I listened intently as the young EMT started his story. An opportunity had recently arisen that would allow him to stay with the private provider he currently worked for, but transfer to a different operation to gain more field experience as he prepared to apply to paramedic school. Shortly after he began work at the new shop, he ran into one of his old EMT classmates, who now worked as a paramedic for the local fire department. He was pleasantly surprised to see his friend and spoke to him at the scene. The pleasant element evaporated immediately when his friend ignored the greeting and told him, "You can just hang out here. I'll let you know when you need to get your wheels," then turned his back and walked into the apartment to see the patient.
The young EMT told me he couldn't believe his old classmate was treating him "like I was some kind of second-class person," unlike the fellow he had studied with and periodically gone out with for pizza and beer. "Why would he treat me like that? What happened to my old friend?" he asked me. "Easy answer," I told him. "Your friend has forgotten his roots."
Historically, the fire service has not trained its own paramedics. Instead, they have routinely picked off experienced EMT-Bs from the ranks of private service providers after they have gained the requisite one to two years of experience. For the most part, this symbiotic relationship has worked. The fire service got the experienced providers it was looking for, and the private sector medics transitioned into the fire service jobs they were looking for, which typically came with better pay, benefits and job security.
The truth is, there is not a single EMSer out on the streets who would be working in EMS land if it weren't for knowledge and skills passed on from veteran EMS journeymen to inexperienced EMS novices. This tried and true model is used in martial arts training, trades like plumbing and carpentry, and more.
Sadly, some private providers make the jump to municipal jobs where, like the EMT told me in his tale of woe, folks choose to simply turn their back on their roots, apparently thinking they are now superior providers-a strange irony when they all wear the same patch and follow the same protocols.
When you forget your roots, the collateral damage can be far-reaching. In the case above, the damage to an old friendship turned out to be permanent. The EMT got the experience he needed over the next year or so, but said that even as he worked in the system, his friend continued to snub him.
However, an even more serious problem can result. In the previous case, it was an EMT-B/paramedic interaction. This same scenario plays out even when both providers are paramedics, with the municipal provider assessing and managing the patient while the private sector medic stays outside. The professional issue aside, from my perspective, there is a much more dangerous legal problem. For the sake of discussion, let's say the patient suffered a poor outcome. Both medics would be deposed, and, during that process, the fact surfaced that the private sector medic was denied access to the patient during the assessment and management process. Rather than two medics working in harmony during the assessment and then cooperatively deciding how best to manage the patient, one waited outside, unable to contribute to the patient care process. How could it be possible to convince a jury that this type of behavior contributes to better patient care? Same patch, same protocols, but one denied the opportunity to do his job. Under these circumstances, the municipal provider has chosen a path that leaves him alone to explain why he denied the patient the benefit of a second competent provider. If the prosecuting attorney can show the poor patient outcome might have been avoided if both providers had worked in harmony, the result could be catastrophic.
Can you imagine this model being played out in a hospital setting, where one physician is denied access to a patient by another physician? That would be a moot point, since that behavior would never happen.
As we learn the craft of prehospital medicine, it is essential that we remain cognizant of how we got where we are, and to never, ever forget our roots. In turn, as we gain more experience and move from novice to proficient provider, we need to find that next young novice and return the favor that was once given us. We need to treat each EMS provider with respect and recognize that they have paid their dues and earned their patch, and with that the right to be treated as the healthcare professionals they are. If you forget your roots, you can damage relationships that may not ever be repaired. From a legal point of view, by letting your ego result in a poor patient outcome, you can suddenly find yourself unemployed and your former employer getting sacked, with a huge financial impact to boot.
Until next month...
Mike Smith, BS, MICP, is program chair for the Emergency Medical Services program at Tacoma Community College in Tacoma, WA, and a member of the EMS World editorial advisory board.