THE MIND’S FUNNY TRICKS
You are called to a house, upon arrival is a man (or woman) who seems confused, angry, crying… Another adult is arguing with the patient, challenging his beliefs, calling him stupid or crazy. The man who called you for help tells you that the other individual needs to be locked up or something, he claims it is Alzheimer’s. You can ask IF there has been any formal, BY A DOCTOR, diagnosis.
As an EMS responder, while a specific diagnosis may not have been officially made, you know that the arguing and yelling is not helping… it only adds to anxiety and possibly hostility. Conditions such as Alzheimer’s, Dementia, Diabetes and Stroke can cause confusion, fear, anger, and depression. As the First Responder, worry about the volatility of the situation, it is NOT for you to make a diagnosis and not for you to argue with the patient (or even the bystander).
Refrain from (verbally) correcting the patient’s physical complaints, never tell them that it is their imagination. Do not question their feelings or frustrations (obviously you can ask questions to fill in the blanks of patient condition, but never pressure them, correct them or make fun of a “symptom”). While there might be more than one illness or condition involved, adding pressure to be more specific may create more anxiety and aggression.
No matter what the patient’s condition, remaining calm and understanding is tantamount to treating and transporting. Kindly ask the caretaker/family member to step back if they continue to argue or otherwise incite your patient. Your patient does not need to be told that he is wrong, imagining things, or is “crazy”, loss of memory or severe confusion often manifests itself with upset and anger. If the bystander does not step back or continues to incite YOUR patient, quietly ask for police presence to assist.
Transport, especially while strapping your patient onto your gurney, is liable to cause more confusion and fear. Sirens and lights will only add to that fear and agitation. While transport safety is primary, reduce the noise (including sirens and radio) and flashing lights if and as you can. Stay aware of sudden movements by the patient and make sure that potential “weapons” (including writing implements) cannot be grabbed by your patient. Reassure the patient that you “are there for them” – do not ignore them to have an unrelated conversation with your partner (or on the phone!).
Use caring responses such as “you are safe here”, reassure them that you are there to help, and never laugh or dismiss if they tell you about their pain or ailments. Be professional, friendly, and cautious during the ride to the hospital (or other facility as directed by your local Medical Director). Passing your patient off to the hospital staff can also cause them undue angst especially if you managed to calm them enroute; take a moment to explain that the hospital staff is there to help and will care for them.
It is always important for your patient to know that he is valued and cared for.
I'm a former NYS EMT and still part of an EMS & FD family. I like to think I can write ;)
