By Laura Hirello & Tyne Lunn
Consider a simulated case where your unit responds to a 70-year-old male in a witnessed cardiac arrest. When you arrive to the home, firefighters have already initiated CPR. You manage the arrest like you have previously: continue CPR, place defibrillation pads, rhythm check, obtain pertinent medical history, manage the airway, oxygenate, establish intravenous access, and administer cardiac medications while searching for reversible and treatable underlying causes. After 20 minutes of effort with no clinical improvement, you consult a physician and mutually agree to terminate resuscitation on scene. Your clinical care is seemingly done, thus ending the simulation. Does this abrupt ending translate accurately to practitioners’ professional experiences with similar events? Or are we missing opportunities to inform on emotionally intelligence approaches supporting the psychosocial aspects of clinical care?
Paramedic practice and education focuses on critical decision making and intervention skills
Psychosocial factors and emotional intelligence are rarely acknowledged as important to the practice of paramedicine
Modern paramedicine results in pracitioners being regularly immersed in complex psychosocial cirsumstances
Medical interventions are only one part of the practice of paramedicine
Skills necessary for negotiating complex social situations are often learned through experiences on the job
Foundational focus on emotional intellignce (EI)
Paramedic education and leadership emphasis on EI to support a balanced core of psychosocial and medical intervention skills
Psychosocial factors acknowledged and included in objective observations used for critical decision making
the practice of paramedicine
Paramedicine Is Healthcare
Paramedicine is healthcare. Having matured beyond the limiting title of Emergency Medical Services (EMS), paramedic services no longer sit on the periphery of the health system, called upon only as a transport modality. The historical ‘you call, we haul’ model of emergency medical response has necessarily evolved into a public service that provides a wide variety of healthcare in vast clinical practice settings and specialities. These may include but are not limited to emergency response, palliative and end of life care, community paramedicine, tactical response, special incident response, critical care, pediatric care, and inter-facility transport.
Aligning with this shift, the daily work of paramedics has evolved. Traditional ‘rescue’ work like managing patients involved in challenging extrications and establishing incident command at mass casualty incidents is mixed with the quieter care work of calming patients’ anxieties, earning the trust of someone in the midst of a psychological crisis and comforting the family of a cardiac arrest patient.
As the profession continually grows and expands, front-line paramedics, educators and leaders are responsible for maintaining a balanced set of skills and engaging in continuing education that reflects the reality of paramedic work and strengthens its practice. Some conversations surrounding required skills may be considering psychosocial aspects of clinical care for the first time, while others realize that these caring qualities originally led people into public service. Though often contrasted against each other, the skills required to stabilize a critically ill patient at a collision scene are foundationally similar to those needed to support a patient experiencing grief – they both require emotional intelligence. At the core, in addition to cognitive intelligence, paramedic work requires practitioners to effectively demonstrate skilled communication, empathy, integrity, trust, respect, authenticity, compassion, and collaboration. Often mislabelled as soft skills, the psychosocial aspects of clinical healthcare are core skills that build the foundation for excellence in paramedic practice.
Paramedics strive to have the competence and capability to handle any challenge they encounter in their practice settings. They achieve this success under dynamic and unpredictable circumstances. Few would argue that cognitive intelligence is required to meet professional performance expectations. When evaluating paramedics’ cognitive intelligence, analytical, logical, and rational abilities, as well as knowledge are highlighted (1). This is additional to appropriate value being placed on critical thinking skills, the ability to organize and execute complex technical interventions, and possessing the control to remain calm under pressure.
If we take a closer look at the skills exemplified by high-performing paramedics, we may find that cognitive intelligence may be taking more credit than its due. There is no question that the scenes paramedics encounter on a regular basis are fraught with emotion. Humans are complex thinking and feeling beings. Therefore, though practitioners carry their emotions to scenes they must manage these to prioritize the needs of their patients. The emotional aspects of clinical care are not new; however, perhaps they have stayed in the background. Let’s explore how emotional intelligence partnered with cognitive intelligence underlies high performance and success in paramedicine.
Emotional intelligence (EI) can be defined as, “a set of emotional and social skills that influence the way we perceive and express ourselves, develop and maintain social relationships, cope with challenges, and use emotional information in an effective and meaningful way” (2). Multi-Health Systems Inc. created a circular Model of Emotional Intelligence with five main intersecting realms: self-perception, self-expression, interpersonal, decision-making, and stress management (1). All domains are encapsulated in the outer circle of emotional and social functioning and well-being (1).
The self-perception domain involves the ability to understand and manage your emotional self-awareness, self-regard, and self-actualization (1). Self-expression concerns the way you engage with your environment and those around you including emotional expression, assertiveness, and independence (1). While the interpersonal domain includes your ability to cooperate and get along with others, comprised of interpersonal relationships, empathy, and social responsibility (1). The EI domain of decision-making involves the ability to utilize emotions in a manner that results in productive choices, problem solving, reality testing, and impulse control (1). The circular model rounds out with the final domain of stress-management, one’s ability to be flexible, tolerate stress, and maintain optimism (1).
When practitioners cultivate a balance of cognitive and emotional intelligence, the benefits to patient care are enormous. Consider the following examples: a paramedic who can self-actualize is willing to continually improve (1). Self-expression enables paramedics to hone the assertive skills required to lead teams towards collaborative patient care goals (1). Empathy is key to authentic and sustainable interpersonal relationships that foster trust with patients, peers, and interdisciplinary teams (1). Paramedics who are respected for their quick, concise decision-making abilities possess the capability to control impulses and analyze reality in a pragmatic and rational capacity (1). Finally, professionals who harness emotional intelligence skills for stress management are able to sustain performance and personal well-being, even through their personal and work day stressors (1).
The value of EI is not limited to the daily work of operational paramedics. Not only are these skills essential for patient care, they are protective against compassion fatigue and burnout (3). If better understood and broadly taught early within paramedicine, EI can contribute to practitioner resilience and mental wellness. Increased focus on EI may result in win-win outcomes of enhancing patient care while providing greater supports to the care givers. Strengthened EI domains would cultivate dynamic and collaborative leaders, organizational systems, policies, and teams that foster cultures of equity, diversity and inclusion. We easily forget the pressures of starting in the profession, learning new skills and figuring out how to balance unique work demands with the rest of our lives. Greater aptitude in EI skills can help educators and preceptors better prepare and support students and new hires. Heightened EI is often what differentiates formal authority from authentic leaders, with EI seen as integral to many effective leadership styles (3–5). While some practitioners enter the paramedic profession with greater inherent emotional intelligence, others must learn it through observation and experience. Currently the bulk of psychosocial skills used in paramedic practice are learned on the job, with wide variations based on experiences modeled by mentors and peers. These skills are harder to measure and quantify in a clinical simulation. They are challenging to consistently demonstrate in training and may be arguably more difficult to teach compared to the steps required to endotracheally intubate, but no less essential. The appropriate balance of cognitive and EI skills will be individual to each paramedic; the key is to seek balance.
Two Halves of a Whole
As we continue to explore and better understand EI, it becomes more apparent that the priorities are not mutually exclusive. Being emotionally intelligent enhances practitioner’s performance in both decision-making and execution of interventions. Both aspects of practice, cognitive and emotional, combine to enable holistic patient care and practitioner performance. Psychosocial skills are not a replacement for cognitive aptitude, instead a complementary set of tools for our patient care toolboxes. Like two halves, cognition and emotion are designed to work cohesively together.
The emotional work and psychosocial aspects of paramedic practice are not soft skills nor optional. Emotional intelligence founds the complex set of core clinical skills, essential to all healthcare professionals. Paramedicine will be bolstered by acknowledging EI’s role in success, shifting language, prioritizing EI in entry to practice education and ongoing professional development, and focusing patient care approaches to utilize EI domains. When we acknowledge that paramedic practice grows best from an emotionally intelligent foundation, we will better serve our patients and our colleagues.
- Stein SJ, Book HE. The EQ edge : emotional intelligence and your success. 3rd ed. Jossey-Bass; 2011. 354 p.
- Multi-Health Systems Inc. Emotional Quotient Inventory 2.0 (EQ-1 2.0). Toronto, CA; 2011.
- Kerr R, Garvin J, Heaton N, Boyle E. Emotional intelligence and leadership effectiveness. Leadersh Organ Dev J. 2006;27(4):265–79.
- Rutledge T, Sinclair D. Your profession needs you (lessons in medical leadership). CJEM [Internet]. 2013 [cited 2019 Sep 13];15(2). Available from: https://doi.org/10.2310/8000.2013.130977
- Yukl G, Mahsud R. Why flexible and adaptive leadership is essential. Consult Psychol J. 2010;62(2):81–93.