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Your EMS Department Policy Manual


Nobody likes the department policy manual. Employees hate it because it’s 300 pages and it’s impossible to retain all the arcane information it contains. Supervisors and managers hate it because it has to be maintained, and they have to know it better than the employees. And it never seems to address any topics that need to be addressed today. In some agencies the policy manual is known as the “Book of Names,” because experienced hands can read each policy and recall the story that resulted in that policy, including the name of the perpetrator of whatever the policy addresses.

If anything, human history has shown we work best with a simple, defined set of rules, be it the 10 Commandments, the Golden Rule, or any other basic set of laws to govern our lives. If our history suggests a belief that 10 policies can be enough to bring order to the world, maybe we really should consider a “less is more” approach.

Despite what some supervisory personnel believe—some with cause, based on their most recent day’s experience—most employees want to do a good job, and will follow the rules if they know what they are and they can understand them. If our rules and rulebook make sense, it will be easy for the majority who want to do well at work to do so.

Start with General and Move to More Specific

Paramedics1 as a group are individuals who are passionate about their work, and committed to alleviating illness, injury and suffering. They live in a world of delegated medical practice, written protocols and more “quality assurance” than almost any other group of healthcare providers. They are not folks who want to hear, “Do it because I said so.” They want to understand why a policy exists. For bosses this means—and this is not unreasonable—if you have rules, there should be good reasons for them.

A policy manual should begin with four “overview” items that describe who the organization is and what it stands for. At the outset, employees should find:

  • The organization’s mission statement (who we are and what we’re here for).
  • The corporate vision (where we want to be in the future).
  • The organization’s core values (what we stand for).
  • The CEO’s Intent statement (when there’s not a rule, what principles should we use to make decisions?).

These four items set the tone for the organization, and if properly developed and understood, may actually make much of the rest of the policy manual redundant.

The CEO’s Intent statement is a concept that has evolved in the corporate world after being developed by our armed forces. In modern day battle, operations are too complex to have every decision made by a higher authority or governed by a rule or policy. So the “Commander’s Intent” statement was developed to provide soldiers guidance when they have to make a decision for which no orders are available. The purpose of this document is to make everyone in the organization aware of the CEO’s expectations and desired outcomes for what the organization does. Keeping this intent in mind, members of the organization will be able to make decisions consistent with the organization’s mission, vision, goals, objectives and plans without specific direction on a particular topic.

A word to those who have to enforce the rules—you CAN enforce rules that are not laser specific. If one of the organization’s core values is “integrity,” or the CEO’s Intent contains a statement about honesty, that’s sufficient call to discipline an individual who falsifies a patient care report or who “pencil whips” a daily check-off sheet.

Get Organized

Policy manuals should be easy to use. The worst policy manuals are those where every policy is on its own complete “form,” and the forms are simply stuck in a book without regard to subject matter. The policy manual should be arranged by subject, and indexed and tabbed if it is a paper document. In this day and age, it is entirely possible to have a user-friendly electronic document with hot-links that take the user from index to topic and from one topic to other related topics.

A sample index might look like this:

Section 1 – Introduction and Intent

Section 2 – Administration of Policies (who is responsible and review schedule)

Section 3 – Personnel

Section 4 – Operations

  1. Safety
  2. Ambulance Operations
  3. Special Operations

Section 5 – Equipment and Facilities

  1. Buildings
  2. Biomedical Equipment
  3. Controlled substances

Section 6 – Credentials and Continuing Education

Separate Policy from Procedure and Protocol

Describing how things should be done can add immense volume to a policy manual. Mixing policy and procedure can negate the value of the policy manual, and make maintenance difficult. Instead, separate “the rule” from the policy statement, like this:

Each oncoming crew will check the ambulance for supplies and equipment in accordance with the current version of the Smith EMS Ambulance Vehicle Inventory and Safety Check Sheet.

Do not include the check sheet in the policy manual, both to conserve space and to allow for the check sheet to be changed as items are added to and subtracted from the vehicle.

In the day of the smartphone, a department on the cutting edge will have its policies, protocols, cheat sheets and check lists available as an “app,” which members can carry with them wherever they go!

Keep It Current!

Keeping a policy manual current is essential to its credibility. An organization can get lost in an administrative void if the organization is “governed by e-mail,” particularly when the e-mail changes items written in the official manual.

Some organizations have found it very effective to have line employees perform an initial review of the policy manual every year. Instead of making this an administrative chore for a manager, take each section of the manual and ask one or two employees to review it and “make sure that this reflects how we really do things around here.” A good policy manual will reflect the culture and actual practices of an organization in daily life, not a fictional “happy place” where the boss would like to be, with no connection to the reality of the organization.

Get to it!

In too many organizations, the policy manual is a space taker and time killer that doesn’t contribute to the organization. Too much emphasis on “form” detracts from the substance of what the manual should be—a guidebook for the operation of a successful organization. Instead of using the same old approach, leaders—both formal and informal—should get together and resuscitate their agency policy manual, so that it can add value to the organization, rather than just allowing it to occupy space and time without valuable outcome.

1. As with all of my writings, I use the term “paramedic” to include all credential levels of EMS provider. Credit for that common sense, media friendly practice goes to our friends of the Paramedic Chiefs of Canada, who were the first to advocate for the easily understood collective term for people in our business.

Skip Kirkwood, MS, JD, EMT-P, EFO, CEMSO, is drector of Durham County (NC) EMS, past president of the National EMS Management Association and an editorial advisory board member for EMS World. He previously served as Chief, Emergency Medical Services Division, Wake County, NC.


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