Culling the Herd: Changing our Industry One Classroom at a Time

This article originally appeared in our November 2016 Newsletter by John Spencer, Customer Support Manager, Lead Medical Educator

EMS professionals are those that people call when they are sick, injured, or in need of some type of help. They are granted intimate access into people’s homes and lives. People trust them to see them when they are at their worst. People blindly trust EMS professionals, but a quick search of the Internet reveals a darker side to the profession. EMS providers are being arrested for stealing money and medications. They are being arrested for doing things that most of the profession would find appalling. What has happened to the beloved profession? How did these individuals, that clearly have no respect for people, make it into the field? Could the actions of these individuals have been prevented? Can the reputation of the industry be saved?

What has happened to our beloved profession?
The EMS profession has been changing from the very beginning. The industry has had to adapt to science changes and the overall changes in the healthcare industry. The job has changed from one of only providing emergency medical care to a career that provides a blend of both emergency and non-emergency care. The EMS systems have had to adapt to an increase in demand for services, often leading to busier shifts and higher stress for the providers. In this beloved profession, only the strong will survive and those that are weak and lacking in integrity succumb to the stress and make bad decisions.

How did these individuals, that clearly have no respect for people, make it into the field?
The providers that you read about in the news, those that are taking inappropriate pictures of unconscious patients, those that are stealing money and medications from patients, and those that treat their patients like lower lifeforms all began in the same way. They were all students in an EMR, EMT, AEMT, or Paramedic program. They were given quizzes and exams to test them on their knowledge and each of them were taught and tested on the skills of the industry. Most of them probably received some type of affective evaluation, probably at the mid-term and end of their course. These professional behavior evaluations were more than likely just pencil whipped by an instructor that didn’t feel comfortable in evaluating people’s hearts and values, let alone intervening and actually having the hard conversations. So these providers “passed” their initial education programs and were turned loose into the field of practice without any real evaluation of such things as their honesty, empathy, respect, and integrity.

Could the actions of these individuals have been prevented?
Some would suggest that the actions of these individuals was unpreventable. That these were poor decisions that were made in the moment and that no one would have had any real way of knowing or predicting that such behavior could happen. The truth is that although we cannot control human behaviors, we can limit their access to our field by having strict policies in place that require frequent evaluation of the affective domain. The evaluations should take place in all areas of the program including the skills lab and clinical arena. These evaluations should include an action plan, when necessary, for the student to follow in order to demonstrate a behavioral change and these action plans should be revisited on each future evaluation. The policy should allow for the removal of the student from the program based on failing affective evaluations and prevent the graduation of any student that has not demonstrated competency on their final affective evaluation. Regardless of the knowledge or skill of the student, the affective domain evaluation should be used to cull the herd and prevent those that fail to share the basic core values of the industry from joining the profession.

Can the reputation of the industry be saved?
Yes, it can. The reputation of the industry can be saved but the catalyst for this change must come from within the industry. EMS programs and instructors must embrace the call to action and recognize the importance of culling the herd by frequent and effective evaluation of the affective domain for all students.