Thanks for the tips they will come in useful for sure