Lt. Daniel K. Kehoe, (Ret.)
Although its name is officially the Patient Advocate Team Program, since its founding in 1996, it has become colloquially known to all as, “The PAT Team.”
History of the PAT Team
As a 15-year EMT with the SVAA, I was getting quite burned out (not an unusual occurrence for EMS responders, especially volunteers). Pondering a decision to quit, Chief Lynn Bergenholz suggested I might want to stay and work with the families of patients during serious calls. Hospitals had Patient Advocates who functioned as a go-between in the emergency room for the family and the doctors. Why not do the same for the family at the scene of a serious call?
This made some sense to me, as I actually knew a Patient Advocate from church. Marianne Moran was a retired nurse at St. Francis Hospital, excellent at helping anxious families get information of their loved ones before the doctors came out to give an update. The advocates would get families water or even something to eat as well, as they waited in the Family Room of the emergency department.
The PAT member: a Patient Advocate in the field
I took the chief’s suggestion to heart, and though I kept signing up for shifts and renewed my EMT certification, I now had a new focus—dealing with the mostly-ignored secondary patients; the families of the loved one in crisis.
Some explanatory documents were drawn up, a PowerPoint presentation was created, and the concept was explained to a few seasoned EMTs in the organization who might like to join me in this new effort. Several did right away: Don Miner, Dierdre Vorih, Lisa Shelanskas, and Jeanine Rose to name a few.
The PAT Team, by design, was self-dispatching to certain serious calls, including heart attack, untimely death, a child-involved call, or anything that would swamp the ability of the on-duty crew to handle the entire scene. Also, once the PAT Team became operational and the police and fire department knew they could count on us, we could be summoned over the radio with a request, “Dispatch, can you contact the PAT Team and have them respond out here?”
The idea was to arrive just behind the ambulance crew—not to interfere, but to immediately begin to separate, inform, and connect the upset family to whatever help they needed next. This often meant consoling the wife of the man having a heart attack, telling the bad news to the family of a deadly car crash victim, or helping children through an untimely death where grandma didn’t come down for breakfast. The crew was tied up working to rescue the patient, so the PAT Team focused on the family—the secondary patients.
A key concept of the PAT Team was to help the family through their “emotional golden hour”—analogous to how in trauma cases the patient has about an hour to have their declining medical condition stabilized, only after which do they start on the long road to recovery. Faced with a medical crisis, most close family members can hold things together emotionally for about an hour on adrenaline, after which they completely fall apart. During the family’s emotional crisis, the PAT Team thinks for them, guides them to the next step, helps them collect medicine, important documents, and medical history needed for the care of their loved one. At the end of this hour, the PAT Team connects the family to the Patient Advocate at the hospital, or their priest, or other counselor, and their role is complete.
PAT PAKs
It was helpful to hand a grieving family a small packet of items as they waited anxiously in the waiting room of the hospital. Blue PAT PAKs were filled with pens and paper to write with, a few snacks or candy bars, and perhaps a small encouraging book of sayings. Usually, a few quarters or dollars were added since payphones were still in use. A transparent kids’ version had crayons or markers, some books to color in, kid-friendly snacks, and a small stuffed animal.
These were useful, as family members tended to rush out of the house with barely anything—so with a PAT PAK at least they could write some important information down as the doctors gave their reports. The light sustenance helped pass the long hours waiting.
Included for your reference are some of the original founding documents and articles about the PAT Team, including an article written for JEMS Magazine that was never picked up but explains the PAT concept well.
The PAT Team lives on
Though I left active shift duty at the SVAA in 2009, I continued to manage the PAT Program and take PAT calls until I moved to North Carolina in 2016. I also spoke about PAT at EMS conferences and started a few PAT Teams in Connecticut and New England. Through the efforts of Don Miner and others, the PAT Team continues as an important service for serious calls, and provides care for those oft-forgotten secondary patients—the family of the victim.
Death notifications
It became apparent as time went on that the PAT Team member would often be called upon to do death notifications. I had always thought there was some legal requirement for the police to perform that function, but in actuality it just fell to them because no one else was doing it. The book, “Grave Words” [Kenneth V. Iserson, M.D., MBA] became a textbook for how PAT Team members would go about telling families the bad news.
While all PAT Team members were available to do all tasks (in theory), members did develop specialties in addition to death notifications, including working with children, sexual assault victims, the elderly, and offering spiritual support. The chaplain was always a de facto member of the PAT Team.
PAT documents
These historical documents are largely from 1996, at the founding of the program. The purpose of the program has largely not changed from its inception.
The PAT Program – Questions and Answers
The Next Big Thing in EMS – PowerPoint Presentation from EMS conventions
The PAT Article – article written for JEMS Magazine
The PAT Logo – shown on a kids’ PAT PAK
