Why We Fight
Fostering and maintaining good working relationships with other public-safety agencies is vital to the service we provide.
Fostering and maintaining good working relationships with other public-safety agencies is vital to the service we provide. Can you imagine treating a vehicle trauma victim alongside the freeway if the police weren't willing to control traffic? How about taking that 400-pound patient down that five-story walkup without the help of a fire department rescue unit? Agencies must be able to work together in these situations. But when we work in close proximity with other agencies, conflicts can arise for a variety of reasons. Some can lead to horribly damaged relationships that take years to repair. If we step back and examine potential problem areas from the view of each provider, we might be able to avoid them.
What Causes Conflict?
While scholars have identified many complex reasons behind conflicts, the primary causes in public safety can be narrowed down to:
- Failures in communication;
- Personality conflicts;
- Lack of cooperation; and
- Misunderstandings of authority and job responsibilities.
Personality conflicts can arise for countless reasons, often unknown, and are often one of the most difficult kinds of conflict to work through. Sometimes there are people we just don't interact well with, and we're not sure why. Failures in communication and misunderstandings of authority and job responsibility are common sources of trouble, but these types of conflicts can often be overcome by reviewing the responsibilities we all have as public-safety providers and the specific responsibilities of each agency and individual.
Here are six common areas where conflict can arise between public-safety agencies:
- Shutting down roads following vehicle accidents and blocking them for long periods of time with fire trucks or ambulances;
- Conflicts over field DUI blood draws;
- Law enforcement response to unsafe scenes;
- Driving habits of volunteer members in private vehicles;
- Control of evidence during fire or EMS incidents;
- Conflicts between fire and EMS agencies.
Accident scenes
Accident scenes are frequently an area of friction between police and fire/EMS. Activities such as extrication and fire control can put medical providers in the path of passing vehicles. If patients' vehicles are in lanes, personnel can find themselves in the middle of busy freeways. In such situations, medical personnel frequently ask police to shut down traffic. Most officers have no problem doing this, and will do it as long as necessary. At times, however, police have either refused to shut down traffic or allowed it to move again while personnel were still in the danger zone, resulting in close calls.
Fire trucks and ambulances strategically placed to protect personnel have also caused conflicts with police, who may want them moved before personnel are ready. In one well-publicized event in 2003, a Hazelwood, MO, police officer arrested a fire captain at the scene of an accident when the captain refused to move an engine to open a lane of traffic.
There should be no excuse for a breakdown in communication that causes a police officer to allow stopped traffic to move again without notifying on-scene medical and fire personnel. No paramedic or EMT should have to worry about being run over while trying to backboard a patient on the double yellow line. With that said, many of us in EMS don't stop to think about the ramifications of stopping multilane freeway traffic or busy highways. Stopped traffic can quickly back up for miles, which can take hours to alleviate after we leave. Frustrated drivers quickly take to side streets and neighborhoods with playing children that aren't used to such traffic. Distracted drivers can cause additional accidents that further tax medical resources and stall thoroughfares. Road rage can cause drivers to do things that endanger everyone.
EMS personnel should not hesitate to ask for roadways to be blocked for their safety. Once patients and crew are off the road and safely in the ambulance, however, remember to quickly notify law enforcement so they can get traffic moving again. Don't stand around on scene and congratulate each other on a job well done; get things replaced and stowed as quickly and safely as possible and get out of the way. There's plenty of time to talk back at the station.
DUI Blood Draws
Some prehospital providers are obliged to draw blood at the request of law enforcement. This can create a volatile situation. EMS' immediate concern may be establishing an airway on a trauma victim, while officers at the scene are primarily concerned about establishing evidence of DUI. This can become even more problematic when the patient you're trying to save is the DUI suspect.
Where patient condition, local protocols and state laws allow, EMS should be willing to help law enforcement with their job responsibilities as much as possible. If the patient you're treating is suspected of DUI and just critically injured a family of four, common sense and a mutual goal to protect the public should dictate that you spend a few extra minutes drawing that blood sample if it will help police make their case (assuming, of course, that the patient has minor injuries). If the patient is suffering from life-threatening injuries and you believe transport cannot be delayed, relay this information to the police and transport immediately. It is unlikely that an officer would actually try to arrest or restrain you at the scene. But be prepared to defend yourself with evidence of the patient's condition should the officer decide to continue the discussion at the ED. If the situation escalates, supervisors on both sides should be consulted.
Police Response to Unsafe Scenes
In the past, it wasn't unusual for EMS to charge into potentially violent scenes whether police had declared them safe or not. I remember, as a paramedic student, watching my preceptor deftly knock the knife from a patient's hand when the reportedly suicidal woman tried to attack our crew. Those days are long gone. EMS providers are now taught to stage a safe distance away whenever a scene is potentially unsafe. For most agencies this has come to include almost all domestic violence cases, assaults, and threatened or attempted suicides. But some EMS providers have reported slow response times or complaints from police when they're requested to secure a scene. One medic I spoke to reported being asked, "Come on, you guys aren't afraid of a little old lady who overdosed on pills, are you?"
This is a situation where there's no reason law enforcement should not respond, regardless of the reported circumstances. If your agency's policies dictate that you stage at all unsecured, potentially violent scenes, then you stage. If your local law enforcement resists this, it may be time to ask your superior officer to open a dialogue with its administration.
Volunteer Driving
In researching this article, I asked several law enforcement officers from around the country their most frequent complaints about fire and EMS personnel. Hands down, their primary concern was the driving practices of fire and EMS personnel en route to emergency calls. Their complaints focused on volunteers responding in personal vehicles. All EMS and fire responders should make sure they respond in a safe manner. Traffic accidents going to and from incidents are a big killer of people in our profession. Not only is your personal vehicle not as visible as a fire truck or ambulance, but in most states responders in private vehicles are not afforded any special exclusion from traffic laws. You're not doing the patient any good by getting in an accident on the way to a scene. Manslaughter charges have been filed against firefighters and EMS personnel who caused deaths while responding to calls in a reckless manner.
Protecting Evidence
Police officers sometimes jokingly refer to fire and EMS crews as evidence-eradication teams. Evidence is vital for turning arrests into convictions, yet it's one of the last things many in EMS or fire think about before cutting open the clothes of a trauma victim or tearing into the driver's door of a wrecked vehicle with extrication tools. A medical provider should never alter the treatment of a critical patient because they're concerned about disturbing evidence, but try to keep evidence preservation in mind at all times (see EMS Evidence-Preservation Tips, below).
EMS/Fire Conflicts
Conflicts between fire and EMS are ever-present in areas where the two operate as separate agencies or where EMS has recently been acquired by the fire department. EMS Magazine has detailed many of these challenges in the past. Whether it's the fire department crew that doesn't like assisting the ambulance or the paramedics who don't like being treated as second-class citizens by firefighters, many conflicts can easily be rectified by following some of the suggestions below.
Conflict Resolution Tips
Sometimes you follow all the tips and go out of your way not to step on toes, and find you've still somehow made an enemy in a neighboring agency. How do you proceed? Ignoring the conflict is not the best choice, because issues can frequently spin out of control. Entire courses are taught on conflict resolution. An excellent resource is the Conflict Resolution Network, found online at www.crnhq.org. Following are some of the steps they recommend for resolving conflicts:
- Take a win-win approach--Not all disagreements have to have a winner and a loser. Try not to think of conflict as adversarial, but approach it from the viewpoint of cooperation. Put yourself in the other person's shoes. Try to arrive at a compromise that benefits the common good rather than just giving you what you want.
- Have a creative response--It's important to acknowledge the other person's concern. This doesn't mean you have to agree with them. It's imperative that you actively listen and not be defensive. If you're not familiar with active listening, research it on the Internet. Once you've heard the other side, be ready to offer a solution that can remedy the conflict for both parties.
- Empathy--Empathy is simply helping the other person feel like they're being understood. It's one of the most important aspects of communication and conflict resolution.
- Be assertive when appropriate--Nobody said you have to get pushed around. When appropriate, don't be afraid to clearly state your position and why you feel it's important. If you're concerned that you were brushed by the mirror of a passing car because police opened the road back up before you were ready, tell them clearly why you feel this is unacceptable.
- Reframe resistance--No matter how professionally you approach a conflict, you may encounter a response that escalates the problem. Hold your temper and reframe negative statements in a way to promote further discussion. Doing this not only defuses anger, but also helps maintain open lines of communication. Responding to negativity with negativity of your own closes off further negotiation.
- Manage emotions--While it can be difficult, keep your emotions in check and don't respond to emotional outbursts or inflammatory comments. Nothing stops the communication process quicker than allowing emotions into a conflict.
- Design options--Work with the other party to explore options desirable to both of you. One of the first things to do is a little goal setting. What is the outcome both parties want? In the case of accident scenes and traffic management, recognize that police want to get traffic moving as quickly and safely as possible. In EMS, you obviously want an accident scene you feel is safe for you, your colleagues and your patient. Is there an obvious answer to which everyone can agree? Work on building a solution together.
- Negotiation skills--There are five basic negotiating skills to keep in mind:
- Attack the problem, not the person.
- Focus on what you both need.
- Always emphasize common ground.
- Suggest creative options.
- Make clear and concise agreements.
- Third-party mediation--There are occasionally conflicts that cannot be resolved without involving an outside party. If you are a supervisor, you may be called upon to mediate a conflict between one of your employees and another person. Mediation training is an invaluable resource for supervisors in such positions. Some important things to keep in mind in any mediation setting:
- Be objective.
- Be supportive.
- Don't judge.
- Steer the process, not the content.
- Always think win-win.
- Broaden your perspective--Conflicts aren't always solved overnight. Recognize that resolving some conflicts can take significant time and effort.
Conclusion
Fortunately, conflict between public-safety agencies is not the norm. Problems can be few and far between, but when they manifest, they can easily lead to long-term breakdowns between agencies. In the face of these occasional conflicts, it helps to understand where our counterparts are coming from and to have the skills and tact to remedy the situation.
Dominick J. Swinhart, BSHS, EMT-P, is chief of the Watertown, SD, Fire Department and works as a fire service and EMS consultant. Involved in the fire service since 1989, he is a graduate of George Washington University's EMS Management program.
EMS Evidence-Preservation Tips
To maintain good relationships and help law enforcement do its job, remember the following evidence-preservation tips:
- When possible, avoid cutting through bullet or knife holes when removing clothing.
- At scenes where critical evidence may be collected, limit the number of personnel to the minimum necessary.
- Refrain from moving furniture or patients' personal items unless it's necessary for access or treatment.
- Always make a mental note of whether you found a door locked or unlocked, and what, if anything, you did to force entry.
- When possible, give law enforcement a few seconds to snap critical photographs before entering or disturbing a scene.
Conflict Resolution in Practice: The Oklahoma State Trooper Video
How could better conflict resolution skills have changed the well-publicized recent confrontation between an Oklahoma state trooper and a Creek Nation EMS unit? The trooper felt the ambulance didn't yield as he answered an emergency call, and also claimed the driver used an obscene gesture. The EMT he choked claimed the out-of-control trooper delayed their transport and committed a felonious assault.
After reviewing the trooper's dash-cam video, I believe the trooper acted inappropriately and has some serious anger-management issues. At the same time, there were some steps the ambulance crew could have taken to try to defuse the situation until they reached the hospital. In the video, paramedic Maurice White leaves the patient in the back to confront the trooper. The driver, EMT-B Paul Franks, also gets out of the vehicle. At this point it's not clear who, if anyone, is remaining with the patient. What follows is a lengthy argument culminating with the trooper putting his hands around White's neck and threatening him with arrest.
In this case, the simplest way to defuse the situation would have been for the driver to apologize if the trooper felt the ambulance didn't yield or if an obscene gesture was used (but certainly deny it if it wasn't). In his statement on the incident, White said he told the trooper, Daniel Martin, that they were transporting a patient and could continue their discussion at the hospital. Martin said White refused orders to get back in the ambulance so he could talk to Franks. It might have been better for White to let that discussion occur or the ticket be written, and simply return to the back of the ambulance to call both agencies' supervisors about the unnecessary compromise of patient care. Having both EMS personnel outside arguing with the trooper not only left the patient unattended, it likely made the trooper feel defensive and even more hostile.
Many readers may disagree with this take, especially after seeing the video. However, keep in mind that our primary concern is getting the patient to the hospital. Arguing with the trooper about who's right or wrong is only going to prolong the transport. I'd suggest doing and saying whatever is necessary to defuse the situation and get the patient to the hospital, then recording the trooper's name and a detailed narrative of the event. Each side's supervisors can then mediate the situation at a more appropriate time and place.
