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140 Characters Away from a PR Disaster


If you don't understand this headline, you may be out of touch -- literally and figuratively -- with your employees or coworkers. (Twitter limits "tweets" to 140 characters.) Odds are, most EMS field employees are Facebook and/or Twitter junkies. A recent Pew Internet poll found that more than 70% of 18-29-year-olds use social networking Web sites, and many are doing it on the clock. That shouldn't be news to anyone; yet, organizations have generally been reactive, initiating social networking policies only after an unpleasant or even unlawful incident compromises their organization.

EMS is unique in many ways from other industries that are also coming to terms with HR in the age of social media. EMTs and paramedics spend their days behind the wheel, where handheld devices can make driving an ambulance lethal. (Yes, paramedics have been fired for texting while driving lights and siren.) Potential HIPAA violations loom large, and the public expects a certain level of decorum from uniformed public safety officials.

At EMS Today in March, a session entitled "Texts, Twitters and Blogs: Legally Regulating On- and Off-Duty Conduct in Today's Multimedia Environment" drew a crowd of EMS leaders seeking answers to what, exactly, they can and can't regulate when it comes to employees' social networking behavior and freedom of speech. The questions aren't always easy to answer, and the legal precedent is still sparse, said Steve Wirth, JD, EMT-P, who presented the session and is a member of the EMS law firm Page, Wolfberg & Wirth.

Can an employer regulate an employee's communications 24/7? What obligations does an employer have if an employee violates, for example, sexual harassment policies and "harasses" a fellow worker via Facebook or Twitter? Is it in the public interest for a municipal employee to indelicately criticize a receiving hospital's staff via a video posted on YouTube or Facebook? Does it make a difference if their criticism is true? How tightly can an organization really regulate its image? Are government employees' communications while on the clock -- even those created and sent on their own devices and accounts -- subject to public records requests? What if the division between public and private accounts is blurred because the organization sends official work-related "tweets" to employees' personal cell phones? The scenarios are nearly endless.

'Lego' Activists
Wirth played a now infamous computer animated "Lego" video that elicited nervous laughs from the session's attendees. (View it atwww.xtranormal.com/watch/6096497.) Seems those innocuous little building toys are championing public safety issues with the help of a video production site called xtra normal. Fire and EMS blockheads, so to speak, are running around virtual towns berating ED doctors and nurses, patients and nursing home staff in profanity-laced tirades.

In this particular video -- and there are dozens of others posted on YouTube -- the target was an ED doctor who dialed 9-1-1 to request transport for a patient to another hospital. The patient had been at the ED for eight hours, had "a cold and a runny nose" and had complained of experiencing the symptoms for several days. Several f-bombs later (illustrating what many paramedics no doubt often think but never say in similar situations), the doctor declared, "I'm a doctor. I can do whatever I want."

The "anonymous" video reportedly caused significant friction between an agency and a hospital. Apparently, a doctor at a hospital shared the same name as the one in the video, although no specific facility or EMS agency was named. He also happened to be African American, which Wirth said raised questions of a racist undertone. Comments on the xtra normal site indicate the creator was fired over the incident. If that's true, was that the appropriate discipline? What if the offending paramedic had an exemplary record otherwise?

"Could you infer that this was a specific individual working at a specific facility? I don't know," said Jamie Orsino, an EMT with the Boston Police EMS Division and president of the EMS Labor Alliance, a national alliance of several unions that represent EMTs and paramedics. "But, you're going to make a business decision to fire an employee because the hospital didn't like it? Nobody was arguing the truthfulness of the content. They were just saying it was upsetting to somebody."

Wirth said, in his own opinion, firing someone who's an otherwise good employee over a social networking faux pas seems a bit harsh, particularly if there's no policy in place that provides employees with a specific set of expectations. That said, most often, agencies are perfectly free to sack someone for exercising what's perceived to be inappropriate "speech."

"People think the Constitution protects them from their employer. It doesn't," Wirth said. "The Constitution was designed to protect us from the government, from unfair government action. It's a common misconception. When an employee says, I have free speech rights,' well, they usually don't -- especially if they work for a private company or a non-profit."

Paramedics and EMTs who work for private ambulance services and non-profits are at-will employees and can be lawfully terminated for any reason -- as long as the reason is not due to unlawful discrimination and the employee is not protected by a collective bargaining agreement (and in that case, the employer simply must show the termination was for "good cause"). Municipal employees have a slightly higher level of protection, because they work for the government, Wirth said. For example, speech deemed to be about "matters of public concern" (such as speaking out about safety issues and other concerns about the provision of EMS that the taxpaying public would have an interest) enjoys some protection -- but that protection does not extend to speaking out about personnel issues or to statements critical of the organization made while functioning in your official capacity. And this right to speak out about matters of public concern is balanced against the government employer's right to maintain order, discipline and its reputation in the community. Tip No. 1: Declaring the fire chief an idiot savant doesn't quite meet that standard.

Time-Stamping Your Stupidity
Tip No. 2: If you're going to break agency policy, or worse the law, it's best not to announce it on Facebook. Wirth told the audience about one EMT who, in the middle of transporting his patient, announced in a Facebook update that he was "transporting another Gomer to the hospital." ("Gomer" stands for "get out of my emergency room" and is generally understood to mean an elderly, demented and incoherent patient.) "That post is now injected with the time." Align it with a patient care report, and you've got pretty solid evidence of on-duty misconduct.

During a recent listserv discussion, a participant (who agreed EMS Insider could share his post but wished to remain anonymous) described another Facebook incident where a "hormonal, young" member of the agency posted a message on his page boasting that he "gets more ass than a toilet seat." Publicly humiliating himself wasn't enough; he posted it alongside a photo in which he was wearing a "very identifiable" uniform and logo. He agreed to take it down, but the organization was prepared to let him go if he had refused.

Managers have found that they don't even have to be Facebook "friends" with someone to learn about an inappropriate post. "When somebody does something that they're particularly proud of, they always tell somebody, and quickly we know," said Matt Zavadsky, MS-HSA, associate director of field operations for MedStar in Fort Worth, Texas.

"In one recent case where we had to take some corrective action, they posted something on their Facebook page at around midnight. One of our employees who was on duty and sitting in a post location using her iPhone found it and forwarded it to one of our on-duty field supervisors. When I came in at 6:15 in the morning, it was already printed out and on my desk. It travels quickly." (Tip No. 3: Beware whom you "friend.")

Preventing Mayhem
To provide employees with a clear set of expectations, MedStar developed an "Internet Communications & Social Networking Policy" that went into effect April 1. Zavadsky said when they started researching sample policies, "there were not a whole lot out there. I hate to say it, but in EMS, we get so busy doing the day-to-day things that sometimes we don't take the time to look at what's beyond the curve up ahead.

"This is a technology that we have to embrace. However, just like carrying around nitroglycerin, in small doses it can be very beneficial. But in large doses, uncontrolled, it could be explosive," Zavadsky said.

The policy reinforces MedStar's existing code of conduct and covers online comments on third-party sites, such as posting responses to news articles or blogs, personal blogs and other social networking content and MedStar-sponsored sites. Importantly, it clearly prohibits several activities, including: sharing protected health information; posting videos, photos or images that could identify patients, addresses, vehicles or any PHI; sharing confidential or proprietary information; posting anything that could "negatively impact MedStar's reputation"; posting vulgar or abusive language or attacking individuals or groups; endorsing commercial products or services; and posting "derogatory, inflammatory or disrespectful" statements.

"We've had some employees asking for guidance because they felt uncomfortable, or they did question some of the things that they were putting on their personal Web sites or blogs or Facebook," Zavadsky said. "I think there will be a lot of workers happy to receive it."

MedStar is incorporating the new policy into their training program. "Whenever we do any type of policy change or new policy implementation, we have a pretty robust distribution system that we use for our 325 people," Zavadsky said. "We make sure that everybody knows it, understands it and, on occasion, with major policy changes, we do some quizzes with the education to make sure that they understand it and they sign off on it."

EMSLA's Orsino said that while he agrees with policies that prevent on-dutyabuses or blatant activities that dishonor an organization, such as taking photos inside ambulances or inappropriate photos in uniform, etc., he's skeptical of any broad-reaching attempt to reign in employees' social networking activities 24/7.

"There is an employer-employee relationship, and at some point during the day, it ends," Orsino said. "It seems to be quite a stretch to me; if somebody isn't in uniform and isn't at work, and he's using his own computer and his own account, the employer has no control over it. To write a policy and to have people agree to it will be very difficult."

However, Wirth said that a supervisor who "witnesses" what could be perceived to be an act of harassment online between two employees may be legally obligated then to act on it. "If you know these comments between one employee to another are sexually harassing, as a supervisor, and it doesn't matter if you're on duty, you have an obligation -- the question will be: Did the company (and supervisors are agents of the company) know or should have know about the unlawful harassment and did they do anything to stop it?" He said neglecting to act could come back to bite an organization if a lawsuit arises. (Tip No. 4: Supervisors should think twice about "friending" their employees; there are some things you really don't want to know about them, and vice-versa.)

PR & Budget Opportunities
Of course, most employees use social networking for positive purposes -- to keep in touch with friends and coworkers, exchange valuable ideas and stay tuned in to news and current events. Medstar has its own Facebook page and Twitter account.

"We want to embrace the technology, because we truly feel that it can help us promote Medstar's mission and vision," Zavadsky said. "We want to embrace it in a fashion that's positive for MedStar, and if we don't have some kind of policy or control over how that's being done, we can have an inconsistent image out there."

San Diego Medical Services, the public-private partnership between San Diego Fire-Rescue and Rural/Metro Corp., has embraced social media for both internal and external communications. Like Medstar, SDMS has a Facebook page and Twitter account. They don't have a specific social networking policy; however they do have a code of conduct that reinforces protection of patient health information and ethical behavior and restricts photos and video. They have not had any negative experiences with employees using social media in a way that reflects negatively on the organization.

"We use the accounts for announcements, for employee get-togethers and to get the word out about positive things that are happening within the organization, said SDMS Director of Public Affairs Michael Simonsen. "It's just another portal that allows us to communicate not only with our workforce but with the public at large.

"As a public affairs person, Facebook is a very valuable tool because it keeps me connected with the community, the stakeholders and the elected officials. It doesn't cost anything, and you control everything. It's media without a filter. It's your own publication, if you will."

MedStar's Facebook account has proven to be a great recruiting tool. "We're finding folks are attracted to the organization based on what the employees are saying on our Facebook page. We've gotten four applicants that way."

Tip No. 5: Facebook introductions work both ways. If you're in the job market, don't post anything on Facebook or Twitter that you don't want a potential employer to see. One HR director told EMS Insider that she's actually passed on candidates after seeing what they've posted online. It's not your typical background check, but it's likely to become more and more common.

While SDMS uses Twitter to keep both internal and external "followers" appriseof current company events, MedStar uses it strictly internally.

"We created a MedStar Twitter account and are testing it with our managers, supervisors, training officers and advanced practice folks. When we send out a tweet' it goes to their cell phones as a text message. We're rolling that out as a pilot to the workforce and asking folks to sign up for it so they don't have to carry their pagers anymore off-duty," Zavadsky said. "We already know folks pay a lot more attention to their cell phones than they do their pagers."

These are personal cell phones, and the company does not purchase text-messaging packages, so employees won't be required to give up their pagers. But, "I'd guess probably 80% of our workforce is texting on a regular basis; I get direct text messages from field employees all the time."

The prospect of dumping the pagers in favor of text messaging has some financial benefits. "Frankly, from a cost-effectiveness standpoint, we've got 450 pagers out there that are costing us $2,700 a month," Zavadsky said. "If we can now only have two pagers per ambulance instead of one for every employee there could be significant savings over time."

No Going Back
Companies everywhere are grappling with the challenges and opportunities social media has created. "It's the wild west, at the moment," Orsino said. Many of the questions presented in this article will be answered in court, probably sooner rather than later. But clearly communicated expectations can go a long way in keeping your agency off the docket.

EMS Insider thanks MedStar for sharing their social networking policy.

Matt Zavadsky can be contacted at mzavadsky@medstar911.org.

Access timely news, announcements and discussions by joining the EMS Insider Group on Jems Connect at http://connect.jems.com/group/emsinsider.


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