Burn the fake EMS policy manual

The unwritten rules of an EMS agency don't get written down because they are stupid — and no one is willing to take credit


My fire to burn the fake EMS policy manual started with a Facebook comment. Sean observed that crews from a particular ambulance service typically cleared the hospital quickly without socializing with crews from other services. Someone else commented that they had a policy to not socialize with personnel from competing ambulance services.

Then another medic cracked open the fake policy manual. You know the one with all the unwritten policies in it? "I worked for a smaller company once that had the same policy," he explained. It seemed that many of us had operated under a nonpolicy of nonsocialization.

I asked if anyone could actually produce a written policy that prohibited intercompany socialization. Of course, nobody could. But the conversation then turned to unwritten policies and whether they should be adhered to or ignored.

Imaginary EMS policies
What imaginary policies have I followed during my career? Had I ever promoted any fake policies? With all of the unwritten policies I’ve heard in my career, surely I must have fallen for or even created a couple along the way.

My ambulance employer in California had a well-known nonpolicy that we should not run the siren within three blocks of headquarters. The owner apparently had a long-standing rule that sirens were disruptive to operations and should be minimized or eliminated during business hours. I heard this rule repeated a dozen times or more during my tenure.

Only now does it occur to me that I never actually heard that rule stated by a manager. We often lamented the hypocrisy of the rule and it’s entirely possible it was invented to make the management team look petty. Once an unwritten rule takes on a life of its own it’s impossible to say where it started.

My own fake policy addition to the fake manual
And then it occurred to me that I may have written in the fake policy manual once or twice. As a young paramedic, I allowed a worried mother to ride in the back of the rig with her croupy child. Convinced that her child was undermedicated, she took it upon herself to administer several over-the-counter cough syrups to the child against my protests. Once the ride was over I vowed to never let another worried mommy ride in the back of my rig. (An unfortunate and misguided policy that I kept for over a decade.)

Interestingly, once I had decided on my no-mommy policy, I wrote it in the fake policy manual and relentlessly dodged accountability. Over the years, I told countless worried moms, "I’m sorry, I’ll need you to ride up front. It’s company policy." With a shoulder shrug, I’d repeat the fake policy like gospel.

Now that I’ve recognized that my own fake policy was ridiculous and unnecessary I have to wonder if it lives on in paramedics that I influenced over the years. It’s tough to erase a policy that was never really written down in the first place.

Fake policies are stupid
And what happens when the unwritten policies become downright dangerous? On our Facebook comment stream, EMS1 columnist Kelly Grayson offered the example of an unwritten policy at a former employer that all gunshot wound victims were required to be in full c-spine stabilization. This policy apparently included a first-offense termination clause, though on later examination, even the medical director was oblivious to its existence.

You might be recognizing something that all of these unwritten policies have in common. They’re all stupid. Trying not to use our sirens in a busy downtown area is stupid. So is trying to limit social interactions between personnel from different organizations. Not letting worried moms in the back of my rig was pretty dumb too. (Now I make them part of my team.) Immobilizing a gunshot victim is, in most cases, clinically dumb.

It makes me think of my old friend Thom Dick’s first rule of EMS. Don’t do anything that you know is stupid. Especially if the person who told you to do it was stupid. It sounds like Thom had come across a lot of unwritten policies.

If a policy is good, someone probably would have written it down by now and three other people would be taking credit for its brilliance.

Unwritten policies live on in unwritten form for the same reason. They’re dumb.

Burn the fake policy manual
Throw your unwritten, fake policy manual into a fake fire. Include the policy that you can’t transport to St. Downtown hospital during rush hour and the one that says that EMTs aren’t allowed to auscultate lung sounds.

Add on the policy that you can’t be back in service until the cot has been made (unless it sounds like a really good call) and the policy that anyone turning in an application to another service will be terminated. Throw in your rule that 18-gauge catheters always belong in the bin on the far right. Nobody ever believed that one anyway. And the policy that you can smoke outside the rig behind the grocery store, but never in front. (And then throw those cancer sticks on the fire too.)

The flames should be looking pretty bright by now. When the flames subside and the fake ashes have cooled, let’s all take a pledge to recognize the difference between our rumors, habits and personal preferences and the written words of the policy manual. They are not the same thing.

Be willing to say, "It’s my preference that we not do this." Or, "There is a rumor that people who apply to so-and-so company get fired."

Don’t ever be afraid to ask, "Is this a written policy that I could review?" If anyone tells you that they have an unwritten policy you can interpret that as meaning, "We have this thing that we all do, but it’s way too stupid to actually write down." And act accordingly.

If you feel bold enough, you can even tell them that you burned your fake policy manual a long time ago. 

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