“The secret to knowing everything is knowing whom to ask.”
My father told me that when I was very young, and I have never forgotten it. As a lawyer, that wisdom has come in handy more times than I care to admit.
The deeper lesson is that information is power; the more one knows about a given thing, the more one can work it to an advantage.
Nowhere is that more true than in EMS, which is an entire universe of variables: Different traffic patterns on the same road, different vital signs, different complaints, different ages and different combinations of everything.
No two days are the same. No two calls are the same. You can respond to the same patient you just left 10 minutes ago for the very same reason, yet it is not the same — something will be different, if only the tiniest detail.
Your ability to apply and adapt a solid foundation of knowledge to any combination of those variables is essentially what defines your abilities as a provider.
You will notice that the “substandard” providers in your area are chiefly characterized by their inability to “handle” some situations through critical thinking.
EMS training programs typically do a sufficient job when it comes to teaching the fundamentals such as anatomy, physiology, patient assessment and appropriate treatment. Higher levels deal with more advanced subject matter.
When the training is done, the new provider should have a workable foundation upon which to build, and experience fills in most of the blanks.
Unfortunately, the vast majority of EMS training programs virtually ignore the law. In far too many cases, training programs offer the minimum legal subject matter required for accreditation as a training facility, usually little more than glancing over some EMS statutes and local rules.
“Don’t mess up, or you will get sued” seems to be the extent of the preparation new providers (who grow to be old providers) ever get with respect to protecting themselves legally.
To me, that is utterly insane!
The law is the box that carries every other aspect of EMS. Everything is rooted in either the law that makes it so or the law that governs how it is done, and it’s all wrapped in the law of what happens in response to getting any of it wrong.
For example, every EMS provider knows that there are serious consequences for “negligence,” yet most providers don’t actually know what negligence is.
How can anyone be expected to avoid something they don’t understand?
Even worse, providers who work with only a vague understanding of negligence, believing that they cannot be held liable if there are no damages, are caught off-guard when they are disciplined, often severely, for conduct that falls short of negligence but is no less egregious.
On the other hand, a provider who understands negligence and how it works will be equipped to avoid it altogether, no matter what the variables. And in doing so, he or she will likewise avoid the other potential pitfalls that exist within it, such as administrative consequences.
The same theory applies to policies, protocols, procedures, communications, scene management, interagency relations and coordination, patient relations, transport modalities, patient status upgrades and downgrades, interpersonal relationships and more.
All of it is created, governed and carefully overseen by the same law each provider must know and understand before being truly effective.
Ultimately, the provider who knows, understands and applies all of the skills required for a particular level will be good.
However, the provider who combines that with solid knowledge and understanding of how the law applies will be good and safe.
And the good and safe provider delivers the best patient care.
