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Home > Columnists > Arthur Hsieh
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EMS News in Focus
by Arthur Hsieh

Underage EMT vs. professionalism

The time to change policies and procedures is when analysis shows a need, not in the heat of the moment

By Arthur Hsieh

This little story about a young EMS provider taking matters into his own hands and driving a squad unit to a medical call in violation of department regulations has taken on a life of its own in social media circles. There have been hundreds of posts and rants about the situation, with the vast majority supporting the EMS provider’s actions to transport the 4-year-old to the hospital after she began having seizures, and no other ambulance crews were available. Stephen Sawyer, 20, did not meet the 21-year-old age requirement to drive the vehicle. 

I have to respectfully disagree with the masses. What he did was reckless, and places the entire organization at risk.

An EMS organization provides its service in a high-risk environment. Like any other business, it tries to mitigate its risk through prudent business practices, including carrying insurance that provides protection for its members and itself in case of a major issue, such as a crash, negligence or other violation of professional performance. The agency depends on its members to follow established guidelines, policies and procedures to accomplish its mission. Not doing so not only exposes the department to unnecessary higher risk; it also shows a lack of discipline in professional performance.

To a certain extent, the details of the actual incident are relatively unimportant. Professional behavior is applied consistently, regardless of the situation. The underlying issue is that there was not an adequately staffed unit to respond to a call, which included having appropriately trained personnel of a minimum age operating the unit. If the problem is that the regulation truly constrains the volunteer organization from performing its mission routinely, it would make sense for the board to review its policy and determine whether there can be changes made that makes deployment more flexible in the face of minimum staffing, while protecting the agency.

To arbitrarily make a brash decision in the heat of the moment is not the way to change business practice. It’s less about doing the so-called right thing, and more about putting others at risk. It’s not professional behavior. Regardless of being a volunteer or career provider, the ability to work within policies and procedures, and making changes when appropriate, allows us to do the right thing every day.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at Art.Hsieh@ems1.com.
Comments
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Michael T. Long Michael T. Long Thursday, January 02, 2014 4:48:29 PM Art, I think that what most of us have an issue with is the unnecessarily restrictive age policy. If you're old enough to hold licensure in EMS, you're old enough to drive the rig, provided that you've passed your company's driving class. Otherwise, they shouldn't be hiring people who don't meet their arbitrary age requirement.
Ken Henke Ken Henke Thursday, January 02, 2014 4:48:32 PM I'm glad you said it. I was trying to say the same thing, but couldn't come up with the right words. You were able to do so. For whatever reason, the service had that rule and he should have followed it.
Jeff Hamlin Jeff Hamlin Thursday, January 02, 2014 4:52:13 PM well good for you and to the author this articlefor being such sticklers to the rules.do you want a cookie?
Ben Darling Ben Darling Thursday, January 02, 2014 5:06:27 PM This is why you are allowed to respectfully disagree. Some people will respectfully retort, some will not. I respectfully disagree with that agencies out of date, out of touch policies. This young man is eligible to drive emergency vehicles in other capacities. This volunteer squad had a policy set based on their own standards, not based on insurance or legal requirements (as reported by various media agencies). If someone is able to prove competencies, and they are over the age of 18 (because that is a magical legal age) then let them drive. This young provider is eager to learn and should be nurtured, not deterred and pushed away like so many seasoned providers do to new providers. Your response isn't focusing on the particular problem of the provider leading. You redirected the issue to adequate staffing of the service itself. I cannot agree with you more. So many services struggle with this every day and every hour to ensure adequate staffing. But please, give this provider and the one before and after their 15 minutes on their soap box. Listen to their story. Fresh perspective can shed light on how a system is broken. Listen. Take advice. Does everything or anything have to change? No. But if you aren't willing to change, your service will suffer.
Dana Weygand Dana Weygand Thursday, January 02, 2014 5:40:28 PM I tend to agree with both sides of this My volunteer squad has a 21 age restriction for driving as well but not because we are old fashioned its because our insurance company had done a risk assessment and had said that anyone under the age of twenty one shouldn't be driving. Thats not to say that they wouldn't cover us but it was there recommendation. That being said we have broke the rules a few times and have had under 21 drivers and it has worked out well!! We do driver training for all our members so when this monster presents itself we have our bases covered.. I also would agree that the decisions that that emt made that day were on the sort of wrong side as you take the calls as they come in and there wouldn't be this mess.
Rob Schellinger Rob Schellinger Thursday, January 02, 2014 5:42:32 PM Had a circular debate with someone on FB about this. I kept pointing out that he endangered the patient, himself and the public of his community. The other person kept saying "but the patient's life was saved". Based on what's been reported, we don't know that the child's life was in danger due to the seizures. If it was, he endangered that child's life by delaying the response sending the ambulance on a second call. I have the feeling that he's a "woo-woo" glory hound and probably made his decisions accordingly. What's more, he was astounded that he didn't get the glory he craves by the board and took his story to the public that generally doesn't understand why you don't do this. Regardless if it was on purpose or not, I believe he deserved suspension at the very least as well as a boot to the hind-quarters.
Amy Marie Devine Amy Marie Devine Thursday, January 02, 2014 6:11:57 PM It's so funny how many different portrayals of this story I have read. I agree with the 21 restriction because regardless they are inexperienced drivers. Especially in emergency situations. Although I have to agree that exceptions can be made with proper training
William Jason Hudson William Jason Hudson Thursday, January 02, 2014 6:25:10 PM I haven't read every story about this so I am asking a couple questions. 1 Did he have a partner? If he did Why didn't the partner drive? If no partner than a transport ambulance should not have rolled in the first place. You can't depend on fire department personnel to ride in on the unit unless you have that agreement in which case he still should not have responded the unit being underage to operate it. I'm sure they have air medical and if the weather was too bad for air than being a 4 yr old child I am sure a law enforcement officer would have been willing to transport in their vehicle or even fire department transport in department vehicle if necessary. There are just too many variables in this situation. However variables aside I as a PROFESSIONAL would never stand by because of a "rule" if it meant the difference between life and death. Also note that the ratio is very low due to deaths from seizures.
David Harbour David Harbour Thursday, January 02, 2014 7:20:21 PM I have to agree that he should not drive, he should never have been faced with that choice. I disagree that this was a brash decision. Art's wording makes it sound like this was a protest action. If I understand the story, this was about getting a little girl to the hospital while she was still breathing. If we are going to put a youngster in a situation to make an adult decision, then we need to give him a reasonable way to overcome the problems. To say "well, you are responsible for the lives of people in our service area, but you may not be able to help them" is just not an option. I'm afraid the bulk of us would say "screw the rules" in the face of watching anyone die. Doesn't mean we should, but I've never found a textbook in EMS that contained every answer to every patient situation I've encountered. No rule is ever perfect.
Tim Stieve Tim Stieve Thursday, January 02, 2014 7:54:13 PM Like most here, I cant judge the situation without knowing the facts. That being said, given a choice between loosing a 4 year old or breaking a rule, you would have to suspend me. As for being at risk, certainly the agency was at risk had it failed to respond
William Chapman William Chapman Thursday, January 02, 2014 8:42:11 PM Amy Marie Devine Its a case of Ageism. If someone has the necessary training and can pass whatever tests are deemed appropriate, then they should be allowed to do the job regardless of age, young or old.
Eric Doc Liddy Sr. Eric Doc Liddy Sr. Thursday, January 02, 2014 9:17:21 PM I have to agree with the dispute on the "underage" thing. If you are old enough to hold the license, you are old enough to operate the rig, pending a driver's safety course, of course. We only know bits and pieces of this from both sides, and until we know the outcome of this through legal counsel, I think all of us should reserve the armchair quarterbacking of the "underage vs. professionalism, because none of us were there.
Thursday, January 02, 2014 9:46:40 PM Folks- This is a big liability issue! Our service will not hire anyone younger than 21, so we do not have that issue. While I am not opposed to minors holding EMT licenses, I wouldn't want one driving me to the hospital. I'm assuming that the reason we do not hire minors is because our insurance rates would be much higher if we did.
Scott Sommer Scott Sommer Friday, January 03, 2014 8:04:25 AM Art, I agree with you 100%, my first squad with the volunteers and the same rule and god forbid you broke it. We also had a very restrictive driving training program so it was never broken in the 15 years I was there.
Jim Medlock Jim Medlock Friday, January 03, 2014 9:32:13 AM Mr Hsieh's comments and description of the EMT's actions as "reckless", a serious legal term, has committed the most heinous disregard to human life and human desire to help others. The EMT obviously knew the situation and knew that a child having seizures needs advanced immediate attention. Mr Hsieh you have shown your abject disdain for Human Life and your blind allegiance to administrative hierarchy and tyranny in addition to your almighty fear of "liability". Mr. Hsieh, I have followed your comments for years and I firmly believe that you now have reached a point that you are no longer interested in the support of human life, but rather you are focused on an allegiance to administrative dictatorial mindless regulations. Mr. Hsieh, since you did not castigate the administrative order which caused the situation, but rather you desired to wreck that young EMT's entire life with serious allegations and possible legal punishment, I call for you to do the honorable move on your part and submit your retirement from the "Human Support" community.
Wayne Collins Wayne Collins Friday, January 03, 2014 9:51:41 AM Sounds like at this point in your career all you so is teach, which means you have forgotten how it is to be out in the streets taking care of patients. 1) You talk about brash decisions in the heat of the moment, and protecting the company. What about the little 4 yo having a seizure where is the child on your priority list. From listening to you rant your BS sounds like she must not even be on the list. I am not saying what he did by breaking the rules was totally correct, but when it comes to saving a life all bets are off in my book. I am a Paramedic and have been doing this for 30 years, and saving a life is much more important than breaking some stupid rule. He didn't damage the unit and saved a life sounds like something to get suspended for to me. If suspension was in order it should be the folks that suspended him getting reprimanded, for the like of having the management ability for proper staffing of an emergency service. So ART maybe you need to get your lazy butt out of the classroom and back into the streets and then maybe you will see what real life as a paramedic really is, besides with a demeanor like the one you used in this article I sure wouldn't want you teaching anyone I had to work in the field with.
Peter Burke Peter Burke Friday, January 03, 2014 11:19:06 AM I believe he was wrong for violating policy, but worse for lawyering up and spreading this on FB. I have 30 years in EMS & Law Enforcement. Keep thr dirty laundry in house. He should be glad he wasn't charged with Unauthorized use of a Motor Vehicle. Have a bent some rules, yes. But something that is an absolute is a little tough to square. Hopefully he learns & grows from this, the Squad takes a look at the policy.
Pamela Nation Pamela Nation Friday, January 03, 2014 12:27:49 PM On one hand, we are not told the details of the 4 yr olds condition. I agree that rules are set to reduce liability but what was the higher liability in this case? If that was my 4 yr old that no one responded to after I called 911, there would definitely be a lawsuit coming their way. An attorney would have ate this department up upon finding out that there was even 1 person available to respond to this call. This is an EMT that made a response to a need from what is written in this article. Bottom line is was the child cared for to the best capability of those who responded to the call? Did they get the child to the hospital providing assistance that fell within their licensure? If so, then it's a done deal...he did his job. Period. I've been an EMT for 31 years and I passed my first licensure as a basic EMT at the age of 16 yrs old.....yes 16 yrs old. I was not permitted on board an ambulance as the primary provider by myself until I was 18 yrs old but I was also allowed to drive at 18. Over the years, insurance companies have forced ambulance services of any level to raise the age of the driver. This started with the old box unit ambulances that once fell under the requirement of having to have a commercial chauffer's license. And in time, I'm sure they will eventually force the age of being licensed as an EMT to be 21 as well. That will be a sad day because there are people that are going to go longer without care in the most critical time or not have any care at all because of the "rules" that are being imposed upon us from insurance companies in the name of protecting us. If most of you are like me, you came into this line of work because you wanted to save lives and help others. Yes, there are some things that have to go into effect to protect us but this is one of those things where someone with common since needs to weigh both sides of what was done. I don't believe that person(s) has weighed this correctly or for the better overall good of the community. I have a young son of the age of 22 who is also a new EMT and I find him calling me to confirm how different calls have gone and I find myself teaching him as well. This young man maybe a bit of a maverick but most of the good LONG LASTING EMTs were mavericks. He needs to be paired up with someone who has been around the block for a while but also knows when to rain him in and when to give him some lead to mold this young EMT to be the best he can be. If the child was not harmed in any way then no harm was done.....this is a training opportunity not a disciplinary situation. This sounds more like someone wanting to be top dog by shoving their disciplinary authority around instead of using their head to make this a teaching opportunity. Sad, because this type of abusive authority scares others into making possible bad decisions that could cost lives in the future. I sincerely hope that it's not one of their family members or god forbid them self that ends up being the victim of some future EMT deciding not to respond because it is the "rule".
Laura Henderson Laura Henderson Friday, January 03, 2014 2:09:29 PM my brother is an emt with rual metro and he tells me that there are many unappreciated emts and also its the company's decision to let 18 year olds to drive that is taking risk for 9.50 hour making the difference if they have a license they should be able to do they same as everyone else that is not an excuse just because of age but i forgot its the fact THEY ARE IN THIS JOB TO HELP PEOPLE INT THE TIME OF NEED and its just because they are young what about the old people who have a better chance of having a heart attack if it is an experience thing you have to start somewhere but the guy is 20 not just yet 21 all of this over a couple of months that is not going to make a difference compared to making a difference to a 4 y/o
Lloyd Penfold Lloyd Penfold Friday, January 03, 2014 4:54:20 PM If that little girl had died through not getting hospital attention, or the elderly person died because the only traansport within the "SOPs" had gone to the first call, who would have been to blame? Certainly not the EMS as it has it's rules to hide behind. Too many chiefs and not enough indians here, methinks.
Lynn Frederick H. Winchester Lynn Frederick H. Winchester Friday, January 03, 2014 6:43:22 PM To put it simply, This man is saying that it is more important to protect their financial standing than to save a child's life. The young man simply cared about the fact that a child would DIE if she did not get some attention as quickly as possible. I would much rather have someone try to save my life and fail, than to have someone say, that is against policy. She will just have to wait.
Jim Green Jim Green Saturday, January 04, 2014 5:42:27 AM I commend the young man on stepping into action. I first drove an emergency vehicle at the age of 16, Simply because it was what needed to be done. That is what the true heart of any emergency service worker will do. The heart of a bean counter will worry about all of the lawsuits and other BS that is what separates the heroes from the administrators that sit in an office and make policy.
Ruth McGuire Woolery Ruth McGuire Woolery Saturday, January 04, 2014 9:42:45 PM I agree...I have several times knowing violated our policies in the name of what is best for the patient/situation. Each time, I self-reported, fully expecting some discipline. He showed his immaturity when he admitted to knowing violate the policy and then quit. How does that help the public he was serving. One less immature provider?
Anne Castioni Anne Castioni Sunday, January 12, 2014 5:29:44 PM I agree with your analysis. I don’t pretend to know all the facts of this case, only what was printed in the news. The squad’s board and captain came to the conclusion to suspend this young man as he had shown a pattern of disregard for both the rules and dispatch protocol. EMT Sawyer chose to split the two person crew on duty that would have responded to the 4 year old seizure patient. In doing so, he made a decision that was unwise not to mention in violation of the SOP. There is a reason why the insurance companies in the region will not write a policy for under age 21 drivers, particularly in the volunteer sector. They are a high risk group. Lastly, what kind of patient care did this EMT deliver after he chose to respond solo? I guess he didn't think.
Jan Schulz Jan Schulz Monday, February 03, 2014 10:42:26 AM So the ESTABLISHED GUIDELINES should also include...Death is preferable to the over-riding of the established professional guidelines/rules. In all instances let the person die! I still maintain strong disagreement with the premise of their policy. Hopefully, this town can review the outcome and outcry for a necessary policy CHANGE!

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