Although the identifying information has been changed, this exchange actually took place between the dispatch center and the captain of the engine company that provides fire services and ALS EMS response to the community it serves.
“Engine 1… Respond to an unknown hazard … 161 Madison Ct. Caller is an elderly female; she states that she cannot reset her GFI.”
“Control from Engine 1 … what is the actual hazard?”
“Engine 1… that’s unknown at this time; no further details.”
“Control from Engine 1 … we are not responding to that. Engine 1 is available in quarters.”
The fire and EMS engine company never responded, nor was the captain sanctioned for refusing the response.
‘Unknown’ everything gets answered
For generations, dispatchers have received and processed calls based on certain criteria and protocols and, when policy demands, units are dispatched. That’s how it works.
EMS responds faithfully and diligently to “unknown” everything calls; “unknown medical,” “unknown trauma,” “unknown hazard,” and as far as I know, it has never been okay to refuse a call because it did not sound serious to the crew of the assigned unit.
Furthermore, how can any captain possibly have known that there was not a hazard that required immediate technical or even medical attention? Was the elderly female caller confused? Did she say GFI intending to say CVA or MI or something altogether different?
We quickly learn that what we are called for and what we find are quite often vastly different; a full cardiac arrest can just as easily be someone sleeping in the park – and vice versa.
Complacency works like a virus
Much like Ebola, apathy and complacency start by seeking out a willing host and then infect a small group. Slowly, but deliberately, compassion is replaced by cynicism, respect is replaced by contempt, and eventually, subjectivity erodes away all objectivity. When objectivity is lost, the damage is done and the virus spreads.
Apathy and complacency are transmitted, not by bodily fluids (that would be nasty), but by the rationalization that becomes example, that then becomes culture. Once it reaches the culture stage, eradication becomes close to impossible.
Apathy and complacency are how legitimate shortness of breath is written off to anxiety or altered mental status is assumed to be intoxication.
Much like Ebola, without aggressive, proper treatment, apathy and complacency can be fatal to one’s career – not to mention patients.
The cure for apathy and complacency
Once identified, eradicating apathy and complacency from any EMS operation can be accomplished at any stage of viral development. Of course, just like Ebola, the longer you wait the more difficult and painful the treatment will be – and successful eradication becomes more and more unlikely.
1. Recognize the problem
The first way to cure apathy and complacency is aggressive self-treatment. This method begins with establishing unambiguous and unwavering standards of conduct, care, and cooperation that are intrepidly supported by forceful and regretless accountability for all members at all levels.
2. Lead by example
Rookies and chiefs must be held to the same standards of performance and conduct; if the rookie does not nap at his desk after lunch, neither does the chief; if the rookie responds to every situation with unmitigated professionalism and unwavering attention, so does the chief … and so does everyone in between.
3. Enforce consequences equally
If the rookie is not willing or able to comport to the highest standards every day, without exception, get rid of him.
This can be accomplished following a simple algorithm:
- Establish and publish the standard
- Demonstrate the standards (Officers & Senior Members)
- Educate non-compliance
- Remediate continued non-compliance
- Discipline failure to comply
- Terminate
If the chief is not willing or able to comport to the highest standard every day, without exception, get rid of him too … and fast. This may require a modified contract or employment terms or even changes to the City Charter; whatever it takes, do it because the people you are meant to protect are depending on it.
The same goes for everyone else, without exception and without excuse. If any member of the agency is unable or unwilling to live up to the highest standards, get rid of them and don’t lose one minute of sleep over it.
It is essential to understand that “the highest standards” cannot be some arbitrary or esoteric construct. The standards must be carefully considered, written, and communicated. Most of all, they cannot be open to interpretation; a full assessment must be defined, expected, and executed; documentation standards must be defined, expected, and enforced.
I recognize that eradication of the host, the carrier and spreader of the apathy virus, can be a significant challenge for any department, but what choice do you have? The sickness will only worsen if the department is unable or unwilling to find, treat, and eradicate the source of its illness.
The second way to cure apathy and complacency is the law. As a cure, the law is much broader and swifter, and much less discerning than even the most aggressive self-treatment a.k.a. in-house eradication efforts.
The law – in every jurisdiction – has already established performance standards and, when they are not met, the law, like a surgeon, cuts until all of the bad tissue is gone.
The cuts may begin administratively; the suspension or revocation of your certification or license to practice BLS or ALS.
If that is not enough, the cuts will continue civilly; you will lose your assets and livelihood.
If that is still not enough, the cuts will reach criminally; you will end up behind bars and under no circumstance will you have the right to cry about it because, although they are metaphorically viral, apathy and complacency are 100 percent voluntary.
Prevention is the best medicine
Like Ebola, critical apathy and complacency are likely relatively well-confined to a small number of personnel in your department. However, precursors like burn-out and fatigue are as ubiquitous as rhinovirus on an elementary school playground, and only prevention can contain the spread of illness.
- Reward good behavior; make sure providers are recognized for leadership by example
- Make sure reform is praised
- Recognize burn out or fatigue and promote counseling or just good old R&R
- For fire departments: train and drill as much on EMS as you do firefighting
Look around. How would you describe the culture of your agency?
Now pretend that any small fib will cause an electric shock to your face. Would you describe it the same way?
Now look at yourself. Imagine you are on your deathbed. How would you describe your own performance and commitment contribute to the spread of apathy and complacency? Are you a super-spreader of this dangerous contagion?
Depending on your answers, what are you willing to do about it? Can you treat what needs fixing before the law does it for you… or before someone dies?
