How to raise EMS standards: 5 readers respond

Field medics relying on inept command staff to promote quality is like an orphan relying on a drunk uncle to raise him right — it's never going to happen.

Not long ago, I received an email inquiry about my column The legal truth about the ‘higher standard', which addresses the expectation that EMS workers should represent the best of what society is supposed to be. It raised five interesting points and good questions that deserve public follow up.

1. How much responsibility does or should commands have to establish this standard and to raise the bar?

In the EMS world I envision, the buck starts with and stops with the command staff — supervisors, officers and chiefs. The command staff should not only be setting the standard, but living it as well.

Unfortunately, we know all too well that’s often not the case. Many operations are led by inept boobs who are in their positions based on longevity or nepotism rather than quality or training. That is why I am such an avid proponent of leadership from the field.

Field medics relying on inept command staff to promote quality is like an orphan relying on a drunk uncle to raise him right — it's never going to happen. If the command staff won't lead, someone must.

Patients don't care who leads, so long as they are safe and well cared for. That means the dedicated providers must take the lead on setting, and enforcing, an example.

When that happens, the command staff will change either by attrition or force. Either way, it's a long, long road.  

2. One of the agencies for which I work brags about having such a high standard. But, one senior member of the command staff has a habit of bypassing any semblance of a chain of command. Even worse, other members of the command staff publicly discuss issues from infidelity and divorce to alcohol problems.

The overwhelming sense of pride that your agency feels and demonstrates is good for morale and quite common. But, you have to know that every agency thinks it is the best. The weaknesses that your agency derides in others are likewise seen in your crews, and your fine agency is equally derided by others.

The other issues you describe are much more difficult to manage in this context — and much more common than any of us would care to admit. In the 20-plus years I have been directly in or on the periphery of EMS, I have and continue to see countless examples of dirty laundry permeating the ranks and infecting the workforce.

Unfortunately, it’s a slippery slope. If EMS life is more akin to a family than a job, then it logically follows that certain family-type issues will arise. If we condemn the natural consequences of that sense of family, won’t that serve to reduce or eliminate the essential connection between providers?

I don’t know the answer, and far be it for me to preach on the subject. That is one glass house from which I will not throw stones.

Yet I can offer this: EMS relationships, like family relationships, should invite and forgive open communication — and like family relationships, they often don’t.

3. Your article was referred to us by our [command staff] based on a belief that the crews are forming cliques, and that teamwork is not first on our minds. Your article seems to follow along these lines in placing responsibility for this elusive higher standard on the field medic with no responsibility or mention of the leadership that should be exhibited by all command staff members.

Good point. I focused that piece on the field because I learned long ago that relying on leadership from above was often futile and disappointing.

However, cliques and teamwork are not mutually exclusive. Cliques are not necessarily bad — like attracts like. The A, B, C shift phenomena is the perfect example: A shift is the anal-retentive group, B shift is lazy, and C shifters are slobs. That reality, or some slight variation, has been the way of the EMS world for generations.

The important thing is that, cliques aside, all providers share and demand the same commitment to the higher standard. Ultimately, the command staff — at all levels — must demonstrate that higher standard. When they don't, true success demands that they be remediated or replaced.  

4. Drinking problems, favoritism among certain FTOs, unstable lifestyles, and a lack of leadership qualities all serve to set the tone and provide the example for the field staff to follow.

That is 100 percent correct! Nevertheless, all of those human faults you identify are part of pretty much every employment environment, and they will always exist.

The questions: How does a quality-driven, higher-standard operation deal with them? The answer: The same way you eat an elephant — one bite at a time.

However, when it comes to favoritism, simple policy changes, accountability with associated consequences, and highly visible checks and balances can nip that in the bud right away.

5. The old dogs you mention see this and know it becomes their responsibility to do what needs to be done, or they see it as an opportunity to slack off and provide the substandard.

My point exactly. Some old dogs can learn new tricks. Some just need to be put down.

Ultimately it all belongs on the shoulders of leadership, but it often ends up on the shoulders of the rank and file, and that is neither right nor fair. However, poor leadership is no excuse for poor performance by those who know better, and those who know better must take a stand and continue pushing toward a better EMS.

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