# Making small talk with patients during long transfers



## rhan101277 (Dec 12, 2008)

I have a hard time talking to people that I don't know, because I don't know enough about them to start up a good conversation.  I want to put the patient at ease.  I have thought about asking stuff like how has your week been, etc.  I just worry about getting to personal since I have a limited time with that person.  Anyhow if anyone has any ideas as to how they do it, that would be great.


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## WuLabsWuTecH (Dec 12, 2008)

I mirror them.  Oftentimes they just want to sit back and rest.  If the make small talk I will too, but usually I'm fine just sitting back and getting up to take vitals every 15-20 minutes.  Generally I'll just enjoy the scenery going by or if I have a book, read it as most patients like to get some rest.


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## Hal9000 (Dec 12, 2008)

I routinely make two to four hour transfers when I'm not doing 911.  If the patient wants to rest, I let them, but my real life personality is blessedly pretty good, and I usually end up chatting with most of my patients.  I've had some of the best conversations on long trips with patients I don't even know.  I usually explain my background and inquire as to theirs (Old people have some of THE BEST stories!) and talk about my hobbies, unusual stories, and other things.  

As for how to do it, the best thing I can think of is to not be...well, shy.  Sometimes I start out asking something boring or stupid, and I usually promptly say, "Wow, that was boring or stupid."  How are you around your friends?  I treat everyone as a potential friend (Not psych pts, actually.) and I've never had a bad experience.  Sure, some crazy whackos that might make me uncomfortable, but I roll with the punches and think of them as one of my crazy uncles.  Works every time.

Anyway, it's personality.  I personally need my alone time, and I can't stand having more than a few close friends.  I still make sure that my patients receive the care and comfort they deserve, so making them comfortable with me as a person is included in the package.

Oh, and avoid being sunshine-sing-along-happy-friendly.  While technically nice, it's not very real.


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## tydek07 (Dec 12, 2008)

WuLabsWuTecH said:


> I mirror them.  Oftentimes they just want to sit back and rest.  If the make small talk I will too, but usually I'm fine just sitting back and getting up to take vitals every 15-20 minutes.  Generally I'll just enjoy the scenery going by or if I have a book, read it as most patients like to get some rest.



Perfect answer


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## rhan101277 (Dec 12, 2008)

Good thanks so far.  The pts. don't get frustrated at you taking their blood pressure 4 times in 60 minutes.  After you count respirations do you auscultate? Or only if you think their condition has worsened.


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## marineman (Dec 13, 2008)

I used to have the same problem with being shy around people I don't know. Shyness is nothing a bottle of jack can't fix, errr I mean. The biggest thing to me is 99% of my (limited) patients so far have been really nice and they usually start asking me questions about school and why I want to do this because they know I'm a student. Once you find a good "opener" you can roll with the punches and carry the conversation from there.


P.S. asking how their week has been is generally not the greatest opener because if they're talking to us it's been a pretty crappy week.


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## KEVD18 (Dec 13, 2008)

during the early part of the trip(packagin, loading, initial vitals, getting comfortable etc) i'll generally make small talk. nothing major or heavy. weather, sports, etc. if all i get back in monosylabic anwers or another sign of general disinterest, then its quite and peacful time. i'll write my chart up(and get caught up with any others), do my vitals every 15 minutes on the dot without question never missing a set on the perfectly stable and sans complaint va patient thats being discharged home three states away by ambulance becuase of the va's limitless budget and just let the patient chill.

some want to talk. some want to nap. give em waht they want.


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## LucidResq (Dec 13, 2008)

Assisting in D&Es at the OB-GYN office has made me a pro at small talk. The procedure is often pretty unpleasant and painful, so as I'm assisting the doc I do my best to distract the patient. I'm convinced that if you can make small talk with someone while they're in pain and anxious with their legs spread open to the world during minor surgery, you can have small talk with anyone. 

I think it's key to realize that some patients, especially those who are feeling really crummy, probably don't want small talk. Be receptive to clues and don't try to force conversation. They may appreciate what feels like an awkward silence to you much more than conversation. 

Younger patients - do you go to school or work? You can proceed to ask about their job/school. Try to focus on the positive, and be careful not to come across as judgmental. Once you're warmed up you can ask them about their plans for the future. What do they want to do for a living? Where would they like to live?

Older patients - most parents and grandparents love talking about their children / grandchildren. Many of my most successful patient interactions started with my inquiring the age of their children, and when told they have a teenager or toddler or 3 boys - "Whoa! You really have your hands full then, huh?" lightheartedly - I usually get plenty of interesting stories out of that.

All patients - Do they live in the area? How long? Where are they from? Do they like it here? If they're wearing anything remarkable ie: sports jersey, tattoo, piercing - what's the significance? For female care providers - complimenting a woman's jewelry/clothing/hairstyle/etc is a good way to get started. 

To keep the conversation going, avoid interrogating your patient. It is important to ask plenty of questions, but balance it out by revealing some information about yourself.

Most importantly, your goal should be to connect with your patient and make them more comfortable. If you over-think being a great conversationalist, chances are you won't simply listen to your patient, which will set you up for failure.


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## WuLabsWuTecH (Dec 13, 2008)

rhan101277 said:


> Good thanks so far.  The pts. don't get frustrated at you taking their blood pressure 4 times in 60 minutes.  After you count respirations do you auscultate? Or only if you think their condition has worsened.



I do the first set of vitals before we're underway.  Can't hear much once we are underway.  Immediately after I do BP, I set up the automatic cuff and make sure its reading agree with the manual.  If it does, and the patient tolerates it, I set the cuff to inflate every 15 minutes (or 20 minutes depending on how I'm feeling).  Take pulse by hand and attach the pulse-oximeter and if it agrees with my reading, I'll leave it on the patient if he tolerates it.  Program alarm limits 93-100% since its continuous monitoring and sit back.  When I hear the BP Cuff inflate, I write down the pulse-ox readings and count respiration rate.  Patients usually can sleep through this so it doesn't really bother them, but if i notice its waking them up, I just set the screen to flash when the bp cuff inflates instead of making the "ding!".  If you can asculatate in the back of a truck running down the highway, more power to you.

Also, generally patients are stable before transport, but if they become unstable, its time to have your partner find a diversion hospital and to take vitals every 5 minutes.



LucidResq said:


> (...)
> 
> Younger patients - do you go to school or work? You can proceed to ask about their job/school. Try to focus on the positive, and be careful not to come across as judgmental. Once you're warmed up you can ask them about their plans for the future. What do they want to do for a living? Where would they like to live?




I've never done a long distance on a child, but I would assume if they didn't want to rest they would want someone to keep them entertained and talking.  I would also assume they might have a toy or gameboy?


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## DT4EMS (Dec 13, 2008)

rhan101277 said:


> I have a hard time talking to people that I don't know, because I don't know enough about them to start up a good conversation.  I want to put the patient at ease.  I have thought about asking stuff like how has your week been, etc.  I just worry about getting to personal since I have a limited time with that person.  Anyhow if anyone has any ideas as to how they do it, that would be great.




I have used a little "Ice Breaker" for years to get a conversation started.......................

Once the back doors close and I sit on the bench seat............. I look right in the patient's eyes and ask "Is this your first time in an ambulance?" When the reply is "Yes"............

I smile and say................ "Mine too."

It has worked well for me over the years.

Kip


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## rhan101277 (Dec 13, 2008)

We don't have automatic cuffs on our trucks, they do seem pretty reliable though.  But anything electronic or mechanical can break.


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## marineman (Dec 14, 2008)

rhan101277 said:


> We don't have automatic cuffs on our trucks, they do seem pretty reliable though.  But anything electronic or mechanical can break.



I'd tread lightly there, it's likely to cause a hellstorm of people coming in with half saying they work well and the other half saying they're crap and you should always do manual with a few in the middle that do half and half.


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## WuLabsWuTecH (Dec 14, 2008)

its completely a personal choice.  I like to think I can trust what I feel and see so that's why I do a manual before going to the auto.  Also, our monitor has in the past been wrong before.  The reason for the auto is that it measures systolic and diastolic where as in a moving vehicle, i can't hear so I can only get a systolic/palp.


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## FFEMT1A (Dec 14, 2008)

Ive been lucky I guess.... Ive never had any really long transfers. Blessing of living in a Metro area. Now that I am living in a rural area and the "big hospital" is 45 minutes away... that may change.


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## traumateam1 (Dec 14, 2008)

Oye... lets not turn this into an automatic vs. manual thread again, there have been many.. and they just turn into mess fest.

As far as the original topic goes.. I, like joking with the patient, will feel them out. If they are in the mood to talk lots, or they have been chatty the whole time, I will keep the conversations going. However, if they are really only into answer medically relevant questions, and other than that, they just wanna lay there.. than I wont start gabbing away. Remember, theres a time and place for everything.


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## pumper12fireman (Dec 20, 2008)

I work in a small town of about 8,000 so that really helps. The older people love talking small town gossip and politics and if I don't know them, they usually know someone on the fire dept or I know the area in which they live. I usually like to ask what they do/did. Some people have/had some really cool jobs. And I like to show interest in that because most are very interested in what it's like to be an EMT/firefighter...

To the OP, I used to be the same way..kinda shy. But, this job has defintely gotten me over that, and meeting new people is one of my favorite parts of the job.


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## 41 Duck (Dec 20, 2008)

Guess I'm lucky--I'm within a half-hour of three hospitals--two of which are Level II's.  I've never taken a PT anywhere other than those three.  I couldn't imagine having to bring them via ground to places further away.


Later!

--Coop


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## pumper12fireman (Dec 20, 2008)

41 Duck said:


> Guess I'm lucky--I'm within a half-hour of three hospitals--two of which are Level II's.  I've never taken a PT anywhere other than those three.  I couldn't imagine having to bring them via ground to places further away.
> 
> 
> Later!
> ...



I work in a system where the hospital is no more than 10 minutes away..yet, it's a 5 bed ER, with the only capability of labs and CT. No trauma, no surg, no cath lab etc. So, a lot of times pt.'s come in POV or by us for stabilization then they get transferred out ALS or BLS, emergent or non-emergent to the city (depending on which hospital a 45min-1 hr 15min drive). We may only run 4 or 5 calls a day, but when some or most of those are 3 hour round trips, it makes for a long day.


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## marineman (Dec 21, 2008)

41 Duck said:


> Guess I'm lucky--I'm within a half-hour of three hospitals--two of which are Level II's.  I've never taken a PT anywhere other than those three.  I couldn't imagine having to bring them via ground to places further away.
> 
> 
> Later!
> ...



I live in a similar area with 5 hospitals within a 15 minute drive one of which is level 2 trauma and it has a peds rating but I forget what it is. Only thing they really don't do is burns but those are flown to milwaukee. We still average 2-3 longer transfers (hour and a half to three hours) daily. That's 2-3 company wide not a single rig. Every now and then we send a rig to the twin cities (5-6 hours one way) on a transport but I honestly have no idea why or what is wrong with the pts.


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## WuLabsWuTecH (Dec 21, 2008)

41 Duck said:


> Guess I'm lucky--I'm within a half-hour of three hospitals--two of which are Level II's.  I've never taken a PT anywhere other than those three.  I couldn't imagine having to bring them via ground to places further away.
> 
> 
> Later!
> ...


Ha!  Yeah, I only do long distrance transfers as discharges!

there are about 12 hospitals in the city and I'm neevr really more than 5 minutes away from one unless tis rush hour in which case it might become 10 or 15.


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## rhan101277 (Dec 21, 2008)

We regularly transport patients out of state, probably 120 miles away.


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## WuLabsWuTecH (Dec 21, 2008)

discharges?  and are you near the state line?


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## katgrl2003 (Dec 22, 2008)

I live in central Indiana, and I've transported patients to Illinois, Ohio, Michigan, and recently to Florida (that was a fun trip). I have the gift of gab, as my coworkers say, and can talk to anyone about anything.  I still base it on the patient. If they want to sleep, I'll work on paperwork; if they want to talk, I can definitely accomodate them.

-Kat


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## Hastings (Dec 22, 2008)

katgrl2003 said:


> I live in central Indiana, and I've transported patients to Illinois, Ohio, Michigan, and recently to Florida (that was a fun trip). I have the gift of gab, as my coworkers say, and can talk to anyone about anything.  I still base it on the patient. If they want to sleep, I'll work on paperwork; if they want to talk, I can definitely accomodate them.
> 
> -Kat



Just flip the words "Indiana" and "Michigan," and that's exactly how I feel about it too.


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## stephenrb81 (Dec 23, 2008)

I don't do many transfers nowadays with the service I currently work for, but back when I worked at a hospital based service it wasn't unusual for me to end up with 2 or 3 transfers in a single 12 hour shift.  More often than not, the patient would just rest for most of the 2 hour trips.   I'm a very social person so I never had a problem holding a conversation during the whole trip for the ones that felt like talking.

I usually carried two bags with me into work.  One was my personal bag with books, study material, laptop, etc... and another was a bookbag with various magazines, coloring books, plain paper and a clipboard, a few local and regional newspapers for that week, etc. I would keep that one on my ambulance during my shift .   I would always offer the patient something to read or write on (Kids the coloring book) during the trip.  I always received praises for offering those.


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## SCClayton (Dec 23, 2008)

On a ride along not to long ago we had to transport a pt from a very rural hospital to one of our larger city's mental health facility. The pt was clearly suffering from bi-polar 2. Which made conversations with him very interesting, so when be became too involved in what he was talking about, the EMT and I would tag team. We found this was easy to do as his mood would reset every time he changed the person he was talking to.


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## rhan101277 (Dec 23, 2008)

stephenrb81 said:


> I don't do many transfers nowadays with the service I currently work for, but back when I worked at a hospital based service it wasn't unusual for me to end up with 2 or 3 transfers in a single 12 hour shift.  More often than not, the patient would just rest for most of the 2 hour trips.   I'm a very social person so I never had a problem holding a conversation during the whole trip for the ones that felt like talking.
> 
> I usually carried two bags with me into work.  One was my personal bag with books, study material, laptop, etc... and another was a bookbag with various magazines, coloring books, plain paper and a clipboard, a few local and regional newspapers for that week, etc. I would keep that one on my ambulance during my shift .   I would always offer the patient something to read or write on (Kids the coloring book) during the trip.  I always received praises for offering those.



On longs transports, would you read books or do things on your laptop in between vitals checks?  Obviously if something was wrong you wouldn't be doing that.  But it seems if everything was going ok, it would pass the time good.


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## danguitar12345 (Dec 23, 2008)

*Small Talk Is Easy*

make small talk and useally it evolves into long talks that you don't want to end. Don't try this with dead patients (personal experience Haha)


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## danguitar12345 (Dec 23, 2008)

small talk i know i didnt read the question enough. OK just ask them what they like to do for fun where they work stuff like that


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## WuLabsWuTecH (Dec 25, 2008)

Yeah, our long transports are IFTs so pt is stable (usually anyways).

We don't have laptops but i'll read a book or magazine if I have one.  Oftentimes just sitting back and enjoying the scenery going by is not a bad way to pass the time.  Sometimes, I might play some music over the speakers in the back if the pt wants.  If not, I might use an mp3 player with the volume way down and only in one ear but I usually have not used the mp3 player when I'm the only one in the back with the patient.  Your sense of hearing is a very important tool to let you know that something is going wrong.  Especially when you're in the captain's chair and can't see the pt!


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## rhan101277 (Dec 25, 2008)

WuLabsWuTecH said:


> Yeah, our long transports are IFTs so pt is stable (usually anyways).
> 
> We don't have laptops but i'll read a book or magazine if I have one.  Oftentimes just sitting back and enjoying the scenery going by is not a bad way to pass the time.  Sometimes, I might play some music over the speakers in the back if the pt wants.  If not, I might use an mp3 player with the volume way down and only in one ear but I usually have not used the mp3 player when I'm the only one in the back with the patient.  Your sense of hearing is a very important tool to let you know that something is going wrong.  Especially when you're in the captain's chair and can't see the pt!



I think I am going to sit on the bench seat, I want to see my patients face and have a good view of the chest rise and fall.  I know they are stable but anything can happen to them.  I would hate to see that they stopped breathing because I couldn't see them from the captains chair.  I know to check vitals every 15 min but still.  Someone can start have problems in between those times.


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## WuLabsWuTecH (Dec 25, 2008)

rhan101277 said:


> I think I am going to sit on the bench seat, I want to see my patients face and have a good view of the chest rise and fall.  I know they are stable but anything can happen to them.  I would hate to see that they stopped breathing because I couldn't see them from the captains chair.  I know to check vitals every 15 min but still.  Someone can start have problems in between those times.


Captain's chair is usually the safest seat in the back.  I always sit there on the longer transports.  If you go back and read one of my earlier posts, I keep the pulse oximeter attached ans set alarm levels (usually 92-100).  So if they stop breathing, my monitor (or pulseox if i'm in one of the rigs that doesn't have a monitor) will start yelling at me.  Which is why I need to be able to hear!

Some people like to hook up the leads too, but I say there's nothing the heart monitor can tell me that I can't get from the pulseox!


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## jochi1543 (Dec 26, 2008)

I had a 14-hour transfer call the other day, it was brutal. Dude was not very talkative, and was thoroughly irritated that I kept taking vitals every 45 mins ("they already did this 3 times at the hospital today!").


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## WuLabsWuTecH (Dec 27, 2008)

jochi1543 said:


> I had a 14-hour transfer call the other day, it was brutal. Dude was not very talkative, and was thoroughly irritated that I kept taking vitals every 45 mins ("they already did this 3 times at the hospital today!").


Every 45?  Our protocol has every 20 minutes at the very least!

Yeah, you know, its not like vital signs change every once in awhile...


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## Medic (Dec 27, 2008)

Id crack those stupid jokes to get a smile on their face and then work it into a convo. thats if there is no language issues.


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## jochi1543 (Dec 27, 2008)

WuLabsWuTecH said:


> Every 45?  Our protocol has every 20 minutes at the very least!
> 
> Yeah, you know, its not like vital signs change every once in awhile...



....and ours is 45....


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## mycrofft (Jan 1, 2009)

*I made small talk and found out they "knew" me from prior job/other state.*

Small world out there!

Ice breakers:
"You come here often?".
"Got kids?".
"What color room do you want at the hospital?".

OK so much for the pediatric pt's....

One to avoid is "Holy C&#P, SHE"S ALIVE!?".


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## mikeylikesit (Jan 12, 2009)

I'm never too worried about getting "too far into it" with someone. Mainly because i have to ask them questions that you normally wouldn't ask a stranger anyway. I start with not hows your day because the answer is usually a smart one. I go with what do you do for a living or have you heard this in the news and so on. general questions....unless shes attractive.


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## daedalus (Jan 12, 2009)

rhan101277 said:


> I have a hard time talking to people that I don't know, because I don't know enough about them to start up a good conversation.  I want to put the patient at ease.  I have thought about asking stuff like how has your week been, etc.  I just worry about getting to personal since I have a limited time with that person.  Anyhow if anyone has any ideas as to how they do it, that would be great.



Carry a bottle of diprivan with you. Than pull out your cell phone and talk to your friends.


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## FireCPT11 (Jan 30, 2009)

I used to hate transfers and trying to make small-talk so much that I would inform the pt that it was perfectly okay with me if he/she took a nap and then retreat to the airway seat so that I didn't have to interact much, if any at all. I was a volunteer and usually the third on an ALS truck, so generally the medic did most of the talking/interacting.

Luckily I eventually started riding with a medic that wouldn't stand for that at all. He made me do my BLS skills, and he banned me from the airway seat so that I would be forced to learn to interact. When I went to medic class, this same guy was one of my preceptors and now that I am finally a medic I am forever greatful to him for forcing me outside of my comfort zone in the name of learning to be a better provider. 

I try to apply the same rules for conversation as I would in the workplace. Anything goes as far as weather, sports, current events, even family and hobbies, etc. I do, however, try to avoid religion and politics. 

Little ones (younger than 5 or so) I usually make a glove puppet or two (if time and pt condition allow) or try to find a stuffed animal of some sort to entertain them with. Young school-age kids usually like to learn about the ambulance and ask questions. I have found this to be a good time for discussions on fire safety, 911 use, etc. Might go something like, "Have you ever been on an ambulance before? How about a fire truck? Do you know when to call the ambulance/fire truck? How would you do that?" Older kids are tough but they can be entertained too...I usually hand over my cell phone or PDA for the duration of the transfer (if it's okay w/ mom or dad).


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## mikeN (Jan 30, 2009)

I had a third rider the other day on day four and we had a transfer that should have been 45 minutes but was 2.5 hours due to snow.  We figured it would take that long anyway.  I gave him some tips for conversation starters because this was a sit and babysit the PT for the ride.  No major PMH or anything, just a slip and fall on ice and had surgery for it.  Some conversations topics:
1 Where are you from
  a.  from somewhere else: how long have you been here
       and what brought you here
2. what did you do for a job
3. kids? what do they do for jobs?
4. grandkids
5. stay away from weather because that is a conversation ender.


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## frogtat2 (Feb 4, 2009)

*Tranports*

We routinely do 90 min tranfers.  I try to play off of the pt's mood..... if they lay back and close their eyes I just let them rest.  If they seem anxious or are talkative, I will talk to them.  I try to ask about their families.  Most everyone has a family member they are proud of.  I often get asked about why I am involved with EMS.  I find it puts my pt at ease if I am willing to talk about myself some, they seem to be more willing to talk about their own stuff then.


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## bittner (Mar 1, 2009)

I also do alot of transfers.  I live in a small town with a level 4 hospital.  Our transfers range from 45 min to 1 1/2 hours.  I have found it easy just to make some small talk at first and find something to build on.  If my pt. would like to rest, I will let them rest.  Most of the time they enjoy the small talk, it kinda puts them at ease.


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## emtfarva (Mar 1, 2009)

I sometimes can't find anything to talk about. So, I sometimes talk for a minute or two and then work on my paperwork. When we get closer to our destisation, I will explain what will happen. I love it when they can't talk to you.


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## rhan101277 (Mar 1, 2009)

Well I have gotten more practice with this, and many people so far seem un-interested in intelligent discussion.  I ask them do they have alot of family here, or they from here?  They answer and then ask questions back, but thats about it.

Some of them I really like to talk to, it makes me feel better about their mental status and if they can talk they are breathing.  Some people its really hard for me to see chest rise and fall because they are breathing shallow etc.  I had this one little old lady, she had dementia really bad and wouldn't go with us unless I assured her we were taking her home.  Which we were taking her to a nursing home.  We get there and she says its not her home but she has lived there for years, and ask to use the phone right away etc.


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## Sasha (Mar 2, 2009)

> Some of them I really like to talk to, it makes me feel better about their mental status and if they can talk they are breathing. Some people its really hard for me to see chest rise and fall because they are breathing shallow etc.



Bahaha. When I had patients who didn't want to talk but would go to sleep and they had really shallow breathing, I used to shake them every 10 minutes to make sure they were still alive. I probably would've gotten by by checking a pulse, but eh... it was quicker!


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