Uncomfortable yet necessary: The impact of PPE on communication in emergency medicine

Abstract

Background The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team, but also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of PPE. Methods We sought to analyze the impacts of the Covid-19 pandemic on Emergency Medical Service (EMS) workers and pre-hospital care delivery. We conducted focus groups and one-on-one interviews with fire-EMS first responders between Sept 2021 and 2022. Interviews included questions about job related stress, EMS skills, work experiences and changes during Covid-19. Interviews were recorded, independently dual coded, and analyzed for themes. Results 223 first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of personal protective-equipment (PPE) was reported to have significantly impaired efficiency and perceptions of quality of care—among EMS team members and also between EMS workers and patients. EMS personnel also experienced on scene hostility on arrival (from both families and other agencies). Use of extensive PPE muffles voices, obscures facial expressions, and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone’s shoulder, wearing name tags on suits, and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. Conclusion Human connection is an important element of health care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, ‘communication-friendly’ adaptations of PPE equipment may be an important area for future research and development in manufacturing and the healthcare industry.

Understanding the Challenges of Intensive Care Staff in Communicating With Patients and Patients’ Families During the COVID-19 Crisis: A Qualitative Exploration

“…This lack of identity of one’s treating doctor or nurse may have increased fear and anxiety among patients in an already stressful environment. The use of name tags/designation tags has been described in several hospitals and our participants also used this method, particularly in the second wave [ 13 ]. The use of hand signals and gestures has been extensively tried to simplify communication with PPE [ 14 ].…”

Perceptions of Use of Names, Recognition of Roles, and Teamwork After Labeling Surgical Caps

“…Yet, names and roles are difficult to remember and there is often a lack of familiarity of OR teammates’ names and roles between different specialties (eg, surgeons and anesthesiologists), especially in large centers where teammates rotate . The COVID-19 pandemic expanded the use of masks and goggles outside the OR, making it challenging to recognize teammates . Increased reliance on temporary workers to address staffing shortages introduced a large and persistent number of unfamiliar teammates .…”

“…10 The COVID-19 pandemic expanded the use of masks and goggles outside the OR, making it challenging to recognize teammates. 11 Increased reliance on temporary workers to address staffing shortages introduced a large and persistent number of unfamiliar teammates. 12,13 Patients also frequently struggle to identify the names and roles of clinicians on their care team, with few able to name their physicians.…”