The 31 Ways to Crash-Land in EMS
In 1959 Robert A. Heinlein wrote a book called Starship Troopers. Many of you have seen the 1997 film adaptation, where future soldiers fight a war against alien bug creatures. Unfortunately the movie was vastly different from the book, which was more about citizenship, civic virtue and personal responsibility. I highly recommend the book; the movie, less so.
The protagonist in the book was completing basic training for the mobile infantry, the traditional “soldier” role in the future military. As part of their training, the recruits were taught the “31 ways to crash-land.” These were considered the cardinal sins of their armed forces. Committing one of these acts could lead to corporal punishment, dishonorable discharge and, under certain circumstances, even death. The example used in the book was striking a superior officer, which brought physical punishment and discharge from the military but could lead to a battlefield execution if done during time of war.
Importantly, these offenses were written down, posted in the barracks of each unit and read aloud each Sunday to the assembled trainees. This was a critical point in the court-martial of one trainee, as he had clearly been made aware of these offenses in advance of committing one.
Reading this section, I realized there is an analog to modern EMS, and so I set forth to identifying the “31 ways to crash-land for EMS”—those infractions that, even as a first offense, can potentially end your career. These are offenses that will at best get you in a great deal of trouble with your department and at worse can result in the loss of your license or certification, paying monetary damages or even being convicted of a crime.
I propose these rules be posted in every EMS station and read aloud to every assembled EMS provider on a regular basis, so that we might stop repeating the same bad acts over and over.
Thou shalt not:
- Intentionally falsify any part of a medical record;
- Access or read any medical record except as necessary to do your job;
- Talk about patients and their conditions except as necessary to do your job;
- Steal money from patients;
- Divert medications from the EMS system and/or patients;
- Take things that belong to your department or organization;
- Accept something of value in your official capacity that you are not entitled to;
- Falsify your certifications, including any CEUs or other educational activities;
- Lie about or inflate your experience or credentials;
- Use your authority to confer a benefit on someone who is not entitled to it;
- Cover up some activity that can threaten another person’s safety, property or person;
- Come to work unprepared to care for patients;
- Fail to respond to a call or otherwise render medical care when appropriate;
- Coerce a patient into refusing care and/or transport;
- Perform actions that are outside your clinical scope of practice;
- Allow your workspace, including your ambulance and equipment, to be unprepared for duty;
- Falsify your sick time or injury status;
- Drive while intoxicated at any time;
- Engage in practical jokes or other (perhaps) well-intentioned conduct that can easily be misinterpreted or escalate into negative conduct;
- Lay hands on anyone in violence, except in self-defense, and then only to the minimum extent necessary to remain safe;
- Touch a patient in a sexual manner;
- Solicit a patient for a romantic or sexual encounter;
- Solicit or conduct a romantic or sexual encounter with a subordinate;
- Have sex or sexually related activity while on duty;
- Take pictures and/or videos of calls and/or patients;
- Post information on any social media that is racist, espouses violence or constitutes sexual harassment;
- Post information on any social media with details about calls and/or patients;
- Post information on any social media that undermines the public’s confidence in EMS, except as necessary to improve the terms and conditions of your employment;
- Allow your personal political, religious or other beliefs to impact your workplace conduct;
- Conduct any otherwise-prohibited action with a student under your charge or trainee under your authority.
You may note there are only 30 offenses listed. I leave this open as a reminder that, no matter how hard we try, people will always come up with one more thing we have never thought of. I think, however, that if we can avoid the activities listed above, we will go a long way toward keeping ourselves and our departments out of major trouble.
Matthew R. Streger, Esq., MPA, NRP, is a member of the EMS World editorial advisory board as well as the law firm Keavney & Streger in Princeton, NJ. He has more than 30 years of experience in EMS in a wide variety of roles and locations.