Family and bystanders

Identifying and managing social influences have increasingly become components of the EMS provider's repertoire in patient care. Patient- and family-centered care requires a familiarity with different cultural perceptions of health and wellness along with beliefs regarding sick behavior and healing. Social isolation, which has been associated with negative health consequences, may be mitigated by interaction with the family and their inclusion in decision making for the patient. Bystanders at emergency scenes, particularly medically trained bystanders, provide both a resource and a challenge for EMS providers. Bystanders should be managed appropriately so that the patient's confidentiality is not violated, patient care is not hindered, and the scene remains safe. The medical director plays a critical role in shaping street-level behavior in EMS providers related not only to clinical care, but to management of psychosocial issues, which ultimately promotes competent and compassionate delivery of medicine in the EMS setting.