Leadership Ethics in EMS
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
A code of ethics is a formal statement of an organization’s ethical values and standards and helps define its mission. It includes the values and behaviors that are expected and those that will not be tolerated. It generally defines individual responsibilities and the treatment of teammates and patients.
To bolster the ethical environment, organizations can appoint a chief ethical officer to establish and broadly communicate ethical standards, conduct ethics training programs, supervise the investigation of ethical problems, and advise leaders in the ethical aspects of decision making. Establishing a counseling center can assist personnel in resolving difficult ethical dilemmas.
Ethical training is important. During training, the code of ethics is outlined and discussions are held to ensure everyone understands their ethical requirements. Important ethical requirements include the respectful treatment of teammates and patients. They also include doing the right thing even if others disagree. Training also may emphasize that team members need to let the leaders know when a teammate has violated the code of ethics. In instances of extreme violation, an individual could lose their job or be transferred to another environment to learn proper application of the code of ethics.
EMS leaders influence organizational culture and ethical values. Culture is the key values, norms and assumptions shared by members of an organization and taught to newcomers. Culture serves two important functions: integrating team members so they know how to relate to one another, and helping the organization adapt to its administrative and operational environments.
Ethical values are among the most important aspects of organizational culture. Ethics are the moral principles and values that govern the behavior of individuals with respect to what is right and wrong. EMS leaders shape ethical values through value-based leadership, including their own personal behavior and their organization’s systems and policies. All leaders have personal beliefs and levels of moral development that influence their personal ethics, but all need to be openly and strongly committed to ethical conduct in their daily actions. Leaders can also influence ethical values in their organizations through codes of ethics, ethics committees and offices, training programs, and disclosure mechanisms to support employees with concerns about ethical practices.2
1. Burns JM. Foreword to Ciulla JB, Ethics, the Heart of Leadership. Westport, CN: Praeger Publishers, 1978.
2. Daft RL. The Leadership Experience. Mason, OH: Thomson-Southwestern, 2008.
3. Northouse PG. Leadership Theory and Practice, 3rd ed. Thousand Oaks, CA: Sage Publications, 2004.
Paul J. Breaux, PhD, LP, has a doctorate in leadership studies and conducts research in EMS, firefighting, law enforcement and military leadership environments. He is a volunteer licensed paramedic for Bandera County (TX) EMS and an adjunct professor at Our Lady of the Lake University in San Antonio.