Professional Development: Part 4--The Social Contract

As EMS practitioners, we act in response to society’s needs and in acknowledgment of a contract with our communities

   EMS needs good leaders and managers. What can you do to become one? This is the latest installment of EMS Magazine's Professional Development series, a comprehensive curriculum for forward-thinking EMS providers wishing to improve their leadership and management skills, increase their authority and responsibility within their organizations, and change their field for the better. We welcome your comments on this series and invite ideas for future content. E-mail

   When our tones drop, when the BlackBerry buzzes, when the PA announces an address, why do we go? On our way to incidents, we are allowed, after ensuring all have yielded, to proceed through red signals. Why? When we arrive on location, someone there expects us to do something. How come? Because all of those things are part of our "contract" with the communities we serve.

   Last month we discussed morals and ethics. One aspect of the EMS Code of Ethics is acknowledging an obligation to society. Dr. Herbert Swick, whose work on medical professionalism guides this series, addresses this obligation directly with the fourth of his defined professional behaviors. Swick says, "Physicians respond to societal needs, and their behaviors reflect a social contract with the community served."1 He goes on to say that any profession best meets its obligations when it pays attention to duty and actively strives to address community and societal needs. As EMS practitioners, we also act in response to society's needs and in acknowledgement of a contract with our communities.

   This can be a difficult set of concepts and behaviors to grasp. As EMS practitioners, the easiest way to get a handle on the idea of responding to society's needs is to examine what we do every day: respond to requests for help. But there is more to the concept of responding to society's needs than just jumping into the ambulance and driving.

   The first thing we can do is assess our communities. Who needs help? What can we do to provide assistance? It is clear that we provide a service that assists people who have experienced "emergencies." Their emergencies may be related to acute or chronic medical problems, or to injuries suffered in traumatic events. Or, an "emergency" might be a request for some sort of assistance completely unrelated to medical problems or trauma. We also provide a medical "safety net" for those who have limited access to other healthcare. Sometimes we meet needs that are less medical than social. When someone needs help and has nowhere else to turn, very often that person will call 9-1-1.

   What are some of the other needs we can meet in our communities? Does society need to reduce deaths from sudden cardiac arrest, or the number of people injured and the cost to treat them? What can we do to meet these needs? Perhaps we can provide CPR training or injury-prevention programs such as car seat installations, bicycle helmet and safe-rider programs, seat belt education for grade-school children, pool safety for middle-school students, anti-drunk driving education for high-school students and adults, and "trip and slip" prevention for the elderly. We could also deliver flu and other vaccines (this is happening now in Philadelphia in response to H1N1). The list can be as long as we choose to make it. Benjamin Franklin recognized the value of prevention more than 200 years ago when he said an ounce of it is worth a pound of cure. The fire service has done a fantastic job in reducing fire-related deaths and costs related to fires. Perhaps EMS should do likewise. I'm certain some of us already are. Are there other ways we, as EMS practitioners, can respond to society's needs and more fully fulfill our obligation--our contract?

The Terms of Our Deal

   What is our contract with our community? Legal scholar Sir John William Salmond says a contract is an "agreement creating and defining the obligations between two or more parties."2 The 'Lectric Law Library begins its definition with the following:

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