Patient Care v. People Care
Part 1: Which aspect should be “The Job” of EMS?
The more time I spend as an EMS legal analyst, commentator and educator, the more I see how EMS is changing and evolving — and in some cases, devolving.
Nationwide — as EMS systems continue to migrate from single-function, multi-provider agency models to single-entity, dual-function fire/EMS models — I am seeing, hearing and reading more about how firefighters are supposedly the ones resisting change; even more so than private or third-service paramedics who are the ones that seem to be ultimately losing their jobs.
“They are changing our culture, our way of life,” one long-time firefighter recently told me. Another veteran of the same department explained that “EMS calls are just a necessary inconvenience of the job.”
Neither of them was a paramedic and never would be, according to them. Their department had forced both of them to go through EMT training; that was bad enough.
Interestingly, I spoke with a paramedic from the same department who told me that EMS was the reason he got into the fire department in the first place.
“It’s hard,” he said, “because there are the old-timers on the engine or truck who think that EMS has ruined the job because now they spend more time ‘carrying drunks and old ladies down stairs’ or rolling several tons of fire apparatus with lights and sirens down busy streets because ‘someone stubbed a toe,’ than actually fighting fires.”
The more people I talk to, the more it seems to be that the greater concern is how the on-scene attitude and conduct of those who don’t want to be there affect the perception and performance of those who do.
“You would not believe what I have seen,” one provider told me in confidence. “They say things like, ‘Why did you call 911? You’re wasting our time’ or ‘You f*ing idiot, I should have you arrested for calling’ or ‘Get your drunk ass in the ambulance and shut up.’”
I have seen that too, I told him. Unfortunately it’s everywhere, and when it comes from an ancillary crew member (read: firefighter) it reflects directly on the paramedic. It can be nearly impossible for the paramedic to affect an adequate and accurate assessment or provide complete and proper treatment when the patient or family has no trust or faith in them. Everyone loses.
I understand change. I have watched it both ruin and improve the world around me. Like countless others, I have shifted my goals, priorities and view of the world because of changes that were either happening or imminent, and invariably out of my control. Sometimes I welcomed it, other times I feared it; and other times still, I suffered angrily and reluctantly through it. Nevertheless, no matter how I felt or how I reacted, the change came; it always does.
More importantly, when the dust settles, when change is done, what is left? In the case of EMS delivery, the answer is always the same: “The Job.”
But what is The Job? In a system as vast and diverse as a large fire department, The Job may seem different from person to person; while one may view the department as being a firefighting organization where EMS is a chore, another may see EMS at the core of an agency, despite the overwhelming emphasis on firefighting in the culture. Just picture dormitory walls adorned with "Backdraft" and "Ladder 49" posters as opposed to "Mother, Jugs, and Speed" or "Bringing Out the Dead."
Many old-timers and veterans resent the fact that the fire department has become a patient care job more than anything else. On the other hand, the new generation — along with most command staff — understands that the vast majority of calls to 911 across the country are for EMS assistance rather than reports of fire, flood or felines in trees. Thus, the emphasis and culture seem to be shifting to patient care first — and in this age of legal liability and exposure, it’s about time.
As I continue spending more time with EMS providers — both the willing and unwilling — I can see and understand the frustration. I understand the frustration of waking six people in the middle of the night to race to the scene of a baby who will not stop crying; the frustration of the paramedics who are left to handle complex situations with little or no assistance from a reluctant engine company crew; and worst of all, the frustration of the citizen who is disrespected, belittled and ridiculed by both the firefighters who don’t want to be there and the paramedics who have been running non-stop since the beginning of the shift.
No matter who you are in the department or how long you have been on, you must recognize that not everyone who calls is a patient, but everyone who calls is a person.
Then, as I was preparing to give another lecture program on this very topic, I had an epiphany.
We have been looking at this all wrong. Until now, the perspective has been confined to that of a firefighter or paramedic, of someone who understands the system and makes it work. Instead, the perspective should be that of the caller, the one who does not understand the system or make it work; the one who instead depends on the system and relies on the knowledge, skill and compassion of those who respond to their call for help.
No matter who you are in the department or how long you have been on, you must recognize that not everyone who calls is a patient, but everyone who calls is a person. And there it is. The Job is not patient care, it’s “people care.” When people care is the focus, then The Job returns to the center for everyone. The crusty old-timer who signed on to fight fire also signed on to help and care for people. The exhausted paramedic who runs 26 calls in 24 hours signed on to care for people regardless of circumstance. The Job is treating people with respect and dignity and helping people through times they perceive as being difficult, even when you disagree.
I know what you are thinking: “rainbows, ponies, sunshine and good times for everyone; oh, how wonderful it will be when we all work together.” It’s okay; I can take it. I can take it because I understand the new reality for EMS. I understand that if providers of every stripe don’t embrace the concept of people care — the concept of treating every person who calls with dignity and respect as if they are the most important person in the world for that moment — then they will be the ones who will be stuck dealing with the ever-increasing number of complaints, numerous days off, more time wasted, and damaging lawsuits. And when you call me to defend you, I will see to it that you have the best defense possible … and that you will pay handsomely for it.
All things being equal, I would rather never get your call or take your money if it means that you took a step back and remembered your responsibility — that you are providing quality patient care for everyone who needs it and exceptional people care for everyone else.
|Author's note: In upcoming columns, I will discuss other aspects of people care and offer techniques every provider, regardless of agency, certification, or service model, can employ to enhance the various facets of what it means to be an EMS provider, as well as the kind of legal protection that keeps both providers and the community as safe as possible.|