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Cultural Awareness and EMS

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Title: Cultural Awareness and EMS


1
Cultural Awareness and EMS
  • Glenn H. Luedtke, NREMT/P
  • Director, Sussex County Emergency Medical
    Services
  • Adjunct Assistant Professor
  • Emergency Health Program
  • The George Washington University School of
    Medicine and Health Sciences

2
Objectives
  • Increase awareness of changing demographics in
    our communities
  • Understand our own cultural identities
  • Understand health traditions that vary from
    Western methodologies
  • Respect religious laws honored by patients
  • Develop new skills to assist in communicating
    with patients from other cultures
  • Ensure all patients are treated with dignity and
    respect

3
Special Thanks
  • Linda Honeycutt
  • Executive Editor, Elsevier Publishers
  • Past President, NAEMSE
  • Beth Adams
  • Quality Manager, Fairfax County Fire and Rescue
    Department
  • Faculty, GWU Health Sciences Program

4
United States has always beena country of
immigration
give me your tired, your poor, your huddled
masses yearning to breathe free
5
Immigration Law Milestones
  • Naturalization Act of 1790
  • 1820 1st immigration records law
  • Chinese Exclusion Act of 1882
  • 1924 national origins quotas
  • 1960 hemisphere limits
  • Title VI/Civil Rights Act of 1964
  • 2001 National Standards for CLAS in Health Care

6
Cultural Competence
  • "Cultural and linguistic competence is a set of
    congruent behaviors, attitudes policies that
    come together in a system, agency, or among
    professionals that enable effective work in
    cross-cultural situations."
  • 2001 National Standards for Cultural and
    Linguistically Appropriate Services in Health
    Care Act

7
CLAS Standards 3 Themes
  • Culturally competent care
  • Language access services
  • Organizational support for competence

8

Organizational dimensions
external dimensions
External dimensions
Internal dimensions
  • Layers
  • of
  • Diversity

Personality
9
4 Layers of Diversity
  • Personality
  • Internal Dimensions
  • Age
  • Sex
  • Ethnicity
  • Physical Ability
  • External Dimensions
  • Life Experiences Choices
  • Organizational/Vocational Dimensions
  • EMS is a Culture

10
Diversity in the US
  • 106 ethnic groups
  • Minorities majority population in 6 of 8
    largest US metro areas
  • 20 of MDs in US are foreign trained
  • Largest Arab-American population outside Middle
    East Dearborn, MI
  • Largest minority population in US Detroit, MI
    (80)

11
Pop Quiz
  • What is the most popular condiment in the U.S.?
  • Ketchup
  • Mustard
  • Mayonnaise
  • Salsa
  • Answer D

12
Diversity in EMS
  • According to self reports to NREMT in 2001.
  • Ethnicity
  • 83 majority 14 minority 3 other
  • 23.37 respondents did not specify
  • Gender
  • 69 male 31 female
  • 0.03 respondents did not specify
  • 133, 526 (Hunter, 2002)

13
How have we adapted?
Assimilation
Amalgamation
Anglo-Saxon Racialism
Cultural pluralism
14
Adapting To New Cultures
  • Assimilation
  • Americanization
  • Conformity

15
Adapting to New Cultures
  • Amalgamation
  • Melting Pot
  • Blending best of old and new

16
Adapting To New Cultures
  • Anglo-Saxon Racialism
  • American WASP

17
Adapting To New Cultures
  • Cultural Pluralism
  • Strength in variety

18
Ways Cultures Differ
19
Cultural Awareness
  • Culture is not overt
  • We are all ethnocentric
  • We observe, interpret, then act based on our own
    cultural programming
  • We may not know when we are offending others
  • Awareness and knowledge increase our choices
  • Understanding ones own culture is a first step

20
AGE
21
The Culture of Age
  • The Greatest generation
  • The Baby Boomers
  • The Me generation
  • Generation X
  • Generation Next

22
The Greatest Generation
  • Lived through the Great Depression
  • Value stability, loyalty to employer
  • Stick with relationships no matter what
  • Dont take risks
  • Fear for their future
  • Health insurance
  • Continuance of promised pensions
  • Being put away in a nursing home
  • Wanted something better for their children

23
The Baby Boomers
  • Increased value for education
  • Witnessed greatest strides in technical
    achievement
  • Loyalty to employers
  • Trusted government in youth, later more
    suspicious
  • Vietnam war a major part of their experience

24
The Me Generation
  • Were young during Vietnam War, but remember it
  • Distrustful towards government
  • Personal agenda supercedes employer loyalty
  • Employers less loyal to employees?
  • Value home and family, but more likely to abandon
    a relationship that isnt working
  • Not as volunteer oriented as their predecessors

25
Generation X
  • Until recently, war has not been a part of their
    lives
  • The first technology oriented generation
  • Job is a means to an end, not an end itself
  • More loyal to relationships than Me generation

26
Generation NextTodays Teens Tomorrows
Providers!
  • 58 have visited or lived in a foreign country
  • 57 have a friend who is openly gay
  • 48 have known someone who is in a gang
  • 21 have a friend who was killed or injured by
    gun violence
  • 19 have been the victim of a crime or violence
  • Source Washington Post Magazine, Kaiser Family
    Foundation, Harvard University poll, 570
    respondents, published 10/23/05

27
Generation NextTodays Teens Tomorrows
Employees!
  • 57 think there will be another terrorist attack
    like 9/11
  • 54 think this country is headed in the wrong
    direction
  • 54 think our countrys best years lie ahead
  • Its a confusing time, rather than bad or good.
    Im stuck in the middle of so many things
    college things, the war, the economy, other
    things that are going on.

28
Generations and EMS
  • Greatest and Boomer now reliant on Me and
    X for emergency care
  • Boomers as administrators
  • Boomers and Me experienced the AIDS epidemic
  • Me and X as supervisors and experienced
    providers
  • X and Next as new generation of providers

29
SEX
30
Sex and EMS
  • Fire Service and Volunteer EMS were traditionally
    male-dominated
  • Although women often ran calls during daytime
    while men worked
  • Fire/ EMS tradition re homosexuality
    transgender generally mirrored societal view of
    the times
  • Often slower than society at large to change
    views
  • Changes over last 20 years have resulted in more
    women in leadership command positions

31
Gay and Transgender Issues
  • Alternative lifestyles more common
  • More gay people out of the closet
  • Legalization of same sex marriage
  • Increased efficacy of transgender surgery
  • Accepted by some
  • Resistance by others

32
ETHNICITY
33
Ethnicity CharacteristicsMainstream American
  • Individualism
  • Independence/freedom
  • Competition/achievement
  • Materialism
  • Technology dependant
  • Instant time/actions
  • Youth/beauty
  • Equal sex rights

34
Ethnicity CharacteristicsMainstream American
  • Leisure time highly valued
  • Reliant on scientific facts/numbers
  • Less respect for authority/elder
  • Generosity in crisis
  • Self esteem issues during illness or recuperation
  • Believe there is cause and cure for any ailment
  • Expect health care professionals to fix the
    problem

35
African-American
  • Not all African-Americans are black
  • Not all Blacks are African-American
  • Extended family networks
  • Religion valued
  • Interdependence
  • Daily survival
  • Technology valued
  • Folk foods
  • Folk healing modalities
  • Matriarchal family structure common

36
African-American
  • Music is central
  • Inquiry re personal info may be seen as offensive
  • 1 in 400 suffer from Sickle Cell Anemia
  • High Blood and Low Blood
  • Common diseases
  • Hypertension
  • Diabetes
  • High cholesterol
  • CAD

37
Mexican-American
  • Extended family values
  • Interdependence with kin
  • Patriarchal
  • Exact time less valued
  • High respect for authority, elders
  • Religion valued
  • Same-sex medical staff preferred
  • Native foods for well-being
  • Very ill/dying pt may wish to say last words to
    each family member

38
Asian-American
  • Tradition highly valued
  • Family/extended family extremely important
  • Patriarchal/elder obligations respect
  • Group compliance, not self-care
  • Holistic approach to medicine
  • Harmony and balance
  • Medical interventions may interfere with ones
    spirit
  • Religious spiritual values
  • Folk care practices
  • Non-aggressive, non-confrontational

39
Asian-American
  • Eye contact a sign of disrespect
  • Touching stranger considered rude, intrusive
  • Same-sex touch preferred
  • Area of body below waist almost never exposed
  • NEVER touch the head
  • Feet should not be pointed at another person
  • Soles of feet should not face another person
  • Smile nod not understanding, or not wishing
    to disagree with authority to their face

40
Asian-American
  • Snickering embarrassment confusion
  • Silence strong disagreement
  • Yes may mean I hear you, not I agree
  • Do NOT like to say no
  • Blood is the source of life (Chinese, Vietnamese)
  • May expect to receive medication
  • Name is private prefer to be addressed by
    profession
  • teacher
  • mother

41
Native American
  • Harmony between land, people, environment
  • Reciprocity with Mother Earth
  • Spiritual inspiration/guidance
  • Folk healers/medicine men
  • Do not heal aid in journey
  • Cultural rituals taboos (cleansing)
  • Authority of tribal elders
  • Pride in cultural heritage nations
  • Respect and value for children

42
Native American
  • No direct eye contact
  • Silence valued
  • Offended if rushed, interrupted, not listened to
  • May be viewed as non-compliant, stubborn by
    Westerners
  • Note-taking may be considered rude
  • High incidence of disease
  • Diabetes
  • Gallstones
  • Ischemic heart disease
  • Rheumatic conditions
  • Arthritis
  • Alcoholism

43
Arab-American
  • Christians Muslims
  • Male-dominated often demanding
  • Head of family given medical info, determines
    disposition
  • Male responsible for sexual purity of female
  • Sexual discussions not tolerated
  • Extended family
  • Passivity in presence of authority figure
  • Look down on female medical personnel
  • Illness is Gods will
  • Evil Eye
  • Food deprivation or bad news illness

44
Arab-American
  • Right hand only offered for dx/tx
  • Left hand used for cleaning, going to bathroom
  • Male-female eye contact sexual invitation
  • Time is servant not master
  • Mourning may be emotional
  • Shoes may be left _at_ door of home
  • Complimenting womans beauty offensive
  • Avoid admiring object in home
  • May feel obligated to make it a gift
  • Rejection of gift is a tremendous insult

45
Pacific Islanders
  • Extended family, interdependent
  • Spiritual bond between family and nature
  • Living family members may interact w/deceased
  • May be inappropriately viewed as bizarre
  • Herbal remedies may be used
  • Avoid conflict, social disruption
  • Heirarchical system
  • Females defer to males
  • Young defer to old
  • Medical decisions made by eldest male or church
    leader
  • Sitting while talking w/pt, family a sign of
    respect

46
RELIGION
47
Religion
  • Christian Science
  • Blood blood products not ordinarily used
  • No medical surgeries generally practiced
  • Church of Jesus Christ of Latter Day Saints
    (Mormon)
  • 24-hour fast required once a month
  • Sacred undergarment (do not touch, remove or cut
    without explaining need)

48
(No Transcript)
49
Religion
  • Hinduism
  • Shoes never worn indoors (_at_ home)
  • Shoes never pointed at elders
  • Jehovahs Witnesses
  • Blood blood products forbidden
  • Medications acceptable if not derived from blood
    products

50
Religion
  • Judaism
  • No pork or shellfish (includes pork-based
    insulin)
  • Sabbath Festival Days, Orthodox Jews may not
  • Work
  • Fill out paperwork
  • Turn electricity on or off
  • Answer a phone
  • Travel, except on foot (unless life or death
    emergency)
  • Opposite sex touching should be avoided with
    Orthodox Jews

51
Religion
  • Islam
  • Pork alcohol prohibited
  • Includes pork-based insulin
  • Alcohol wipes may be unacceptable
  • Opposite-sex touching should be avoided
  • Deceased persons body turned to face east
  • Allow only Muslims to touch body
  • Ramadan (9th month of lunar calendar)
  • Month of fasting from sunrise to sunset

52
Religion
  • No medical restrictions for EMS for
  • Bahai
  • Buddhist
  • Roman Catholic
  • Seventh Day Adventist
  • Unitarian/Universalist

53
Other Cultural Concerns
  • Homeopathic remedies
  • Dermabrasion
  • Acupuncture
  • Coining
  • Cupping
  • Herbal remedies
  • What was done before you arrived?

54
Coining
55
Cupping
56
Other Cultural Concerns
  • Cleanliness
  • More valued where water is plentiful
  • Body odor as sign of being alive
  • Layer of dirt layer of protection
  • Personal space
  • Mainstream American arms length
  • Middle Eastern, Latin American close enough to
    feel breath
  • Modesty
  • Opposite gender touching
  • Disrobing

57
Other Cultural Concerns
  • Gestures
  • OK sign obscene in S. America, Mediterranean
  • Smile
  • Korea stupidity
  • Middle East sexual come-on
  • Come here gesture w/index finger used in Asia
    ONLY to call animals
  • Thumbs Up sign FU sign in Middle East

58
Other Cultural Concerns
  • Pain
  • Stoic cultures (true feelings never revealed)
  • Emotional cultures (free expression of feelings)
  • Language
  • English very difficult to learn
  • Non-English Speaking feel they are assumed to be
    less intelligent, less competent
  • Children as interpreters
  • Confidentiality?
  • Role within the family
  • ATT Language Line

59
Other Cultural Concerns
  • Time
  • Agricultural groups have no need to keep time
  • No word for time in many Native American
    languages
  • Orientation may be difficult for peds, elders,
    homeless
  • Relationships
  • Family a necessary part of healing in many
    cultures
  • Show respect by addressing family (eldest first)
  • Death Dying
  • Family may be expected to make decisions for
    gravely ill patients
  • Some pts not told they have terminal illness

60

What Can We Do?
  • Awareness of our attitudes
  • Awareness of attitudes of others on the scene
  • Educational support for competence

61
Beth Adams Rules
  • Every person deserves to be treated with respect,
    and as an individual.
  • In truly life-threatening situations, most
    rules are ignored, but asking first will offend
    no one.

62
LEARN to Communicate
  • Listen
  • empathy understanding to the patients problem
  • Explain
  • your perception of the problem
  • Acknowledge
  • and discuss differences and similarities
  • Recommend
  • course of action/treatment
  • Negotiate
  • agreement (go to ED or stay home)

63
Communication Tips
  • Start with a formal tone
  • Introduce yourself by full name title
  • Address other person by name title
  • Mr., Mrs., Ms., Dr., etc.
  • Avoid yes-no questions- give choices
  • Watch body language (yours theirs)
  • Smile, laughter may indicate confusion,
    embarrassment

64
Communication Tips
  • Avoid use of idioms
  • Cold feet may be perceived as circulation
    problem
  • Fanny means Vagina to Australians South
    Africans
  • Rubber is an eraser in most places
  • Plusses and Minuses of using children as
    interpreters

65
Conclusion
  • You cannot be expected to remember all of the
    unique elements of every culture
  • In life threatening situations, many rules are
    exempt
  • Asking before assuming will offend no one
  • Above all, treat everyone with respect

66
gluedtke_at_sussexcountyde.gov
Thank You!
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