You’ve seen the footage – Now what?
Teaching points from the ‘malpractice or murder’ case – Part 1: Action steps for EMS leaders
Two Ill. EMTs were charged with first-degree murder and booked into Sangamon County jail on $1 million bond each after a patient in their care died.
Read the details of the case as they were first reported, watch the bodycam footage, and find expert analysis and ongoing updates in our coverage.
EMS leaders have a fundamental responsibility to work hard to prevent this type of tragedy from happening in their organization. This article contains 14 action steps for EMS leaders from Doug Wolfberg, Esq.; and Steve Wirth, Esq. Send your questions about how to implement these action steps to us at email@example.com.
By Steve Wirth, Esq.; and Doug Wolfberg, Esq.
You’ve watched the bodycam footage and were outraged. What happened to Earl Moore, Jr., in Springfield, Illinois, can only be described with words like “despicable,” “reprehensible,” “disgusting,” “sickening,” – and the list goes on. We have been literally brought into that bedroom and had a front-row seat to this call through the power of technology. We’ve watched the video and shook our heads in near disbelief. And now the key question is this: What are we going to do about it?
As the phrase goes, “Now what?” Let’s make this tragedy a call to action to everyone in EMS – regardless of your role – to take concrete steps now to prevent this type of conduct from happening in our own EMS agencies.
We all agree that Earl Moore Jr.’s death in the care of two EMS providers was senseless. It should have never happened. Most of us will also agree – if we are truly honest with ourselves – that we have seen this type of abusive conduct before –just not quite to this extent. We all have witnessed EMS practitioners who were rude, disrespectful and even abusive to patients who got under their skin. And that could mean that the patient may not have received the level of care, competence and compassion that patients deserve.
EMS leaders have a fundamental responsibility to work hard to prevent this type of tragedy from happening in their organization. Here are 14 action steps for EMS leaders to consider.
1. Talk, talk, and talk about this some more!
Turn this tragedy into positive teaching moments. Do not avoid the conversation about this horrible conduct – engage in the conversation now while its fresh in everyone’s mind. Engage people in candid conversation and talk about it at all levels of your organization.
Complacent and callous behavior can occur not just in the field, but also in the dispatch center, billing office and elsewhere in the organization, so don’t leave out those departments. Leadership teams should discuss system changes that might help root out and prevent disrespectful behavior across the organization.
Leadership (including your medical director) should review the bodycam videos from the Earl Moore tragedy with your EMS practitioners and openly discuss what went wrong and what should have been done differently from the initial approach until Mr. Moore was thrown onto the stretcher and strapped down in a prone position. Let people know how you feel about this despicable conduct and openly discuss ways to prevent it from happening in your organization.
2. Create a culture of respect – before they get here
Your agency’s reputation is a powerful tool in recruitment. Build that reputation of service and the word will get around. People are attracted to an EMS agency with a culture that is friendly, professional, upbeat and supportive – one that visibly shows concern for its patients and that provides support for the people who serve the patients.
EMS professionals want to work for an organization that embraces high quality patient care and a positive workplace. Those who learn of this positive reputation are more likely to want to work for your agency and this can lead to an increase in your pool of applicants.
Read more: 4 easy ways to improve your EMS recruitment efforts. No one wants to join a sinking ship
3. Hire for positive attitude and values first
Work hard to throw a wide net to recruit people who truly embrace helping others. When interviewing potential team members, ask pointed questions that can get to the core of their desire – or lack of desire – to help others. Ask how they would handle situations like this case. Role-play a few actual patient care scenarios and evaluate how they would handle them. Let them meet with your crews and get their feedback on whether they think this person will make a positive contribution to your noble mission of service to others.
We need to hire people who enjoy the calling of EMS and truly want to help others in need, and who understand how important it is to treat all people with empathy, respect and dignity.
Read more: The best employee you never hired. A guide for hiring for longevity and fit as opposed to the best technician/clinician
You’ve seen the footage – Now what?: Part 2
Teaching points from the ‘malpractice or murder’ case: Action steps for EMS practitioners
4. Conduct onboarding that focuses on people skills and core values
Often, staff orientation focuses solely on policies, procedures and clinical care protocols. That’s all well and good, but onboarding that emphasizes the core values of the organization is essential. Focusing on positive communication skills, such as how to approach and interview a patient, how to actively listen, and other fundamental customer service techniques helps instill how important an attitude of service and respect to others is to your agency.
Read more: 10 clinical commandments. Harris County ESD11 Mobile Healthcare developed 10 commandments to set initial expectations while onboarding 200 paramedics
5. Let people know what you expect of them – often
Letting new team members know what is important to your EMS agency and you personally is critically important to set the right tone for new staff members. Andy Lovell, chief of Gloucester County EMS in New Jersey, spends several hours at the beginning of new staff orientation reviewing his list of expectations.
It’s a two-page simple document titled, “Andy’s Expectations,” and No. 1 on that list in bold print is the most important expectation: “Patients and incident responses are not an interruption of our day; they are the reason we exist.”
This clear statement reminds people that everything they do revolves around the patient. Some of Lovell’s other expectations include treating patients with respect and dignity at all times, and bringing our lifesaving equipment to the side of the patient – which did not happen in the Earl Moore tragedy. Sometimes we can stray from the basic fundamentals, so it’s important to remind our people frequently how critically important these basic expectations are to providing the patient with the compassionate and competent care they deserve.
6. Recognize the unconscious biases we all have and conduct training to deal with them
EMS professionals are exposed to people in their worst moments and under very difficult circumstances. Treating intoxicated and impaired patients on a regular basis can cause negative attitudes or stereotypes that affect our understanding, actions and decisions in an unconscious way – including how we treat all our patients. Could that have played a role in what happened to Mr. Moore when the white EMS crew was called in the middle of the night to assist a Black man who is a known alcoholic? It sure could have. Unconscious bias is a major issue in healthcare and is not limited to EMS. We need to teach our people to recognize these biases and conduct training on how to deal with them.
Listen for more: Code 3 Podcast: Unconscious racial bias in EMS. Jamie Kennel and Scott Orr discuss a study that revealed disparate treatment of patients based on race
7. Employ supervisors who don’t look the other way
Far too often, supervisors are tempted to look the other way and ignore the negative behaviors of other team members they observe. It takes time and energy to confront someone who is being disrespectful or discourteous to others. They may ignore the behavior and not deal with it because that is the easy way out, or they may be too busy doing other things.
EMS agencies need to conduct regular training with their leadership teams and front-line supervisors on how to deal with difficult staff members who do not embrace the culture of service that you have established. And they need to free up their time to allow them to get out and watch their teams in action so that they can provide essential feedback to them – both positive and negative.
Read more: Achieving positive discipline without destroying trust. A 3-step guide to disciplinary action that demonstrates good faith, while putting the responsibility for their actions on employees
8. Get out and ride along or just show up
Senior leaders need to get out of the office and ride along. Observe your teams in action and actively listen to their concerns. This shows support and instills accountability when you give face-to-face feedback to them – both positive and negative.
Duty supervisors should show up on all types of calls to observe and assist – not just the vehicle crashes and other heavy duty calls. Watching your team members deal with the intoxicated patient, the drug overdose patient, the mental health patient or the so-called minor calls and repeat callers is also important to see how your teams conduct themselves in those situations that may challenge their communication skills.
Read more: How often do your agency’s supervisors interact with providers? The No. 1 influence on engagement is relationships with direct supervisors
9. Provide stress management and mental wellness support
We must provide more than the traditional employee assistance programs for drug and alcohol problems. Leadership needs to explore and invest in mental health and stress management programs that:
- Are readily accessible
- Are at no cost to the employee
- Preserve anonymity.
These programs can help staff members recognize the issues that can impact behavior and provide techniques and counseling to help them deal with the workplace stress that comes from a variety of sources.
Read more: Make the investment in your people. Tips from Boston EMS for starting a health and wellness program to support member resiliency
10. Make sure crews are well rested
Consider a policy that allows for nap periods or quiet rest while on duty, especially with extended shifts. Very often, fatigue and exhaustion from being overworked and just not having enough sleep will lead to bad behavior. Developing work schedules and overtime policies that don’t work people to death are essential. Give your staff the ability to call themselves out if they feel that they are not mentally or physically able to take a call and have a process for dealing with those situations in a non-punitive way.
Watch for more: Fatigue in EMS. Ongoing research into fatigue and strategies to both prevent and manage it
11. Take steps to improve listening and provide regular constructive feedback
The NAEMT’s “2022 EMS Worker Engagement Survey” revealed that a significant number of EMS practitioners believe that management does not do an effective job of providing clear and consistent communications and does not provide regular constructive feedback on individual performance.
Leadership needs to devote time to listening to team members to hear their concerns, and to communicate what leadership is doing to help them do their jobs more effectively. Good communication and a show of support can help reduce the likelihood of bad behaviors when management is not around. Leadership also needs to ensure that regular and consistent feedback on job performance is provided to team members in a constructive and practical manner – direct and informal feedback is far better than a formal performance review.
Read more: The EMS Workforce: Critical Condition! Matt Zavadsky and Robert Luckritz outline specific suggestions for improving communications and feedback to field staff, such as scheduled listening sessions and implementing structured rounding tools to track leadership interactions with frontline employees
12. Consider implementing body-worn cameras
After the George Floyd murder, police agencies nationwide implemented BWC programs in their departments. The result? Complaints about misconduct of police officers went down precipitously. It’s a simple point about human behavior: people are more likely to behave better when they are being watched.
EMS agencies simply cannot have a supervisor on every call. We rely on our individual teams to conduct themselves in a professional way that supports patients and reflects favorably on the organization – without direct supervision. BWCs can add a degree of accountability that is difficult to achieve in an EMS agency where we are simply not able to provide direct supervision on a regular basis.
BWCs can help instill greater accountability through transparency and can be a great quality improvement tool to critique our performance in a case review setting. Of course, there are privacy and other legal concerns that should be addressed with legal counsel before implementing a BWC program.
Incidentally, the use of BWCs by EMS practitioners does not violate HIPAA. Agencies need only address the handling, retention use and disclosure of video files in a manner similar to other protected health information, such as patient care reports.
Learn more: How to buy body-worn cameras. Download this BWC buying guide to learn key steps for product selection, purchasing and implementation
13. Practice interagency accountability
The Springfield Police Department issued a statement saying this about the Earl Moore, Jr. case: “the officers, who are not emergency medical professionals, are not trained nor equipped to provide the necessary medical treatment or to transport patients in this type of situation” and that the police officers “turned over care of the patient to the licensed, medical professionals at the scene.” This statement smacks of a deflection of blame for Moore’s death. The truth is, medical training isn’t required to look at the video and see bad behavior. Millions of laypeople across the country viewed the footage and immediately came to the same conclusion.
EMS agency leaders should reach out to their local law enforcement partners, and establish an understanding that bad behavior should be called out across departmental lines. Those police bodycams were attached to bodies who failed to intervene when directly witnessing this unconscionable behavior unfolding in real time. This type of interagency accountability doesn’t mean there has to be a police vs. EMS brouhaha unfolding in front of the patient. But imagine how differently this call might have turned out for Moore if a police officer had taken the aggressive and inappropriate EMT aside for a moment and quietly said, “you seem to be having a bad day, you’re being needlessly aggressive toward this man who needs help. Take a deep breath and let’s start over.”
Read more: Law enforcement and EMS: Living the common mission. Public safety agencies must come together equally and with mutual respect to provide the best public service
14. Address bad behavior
Finally, we should never tolerate disrespect – either in interactions with each other, or in interactions with patients and their family. We all need to be moral rebels who don’t sit idly by watching improper conduct that could potentially harm another human being. We can’t be bystanders when we see abusive, negligent, disrespectful or other bad behavior toward another person, especially a patient. Doing so normalizes the bad behavior. And then the perpetrator of the behavior may feel it is OK to engage in it and others will see that as acceptable conduct. It’s not.
EMS leaders need to send a message at all levels that not only is disrespectful or abusive conduct and poor care unacceptable: it is everyone’s responsibility to recognize it and take steps to stop it – for the patient’s sake.
Read more: Doing nothing is not nothing: Learn the skills to stand up and speak out. Breaking a groupthink mentality requires two key skills – and support from leadership
About the authors
Stephen R. Wirth, Esq., EMT-P; and Douglas M. Wolfberg, Esq., EMT, founders of the national EMS law firm Page, Wolfberg & Wirth, are among the most well-known and respected EMS attorneys in the United States. Both served as EMS providers and administrators prior to becoming lawyers. They can be reached at firstname.lastname@example.org and email@example.com.