Paramedic Communication, Influence And Decision-Making: A Guide For EMS Professionals by Anthony Haley - Read Online
Paramedic Communication, Influence And Decision-Making
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Paramedics take highly complex and often rapid decisions under the most challenging of circumstances. Often the outcome for the patient and the required co-operation from all EMS responders in developing a short-term patient care plan will hang on the first decisions and initial communications. This book explores the complex and unpredictable world of pre-hospital care decision-making and invites the reader engage in the dilemmas presented. These often involve life-threatening situations. The author writes in an interesting way to probe and challenge the reader’s thoughts and decision-making. He has a very wide and varied experience base, gained from more than 22 years of emergency care work. The situations described are based on real-life experiences and reflect the author’s clear ability to analyse, reflect and learn from both the successful and not-so-successful communications and actions. All established, new and aspiring ambulance paramedics and EMT's should read this book.

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ISBN: 9781311730688
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Paramedic Communication, Influence and Decision-Making:

A Guide For EMS Professionals

Anthony Haley, BSc, PgCert, Paramedic


Title & Cover


Use of this book

Reader Comments



Chapter 1 – Then versus now

Chapter 2 – Communication breakdown

Chapter 3 – Factors that influence decision-making

Chapter 4 – Complex and challenging situations

Chapter 5 – Listening skills and how to apply them

Chapter 6 – Communication, influence & decision-making in immediate life-threat


About the Author


Copyright Information

Paramedic communication, influence and decision-making:

A guide for EMS professionals

Anthony Haley

Copyright © 2014 Anthony Haley

Published by Smashwords

The content of this publication is copyrighted material. All rights are reserved. The views and opinions expressed in this publication are entirely the views and opinions of the author. The rights of Anthony Haley to be recognised as the author of this work should be recognised and asserted to him under the appropriate laws and acts under which country the reader has undertaken electronic access to the material (download).

Use of this book

This book is intended for personal communication advice only. The author provides no warranty that the techniques described should be used to substitute processes and procedures required of individuals employed, or otherwise engaged in pre-hospital care. No assertion is made about the medical efficacy of the techniques described. Readers should ensure that any medical procedure carried out must fall within their scope of practice. For medical advice, please speak to your doctor.

The techniques described in this book have not been endorsed as recommended practice by any NHS Ambulance Service. All reasonable steps have been taken to ensure no individual is identified. All names (except the author) have been changed as have some other details regarding the incidents described. The work has been reviewed by the Clinical Director of the NHS authority in which the incidents took place and no concerns regarding patient confidentiality were identified.

Reader Comments

Although the author has primarily written this book with students as his intended target audience, I strongly believe that all frontline ambulance personnel would benefit from reading it, as the scenarios provide invaluable material on communication, risk assessments and clinical thought processes while attending to a service user. Consequently, while reading this book, you can’t help but question your own current approach on the said subjects and also analyse how you might adapt your practice in the future, thus allowing a significantly improved pre-hospital healthcare experience for your patients and their relatives. This book is an absolute must read for potential and serving pre-hospital health care professionals.

Andy Thompson – Yorkshire Ambulance Service HCPC Registered Paramedic and author of: The Dark Side – Real Life Accounts of an NHS Paramedic – The Good, the Bad and the Downright Ugly

As someone who has been concerned over at least two decades to discover systematic answers to carefully crafted questions through painstaking research study, it is timely to be faced again with the wider array of knowledge, insight and empathy that are needed for effective practice. For all that research studies can provide evidence that can inform ‘best practice’, a much wider appreciation of knowledge and reflection is needed. The findings from research are just one ingredient that helps us to understand complex human environments, and the impacts of actions within these. This book points to many other essential ingredients. The Author has produced a readable and engaging set of scenarios that provoke reflection on crucial questions, such as: what do I need to know? How can I come to know it? How does what (I think) I know get balanced with intuition and tacit knowledge to inform effective action? With a skilful mix of real-life scenarios, engagement with the literature on reflective practice, and careful discussion, he suggests that effective practice is as much a carefully crafted set of skills as it is a series of evidence-based decisions.

Professor Huw Davies - Professor of Health Care Policy & Management, University of St Andrews, and co-author of the book Using Evidence (Policy Press, 2007)


By Gerry Egan QAM, Dip IMC RCSEd

Paramedic Clinical Director of the Scottish Ambulance Service

It is well documented that Paramedics take highly complex and often rapid decisions under the most challenging of circumstances. Often the outcome for the patient and the required co-operation in developing a short-term patient care plan will hang on the first decisions and initial communications.

The author writes in an interesting way to probe and challenge the reader’s thoughts and decision-making. He has a very wide and varied experience base, gained from more than 20 years of ‘out of hospital’ work. The situations described are based on real-life experiences and reflect the author’s clear ability to analyse, reflect and learn from both the successful and not-so-successful communications and actions.

As I look forward to ‘putting my feet up’ following an ambulance career of some 35 years, I reflect on all the text books I must have read and it seems to me that this one is uniquely different. I believe it fills a gap between learning and practice; in that it expertly assimilates the learning one finds on Paramedic initial education programmes to the real-life situations paramedics find themselves in on a daily basis.

I think this is essential reading for new paramedics starting their career and thought provoking reading for the more mature paramedics amongst us.

It may well change the way you communicate for the better.


As I start writing this I am in my twenty-third year in the NHS ambulance service in the UK. I have been based in rural, semi-rural and urban locations. I have probably treated, advised or transported over 22,000 patients who, for one reason or other, have found themselves ill or injured and in need of my advice and help.

For a long time now, I have felt that I have a book in me. Up till now I have never been very sure what it was, but over the past few years I have come to a reasonably good conclusion as to what it wasn’t. I knew it wasn’t going to be an anecdotal or amusing look at the UK’s ambulance service. There are books in that style now appearing on book shop shelves. Some are very good and I admire those authors who can eloquently describe the details of amusing incidents or strange quirks of fate which led to an incident being worthy of recounting to interested readers. I don’t have a good enough memory for that type of stuff.

I also knew that it wasn’t going to be a book telling people how they should carry out their role as a Paramedic or EMT. I don’t find it productive to tell people what to do in that directive or instructional manner (despite six years in the military in a previous life!). Do it this way, do it that way, this is how you do it; it’s just not me. Don’t get me wrong; as a paramedic, there are times it is required and I do it easily. It’s just that I don’t think I would be good at writing in that particular style. What I am good at is examining, analysing, reflecting, coaching and enabling.

I have found that this approach is much more rewarding, and it seems to be very much more productive and empowering for patients and their families. It also seems to generate very few complaints. I have been involved in only two complaints in twenty two years, both from family members of patients who were refusing to go to hospital. Not a single patient, emergency worker or health care professional has complained about my treatment, my tone, my communication, my suggestions, decisions or actions. I have also, never been physically assaulted, despite working in a challenging environment for most of my career. I am not saying this approach is perfect. I have stepped out of the way of a swinging arm or closed fist a handful of times. I happened to have been in the right position far enough away from intoxicated, unruly people (another skill one develops through time!). I have come to assume from these statistics that this approach works well.

It is very rewarding to enable people to think from a different perspective and take much more into account, then firing that little spark in their analytical brain which leads them gently towards the right path. This is true of colleagues as well. Over the past twenty two years or so, I have often reflected on what made a job go well and what factors made it go not so well. I have found this continuous reflective cycle has led me to conclude that I should write about what factors have influenced decisions and communications in positive and negative ways. I thank all the patients and colleagues I have ever come into contact with for providing me with the learning experiences which have enabled me to write this book.


So what’s the point? How do you use this book? My aim in this book is to accelerate your decision-making, communication and influencing skills to an advanced level by sharing my experiences with you in such a way as to enable you to reflect and analyse the factors that had a significant influence on each situation. It has taken me twenty two years of hard work and hard knocks and much reflection and analysis to acquire the skills and knowledge needed to consider myself an ‘expert’ in this field. During the first half of my career there was very little in the way of pre-hospital literature. It is only in recent years that books and articles relating to the unique environment of pre-hospital care have become available.

At the start of my career I reflected and analysed in my own way. I was unaware of the many tools around to aid these processes. It was only later in my career that I started to read and study significantly. So it took some time to become a really proficient, analytical decision-maker. By analysing and reflecting on the situations presented in this book you will be providing yourself with opportunity to ‘fast-track’ your decision-making, communication and influencing skills to an advanced level.

Apply the techniques I describe in this book during your patient and colleague interactions and critique them by analysing how well they worked in the situations you find yourself in. If you reflect on their effectiveness on a regular basis, re-apply successful ones and mould the unsuccessful ones into ones which work, you will find you can become ‘expert’ in these skills in the first few years of your career as a Paramedic or EMT.

You will spend the rest of your career with very few complaints from patients, family-members and other health professionals. You will have increased job satisfaction, because you’ll go home after each shift in the knowledge that you have enabled your patients to make the best possible choices. You will quickly gain the respect of your colleagues, nurses, doctors, police officers, fire-fighters and other health professionals and you will have built yourself the best possible foundation for improving the lives of the patients you care for (you will also give yourself the best possible chance of getting to the end of your career relatively sane and physically intact!).

If you use a reflective model, Gibbs¹, Johns² or Kolb³ for example, then that’s fine. Gibbs and Kolb’s models seem to lend themselves to the way I have presented the information in this book. Although, any model you feel comfortable with will probably help you to apply the thinking and reflective processes I will discuss in each situation. The six chapters which follow contain twenty-seven scenarios which you should read through and think about. Consider each dilemma or situation and if the situation requires it; ask yourself what you would do. In some of the scenarios I have used people’s names. These are not the real names of any individual involved (apart from my own of course).

If your employer or registration body require you to have a record of Continuous Professional Development (CPD), and you are viewing this book electronically, then there is a link at the end of the book which links to a web page where you can print a CPD certificate.

If you do not require a CPD certificate, but would like to provide feedback anyway, then once you have finished the book, return to this page and click here.

Chapter 1 – Then versus now

It’s day one; the first shift of my career in the ambulance service. I am travelling ‘blue light’ (my phrase to describe travelling with all warning systems to an emergency call) to an elderly male who has fallen in the street and sustained a facial injury, and yes, I am describing the very first incident I ever attended in the ambulance service.

The powers that be have been kind enough to put me on a day shift for my first ever shift. However, they have also thought it prudent to partner me up with a colleague who joined the service the same day as me and who completed the same initial training course as me just a couple of days before. I am, of course, being ironic when I say prudent! It’s not all that scary though. They have been kind enough to have an experienced EMT (Emergency Medical Technician) on with us, making a three man crew. His is about four or five years in the job and a kind of a ‘gung-ho’ chap but likeable and easy to get along with.

We arrive on scene after a seven mile trip to find that our patient is a lollipop man (in the UK these are folk who assist kids across the road at school time – they have a round sign on top of a pole asking traffic to stop. This pole and sign arrangement resembles a lollipop). He is sitting on a chair which a kind member of the public got from a nearby house and he is holding a handkerchief to his obviously bloodied face.

Our experienced colleague leads the way with the patient examination