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The Art of EMS
by Steve Whitehead

Social courage: Stop making excuses and confront unacceptable behavior

In an industry where courage and bravery seem plentiful, we shrink from even the slightest appearance of social conflict

By Steve Whitehead

Wandering the various EMS forums and groups out in cyberspace, I have an opportunity to hear a lot of rants and gripes about EMS life in general. Some folks ask for advice with challenging interactions, and others just want to blow off some steam.

Some of the situations are run-of-the-mill conflicts that are pretty predictable when human beings work together in stressful situations:

  • My Q.A. manager wants to know why I didn’t give nitro to an inferior wall M.I. with hypotension. Should I really have to explain this?
  • The local firefighter / paramedic gave me a patient that was clearly an ALS transport.
  • The off-going crew always leaves us a dirty rig.
  • Some of our volunteers never show up to our company trainings.

Other individuals describe behavior that is so deplorable that it’s hard to imagine how these folks continue to work among us:

  • I hung up a “supplies needed” dry-erase board and the supervisor broke it in two and threw it in the trash.
  • Our officer consistently shows up drunk on calls. He often drives the apparatus even though the local police have warned him about it.
  • I am repeatedly grabbed inappropriately by multiple coworkers.

I tried something new in 2013. Instead of offering advice, encouragement or understanding to these folks. I began asking a simple question: What did you do? I didn’t ask accusingly. I just requested the rest of the story. After this thing that you described happened, what did you do next? What did you say?

I’ve noticed that when the stories of wrongdoing and misadventure are offered, the storyteller’s response is often left out of the story. More often than not, this is because the storyteller didn’t respond or address the issue when it occurred. They walked away and stewed about it for a few hours or days before going online and expressing their frustrations to everyone except the individuals involved.

When I ask people, “What did you do?” the answer is typically, “I didn’t do anything.” Or “I just sat there and smiled.” Or “I ignored them and walked away.” Time and again, when confronted with both minor and major offenses in social etiquette, failures in knowledge or performance and behaviors that are immature, mean, offensive and sometimes even illegal, we choose the option of non-confrontation.

Sometimes individuals offer up some explanation for why they failed to respond. “It won’t make any difference.” “You can’t get through to those guys.” Or, my personal favorite, “I’ve got kids to feed. I can’t afford to get on people’s bad sides.”

It amazes me. We will go inside burning buildings looking for strangers. We will stand on the side of an icy freeway while cars drive past us inches away. We will treat violent and aggressive patients (often with far too little regard for our own personal safety). In an industry where courage and bravery seem plentiful, we shrink from even the slightest appearance of social conflict.

So why do we avoid uncomfortable personal confrontations so much? The simple answer is fear, but fear takes on many forms. When I ask individuals why they didn’t confront some misbehavior in their coworkers or managers, they tend to offer the same three excuses. I’d like to address each one of them individually.

The ineffectiveness excuse

With the ineffectiveness excuse, we rationalize that our protest will be a useless gesture for a variety of reasons. It’s comfortable to believe that because of our lack of authority or the persistence of the problem or the stubbornness of the offender, any direct communication with the individual is worthless.

Those who fear ineffectiveness say things like, “You can’t get through to these guys.” Or “Why bother, it won’t make any difference.” Or “It’s been this way for as long as anyone can remember. It isn’t going to change any time soon.”

What we need to remember when we offer the ineffectiveness excuse is that we can diplomatically and respectfully stand up for what we feel is right regardless of the final outcome. Whether or not we feel we will ultimately be successful shouldn’t change our willingness to do the right thing. The final outcome doesn’t need to be the complete resolution of the problem. Our influence doesn’t need to be definitive, it only needs to be positive.

Often, we use the ineffectiveness excuse as a way of avoiding the social pressure of doing the right thing even though we are actually very poor predictors of our ability to influence. Rosa Parks wasn’t trying to be a civil rights leader, she just wanted to rest her feet. When Henry David Thoreau wrote “Civil Disobedience,” he simply wanted to give people the courage to stand up for themselves. Instead, he managed to bend the course of human history in ways he never could have predicted.

With the right words and a polite refusal to simply ignore the problem, you might be amazed by what you accomplish.

The forbidden fruit excuse

The forbidden fruit excuse is the rationalization that there are some unspoken rules that prohibit us from addressing the conflict. Perhaps you work for the local private ambulance service, and the other half of the conflict works for the local fire service. Or perhaps the individual at the root of your issue is a promoted officer, a supervisor, a hospital employee or in some position of authority.

Once we perceive that the other individual in the conflict has some sort of protected status, we can dismiss any notion of confronting them because ... well, we just don’t do that sort of thing around here. When we would prefer to avoid having an uncomfortable conversation, we will create all sorts of rules and reasons why that would be prohibited.

While there are often social and organizational rules and traditions that need to be honored, they rarely prohibit us from speaking up when faced with a conflict. Unacceptable behavior is still unacceptable, regardless of what is normative in your organization. You may need to begin with the chain of command. You may need to begin with a trusted mentor. Even better, you may want to just bring the individual you are confronting a cup of coffee and politely request to have a private conversation.

No method is always appropriate, but some method is appropriate in every situation. There is a diplomatic way to say whatever it is that needs to be said. What’s missing isn’t the permission to say what needs to be said, it’s the courage to say it. Choose your method, but don’t choose silence.

The fear of retribution excuse

This is perhaps the most common excuse for ducking an important conversation. It’s the idea that if we make waves and cause others discomfort, they will somehow punish us in the future. We worry that punishment will be direct, like termination, or indirect, like a denied promotion or reduced job responsibilities.

We evoke the fear of retribution with phrases like, “I have a family at home.” Or, “I can’t afford to lose a good job over stuff like this.” The implication is that there are greater priorities than speaking the truth or holding individuals accountable.

In over two decades of work in emergency services — from public agencies to biotech firms and universities; from large multi-national ambulance providers to small mom-and-pop ambulance companies — I have never even once seen anyone fired or disciplined for honestly and respectfully speaking their mind. Yet this fear is rampant in our culture. Folks seem to be convinced that they are required to toe the line and say yes on cue or face some negative consequence.

On the contrary, I have found that just the opposite is often true. It is often the individuals with the courage to speak honestly and openly about their observations that gain the trust to be considered for promotions and additional responsibilities. Individuals who are confronted in a respectful manner often develop greater trust and confidence in the individuals who are willing to speak up when they see the need.

When new opportunities arise, we often want to pass them to employees who are engaged in the process of improving our organization. Those are often the individuals who are willing to challenge the social norms and work toward a better future.

Perhaps our greatest point of confusion about interpersonal conflict occurs when we automatically link conflict and disagreement to disrespect, judgment and anger. Having the courage to confront inappropriate behavior and poor performance is not a license to disregard people’s feeling or disrespect others.

We need to be able to approach individuals with respect for their individuality and dignity. We need to begin from a place of caring about them as individuals, caring about our shared responsibilities, and caring about making a better future.

Social courage means being brave enough to care about working together better. We don’t confront others to tear them down. We confront them to build them up. And if we are courageous enough to try, we will often find that we better ourselves as well. Let go of your fear and you may find that you can bend the course of history.

About the author

Steve Whitehead, NREMT-P, is a firefighter/paramedic with the South Metro Fire Rescue Authority in Colo. and the creator of blog The EMT Spot. He is a primary instructor for South Metro's EMT program and a lifelong student of emergency medicine. Reach him through his blog at or at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Skip Kirkwood Skip Kirkwood Tuesday, January 28, 2014 4:57:14 PM The "fear of retribution" thing always amazes me. When I work with other agencies, I often ask, "Where is the mass grave?" How many people have actually been disciplined for speaking up about valid issues? Usually, nobody can tell me about ANYBODY - or if there is an example, it wasn't that they raised an issue, it was that they did so in an unprofessional, disrespectful, or dishonest manner. Sometimes I think we need to give "thin skin innoculations" in EMT and paramedic school. Other professions deal with conflict and confrontation in a professional manner - I wonder why we have such difficulties???
Bruce A Mills Bruce A Mills Tuesday, January 28, 2014 5:10:37 PM Well when certain questions are raised over and over that's where the rude, unprofessional behavior comes from. When you get tired of taking your job seriously and the chain of command fails and your told to just run the call or you have a bad attitude what option is there for the rank and file ?
Jeffrey J. Stuck Jeffrey J. Stuck Tuesday, January 28, 2014 5:33:05 PM Well said. I like to look for peers that speak there mind. In these PC times they are disappearing.
Beth Conrey Beth Conrey Tuesday, January 28, 2014 5:55:14 PM Good words
Don Lundy Don Lundy Wednesday, January 29, 2014 6:32:16 AM The option is the stand up and do what's right. Quit whining about things you can't control and be a leader. There has NEVER been any retribution against anyone who spoke up at any place I worked. Everyone is way too sensitive. Get a pair. Be a leader.
Mike Smertka Mike Smertka Wednesday, January 29, 2014 9:01:38 AM I think the fear comes from initial EMS training. In most EMS training students are taught there is only right or wrong. If you are not regurgitating the proper drill and dogma in the proper order, you are wrong. That sets the stage. Fast forward that mentality and reinforcement to the job. Not only in bringing forth problems, but also in the form of Monday morning QBing calls providers were not on and her some details second or third hand. All of EMS has a right answer and a wrong answer. In medicine, the most accurate answer is "it depends."
Julia Harris Julia Harris Thursday, January 30, 2014 2:00:40 PM Wow...really? I love the leaders of organizations making these statements, about no retribution in their services. If that's true I might be applying for a job. I have my card in both states. I've worked for several counties in SC, in all of which I experienced truly reprehensible behavior. Behavior that resulted in the death of a patient and a falsified PCR in one case. I spoke up and was labeled a troublemaker, then shown the door. I consoled myself with I can sleep at night, but it didn't bring me a paycheck. In fact 2 years later they felt free to bad mouth me at my next job, nothing I could prove of course. I could rant for quite awhile about the unbelievable crap I've seen in the past 12 years, both in 911 and non-emergent. I'm blessed to have an amazing job with a good organization now. I've slowly but surely learned my lesson, keep your head down and your mouth shut. Maybe Charleston and Wake counties really are the exception to the rule I've found. It would be an amazing breath of fresh air if that is the case. I don't mean to disrespect these men, I know they are both strong leaders in NC and SC. It's my hope that things not only are different in their respective organizations, but that their leadership spreads the novel idea that the patient and their care is more important than protecting the good old boy establishment!!
Barbara J Power Barbara J Power Friday, January 31, 2014 8:53:53 AM I am fortunate and blessed to have a wonderful boss and a great place to work. But I agree with those of you who have found reason to keep your head down and stay quiet. There is a lack of professionalism in EMS and too many times the boss takes your comments personally or the paragod you work with makes your work day hell out of revenge, spite, or just because he can. It was my impression when I began EMS that paramedics eat their young, meaning the rookie was put down, run down and sometimes stomped on. And then I met a few rookies who thought they knew more than the seasoned EMS personnel and were arrogant and disrespectful and didn't want to learn. Like I said, lack of professionalism and lack of respect toward others. If the director and those in charge can't rise above their own insecurities and stress levels, retribution does happen. And while fear of losing your job may be your motivation for remaining quiet, losing your source of income is a real concern in today's world. I've heard the phrase "escalation of conflict" as an excuse to fire the one who stood up against the status quo, even when the unfortunate paramedic was properly addressing sloppy and dangerous practices. And one hospital EMS chose to outsource their EMS services rather than deal with personnel issues. I'm a believer in standing up for what's right, but in this crazy world, you had better pick your battles.
Ian R Frankel Ian R Frankel Saturday, February 01, 2014 9:13:15 PM Addressing new paramedics, I always introduce myself and try to make them feel welcome. How can you build an organization if you knock the new guys down and tell them everything stinks.
Nathan Stanaway Nathan Stanaway Sunday, February 02, 2014 8:43:16 AM Well said Steve!
Curtis Powell Curtis Powell Saturday, August 09, 2014 10:53:29 AM I couldn't have said it better. In today's EMS, many good people have become the victim of local politics and the good ole boy system. It only takes a single gossip or grouchy partner to ruin someone's EMS career.

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