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The Legal Guardian
by David Givot

Perception is Reality, Even When it's Not

By David Givot

All news is local and every patient is yours


"Dallas paramedic faces accusations of sexual advances to female patient"

"New York City EMT in pervert rap"

“Paramedic charged with stealing dying man’s wallet”

“EMT punched patient on the way to the hospital”

"Sexual misconduct trial of fired paramedic begins"

“Paramedic didn’t check pulse, left woman for dead”


While headlines like these may be shocking, they clearly are not representative of EMS as an industry. Nevertheless, they must be viewed with great caution.

The impact of disturbing headlines and even more disturbing stories is not the presumption that one bad apple spoils the whole bunch — one bad apple, after all, is just one bad apple. The true danger is the collateral harm that exists between perception and reality, where opinions are formed and judgments are made by those who know less than what their eyes see.

When it comes to those outside EMS, people only see — and thus draw conclusions from — the EMS providers they come in contact or the representation of providers by the media.

By its very nature, the EMS industry precludes "normal" folks from having any understanding whatsoever of the inner tickings of an EMS provider. For generations — or at least the two decades I have been involved — true EMS providers have had to work vigorously to win the respect from their police and firefighting counterparts. Many paramedics in the fire service are hailed for their role as firefighters, but their EMT skills are given only lip service. Private ambulance EMTs, especially on the West Coast, are treated like step-children at a family reunion. Somehow, the industry seems quick to forget that EMTs are EMS professionals.

The general public is primarily concerned with one thing: Getting help when help is needed.

Those dedicated EMS providers who believe that quality patient care is the core of the job must continually fight a two-front battle to keep expectations high and standards even higher.

Being proficient at the job and raising perceived standards begins at the foundation of the job. That means delivering comprehensive assessments, proper treatment, valuable documentation, and safe transport no matter how tired, burned out, or bored you may be. And yes, it also means doing so with a people-friendly attitude and sharp, clean uniforms and vehicles.

And perhaps the biggest challenge is that each provider must be prepared and willing to hold themselves and their coworkers accountable under the same high standards. This means seeking remedial action when necessary, which often results in confrontation and turmoil in an already capricious environment.

The common thread between both battlefronts is the law. The law already holds providers — and coworkers — to a standard. The law is an equal opportunity arbiter; when either falls short, both may find themselves on the uncomfortable and sometimes devastating side of legal action for the same incident.

Take, for example, ongoing cases in Texas, New York and Michigan, where providers are entangled in allegations of sexual misconduct. Being a strict Constitutionalist, I believe in the concept of “innocent until proven guilty” — and I would like to believe the best. Nevertheless, playing devil's advocate, let's say the allegations are true.

Did their partners know what they were doing? Was there a known or suspected pattern of such behavior? Was their behavior ignored because they were “great guys?” (Maybe, but keep your eye on the ball.)

Inasmuch as these types of incidents — though sexy fodder for the media — are abhorrent and aberrant, it matters less than another misconduct that goes on every day at (almost) every agency: disinterested patient care.

Take a close look around - what do you see?

  • Do all of the EMS providers in your agency, including you — regardless of level of training — take special care to cross every “t” and dot every “i” on every call?
  • Does each patient get the same degree of assessment and follow through or are patients sometimes prematurely released from the scene when something better comes over the radio?
  • Is the short-of-breath executive in the office building at noon treated the same as the homeless person retching in the gutter at midnight?
  • Do C-Spine precautions have varying degrees — full, sitting, walking?

More importantly, when you see substandard care, unequal treatment, or actual negligence, what do you do? If the answer is “Nothing,” then the shadow of impropriety is cast beyond the malefactors and onto the agencies, their respective members, and you — and rightly so. The law dictates that permissive behavior can be as culpable as affirmative behavior; doing nothing can be the same as actually doing the bad act itself.

Unfortunately, the ultimate result (for providers) is that good folks — dedicated providers who believe in the full potential of EMS — become smeared with the silt dredged up by the few.

On one hand, blowing the whistle can mean an unbearable work life. But on the other, silence means being wrapped in the veil of speculation. Speculation becomes truth in the eyes of an uninformed public - the same public that allocates funding and award contracts; that commissions background examinations on candidates for future jobs; that sits on jury panels and determines damage awards.

Ultimately, all we can do is our “level best” and sometimes that means making big decisions and loyally providing the best possible patient care. We must move past the code of silence — silence that can be shattered by the piercing shrieks of a mother kneeling beside her child’s grave.

For me, the “level best” means taking advantage of every opportunity to contribute to the advancement and improvement of EMS and to protect those who provide it. Because the public and media’s perception of EMS can often be skewed, we must rely solely on our skills and actions to straighten society’s outlook.

Take a close look around, what does it mean for you?

About the author

David Givot, Esq., graduated from the UCLA Center for Prehospital Care (formerly DFH) in June 1989 and spent most of the next decade working as a Paramedic responding to 911 in Glendale, CA, with the (then BLS only) fire department. By the end of 1998, he was traveling around the country working with distressed EMS agencies teaching improved field provider performance through better communication and leadership practices. David then moved into the position of director of operations for the largest ambulance provider in the Maryland. Now, back in Los Angeles, he has earned his law degree and is a practicing Defense Attorney still looking to the future of EMS. In addition to defending EMS Providers, both on the job and off, he has created TheLegalGuardian.com as a vital step toward improving the state of EMS through information and education designed to protect EMS professionals - and agencies - nationwide. David can be contacted via e-mail at david.givot@ems1.com.
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