Integrity
It seemed timely that when posting a piece titled “Integrity”, that I touch on the recent events that happened in Illinois. Two EMS providers are charged with 1st Degree murder in the death of Earl L. Moore Jr. I’m not a legal expert, I do not know if those charges will stick or not. My friend and mentor Steve Wirth touches on the legal aspect of the case in this article in EMS1.
I will say that the videos of this case are hard to watch. There is not just a lack of compassion and empathy from an EMS provider point of view, there was a lack of human decency. That man was killed by two people that showed zero interest in the wellbeing of another person in need. He was having a true medical emergency, DTs can kill you, and they failed to even remotely acknowledge that. Even if he called 911 for pinky toe pain, you do not treat someone the way they did. They were fed up walking through the door. It makes me sick to think how they have treated other patients before they were caught with Mr. Moore.
At the end of this post I shared a list titled “18 ways to ensure patients feel human”. It was posted by @the.prehospitalist on Instagram. She always shares great content, with medical education and dogs. You can’t go wrong.
The values I chose to highlight on this page are integrity, respect, humility, collaboration, and clinical excellence. In the next few posts, I want to break them down more, talk about what each means to me, and use some examples of times that maybe things did not go so well, and these values may have been lacking. I also want to share times when people in my life exemplified these values.
According to the U.S. Army, Integrity is the principal foundation upon which our ethical and moral compass is built. Author Zig Ziglar said: “Trust is the byproduct of integrity.” My favorite quote on integrity, and one that I use often, was by C.S. Lewis: “Integrity is doing the right thing, even when no one is watching.”
According to Eve Ash, who is a psychologist, author, filmmaker, public speaker and entrepreneur, there are seven aspects of integrity. They are honesty, respect, generating trust, pride, responsibility, keeping promises and helping others. Reference: Link Let’s look at each one as it pertains to EMS, with the exception of respect, that will be an entirely separate post.
Honesty
As a paramedic, it is my duty to be honest with patients, tell them when things are good, and when they maybe are not so good. To tell them honestly what I am doing and why, and when I do not know something. As a field training officer, I need to be honest with my trainees and tell them when things are going great and when they are not. There should be no false illusions about where they stand with me or the agency. As an employee I owe it to my employer, and especially to my medical director, to own up to and be honest about any mistakes I may make. My employer owes me the same.
You would think this one would be easy, momma always said honesty is the best policy. In my agency we tell new folks all the time that it takes a lot to get fired, you can make mistakes, it will be okay, just don’t lie about them. I also tell them if a supervisor or doctor pulls you into the office to talk about something, they already know what happened, you might as well own it.
I had a trainee once that was giving handoff on a stroke patient. We knew walking in the door that there was a question as to the patient’s last known well time. We just did not know it, there was conflicting information from the family, and there was a wide range of when it could have been, between 4 and 8 hours or something like that. My trainee started to give report (details are made up, no actual patient data): 65-year-old male, right sided weakness, last known well was 4 hours ago, vitals 160/100, heart rate of 80, respirations of 12 and a blood sugar of 102. I stepped in, reported the last known well as between 4 and 8 hours, explained why and took my trainee aside.
I asked him why he gave a definitive time when it was inaccurate. He said he didn’t want to look bad and like he didn’t know what he was doing. This trainee had not had any other issues during his training process, we had openly talked about minor things over the past week but nothing too egregious. I asked him if he thought it was appropriate to lie and make up a number that could potentially alter the course of treatment for the patient, of course he said no. After documenting the incident, he was provided the opportunity to seek employment elsewhere. He was fired. Something so simple, if he had just been honest, he would probably still be employed. He was a good guy, just made a poor decision and lied.
Generating Trust
EMS is a unique animal in that people dial 3 digits on their phone, two (or more) people that they never met show up to their house and walk right in, and then they are instantly supposed to trust us with their lives and their homes. If you ever sit and really think about that, its mind boggling the amount of trust the public puts in us. We owe it to the public, to our patients, to never break that trust. We have all seen the headlines of paramedics behaving badly, whether it be stealing money or medications from a patient, or assaulting a patient. Those few that do these awful things cause the public’s trust to waver just a bit and affects all of us.
Trust is also built between your employer, your medical director, your supervisor, your coworkers, your partner, and in my role, between trainer and trainee. My trainee has to know that I have their backs, that they can go in and do the thing and know that if they start to go down the wrong path or hit a speed bump with a patient I will help them. That I will not demean them or disrespect them, but teach them and build them up.
Trust is gained by being reliable, and doing what you say you will. For patients, being confident, but not cocky, being personable and showing competence, goes a long way in building rapport and trust. An important concept is that confidence does not equal competence. For employers, being on time and consistently following the rules goes a long way. Life is easier when you stay between the lines most of the time. Most, if not all, of the rules in most agencies are there for a reason and relatively easy to follow. I had a partner tell me once, in front of our supervisor, that he did not like working with me because I was a rule follower. I shrugged, looked at my district chief, and said “I’ll take that criticism.”
The trainer/trainee relationship must have trust. I always say that the first shift or two together are like long, awkward first dates. You just met, trying to feel each other’s personalities out, what works for them, what does not, if they have pet peeves or not, what they know, what they don’t. I always have a conversation about that stuff on the first day, just put it all out there. If expectations are not established and discussed, it is impossible for the trainee to meet them. A trainee builds trust with me when they communicate. They need to tell me when they do not know something, when the patient’s condition changes, or when they are unsure. That tells me that I can trust that they are not going to just make stuff up and that they are paying attention. When they communicate these things to me and we talk through things in a constructive, respectful manner, it tells them that they can trust me to teach them and not demean them. We all had a first day and had to start somewhere.
Pride
Having pride in yourself, your profession, your agency, and your equipment are huge sticking points for me with trainees and in how I personally approach my job. Looking put together gives the outward appearance that you are a professional and you know what you are doing, that you care and want to be there. As much as we make a general impression of our patients when we walk through the door, they are making a general impression of us, as well. You represent not only yourself, but your agency and the profession. You may be the only paramedic they ever meet, hopefully for them, and the image you leave is the image they will have of all paramedics.
Having pride in your equipment not only looks good, but makes the job so much easier, safer, and more efficient. From cleaning the interior and exterior of your truck, to checking off and organizing your equipment, it is all part of having integrity and pride in what you do. Ensuring you have all your equipment is your responsibility and ensures appropriate, safe patient care. At least in my agency, we spend most of the day in the truck. I do not want to ride around in a dirty and unorganized truck, its unsafe and just plain gross.
Responsibility
Responsibility to me is taking ownership. Taking ownership of how treat patients, interact with co-responders and other healthcare professionals. Taking ownership of your attitude, and your approach to the job and understanding just how important taking the job seriously is. Not taking yourself too seriously, but approaching your job seriously.
A flippant approach to how you train, how you check off your truck, if at all, how you manage patients and how you carry yourself not only can negatively affect your reputation, but can negatively affect patient care.
Keeping Promises
I got in trouble for making a promise once. Not really trouble, but it was negative feedback on a promotional assessment center. The mental health patient in the scenario didn’t want any needles, and while they were manic in the scenario, I had them calmed and could redirect them. I told the patient that I wasn’t going to give them any needles. I didn’t need to, right then, but during the evaluation it was pointed out that I made a promise that I couldn’t necessarily keep. The patient could have needed an IM injection at any point if they needed to be sedated, and I was potentially going to have to break their trust. It wasn’t my intention to be deceptive, but I had been. Lesson learned.
Keeping promises not only applies to patient care, but also in how we interact with each other and how supervisors interact with their employees. If a supervisor cannot keep their word, their employees will no longer trust them and they are no longer effective leaders.
Helping Others
This is something we do on every call, but it is so much more than that. Taking care of each other, watching each other’s backs, being there when someone needs an ear, or a shoulder. Recognizing when someone needs more support. It doesn’t take much, just acknowledging and validating how someone feels can go a long way. I’ve seen many of my coworkers jumping in and cleaning the back of another crew’s truck while they’re in the ER giving report after a mess of a call. Leadership, be leaders, get out and help your people. Set aside two hours a week and check in on calls, park at an ER and help crews make stretchers. Don’t take over the call, be there to help. Don’t just show up at the ER to drive people to get back in service, just show you are human and do care. Most of us in EMS are type A, confident, take charge people, but something I have learned over the years and tried to reinforce with others is that EMS is a team sport.
Integrity is the foundation of your character and helps to define who you are. It is the basis of your reputation and legacy, make it a good one.
18 ways to ensure patients feel human:
(In parentheses are my thoughts and additions to the original post.)
Clean them up & cover them up. Protecting patient dignity is a part of the most basic patient care. (When possible, move out of public places quickly. Don’t try to treat a teenager in the middle of the mall, move somewhere private. Same with people who call while at work, get them out of there and somewhere private.)
Use their name. Ask how they’d prefer to be addressed. (Also, ask about which pronouns they prefer.)
Explain what’s happening, even to patients who are altered or unresponsive. Unresponsive does not always mean unaware. (Patient education is a huge part of our jobs. Many times people don’t understand the importance of managing their blood pressure or diabetes. Also, it must be terrifying to be aware, but unable to respond. Talk, explain, be compassionate.)
Take care of their belongings and home when situation allows. Lights off, doors locked, pets fed. (I always make a walkthrough of the kitchen and ensure stoves are off. Don’t forget their phone charger. People always remember their phones, never a charger.)
Ask if there’s anything we can do to make them more comfortable. Blankets, temperature, position. (It is about the patient’s comfort, not yours.)
Bring assist devices. Hearing aids, glasses, walkers,. Without these, many patients cannot function.
Ensure patients know they have a choice and say in their care. Patients already feel helpless during a medical emergency - let them know they still have control.
Put the iPad down. Make eye contact. Listen.
Use touch. Hold their hand, place a hand on their shoulder. Show them you’re human, too.
If obviously anxious or apprehensive, ask why. Address individual fears or concerns.
Ensure that they don’t feel bad for calling us. Tell them they did the right thing.
Introduce yourself. Get on their eye level. Avoid talking down to patients - they already feel vulnerable.
Ask them about their life, their family, their pets, their hobbies. (My favorite part of the job is interacting with people and hearing their stories, and most people love telling them. It puts people at ease when you simply have a conversation and listen, plus you hear some really interesting stuff.)
Treat concerned family members with respect and thank them for their help. (Family care is huge and underrepresented in EMS education. If the patient allows, always keep family in the loop, this is even more important with patients in nursing facilities.)
Avoid talking to geriatric patients like children. They’re adults - treat them as such. (Avoid talking to children like children. Tailor your approach to the age and maturity of the individual child. Most are smarter than we sometimes give them credit for.)
Let patients know what they can expect upon arrival at the ER. Eliminating some degree of unknown can significantly decrease anxiety.
Even when we’re exhausted, overworked, and can’t go above and beyond, recognize that basic kindness and respect are still expected. “If we can’t fake it at 2am, we need to find another job.”
Even when we’re exhausted, overworked, and can’t go above and beyond, recognize that basic kindness and respect are still expected. “If we can’t fake it at 2am, we need to find another job.”
Understand that each human experience is a unique cocktail of brain chemistry, life happenings, and upbringing. Our individual perspectives are a microscopic sliver of the possible combinations. We may not understand a patient’s how or why, but that doesn’t make their experience any less valid. Be kind.
Understand that each human experience is a unique cocktail of brain chemistry, life happenings, and upbringing. Our individual perspectives are a microscopic sliver of the possible combinations. We may not understand a patient’s how or why, but that doesn’t make their experience any less valid. Be kind.
I know the last two were typed twice, I did that on purpose because they are such important points. Every person deserves basic human decency and kindness. Maybe Mr. Moore would still be alive today if the people called provide him care simply did nothing else other than show a sliver of kindness and compassion.
