The Lost Art of Empathy
The story of why first responders struggle with empathy and how we can seize it back
Medic 94, Medic 94 you need to respond to **** Aldine Bender Road for a 26-Alpha-1, time out 0215.
I had only been asleep for maybe 10 minutes when the tones alerted to respond to a medical call at a nearby apartment complex. 20 hours of my shift on the ambulance passed by already, I only had 4 hours remaining. The day was busy as one would expect for working the north side of Houston. By this point, I was exhausted. Rolling over, I searched for my glasses. There was frustration in my mind at the moment. A 26-Alpha-1 is a very low acuity call. The type of call where a person probably doesn’t need to call at 2am, but they did and we would respond.
Zipping up my boots and tucking in my shirt, I sluggishly made my way to the ambulance. My partner and I didn’t say a word; it was silent throughout the drive to the apartment complex. I read the call notes on our computer; it seemed we were responding to a elderly woman, but didn’t specify the actual complaint.
Arriving on scene, we were surrounded by dozens of low lit apartments identical in their design. The numbers of the apartments seemed to have no order or system. Stepping out of the ambulance, I started walking towards where I thought the unit may be, looking for clues like room lights being on. Finally, I found the apartment at the end of a long winding sidewalk. Knocking on the door, I announced “Ambulance.” A elderly woman opened the door with baggage in hand and began to speak.
“Oh my tooth it hurts, it hurts really bad.” She spoke to me before I could introduce myself. She went on to explain this has been going on for several days. In a condescending tone in my mind I thought, “why haven’t you gone to a dentist?” It seemed like the reasonable thing to do to me. I also knew an emergency department would do little to nothing for dental pain as they will refer you to a dentist. However, if she wanted to go we would take her. She was walking around her apartment trying to collect several bags as if she may be there for multiple days. I tried convincing her she would not need all of that, but she insisted. This irritated me even more. I had to ferry the luggage, my equipment, and her to the ambulance. My words and assessment were short. I was tired, I was frustrated, I was annoyed. This was not what I signed up for.
Contrary to popular belief, not every 911 call is life and death, where split second decisions need to be made before the person slips away into the grips of the afterlife. Those adrenaline infused calls are typically the exception, not the rule. As a first responder, you begin to realize that rather quickly. Typically most calls resolve around falls, mental health, or alcohol intoxication. Providers begin to feel the skills they spent hundreds of hours learning are being under utilized, if not wasted.
There is persistent mythology of first responders that gets played out on media. Through shows like 911 or Chicago Fire, it appears what we do is life defying medicine on every call. It neglects to tell you we EMS responders are the defacto primary resource of health care to many communities. This is even more prevalent in communities with higher poverty.
This does not mean providers do not respond to high acuity calls. As an EMS responder, they will take care of children who were abused and potentially the abuser themselves. They will respond to suicides of teenagers and homicides related to gang violence. Providers will treat patients who were struck by a drunk driver and the intoxicated driver as well. The book of horrific things they do see throughout their career is not a reading anyone would gleefully read.
Providers also face extremely low pay. Not that most providers get into this career for the fortune, but at many jobs, they may just break over the minimum wage amount with little to no benefits. EMS providers also face high rates of violence against them. I can personally attest to being spit on, kicked, lunged at, and hit by patients. That is a fairly standard communal experience among EMS providers. Responders have shared stories with me where they have had guns pulled on them, had their ambulance shot at, and have been robbed. We have been cursed at, verbally abused, taunted, and much more. Opposite of those aggressions, we wrestle to maintain a professional presence.
The total sum of these seemly independent variables began to take a toll on those in this field. Often that is reflected in the demeanor and presentation of a responder. Verbally, they may become condescending with the patient. They may minimize their medical complaint and not treat appropriately, which is most evident on the lower acuity calls. Burnout becomes intertwined into the job. Those who face the brunt end of the burnout typically are the patient.
Empathy is a lost art. It is a lost skill in the world of emergency medical services and that extends into other first responder professions like police and the fire service. The causes are not mutually exclusive, but merge together into what feels like an unbearable weight. However helpless it may feel at times, we have the opportunity to improve the art of empathy in the world of emergency services.
It begins with several basic steps:
- Education — It starts when responders are in school. We do an exceptional job at teaching responders on how to handle the physical needs of a sick patient, or how stop a fire, but rarely do we incorporate the patient’s or victim’s emotional needs. Let me be clear, we will not solve a person’s problem in our limited interaction, but we can make it a little easier for them during that time. There needs to be an additional emphasis on emotional intelligence. This foundational piece should string itself throughout the program. It should not be a one hour lecture and move on, but something that is continuously reexamined, especially when responders begin to answer calls.
- Volunteering — Volunteerism sometimes sounds like a thing of the past, but is really a great opportunity often overshadowed with busyness. Providers should take the opportunity to volunteer whether it be at a meal center, an after school program, a juvenile center, a food bank, or a nursing home. These moments allow for people to be placed out of their comfort zones and to connect with people on a non-emergency basis. Agencies should encourage and make allowances for responders to volunteer. These moments should not be used as a “pat oneself” on the back, but rather a real moment to connect with people we may only run into at an emergency scene. Spending time listening, hearing others’ stories, and building relationships with those people we often overlook in our communities.
- Organization — Often we see in the mission statement or values section the phrase “community focused” or something of the like. But what does that really mean? Is it just something we think looks nice to add to our organizational motto? What are we doing to create an organization that sees itself as a true service for the community? This is not a passive task, rather one that takes the whole organization to be driven by the community approach. In your hiring process are we looking for people who are community servant oriented? Are you creating leaders who are servant-leaders? Do you create an atmosphere that puts the citizen at the center of everything we do? Like it or not, our jobs are not to serve ourselves, but those citizens we respond to and even those citizens who have not beckoned us yet. The department’s culture should be one fiercely driven with the mentality of serving the community.
- Career Development— Empathy from a provider can dissipate quickly. There needs to be continuous development for providers not just on empathy, but mental health, social-emotional skills, and emotional intelligence. Creating emotionally agile responders will give them more tools and a greater understanding on how to utilize empathy. These shouldn’t be the once a year class on “talking feelings” but something that is rooted more deeply. It should be interwoven into the culture of the organization. Education is one thing (and an important one at that), but putting it into practice is something much different. This takes purposeful steps to make this the lifeblood of an organization.
Empathy is not learned on a powerpoint, it is not learned in a lecture, nor is it something that naturally refills itself when it runs empty. It takes making deliberate and calculated steps to support our first responders. If we allow for a culture of burnout, indifference, and frustration to wallow throughout the first responder community, we create a disservice for the very people we are supposed to serve. We must be resolute in addressing these needs.
Though these steps will only address some of the challenges responders face, it is essential these steps be taken. There is no easy road to correct all the complex issues of life as a first responder. To surrender to those issues will be a great travesty for all first responders, but most importantly for the community members we are supposed to serve.
Often we overlook the needs of the vulnerable. That night in north Houston, I minimized the needs of this elderly patient. Admittedly, I have probably done the same thing to dozens of other patients as well. Recognizing those failures has been difficult to swallow. There was nothing I was going to do that night that would fix her medical problem, but at the very least I could have lent empathy, compassion, and an ear to listen.
