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Underage EMT vs. professionalism News

January 2, 2014

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
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Joseph Moore Joseph Moore Monday, January 06, 2014 7:13:08 AM I have to respectfully disagree with your definition of professionalism. There are many times that rural EMS providers must make decisions that do not fall within the protocols or policies of a department or medical control authority, whatever the name of the organization is. We should always have thinking, empathetic, and rational EMTs and medics in the field, specifically in a rural area where there is no backup available. My definition of professionalism would include decisions made in the care and transport of a patient that are in the best interests of the patient even if it violates rules and policies. Perhaps an example might suffice. Stroke patient with left sided weakness. Protocol says to contact helicopter for transport. Helicopter arrives. Patient weighs too much for helicopter. One hour wasted of the patient's three hour window. Crew of helicopter takes over care and transport decisions. Three hours later, a USCG helicopter arrives and patient is transported in USCG helicopter with emergency helo crew aboard. Patient did not arrive until more than six hours after onset of symptoms, but protocol and policies were followed. I believe the proper method would have been to get the patient to the mainland hospital by any means possible, such as a privately owned aircraft from this Island in Lake Michigan. Protocols are recipes. Sometimes the recipe doesn't fit the situation. Second example: Another stroke patient. EMS arrives ten minutes after onset of symptoms. Patient loaded into ambulance, taken to the local airport. Flown by private aircraft to mainland airport and transported to Stroke Center. Patient arrives at Stroke Center within 90 minutes of onset of symptoms. Which patient received the professional treatment and transport that he or she deserved? I know my answer.

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