What is accountability? Although I think we all sort of know what it means, it's a hard concept to put into words. Take a moment and think about how you would define it. To one source, accountability means "an obligation or willingness to accept responsibility or to account for one's actions."1 Another definition is "the obligation to bear the consequences for failure to perform as expected."2
According to Dr. Herbert Swick, who has been guiding our discussion of professionalism, "Physicians exercise accountability for themselves and for their colleagues."3 He goes on to say that accountability is related to members of a profession setting and enforcing standards of practice for their field. Society has granted the practice of medicine the privilege of autonomy; accountability is the key to that autonomy.
Although we as EMS practitioners are not fully autonomous--we practice under the auspices of a physician's license--we are most often assessing and treating patients without direct supervision. Sometimes we make contact with a medical command physician, but in many places, in many systems, there is little or no need for online medical control. In those circumstances we follow protocols or standing orders. These are part of our standards of practice. If we aspire to practice professionally, we should endeavor to hold ourselves and our colleagues accountable to our standards of practice.
What are the other components of our standards of practice? There is the National Scope of Practice, which is part of the ongoing initiative to implement the EMS Education Agenda for the Future. There is likely enabling legislation in your state or commonwealth that describes the limits of EMS practice there. In my commonwealth, Pennsylvania, the current scope of practice is defined by legislation. This legislation will soon be replaced by new legislation, Act 37, and there are rules and regulations that will follow. Additionally, we have protocols. These detail the expected course of action for EMS practitioners related to various patient complaints and assessment findings. Most of these standards concern clinical aspects of our work.
Do we have other standards of practice? As we discussed in an earlier article, the National Association of EMTs has an EMT Oath and Code of Ethics on its website (www.naemt.org). How many of us swore the oath or know the ethical code? What do they mean to us as practitioners? To help us understand, let's look at some hypothetical cases.
You are on your sixth call of the day. A middle-aged man called because he was feeling short of breath. You've placed nasal cannula and completed your assessment. When you ask the patient about his medications, he says he can't remember the names of all of them, but they are organized on the dresser on the other side of the room. Your partner goes over to check, and you see him writing them down. He tells you, "He's taking Lasix, Theo-Dur, prednisone, some pressure meds and some other stuff. I'm making a list." As you prepare to establish IV access, you glance over and think you see your partner put something in his pocket. You think nothing of it at the time. You transport the patient and go on with the day.
Later, back at the station at the end of the shift, you see your partner talking with one of the oncoming crew. He reaches into his pocket and takes out a pill bottle. He opens it and dumps some pills into the hand of the guy he's talking with. They laugh, fist bump and head out to the parking lot. Seeing this makes you think. Your partner has been out sick a lot lately. He has been moody, and sometimes he is rude and impatient on calls and around the station. He seems to be tired all the time. "What," you ask yourself, "is going on?"
What can you do? What should you do? What would you do? This is a complex and disturbing situation.