EMS Revisited: Professional Etiquette

Professional etiquette is more than just making nice. It’s how you show your respect for people. And to show it, you have to mean it.

This article first appeared in the April 2004 issue of EMS World Magazine and is reprinted here as part of our EMS Revisited series.

Probably not much in medicine is sillier than an 18-year-old high school graduate completing an EMT class with an 80-hour certificate and suddenly being instructed to “act like a professional.”

How we relate to a boss, colleague, medical director, patient’s physician, ED nurse, a crowd, a patient’s family members and (oh, yeah) a patient is crucial, even on our very first day as EMTs. It determines not only our effectiveness as communicators and caregivers, but also our safety and continued employment. Certain behaviors at public scenes or in the privacy of someone’s home are so significant, they can get us killed. Yet, they have been omitted from our training.

Professional etiquette is more than just making nice. It’s how you show your respect for people. And to show it, you have to mean it. As an EMT, you will meet plenty of people who are smart enough or sensitive enough to know when you’re faking.

Respect for people comes easiest when you naturally like them. But more than that, you need to understand a little bit about their responsibilities and what makes them tick in order to get a feel for what they expect from you.

The scope of professional etiquette warrants more than a single journal article, but the following should serve to outline its basic elements.

Etiquette Toward Other Medical Professionals
Since its inception, probably no area of EMS has been as fraught with on-scene and in-hospital misunderstandings as the interface between EMTs and other medical professionals. Things are better now than they once were, but EMTs still don’t learn much about their medical colleagues except by experience. Let’s review.

Physicians make medicine happen. When a physician identifies himself as a patient’s personal physician, and the patient agrees that’s his doc, the physician’s word is law, figuratively and literally. If you’re absolutely convinced the patient’s physician is wrong about something, your best recourse is to involve your designated medical control physician and get the two docs to talk to one another. Otherwise, don’t ever get between a physician who is assuming responsibility for a patient and a patient who really needs care.

Nurses, especially critical care nurses, deserve similar respect. They tend to be overworked, underpaid, over-responsible, and much better educated about medicine than their field counterparts. At the same time, show respect to all caregivers, including those who work in subacute settings like hospices and nursing homes. They all do jobs that require their own kinds of competencies, which we do not necessarily possess.
CNAs—certified nursing assistants—are some of the hardest-working, least appreciated people in medicine. In most states, they receive about the same amount of training as an EMT, but receive less pay and terrible benefits. A typical CNA working in a nursing home might be responsible for 10 or more patients per eight- or 10-hour shift.

During that period, the CNA would likely be responsible for bathing (sometimes more than once), feeding (three times), skin care, dental care, change of linen (sometimes more than once), administering medications (sometimes more than once), exercise, social interaction, janitorial duties and all related charting of care for each patient. Due to financial difficulties in many nursing homes, CNAs routinely shoulder at least some nursing responsibilities. As a result, they are often the most knowledgeable resources concerning patients. If the patients are poor or have no relatives, they often come into facilities without personal essentials like robes, slippers, hairbrushes or toothbrushes. It is not uncommon for CNAs to provide these things out of their own meager wages. They deserve both personal and professional respect from EMS crews.

Etiquette Toward First Responders
When it seems appropriate to ask a first responder crew to do something (like placing someone in c-spine), it is usually considered appropriate to address the engine company’s ranking officer, unless you are closely acquainted with the department and crew. In that case, you can communicate much more informally.

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