# Calming a parent.



## Household6 (Mar 18, 2014)

I was paged out for a seizure of a 12 month old, ALS rig was about 10 minutes out.

I got to the house, solo in my POV, to find a young dad obviously hysterical, holding his postictal infant. It's my first time in this scenario.

I'm positive it was febrile, the pt was on day one of ABs for an ear infection, dressed in PJs, and napping on dad's chest under a blanket when the seizure happened, and feverish when I arrived. I didn't need to take her temp to tell she had a fever. I would guess about 102.

I tried to put dad on the task of packing a bag while I assessed and undressed the baby.. "Let's get some diapers and wipes in a bag, change of clothes, include her meds." He wasn't really able to even go do that. 

Any advice for dealing with parents so emotionally escalated?


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## mycrofft (Mar 18, 2014)

You did the right thing. Acting calm and giving instructions , maybe as a question ("Do you keep a diaper bag packed for going out? Where is it?"), create an environment where the parent or bystander feels less out of control and can keep them a little out of your hair, while doing good. Encourage questions but do not answer them directly if you are not sure. If it is out of for league, try not to encourage questions, say "We need to ask the doc later" or some such.

The older I get, the more I learn that treating people (not conditions) involves NOT doing things, like not taking this as a preaching moment, not stumping in and taking numbers and bellowing orders, and not voicing a lot of personal anything.  Don't promise anything you won't follow through on.


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## UnkiEMT (Mar 18, 2014)

mycrofft said:


> You did the right thing. Acting calm and giving instructions , maybe as a question ("Do you keep a diaper bag packed for going out? Where is it?"), create an environment where the parent or bystander feels less out of control and can keep them a little out of your hair, while doing good. Encourage questions but do not answer them directly if you are not sure. If it is out of for league, try not to encourage questions, say "We need to ask the doc later" or some such.
> 
> The older I get, the more I learn that treating people (not conditions) involves NOT doing things, like not taking this as a preaching moment, not stumping in and taking numbers and bellowing orders, and not voicing a lot of personal anything.  Don't promise anything you won't follow through on.



That. Though I'll add a couple sub points.

At some point you need to do the math on sending them out of the room ("Why don't you go stand outside and wait for the ambulance so you can show the crew where to go when they get here?"). This is kinda a rough thing to do to someone, while they're standing outside, they'll be imagining the worst possible scenarios inside, so don't do that lightly. If they're interfering with pt care, however, it's often your best bet.

Second, and anecdotally, the only time  I've ever had a gun pulled on me was by the parent of a baby who was obviously dead, demanding that we save her. We ran the family code until we got on the road, then had PD waiting for us at the ER. The moral here is, "Always gauge the parent before you deliver bad news.".


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## Handsome Robb (Mar 18, 2014)

Even in resuscitation it's shown that including family in the care is important. 

I have an unfortunate amount of experience with bad pediatric calls. The ones where I booted the parents and didn't explain never went as well as the ones where I calmly explained what I was doing, what I thought was going on, why I thought it was happening. Not only does it show you're competent it builds a rapport with the parent. Don't forget about the patient to though. 

Like you did giving them tasks is always a good tool as well to get them to calm down and focus, however don't apply pressure to them. "We need that bag so we can go" is going to rile them up rather than "what all do you have in there? Do we need anything else? How about xxx?" 

I've always had pretty good lucky with parents doing it this way.


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## wannabeHFD (Mar 18, 2014)

Whatever you do, don't call them erratic. Especially a new mother...that was a bad night


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## mycrofft (Mar 19, 2014)

UnkiEMT said:


> That. Though I'll add a couple sub points.
> 
> At some point you need to do the math on sending them out of the room ("Why don't you go stand outside and wait for the ambulance so you can show the crew where to go when they get here?"). This is kinda a rough thing to do to someone, while they're standing outside, they'll be imagining the worst possible scenarios inside, so don't do that lightly. If they're interfering with pt care, however, it's often your best bet.
> 
> Second, and anecdotally, the only time  I've ever had a gun pulled on me was by the parent of a baby who was obviously dead, demanding that we save her. We ran the family code until we got on the road, then had PD waiting for us at the ER. The moral here is, "Always gauge the parent before you deliver bad news.".



That back at ya.


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## mycrofft (Mar 19, 2014)

Robb said:


> Even in resuscitation it's shown that including family in the care is important.
> 
> I have an unfortunate amount of experience with bad pediatric calls. The ones where I booted the parents and didn't explain never went as well as the ones where I calmly explained what I was doing, what I thought was going on, why I thought it was happening. Not only does it show you're competent it builds a rapport with the parent. Don't forget about the patient to though.
> 
> ...



Ditto that as well too, or something.


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## ZombieEMT (Mar 20, 2014)

I personally DO NOT try to get them focused on other tasks. Infants/todlers/young peds are sometimes hard to assess a normal mental status. They also can not normally recite a history or their demographics. I get them talking, both positive things and negatives things. I explain what is going on and what is going to happen. I also try to provide insite on what might cause what is going on. Never do I try to get rid of them.


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## Tigger (Mar 20, 2014)

If I can't them to be part of the process then I find a subtle way to get them to another place. Sure, often times parents are the only historians present but if all their going to do is scream that their child is going to die and shake him (last weeks fun and no the patient did not die), then they should be refocused. Ideally I want parents present, but we aren't going to sacrifice care just so that can occur.


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## EMDispatch (Mar 20, 2014)

General suggestions from behind the radio.
We're taught repetitive persistence. You can successfully refocus a manic or distraught person by using a calming tone (but firm), providing a focusing statement or task, and repeating it ia same manor until they respond. The statement should be along the lines of, "I need you to do this, so I can help". It's much more successful if you provide a cause and effect statement than an unexplained directive. It still doesn't always work, but 9-10 it will in one to two repeats.


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## mycrofft (Mar 21, 2014)

EMDispatch said:


> General suggestions from behind the radio.
> We're taught repetitive persistence. You can successfully refocus a manic or distraught person by using a calming tone, providing a focusing statement or task, and repeating it ia same manor until they respond. The statement should be along the lines of, "I need you to do this, so I can help". It's much more successful if you provide a cause and effect statement than an unexplained directive. It still doesn't always work, but 9-10 it will in one to two repeats.



Good one. Sometimes, drunks too.


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## spnjsquad (Mar 21, 2014)

*Re: Calming Parents Down*

I agree with others, just keep reassuring the dad (not frequently enough to pull you away from working) but enough to try and calm him down. Also, even though you "could tell" she had a fever, you should still take her temperature for a more accurate reading, even if ALS is 10 minutes away. Tell him to gather the needed things for the infant as you and ALS are taking her to the rig, and tell him that everything will be OK, and to be sure not to follow you (considering code 3).


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## MrJones (Mar 21, 2014)

spnjsquad said:


> ...and tell him that everything will be OK,....



Never, ever, ever, ever.



Never.


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## Handsome Robb (Mar 21, 2014)

MrJones said:


> Never, ever, ever, ever.
> 
> 
> 
> Never.



Agreed.

Do you want to be the Paramedic that that family member clings too for the rest of their lives saying "the paramedic said they'd be ok"?

I'm gonna get deemed but there's an episode of Trauma that had a situation like this and the patient who survived wouldn't accept the death of his friend because the paramedic told him he'd be fine on scene. Is there dramatization to make it more intense? Absolutely, but it's a very real issue. 

"I'm doing everything I can, this is what's happening, this is what I need from you, you're doing awesome, i need this from you so I can help xxx". Use names, makes it seem like you truly do care.


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## mycrofft (Mar 22, 2014)

Had an elderly couple (About my age now) in a car accident, high speed broadside. HUsband had foot trapped by firewall wrinkling up around the foot (extricated by cutting the floor mat out and just lifting) and a broken humerus, closed left parietal head impact. Asked how wife on bench seat next to him was doing (we had removed her already).

 Told him she was stable. Was dead without a mark on her (C1-C2 fractures).

I still remember that and wonder if I did the right thing. I think so in that case, we were in a hurry. Thinking it through and looking at these replies, I'm still not sure.


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## UnkiEMT (Mar 22, 2014)

mycrofft said:


> Had an elderly couple (About my age now) in a car accident, high speed broadside. HUsband had foot trapped by firewall wrinkling up around the foot (extricated by cutting the floor mat out and just lifting) and a broken humerus, closed left parietal head impact. Asked how wife on bench seat next to him was doing (we had removed her already).
> 
> Told him she was stable. Was dead without a mark on her (C1-C2 fractures).
> 
> I still remember that and wonder if I did the right thing. I think so in that case, we were in a hurry. Thinking it through and looking at these replies, I'm still not sure.



I used to work as an ER tech in the only trauma center in the state, the line that EMS used to use a lot (and we'd continue using once they got to us) when one pt lived and another died was "I don't know, they went to another hospital".

I never quite figured out how I felt about that, at once I have the knee-jerk reaction of "never lie to a pt", but then their mortality isn't going to be improved by being upset about their loved one. I do think it's better than "They're fine", though.


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## Handsome Robb (Mar 22, 2014)

I've used "I'm not sure what is going on but my coworkers from the other unit are with them doing everything they can" before.

Only once so can't really say if it's consistent or not lol


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## mycrofft (Mar 24, 2014)

Someone once said (I think it was Lenny Bruce) that you might have a mistress or an affair, but never tell your wife, absolutely no matter what, there being no upside for anyone. Lie like a sonofagun. :unsure:

I'm willing to lie my arse off if it will profit the pt's condition. Isn't that very noble of me? :glare:

Little pompous too.  But if it will help you, I'll do it and face the music later.


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