EMS practitioners, people like you and me, have chosen this line of work. With this choice comes significant responsibility to the people we serve. One aspect of that responsibility is to behave in ways that reflect core humanistic values. You might ask, "What do values have to do with professional behavior?" As we will see, they have everything to do with it.
We deal every day with people experiencing things they cannot cope with on their own. Sometimes we are challenged by thoughts that their calls are nonsense, or not a "real" emergency. Sometimes we go so far as to judge people "system abusers."
I've been in EMS since 1980. I've worked in a volunteer third-service ALS transport ambulance corps that served one of the wealthiest townships in America. I've worked in a hospital-based ALS transport system and an ALS quick-response vehicle supported by a volunteer transport ambulance service. And I've worked in a large metropolitan fire-based ALS transport system. Some things remained the same over that time: About 70% of calls actually generate a patient. About 20%-25% of those patients get some form of ALS care, from simple ECG monitoring and a KVO line to full-blown cardiac arrest care. Another thing that hasn't changed, and I suspect never will, is responding to calls from folks who are not at risk for loss of life, limb or function. Clearly, some people call 9-1-1 who are not suffering from acute medical problems or serious injuries.
It is our responsibility to respond, render care and serve the needs of everyone who calls. True system abuse is rare. But how do we continue to respond when demand is high and resources are limited? How do we continue to do the job people expect us to perform? It is a choice we have to make for ourselves. One place we can turn to help us continue is to examine our values.
Our core values provide a foundation for our actions. They must be central to our practice if we are to be effective in addressing the needs of our patients, their families and all the people we come into contact with. In his 2000 article "Toward a Normative Definition of Medical Professionalism," Dr. Herbert Swick said, "Physicians evince core humanistic values, including honesty and integrity, caring and compassion, altruism and empathy, respect for others, and trustworthiness."1 We can expect similar values from EMS practitioners. Let's look at Swick's statement, break it down and determine how we can apply its ideas to our practice in EMS.
To evince means to demonstrate or show clearly. We must clearly demonstrate our values in our actions. Core means central, and humanistic has to do with concern for the interests and welfare of humans. Values are those ideas, concepts or principles we believe are important. They are a collection of guiding, usually positive, principles-what one deems to be correct and desirable in life, especially regarding personal conduct.2 Core values are a small set of key concepts and ideals that guide a person's life and help them make important decisions.3 They help give us purpose and confidence, and make it easier for us to make good choices.
Honesty and Integrity
What do the words honesty and integrity actually mean? Take a moment to think about it. How do they apply to our practice? Honesty is about being truthful and sincere. Is this important to our practice of EMS?
We must be honest with our patients and their families. We must be honest with our partners, coworkers and all the healthcare team. We must be honest in reporting our assessment and interview findings. We must be truthful in our documentation. Do we always document that we established IV access on the third attempt? Do we always take at least two sets of vital signs, or did the second set just match up really well with what the triage nurse documented? Behaving honestly supports our credibility as EMS practitioners and professionals.