You are the operations director for Regional EMS, a medium-sized EMS service, enjoying an otherwise unremarkable day when one of your medics comes into the office with a complaint. It seems his partner likes to go shopping while they are on duty. When you question the partner, his response is simple: "We don't have a policy against it." You think about this for a few minutes and realize that, although you lump this particular circumstance into the "common sense" area, your EMS agency doesn't actually have a written policy about it. So, you sit down at your computer and draw up the "Agency Policy" template, pondering all the circumstances you can fix with this simple piece of paper. As you write all the possible outcomes, you wonder, "Will this actually fix the complaint, or am I just responding to a situation in an effort to cover my decision-making process?"
EMS agencies need a variety of written policies to deal with the various operational and administrative issues that will certainly arise in their day-to-day operations. These policies will run the gamut from mutual aid issues to time/attendance, and should encompass events such as needlestick injuries, vehicle accidents and injuries in the line of duty.
Since each EMS agency is somewhat unique, there is no standardized "model" policy. In this article, we will provide suggestions for items we believe EMS services should consider when developing service-specific policies and procedures. In some instances, your service will need to interact with, or obtain guidance from, other agencies and organizations in order to develop the necessary policies. Assistance, information and/or guidance should be sought from your EMS agency medical director, county EMS coordinator, hospital EMS liaison, regional EMS authority, agency attorney, insurance company, and others.
It should be noted that policies, however necessary, are not the end-all of each agency and in no way absolve the manager from actively managing the agency. They should not be used to excuse or dismiss questions, comments or issues from staff requesting clarification of operational rules.
TYPES OF POLICIES
Webster's Dictionary defines a policy as "a definite course or method of action selected from among alternatives and in light of given conditions to guide and determine present and future decisions or a high-level overall plan embracing the general goals and acceptable procedures especially of a governmental body."
So what makes policy? The answer, according to Webster's, is "any action by management that changes or guides a course of action." That being said, some of the more common policy terms used in EMS are: SOG (standard operating guideline), SOP (standard operating procedure), memos, verbal orders, TO (technical orders), OI (operating instructions) and past precedence. Each of these, if implemented globally, is considered policy; therefore, when authoring any of these forms of communication, be extremely alert to the nature and long-term repercussions of their action.
There are two basic types of policy: operational and administrative. Each serves a valuable function to an EMS organization. Administrative policies govern all aspects of how an organization operates "behind the scenes." A policy that requires all levels of personnel to provide a copy of a valid EMT or paramedic certification and a BLS HCP or ACLS card each year would be considered an administrative policy. Additional examples of administrative policies include, but are not limited to: how many hours a week a part-time employee can request, how many hours of continuing medical education (CME) are required to stay current, or how the board of directors is elected and for how long.