The Missing Tool in Your Community Paramedicine Toolkit

BY: By Desiree Partain, CCP-C , Brandon Pate, BS, LP  / JEMS

You arrive to the home of a 45-year-old male who was recently referred to your Community Health Program due to his excessive use of 9-1-1 and ED services.

During your assessment, the patient relates that he uses the ambulance to go to the ED because he has no other means of transportation and the ED fixes his problems fairly quickly. When you inquire about a primary care provider, the patient appears apprehensive about getting connected to one and doesn’t feel your program will provide any benefit to him. Sound like a familiar scenario?

Fighting Against Change Resistance

EMS is a desirable profession because it provides an opportunity to help others who may be in need. EMS providers, by nature are fixers, menders, and problem solvers. But what do you do when you encounter patients who are ambivalent, resistant to change, or don’t want your help?

How the community paramedic interacts with their patients can play a vital role in influencing their thoughts and behaviors. Motivational interviewing is a therapeutic approach that helps to elicit change and shifts a patient away from doubt and resistance and toward confidence. It allows the community paramedic the ability to empower their patients to want to make changes in order to ensure program success.

By exploring the key characteristics of influence, socials determinants of health, and understanding the stages of change, the community paramedic will have a better understanding of their patients’ perspectives and will be able to use a more empathetic style to promote self-reliance.

The core of motivational interviewing focuses on tools to enhance collaboration rather than confrontation, evocation rather than education, and autonomy rather than authority. It addresses roadblocks to listening, key questions to ask patients when faced with resistance, and strategies for understanding and working through ambivalence. It provides steps to further prepare patients for change by setting goals, developing next steps, problem solving, and establishing boundaries.

Above all else, it allows the community paramedic the ability to gain trust with their patients and form lifelong relationships the provide meaning for the patient and for the community paramedic.

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