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The legal truth about the ‘higher standard’

Standards apply every day, all the time, on or off the job

And it is written, and it is said: “EMS Providers shall be held to a higher standard.”

EMS providers are held to a higher standard... blah, blah, blah.

Over the years, it seems as though that has become more cliché than anything else, so over-used and under-enforced that is has pretty much lost any meaning in the real world.

If you don’t believe me, look around.

While I am sure that your patients receive nothing but the best possible care, what about your coworkers? Does each of them consistently deliver the highest level of care — the level of care expected by the industry and required by the law? If not, what’s the consequence?

While we’re at it, I’m also sure that you consistently provide an exceptional level of service. Do your coworkers? If not, what’s the consequence?

Of course, your uniform is always pressed and sharp; your rig is always clean and stocked; and you never cut corners. What about the others on your job? Can the same be said about them? If not, what’s the consequence?

If your answer is that nobody on your job delivers less than the best care and service; that everyone looks and acts sharp; that nobody cuts corners, here is your reality check: It’s you. You are the substandard provider who provides less than the best service and looks like a slob.


The fact that the notion of EMS providers being held to a higher standard has been so critically diluted is, I believe, due in large part to how fast EMS has grown over the past 30 or so years.

I think that, as is true in so many other aspects of EMS, the industry, the technology, and the scope of practice have grown much faster than the ability of the individual provider to adapt. In other words, EMS is filled with old dogs forced to constantly learn new tricks and new dogs who believe that the new way is the only way.

At the same time, it seems that there are always new spins on old tricks to learn. It never ends, and the result is this: The “higher standard” has become subjective rather than objective, and different providers get held to different standards — as in golf, EMS providers are now afforded handicaps.

Likewise, it seems that society’s expectations have grown much faster than the field provider’s ability to adapt. For that, I blame the lawyers.

Lawyers and gold-digging plaintiffs have taken over the role of societal watchdog. Now more than ever, lawyers are responsible for how the “community feels” about a given thing. Plaintiff’s lawyers have become highly adept at translating simple, reasonable, understandable mistakes into career-ending, multi-million-dollar payouts for undeserving clients. Truth be told, my disdain for so many lawyers is one of the reasons I became one: They want to fight? I will give them a fight! They want to hurt my (EMS) people? They have to get through me first!

Nevertheless, the world is what it has become, and we must all live in it. For EMS providers, that means the “Higher Standard” may be something of a moving target, so allow me to help.

What is the ‘higher standard’?

Every jurisdiction communicates the standards in its own way, but every jurisdiction has established them, and they are all – I am guessing – pretty much the same, because in every jurisdiction, the law looks at the “higher standard” in the most simplistic terms:

  1. EMS providers shall know all current protocols, procedures, and policies; without exception or exemption, and without uncertainty.
  2. EMS providers shall perform in strict and unwavering adherence to the appropriate protocols, procedures, and policies; based on objective findings gathered from only thorough assessments; without fail and without unreasonable error.
  3. EMS providers shall earn and maintain the public trust; shall not violate the public trust; shall not undermine the public trust; shall not betray the public trust.
  4. EMS providers, on the job and off, shall represent the best of the community in deed and in spirit.

If you read your jurisdiction’s standards governing EMS and EMS providers, I am confident you will see essentially the same thing, either expressly or inferentially.

What does ‘higher standard’ mean?

It means that you represent the best of what society is supposed to be: the thin slice of humanity that is willing to care for and care about the whole of the community without any external bias, prejudice, or concern.

Let’s face it, nobody outside EMS thinks that, much less lives it. Actually, I cannot think of one example throughout history of any other group that fits that description. Only in EMS has it ever been true. But how true is it anymore?

Why does the world hold EMS to such a high standard?

Because you told it to!

When you accepted the certificate or license, when you donned the uniform, when you put yourself in the position to answer the call for help, you told the world: “I will be there!” “I will be the best!” “You can depend on me for all the safety and comfort I can provide!” “You can trust that I will be what you need when you need it!” “On the job or off, I will lead a life of which you can be proud!”

You may not have known it, but those are the promises you made, and that is why you are held to such a standard.

If you are still not convinced, not to worry. Those are the standards to which the law holds you, and you will see when violation brings serious consequences.

The standard applies 24/7/365

Almost by the minute, posts updates and breaking news stories from across the spectrum of EMS. Sadly, many of the stories involve providers who find themselves in serious trouble for things they allegedly did on the job.

Alleged theft; alleged sexual assault; alleged acts of gross negligence; alleged substance abuse on the job: each of these – in every jurisdiction I know of – is sufficient to revoke the provider’s license or certificate and result in termination. If proven true and in apposite context, revocation and termination may be appropriate as established by the local laws that govern on-the-job conduct.

On the other hand, in many jurisdictions, certainly here in California, the agency responsible for the administration of EMS has established rules and regulations for provider conduct away from work.

DUI, drunk in public, domestic violence, drug possession or use, theft, weapons charges, and pretty much all other criminal conduct allegations – regardless of conviction – can result in the probation, suspension, or revocation of an EMS certificate or license.

Moreover, many jurisdictions, just like California, aggressively investigate and pursue allegations of non-work-related misconduct because the “higher standard” to which providers are held exists 24/7/365.

The law between the lines

I think most providers understand that their role in EMS carries a long list of requirements related to personal conduct and, by and large, most providers are equal to the tasks.

However, my experience has been that far too many providers do not recognize that “the higher standard” is not limited to personal conduct; in reality (and under the law) each provider of EMS is as responsible for the conduct of their coworkers as they are for themselves.

Hypothetically speaking, of course:

Your skills and performance are above reproach, but your partner (or other known crewmember) is a knucklehead who doesn’t know the difference between MI and IM, and you say and do nothing about it.

If you know about it and fail to act, that crewmember’s incompetence can be used to discipline, suspend, or revoke your certificate or license. Take a minute to let that sink in.


When you say yes to the certificate or license; when you say yes to the job; when you say yes to the responsibility, you are saying yes to all of it. If you are truly prepared to accept and execute the responsibilities, then I wish you Godspeed.

However, if there is any part of the “higher standard” to which you are not willing or not able to be held, then it’s time to go and leave EMS to the committed.

Toughest of all, where you see a failure to adhere to that “higher standard,” you must summon the courage to act, lest your silence cost you your job ... or a life. columnist David Givot, a seasoned EMS employee with three years of law school under his belt, is looking to the future of EMS. He has created as a first step toward improving the state of EMS through information and education designed to protect EMS professionals nationwide.