Leadership Ethics in EMS

Ethical values are among the most important aspects of organizational culture


Ambulance 2 responds to a traffic accident at an important intersection in its community. Two vehicles are involved. The ambulance team consists of Travis, the driver, up front and Sue, an EMT-Intermediate, and Jerry, a paramedic, in the back. Jerry is the crew leader and provides direction as well as patient care.

The ambulance team meets with all the individuals involved in the accident. They assess each one thoroughly and find only one individual seriously hurt: Jim has back and head injuries and has lost some blood. The crew applies a neck brace and places him on a backboard.

With the assistance of first-responder firefighters, Jim is moved onto the stretcher and into the ambulance. The crew provides him oxygen and starts an IV. Jim, however, does not like the idea of an IV being started. Sue looks at Jim and tells him to shut up because an IV is the protocol. Jim relates that he is scared of having a needle stuck in his arm. Sue tells Jim he’s stupid and to stop moving around. She puts her hand on Jim’s chest and says he is a scaredy-cat and should quit being such a baby.

Jerry pulls Sue outside to tell her she needs to treat the patient with respect and calmness. Sue responds that the patient is a jerk and needs to be disciplined. Jerry tells Sue to calm down and that he will take over the patient’s treatment. Sue gives Jerry an angry look and gets in the passenger seat of the ambulance instead of the back.

Jerry gets into the back and sits next to Jim. “Jim,” he tells him, “my name is Jerry, and I’m going to take care of you. It is important to start an IV due to the blood loss you’ve experienced. I will work with you to carefully insert the needle and minimize the pain you may experience. I’ve done a number of IVs in the past. I respect you’re scared regarding the IV; however, you will find it will be accomplished with proper care.”

Jim looks at Jerry and says he’ll try to stay as still and calm as possible while the needle is inserted. Jerry thanks Jim for his assistance and cooperation. They achieve the IV, and Jim is cared for properly en route to the hospital. At the ED, Jim thanks Jerry for his careful treatment and respect.

When Ambulance 2 arrives back at the station, Jerry and the EMS director sit down with Sue to advise her she needs to be calm and respectful to patients. They tell her it’s important to treat all patients ethically, and if this happens again, she will be disciplined. Sue is not happy with the discussion, but understands she needs to respect her patients and her teammates to assure proper care is provided. She knows practicing ethics is important and says she’ll do her best to meet the organization’s ethical standards.

Right vs. Wrong

Leadership ethics are important in EMS. Ethics are about how we distinguish between right and wrong or good and evil in relation to the actions, volitions and character of human beings.1 We as EMS providers should know ethics are important to both ambulance teams and their organizations. Leaders need to teach, demonstrate and emphasize exceptional ethical behavior and practices. Value-based leaders who model good ethics generate high levels of trust and respect from employees, based not just on their stated values, but on the courage, determination and sacrifice they demonstrate in upholding them.2

For EMS organizations to be ethical, leaders—organizational leaders as well as ambulance team leaders—need to be openly and strongly committed to ethical conduct. They need to work with all personnel within the organization, not just the field providers. Leaders have ethical responsibilities to treat followers with dignity and respect. This demands that leaders be sensitive to their followers’ interests, needs and concerns. The leader’s duty is to assist followers with change and personal growth.3

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