5 Tips to De-Escalate Tense Situations
You are called out to a motocross course at the furthest reaches of your district at 4 p.m. on a sunny August day. Your patient is a 12-year-old boy who was thrown from his bike when another bike rear-ended him. He’s breathing and awake, but that’s where the good news ends. He doesn’t react to your presence or attempt to introduce yourself to him. He seems listless and lethargic. You check his left pupil, which is round and reactive. You’re moving over to the right, which is the same size, when he vomits spectacularly onto your lap. You’ve already decided to load-and-go and are trying to decide between the Level III trauma center that’s 12 minutes away or the Level I that’s 28.
"Can he go back in next round?” You look up to see a man with eyes precisely the same shade of brown as your patient.
“What?”
“Today is important. He’s got to compete in the next round.” The man looks down at his watch. “Starts in six minutes.”
You and your partner look at each other with wide eyes. Your partner tries to explain, “Sir, these symptoms are very serious … ”
The man raises his voice. “You fools always say that. You always say that! He’s fine. I’m his father. I’d know if he wasn’t.”
You can choose from several paths forward here. One option involves telling the man that he’s a terrible father who doesn’t care that his son could be dead in an hour and then trying to get the police involved. But that’s certainly not going to calm anything down and it could be 45 minutes before backup arrives—precious time with this severe of a head injury.
Tips for De-Escalation
De-escalating tense situations ultimately comes down to keeping yourself calm, but there are things you can do and say to help calm agitated family members and bystanders, while keeping patient care first and foremost.
1. Remember you’re the professional. No one likes to be summoned to a specific location to be screamed at by the very person that asked them to come. Finding that experience irritating is normal. However, in EMS we maintain our calm. It’s perhaps the most important thing we’re asked to do. Remember that you’re a well-trained professional who won’t match this individual’s energy. Furthermore, keep in mind that while this is a totally average workday for you, other people who don’t work in healthcare find these experiences upsetting. If, for whatever reason, you can’t maintain a calm and professional demeanor, excuse yourself from the situation.
2. Assume the absolute best of the agitated individual. Choose to interpret their actions—at least for the sake of this patient encounter—in the most flattering light possible. Consider that the person is behaving only out of the deepest love and concern for your patient, and that their actions and words may not be their norm.
3. Maintain your volume instead of matching theirs. Don’t start yelling just because the bystander did. That loss of control will reduce your authority. You want calm bodies, minds, and voices in this conversation.
4. Say the magic phrase. And say it like you mean it. “Thank you for advocating for my patient today." You can continue from there in the same vein, in whatever way is most authentic to your actual voice.
In the scenario above, that might look like, “I can see that you’re a really caring father. And let me tell you, I see people all the time who don’t have anyone. It’s a breath of fresh air to see someone who is loved so much.”
It’s possible, but difficult, for someone that you’re sincerely thanking to continue to scream at you. If you sound sarcastic or forced, saying this will make everything worse. People can detect condescension and falsehood. You need to mean this.
Think of the patients you see all the time who are entirely adrift in the world with no one to look after them. Recall situations where you felt out of control, where your love for someone precious totally overrode common sense. Remind yourself that this person truly is behaving poorly out of genuine love and concern, that anger is generally the tip of an iceberg of worries churning beneath the surface.
5. React appropriately to threats or danger. If you get a sense that someone is dangerous, take that seriously. If they’re making threats, such as repeatedly screaming that they’re going to kill you, don’t try to talk them out of that. The scene is not safe; remove yourself. The magic phrase is for calming a basically reasonable, but currently distraught, person. Use common sense to keep yourself safe from anyone who will actually hurt you.
Scenario Conclusion
You close your eyes for a few seconds and remember this is a scared father who cared enough to spend this beautiful Saturday on his son’s expensive and dangerous hobby.
“Thank you for advocating for my patient today.”
He stops and stares at you, appearing confused that you’re not yelling back. You continue, careful to speak as though this child receiving the emergency care he clearly needs is a foregone conclusion. “Your son is going to be really upset he had to miss this next round, isn’t he?”
The man, stuttering, agrees. His son loves motocross the way other boys his age love video games.
“It’s really nice, how much you’re willing to do to make sure he gets to ride.” You gesture at the increasingly sleepy boy behind you. “I’m gonna guess your son is usually active, curious, lively?”
“Yeah. He usually can’t sit still for two minutes.”
“So, this isn’t like him at all? How he’s acting now? I mean, you’re the expert on what’s normal for him.”
“No,” The man finally says. “No, he’s being downright strange.”
“What part of town are you all from?”
He provides their general neighborhood. You remark that that’s pretty close to the Level I trauma center, which has all the best specialists to give his son the best care. Does he think that sounds like a good destination?
The man who was, three minutes ago, loudly declaring that he would send his son out on the course to ride before letting him into the ambulance, agrees that whatever is best for his son is the right choice today.
Your partner accuses you of performing occult rites, and you take it as a compliment.
