EMS practitioners, people like you and me, have chosen this line of work. With this choice comes significant responsibility to the people we serve. One aspect of that responsibility is to behave in ways that reflect core humanistic values. You might ask, "What do values have to do with professional behavior?" As we will see, they have everything to do with it.
We deal every day with people experiencing things they cannot cope with on their own. Sometimes we are challenged by thoughts that their calls are nonsense, or not a "real" emergency. Sometimes we go so far as to judge people "system abusers."
I've been in EMS since 1980. I've worked in a volunteer third-service ALS transport ambulance corps that served one of the wealthiest townships in America. I've worked in a hospital-based ALS transport system and an ALS quick-response vehicle supported by a volunteer transport ambulance service. And I've worked in a large metropolitan fire-based ALS transport system. Some things remained the same over that time: About 70% of calls actually generate a patient. About 20%-25% of those patients get some form of ALS care, from simple ECG monitoring and a KVO line to full-blown cardiac arrest care. Another thing that hasn't changed, and I suspect never will, is responding to calls from folks who are not at risk for loss of life, limb or function. Clearly, some people call 9-1-1 who are not suffering from acute medical problems or serious injuries.
It is our responsibility to respond, render care and serve the needs of everyone who calls. True system abuse is rare. But how do we continue to respond when demand is high and resources are limited? How do we continue to do the job people expect us to perform? It is a choice we have to make for ourselves. One place we can turn to help us continue is to examine our values.
Our core values provide a foundation for our actions. They must be central to our practice if we are to be effective in addressing the needs of our patients, their families and all the people we come into contact with. In his 2000 article "Toward a Normative Definition of Medical Professionalism," Dr. Herbert Swick said, "Physicians evince core humanistic values, including honesty and integrity, caring and compassion, altruism and empathy, respect for others, and trustworthiness."1 We can expect similar values from EMS practitioners. Let's look at Swick's statement, break it down and determine how we can apply its ideas to our practice in EMS.
To evince means to demonstrate or show clearly. We must clearly demonstrate our values in our actions. Core means central, and humanistic has to do with concern for the interests and welfare of humans. Values are those ideas, concepts or principles we believe are important. They are a collection of guiding, usually positive, principles-what one deems to be correct and desirable in life, especially regarding personal conduct.2Core values are a small set of key concepts and ideals that guide a person's life and help them make important decisions.3 They help give us purpose and confidence, and make it easier for us to make good choices.
Honesty and Integrity
What do the words honesty and integrity actually mean? Take a moment to think about it. How do they apply to our practice? Honesty is about being truthful and sincere. Is this important to our practice of EMS?
We must be honest with our patients and their families. We must be honest with our partners, coworkers and all the healthcare team. We must be honest in reporting our assessment and interview findings. We must be truthful in our documentation. Do we always document that we established IV access on the third attempt? Do we always take at least two sets of vital signs, or did the second set just match up really well with what the triage nurse documented? Behaving honestly supports our credibility as EMS practitioners and professionals.
Integrity is closely related to honesty. It means "firm adherence to a code of especially moral or artistic values."4 How does integrity apply to us? In Part 3 of this year's series, "Adherence to Moral and Ethical Standards," we discussed the EMS Code of Ethics. Integrity for an EMS practitioner would include firm adherence to that code. When we are faced with difficult choices, knowing the Code of Ethics provides some guidance. We should choose the course of action dictated by our code.
The National Standard Curriculum for paramedics lists integrity as the first of 11 professional behaviors, and the National Education Standards, which will replace the NSC in the next couple of years, maintain the same list. The description of specific behaviors related to integrity includes "consistent honesty, being able to be trusted with the property of others, can be trusted with confidential information, complete and accurate documentation of patient care and learning activities."5
Caring and Compassion
These two values seem to be clear and obvious requirements for EMS practitioners. But let's analyze them closely so we can be sure we understand what they mean. What is caring? Merriam-Webster's online dictionary says caring is "to feel interest or concern."6 The American Heritage Dictionary of the English Language defines caring as "feeling and exhibiting concern and empathy for others."7 How can we do this work if we are not concerned for others? Everything we do as EMS practitioners, we do for the people we serve, and part of our service is being concerned.
Compassion is a value that follows with caring. Compassion means "sympathetic consciousness of others' distress, together with a desire to alleviate it,"8 or a "deep awareness of the suffering of another coupled with the wish to relieve it."9 Would you agree that compassion is a key component of the practice of EMS and a required value for EMS practitioners? Anyone in EMS who does not care for people or has no compassion belongs in another line of work!
Teaching and Evaluating Values
When we think of values, particularly these core humanistic values, what informs our thoughts? When and where did we learn them? Who taught us? The first answer is our parents and our families. Then, as we grew up, our religions, our friends, our communities, our schools, our society and even television influenced how we developed our value systems. Many medical schools, residency programs and other healthcare education programs have also begun teaching values through an increased emphasis on professionalism.
One of the most important components of teaching core humanistic values is to clearly define and articulate what sorts of values are important, then discuss them and make clear what behaviors are expected that demonstrate them. Role models are powerful influences on students. We must ensure our instructors and preceptors are good role models.
We can use role-play scenarios that put students in situations where particular values are tested. Then we can evaluate their performance against specific expectations: the expected behaviors discussed in class. Students should take on different roles: the patient, a family member, a bystander and the EMS practitioner. They should role-play both the expected and unacceptable behaviors so they can experience all sides of the interaction. This allows students to understand what it feels like to be involved with someone who demonstrates adherence to values and someone who does not.
We can find video clips from shows such as ER, Grey's Anatomy, House or Scrubs. We can use clips from movies such as Mother, Jugs & Speed, Bringing Out the Dead, Ambulance Girl and Paramedics. Watching videos or movie clips provides a safe starting point for discussion about what the characters did right or wrong.
In the Philadelphia Fire Academy, we have 16 banners that hang in our auditorium. Each displays a single word that represents one of the department's core values. We discuss these values in every cadet class. Whenever we host a guest speaker, have a meeting or run a class of any kind, everyone in the auditorium sees the banners and is reminded of our core values. They are on display every day. We strive to have these values displayed by our members as well as on the banners.
Do you know the core values of your organization? Have you thought about what your personal values are? As long as we continue to choose careers of service, we must keep core humanistic values in mind. And we must demonstrate our commitment to them through our actions.
Next month we will continue our exploration of core humanistic values by considering altruism and empathy, respect for others and trustworthiness. We'll also discuss in greater depth how we can teach and evaluate behavior related to values. In the meantime, make good choices based on good values.
Humanism in Medicine
The Arnold P. Gold Foundation promotes the values of humanism in medicine, helping foster "relationships with patients and other caregivers that are compassionate and empathic." Its stated values, represented by the mnemonic i.e., cares, include:
Integrity: Congruence between values and behavior.
Excellence: Clinical expertise.
Compassion: Awareness of suffering, desire to relieve it.
Altruism: Putting the interests of others before your own.
Respect: Regard for the autonomy and values of others.
Empathy: Putting oneself in another's situation, such as the patient's.
Service: Sharing one's talent, time and resources with those in need; giving beyond what is required.
Michael Touchstone, BS, EMT-P, is chief of EMS training for the Philadelphia Fire Department. He has been involved in EMS since 1980 as an EMT, paramedic and instructor. He has participated in EMS leadership, management and educational development initiatives at the local, state and national levels. Contact him at email@example.com.