Top 10 Things that Get EMS Providers in Trouble
In some professions a mistake might get you in some hot water—maybe you get yelled at, maybe you need to work overtime to correct it, maybe you even get fired if the mistake is bad enough. But in EMS, mistakes can literally be the difference between life and death. At the very least, a mistake might take a patient’s day from bad to worse. That’s not good patient care. But it is preventable.
During the recent 2014 Working Together Conference and Expo, sponsored by the Wisconsin EMS Association, in Milwaukee, Gordon Graham, a retired 33-year veteran of California law enforcement, who also has a lengthy background in risk management and as an attorney, spoke about why things go right—and why they go wrong—in EMS operations.
According to Graham, the vast majority of things EMS providers do, they do right. But, he noted, when EMS personnel do get in trouble it’s for just two things. “Some of your problems come from intentional misconduct, where bad people do bad things on purpose knowing what they did was bad when they did. And some of your problems come from negligence, where good people make honest mistakes.”
The first thing can be prevented by hiring better people. That starts with improving the screening process for new hires to eliminate bad apples before they have a chance to do any harm.
“EMS agencies are not ‘evil cauldrons’ that hire good people and turn them into bad people,” Graham said. But agencies in every public safety sector do occasionally hire bad people. By implementing improved background checks EMS agencies can reduce the likelihood of intentional problems up front, something each agency owes the people it serves. “Without the public trust we have nothing,” commented Graham.
Problems that arise from negligence occur every day, and some aren’t directly the fault of EMS providers. Another motorist might ignore traffic signals and collide with an ambulance in the middle of an intersection, for example. But most of our tragedies start with an internal error, and those can be corrected.
The majority of the tasks EMS providers do are high frequency, Graham said, meaning your past experience will show you how to do it right the first time. Mistakes can happen during high frequency events, but they’re rare. “However, if you put a good person in a low frequency event—particularly one that is high risk in nature—then I hear trains coming,” Graham said.
This can include workplace violence, chemical spills, many kinds of severe medical or trauma incidents, wildland and structure fires, earthquakes and other natural disasters, and other similar events. These events may happen infrequently, Graham said, but that’s all the more reason to train for them—every day.
“The good news is in an average career of 30 years, less than one shift is really spent on this type of task,” Graham said. “The bad news is that in an average career of 30 years, less than one shift is really spent on this type of task.”
Graham recalled when he first became a sergeant with the California Highway Patrol he would end every daily briefing with a training tip. At first, some of his colleagues thought he was crazy for bringing up training scenarios that might be obscure. Eventually though those tips started coming in handy when a rare event did occur, and Graham’s peers began offering the tips to their officers as well.
Because of the high level of risk involved in some of the low frequency tasks EMS providers might find themselves performing, it’s all the most important to emphasize training in those areas, Graham says.
Thankfully, most of the incidents EMS providers find themselves involved in are high frequency or give providers time to think. And if you have time to think, Graham noted, use it.
Gordon Graham’s Top 10 Things that Get EMS Providers in Trouble
- Vehicle and roadway operations. Take care of your stuff and drive it like you own it. That means always perform a pre-shift inspection checklist; use logbooks; use seatbelts every time you’re in the vehicle and it’s moving; avoid distractions like in-vehicle computers and cellphones; don’t stand between vehicles; and always be aware of your surroundings.
- Harassment, bias and discrimination. Recognize risks within your agency and build a good policy to address every protected class. Understand all three types of harassment—quid pro quo, retaliation and hostile environment—and make sure you have a good complaint process in place to handle incidents.
- Integrity issues. Only hire good people. That means conducting thorough background investigations before employees are hired, and performing ongoing background investigations after they’re hired.
- Report writing. Reports are best done during discretionary when providers can take the time to think through events. But take notes as incidents develop. And be careful with computers—don’t just copy and paste reports from prior similar incidents, unless you want your report to show you treated a 30-year-old male patient in respiratory distress who also happened to be pregnant.
- Health and fitness. Keeping yourself in shape can go a long way to avoiding workplace injuries. Agencies should strongly consider fitness training that specifically addresses EMS functional movements. And get enough sleep!
- Personal Protective Equipment. Use it, and keep it in good shape.
- Off-duty behavior. Your free time is your own, but always be aware that what you do does reflect on your agency. Anything you post on social media is there forever. Alcohol and sex are bad combinations, especially with co-workers. And if you do take action related to your job while you’re off-duty, always identify yourself and afterward fill out an overtime slip so there’s a record of what you did on the books.
- Decision making. Teach people how to think, not just do.
- Mental health issues. We know public safety workers have high incidences of suicide. Don’t ever downplay how someone may be feeling.
- End of career/end of life planning. Start preparing for retirement on day 1 of your career, because before you know it it’s all going to be over.
