To sum up this article: a patient's mother said,
"'While my daughter lay in her bed dying, your paramedics and
firefighters were hiding. So I’d like to know: Is your priority
to provide emergency medical services to the people of this
community or to stand by, watching out for yourselves
while people die?'"
The author says that he thought long and hard about that statement. He came to a mindset that,
"the first priority of EMS providers is not, as my wake-up
caller said, to save lives but to protect ourselves–even if it
costs someone else’s life. I’m not sure that priority can
be sustained in today’s society. Truthfully, it seems
horribly and terribly outdated [emphasis mine]."
He believes that,
"The practice of staging EMS resources for every unresponsive
patient where drugs or alcohol are involved, every suicidal
threat, every elderly nursing home patient who assaults a staff
member, every psychiatric-related call, and every response where
law enforcement is dispatched needs to stop. Refusing to
enter an active shooter or hostile event scene without a police
escort to render immediate care to dying victims also needs to end. "
I've listened to the conversation spurred by this article, and I see it being hailed as the new direction that we in EMS need head in our training and understanding. I see a bandwagon forming. But I'm not convinced.
The author makes faulty arguments and encourages a dangerous shift in mindset that is not only potentially catastrophic to individual providers but is psychologically unsound.
First, while it's sad that some people might die because I chose to protect myself, basing a decision upon that sadness is an appeal to emotion, a logical fallacy. Emotion does not determine fact.
When I am dispatched,
I have a duty to act.
I have a duty to serve.
I have a duty to help.
I have a duty to provide medical care.
I do NOT have a duty to die.
I do NOT have a duty to sacrifice, endanger, or potentially endanger my mental or physical health.
These may seem like powerful statements, but they are not an appeal to emotion. I am not manipulating emotions and asking someone to change their mind based upon the sadness created within them. It is a statement of responsibility and of the job I was hired to do. To endanger myself in light of known or assumed risk is not in my job description.
The facts remain that no scene is safe, true, but that is not an excuse for recklessness and not a reason to not treat scenes with caution. Risk is something assumed differently by different people. This is why we must have professional standards and uniformity in policy that is rarely interrupted based upon changing situations. The author was bothered by across-the-board policies such as not entering a scene with an unconscious person when drugs or alcohol are involved, but such broad declarations prevent people from being pressured to change their priorities in the heat of the moment, based upon emotion, when minds may not be clear or all variables considered.
"Over the years, EMS has drifted far apart from our public
safety brothers and sisters in our ability and willingness
to acknowledge, recognize, and effectively manage the risks
we all face."
Perhaps we drifted because of a change in identity that we are not, in fact, public safety workers, but health care providers. And really, we have improved in risk mitigation. We have made our jobs safer, more efficient, and continue to improve as every year goes on.
"As a consequence, the public is beginning to question
our ability to do our jobs."
Again, is this true? Does the the public really question our competence in light of risk mitigation or is he relying on anecdotal evidence from a distraught mother? And even if the public does question our tactics, does that matter? Even if the public views us a certain way, does that mean that we are not, in fact, competent? The author is attempting to equate staging policies with incompetence.
What concerns me most is the psychological underpinnings of this stance. I see:
--an unhealthy need to rescue and take responsibility for other people at the expense of self
--to derive purpose and a sense of self-esteem from self-sacrifice (read: competence in the eyes of the public)
--choose to enter and stay in a rescuing situation despite cost to self
--to try to fix complex situations of others in trouble at the cost of self
--a pattern of engaging in rescuing situations at the cost of self, even though well-intentioned
This is not good policy. This is not a healthy mental stance. These are hallmark signs of codependency. With the mental health of EMS workers in shambles, we don't need formal policy that institutionalizes poor mental health.
Strong mental health includes an acceptance of responsibility for self. No one is responsible for meeting my needs and keeping me safe. I am responsible for myself and others come after me. This is actually a kindness because it allows others to do the same instead of caring for me. We often hear this concept described in training as, "Don't make two victims." By caring for myself, I prevent myself from becoming a victim that others must rescue along with the original victim. This is sound policy and sound mental health.
Our determination of staging policies will continue to change as time passes; understanding of risk grows and values change. However, we should base policy changes upon logical, healthy arguments--not faulty appeals to emotion and a sense of codependency.
Policies should be set by experts in risk management who understand the field and, with cool heads, look at situations and determine what is appropriate. Policies should be based on a sense of responsibility to first to self and then to the community, not some emotional and non-existence duty of self-sacrifice.
Only when we care for ourselves in healthy ways can we truly serve our communities in lasting ways.
