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The Ambulance Driver's Perspective
by Kelly Grayson

Restricting medics' rights: Where to draw the line?

Volusia County, Fla., EMS created a policy that would require medics to pass nicotine tests to keep their jobs

By Kelly Grayson

Of all tyrannies, a tyranny sincerely exercised for the good of its victims may be the most oppressive. It would be better to live under robber barons than under omnipotent moral busybodies. The robber baron's cruelty may sometimes sleep, his cupidity may at some point be satiated; but those who torment us for our own good will torment us without end for they do so with the approval of their own conscience. ~ C.S. Lewis

**********

Several years back, Volusia County, Fla., made EMS headlines by becoming one of the first urban EMS systems in the country to remove endotracheal intubation from the skill set of its first responder medics. Running a system with ALS first response from the fire department and dual-medic transport ambulances, they discovered that, much to their chagrin, their first responder medics had an ETI success rate of only 45 percent. Their transport medics were almost twice as good with an ETI success rate of 88 percent, which is "good" only in the sense that a feces sandwich tastes good if you serve it on rye bread with lots of spicy mustard.

Considering that you can't swing a dead cat on a scene there without hitting half a dozen medics, the obvious culprit was skill dilution from having too many medics and too few opportunities to practice ALS skills. But rather than make the obvious conclusion that they had too many medics, Volusia County made the head-scratching (and perhaps politically expedient) solution of limiting the skill set of a significant number of its medics. It is easier to cut skills than jobs, after all. Now, seven years later, comes another head-scratching decision from Volusia County regarding its EMS crews:

Ambulance employees are currently allowed to smoke if they were hired before the anti-smoking policy took effect earlier this year, but now that those employees will become county workers, all of them will have to pass nicotine tests to keep their jobs.

The nicotine test only applies to uniformed workers, like law enforcement. Paramedics and ambulance crew members will be required to take a nicotine test starting on Oct. 1.

***LIBERTARIAN RANT ALERT!***

I don't smoke. I don't like to be around cigarette smoke. I don't like breathing it, don't like the stench it leaves on my clothes, don't like the fact that a great many of my colleagues seem to plan their shifts around their next cigarette break. It's a nasty, disgusting habit that costs insurers and taxpayers billions of dollars in increased healthcare costs every year.

But it's still a perfectly legal activity, and Volusia County has no right to restrict the legal activities of its employees away from the workplace.

Now, before you say that employment agreements are like contracts in which both parties agreed to the terms beforehand, keep in mind that before Volusia County's takeover of the ambulance service, these EMT's were allowed to smoke by their previous employer. They didn't enter into employment by the county with the understanding that smoking – even off-duty – was forbidden.
And some of you might say that taxpayers shouldn't have to pay the exorbitant healthcare costs incurred by smokers. And you're right, we shouldn't. The smokers should have to absorb those costs.

But you see, there's already a mechanism for that. Private insurers, and I'm willing to bet good money that Volusia County's employee benefits program is administered by one of the major private insurers, have already devoted a great deal of time and effort into calculating the increased risk of insuring a smoker, and they pass that cost onto the smoker in the form of much higher premiums than non-smokers.

What's wrong with leaving that mechanism in place? Now, if Volusia County's insurance carrier wants to require nicotine testing to determine which employees should pay higher premiums, I can see that as a reasonable requirement. But staying nicotine-free as a requirement of employment, especially for people who didn't agree to that before the takeover?

Not hardly.

What about employer support for smoking-cessation programs? There is no mention of such a thing in place, and presumably a medic wearing a nicotine patch could be just as vulnerable to termination as the guy merrily puffing away at a rate of two packs a day.

And why does the ban apply only to uniformed employees? Why not non-uniformed employees? Why not the county administrators who implemented the policy? Or are the uniformed public-safety employees a de facto test case in future plans to curb the rights of its other employees? After all, in today's economic climate, public safety employees and unions are almost as safe to pick on as smokers.

And where does it stop? Will they start to ban other risky pursuits, like motorcycle riding? What about trans fats? Those are bad for you too, you know. So is excess sodium intake, and alcohol abuse. Will they come to their employees' homes and raid the pantry and liquor cabinet?

Before you accuse me of hyperbole in making my point, allow me to quote Volusia County official Dave Byron to demonstrate their mindset:

"When you work for a public agency there really is no such thing as invasion of privacy. They work for the public you know and that's part of the price."

If you really believe that, Mr. Byron, put your privacy where your mouth is, and post your private health information on the internet. You're a public official, too. You should be willing to sacrifice your right to privacy, just like those uniformed public safety workers to whom you're imperiously dictating terms of employment.

There are better ways to curb health care costs. Volusia County needs to find one that doesn't involve them intruding into their employees' private lives.

About the author


Kelly Grayson, NREMT-P, CCEMT-P, is a critical care paramedic in Louisiana. He has spent the past 18 years as a field paramedic, critical care transport paramedic, field supervisor and educator. He is a former president of the Louisiana EMS Instructor Society and board member of the LA Association of Nationally Registered EMTs.

He is a frequent EMS conference speaker and contributor to various EMS training texts, and is the author of the popular blog A Day In the Life of an Ambulance Driver. The paperback version of Kelly's book is available at booksellers nationwide. You can follow him on Twitter (@AmboDriver) or Facebook (www.facebook.com/theambulancedriverfiles), or email him at kelly.grayson@ems1.com.

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