Which policies belong (or don't) in the employee handbook?

"That guy" policies are top candidates to remove from your EMS employee manual or student handbook


EMTs and paramedics, as well as students, are subject to policies, which they might know as standard operating guidelines, and clinical care protocols. Additionally, policies for students might be applied by clinical sites, like a hospital or field internship. Policies, ideally, have their origin in applicable state and federal statute, regulations and court rulings.

Policies, when coupled with appropriate training and oversight, are a powerful tool to mitigate risk or harm to an organization and its providers. Unfortunately, some policies have less noble origins.

EMT Trevor Sizemore posted a photo of a deceased patient to Facebook. It wasn't reported if Sizemore, who received a fine, suspension and mandated ethics training, is still employed or if his employer had a policy against posting patient photos to social media.

Policies, when coupled with appropriate training and oversight, are a powerful tool to mitigate risk or harm to an organization and its providers. Unfortunately, some policies have less noble origins. (Photo/Blue Diamond Gallery)
Policies, when coupled with appropriate training and oversight, are a powerful tool to mitigate risk or harm to an organization and its providers. Unfortunately, some policies have less noble origins. (Photo/Blue Diamond Gallery)

Creating a policy, accompanied by employee training and acknowledgement, to ban EMTs and paramedics from posting a dead patient's photo to Facebook is a too narrowly focused policy especially since the policy is likely to endure long past the original offender's employment. Since a policy can't anticipate every potential application it needs to be generalizable to environments, incident types and the different types of field personnel, operations staff, volunteers and students who make up your organization.

EMT student violates patient confidentiality policy

An EMT student I knew rushed out of the trauma bay, rapidly dialing his smartphone, after the emergency physician ended the resuscitation attempt. The student had just done chest compressions for the first time, pressed the shock button on the defibrillator and had been complimented on his performance by a nurse.

Unbeknownst to him, he was standing near the patient’s family as he shared his exciting accomplishments into his phone. As he was retelling the story, a nurse firmly grabbed his elbow, walked him into the ambulance bay and ordered him to leave the hospital immediately.

The student, already struggling to pass EMT class, was expelled. His poor judgment and violation of patient confidentiality policy gave rise to a new program policy – no personal phone calls during a clinical shift. His offenses – which warranted termination without unnecessary policy creation – led to the punishment of generations of EMT students who might need to take a call about a sick child or alert their employer that a clinical shift is going over time.

Criteria for imperfect policies

Many years later, instructors still talk about "that guy" as they explain the no personal calls policy, which is in addition to many other program policies about patient confidentiality and privacy, clinical behavior and other program performance expectations.

A "that guy (or gal)" policy meets all or some of these criteria:

  • Emergence from an isolated incident
  • Triggered by an anonymous complaint
  • Overlap with other department or organization policies
  • Persistence well beyond the person who caused the policy to be developed
  • Specificity to a unique behavior rather than broad application to principles of professionalism and ethics
  • Replacement of a common-sense opportunity with an ironclad rule

No to cats in the station, but yes to dogs

San Francisco paramedics were recently forced to remove a cat from the ambulance deployment facility after an anonymous complaint was filed with the city. Fire department officials said in a statement that "public health and safety concerns" were the top reason to evict Edna.

Administrative actions, based on policies or creation of a new policy, because of an anonymous complaint, rarely improve morale or respect for authority. The best policies come from consensus decision-making between labor and management, analysis of the policy’s risks and benefits, and learning from the success of other organizations.

As paramedics search for a new home for the station's adopted cat, an EMS agency in New York is announcing their new K-9 therapy dog. Marley, a mixed breed rescue, recently completed an eight-week training course through Therapy Dogs International (TDI) to become a therapy dog for the members of CHS Mobile Integrated Health Care. Ideally Marley's adoption was accompanied by updates to an existing employee wellbeing policy and includes deploying the newest member of the team, continuing education and ongoing care, as well as eventual replacement of Marley or additions to the team. 

Update the EMS policy manual

EMS policy manuals or handbooks only seem to get longer and more specific. When was the last time your organization removed a policy from the employee manual?

Because EMS personnel continue to violate patient privacy and social media policies, reviewing and updating those policies should be high on the list. Also review the initial and ongoing training associated with those policies. Find and fix gaps that put your agency at financial and reputation risk.

Next, look for "that guy (or gal)" policies in your manual. If the policy has lived beyond the employee that caused the policy to be written and you haven’t had the same infraction since, remove the policy.

Or at least ask the questions:

  • Why does this policy exist?
  • Does this policy address a known risk to our organization or personnel?
  • Does another policy cover this same issue or topic?  

What are some of the "that guy" policies in your organization’s policy manual?

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