Are You a Closer?

A…B…C…
This is the second article in series for new EMS providers.

I precept several new EMS providers a year and the biggest issue I see in new EMS providers is they aren’t able tot close the deal.

What do I mean by close the deal?

If you don’t know what I mean by close, go watch the 10 minutes of Glengary Glen Ross where Alec Baldwin delivers his speech. [NSFW language: Coffee is for closers]

New EMS providers are usually able to get through the SAMPLE and OPQRST part with a patient fairly well and then things come to a screeching halt. Once the assessment and history gathering are done there is an awkward silence as they look to the preceptor for direction. They don’t close the deal.
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At the risk of oversimplifying things, in the end you have two outcomes of a 911 call:

1. The patient goes to the hospital with you.
2. The patient does not go to the hospital with you.

Sometimes it is obvious what the choice is, other times patients are unsure what they should do.

Our job as EMS providers is (should be?) to inform and educate patients so they can make a health care decision that is right for them. What follows seems like common sense but I think you would be surprised how many newer EMS providers find this to be a stumbling block.

If the patient is not sure of they want to go to the ER, do your assessment, gain enough information to counsel them. Once you have decided that you feel a patient should go to the hospital by ambulance or that they don’t need an ambulance if they don’t want one*, don’t turn to the preceptor and look for direction, just take the ball and run with it.

Trust me, if we see you making a dangerous decision we will intervene. Summarize your findings to the patient, tell them your plan and ask them to act upon it, let them be involved in the decision making and close that deal.
 “I think you should go to the hospital with us, does that sound okay?”

 “Here is what I would like to propose, I would like to start an IV, give you some medication for pain, let that marinate for a moment to kick in and then take you to the hospital, how does that sound?”

In non-injury accidents I will often tell the patient, “We are not finding any injuries and everything looks okay, however the safest course of action would be to go to the ER and get checked out and we are happy to take you. Do you want to go to the hospital with us?”

You may have no idea what is going on with the patient that is okay. While EMS does diagnose, we do not diagnose every patient every time. I often tell patients I am not sure what is causing their issues and that is why they should go to the ER to get a much more thorough evaluation.

“I’m not sure why you are having chest pain but  I do think you should go to the ER, where they can do things like lab work and imaging and you can be checked out by a doctor. Does that feel like an okay plan to you?”

You may think that telling patients you are unsure about their diagnosis is going to undermine their confidence in you, it will not. In fact it will have the opposite effect making  them trust you more so long as you are confident in your delivery . Honest communication is the cornerstone in building rapport.

Don’t stop until you close the deal. Either you close them and they go with you in the ambulance or they close you and say they do not want to go with you to the ER.

*Please note I am not advocating for EMS initiated refusals here. Use common sense and be a patient advocate.  If a patient has toe pain from gout and they understand the risk of not going to the ER by ambulance then I am fine with that. If a patient has a huge STEMI and chest pain but doesn’t want to go to the ER I am going to really try to get them to go to the ER.