PHOENIX — “The world will not be destroyed by those who do evil, but by those who watch them without doing anything.” — Albert Einstein
In a Pinnacle EMS leadership conference session, Monte Chambers and Abigail Tucker, PsyD, offered a wake-up call and a solution to complacency grounded in science: active bystandership.
Chambers, a public safety consultant with Monumental Access LLC; and Tucker, a licensed psychologist and cofounder of Heroes Active Bystandership Training, called on attendees to recognize the role we each play in keeping our colleagues accountable.
| Get your copy: What paramedics want in 2025 — From chronic burnout and staffing gaps to a lack of meaningful leadership engagement, personnel are sounding the alarm — and offering a roadmap for change
Memorable quotes
- “I truly believe most individuals in this line of work want to do good.”
- “When we take a moment to reflect on our own experiences, we’re more likely to take that forward into new learning.”
- “Our society likes to spend a lot of time focusing on what’s not working … we’re missing the opportunity to look at every one of these examples to look for the missed opportunity to intervene.”
- “‘Is this the norm here’ is code for that’s not right but I don’t know if I’m allowed to say anything here.”
Following are top takeaways from their discussion.
Silence harms
In EMS, where burnout, trauma and human error intersect, silence can be deadly. Chambers offered a compelling example centered on “George,” a 15-year veteran paramedic suffering from burnout. Known for his reliability, George had become physically and emotionally exhausted. On a shift with a new EMT, George bypassed a full assessment for a frequent patient, joking dismissively and facilitating a refusal.
Before they even arrived back at the station, the patient coded. When EMS returned, it was too late. The cause wasn’t incompetence — it was unspoken burnout, compounded by silence from a newer provider who noticed, but didn’t intervene.
The damage extended beyond the fatal outcome:
- The EMT questioned the profession’s standards.
- Leadership missed warning signs.
- A culture of looking away enabled the failure.
Dr. Tucker asked attendees to think of a time they noticed a colleague slipping, and consider the following:
- What was the harm that occurred?
- Do you still think about it today?
- Are there other people who witnessed that deterioration, mistakes, harm?
- What would the news headlines read?
Why EMS needs active bystandership
Active bystandership — developed from the research of Dr. Ervin Staub — empowers individuals to act when they see potential risk or harm.
“A bystander is a witness who knows action is needed and is in a position to take that action,” Dr. Tucker said. “There is no neutral.”
Active bystandership trains individuals to recognize when something’s wrong and gives them the skills and confidence to intervene.
Chambers added, “Training is a pathway to culture shift. It’s not blind loyalty — it’s calling things out to protect each other.”
Barriers to action
Several psychological forces keep EMS providers from stepping in:
- Diffusion of responsibility. “Someone else will do it.”
- Pluralistic ignorance. “If no one else is reacting, maybe I’m wrong.”
- Hierarchy and role confusion. “That’s above my pay grade.”
Cultural idioms, like “Not in my job description,” “It is what it is” and “I just work here” erode accountability and reinforce silence, particularly around shift change when fatigue is high and refusals spike.
5 principles for EMS leaders
Dr. Tucker outlined five actionable points to build a harm prevention culture:
- Active bystandership is a learnable skill. It should be taught and practiced like any other clinical skill.
- There is no neutral. Inaction is a form of permission.
- Choose the right tool for the situation. Like varying BVM mask sizes, no one intervention fits all.
- Effective training changes culture. Peer-driven, in-person training — especially across disciplines — is critical.
- A healthier workforce makes fewer mistakes. Invest in health and wellness — and make sure resources are actually used.
Bottom line
When EMS professionals fail to intervene — whether out of deference, fear or burnout — harm often follows. But the tide can turn. With proper training and leadership modeling, a culture of active bystandership can protect providers and the communities they serve.
As Dr. Tucker put it: “We spend so much time focusing on what’s not working, we miss the opportunity to ask — what could I have done differently?”
Don’t just rely on policy. Lead by example. Empower your workforce to speak up, step in and support each other.
EMS1 is using generative AI to create some content that is edited and fact-checked by our editors.
