Although we lack a single, globally accepted definition for the term "professional," it's generally recognized that until the 13th century, only three professions existed ƒ physicians, clerics and lawyers. Members of these professions, after long study under their masters, declared a body of knowledge unavailable to the masses through service in the form of advice, action or both. As society became more complex, increasingly specialized bodies of knowledge became necessary, and more professions emerged.
Today, the traditional ideas associated with professionalism have become blurred. Overuse of the terms "profession" and "professionalism," our increasingly casual society and the overtly unprofessional behaviors of some within the professions have made it difficult for these traditional ideas to re-emerge. As these ideas fade, it becomes more difficult to distinguish a profession from a mere occupation. Also, as this line blurs, quality within the professions suffers because the values of each profession change.
Societies clearly need a justice system, medicine, engineers, law enforcement, fire suppression, EMS and many of the other professions. Therefore, it's important for EMS personnel to recognize that they belong to a profession and to re-learn what it means to be a professional if we are to maintain our self-respect, as well as the respect of other professions.
What is a profession?
Although some analysts and leaders consider EMS more of trade than a profession at its current state, most field personnel have a sense of belonging to an actual profession, with no consensus as to why or what the characteristics of a professional are. However, we must all agree that some standard or ideal must exist if we are to distinguish a profession from just a "job."
In his article, "Some Problems in the Sociology of the Professions," Everett C. Hughes writes, "A profession delivers esoteric services-advice or action or both -to individuals Ú or governments, to groups of people or the public at large Ú. The practice should rest upon some branch of knowledge to which the professionals are privy by virtue of long study and by initiation and apprenticeship."1 These services, advice or actions are essential to good order and the well-being of the community. EMS should engage in the professional practices of other organizations, such as research and sponsorship of community change, as physicians and nurses do. This involvement would create a positive, educational social impact and increase political clout. Long study, initiation and apprenticeship serve to validate the EMS profession and distinguish it from vocations that don't require such stringent training and lifelong educational commitment.
The importance of self-policing
Those who receive our service, not being privy to the body of knowledge themselves, are not appropriate judges of what we do. When we provide medication to a patient, they trust their lives to our knowledge, as they themselves have not studied the pharmacokinetics, pharmacodynamics, indications and contraindications of that medication. Similarly, when we choose a destination for a patient, they trust that we understand their condition and treatment needs, as well as the capabilities of the destination we choose. These examples emphasize why self-policing is a vital component of each profession's claim. Self-policing in EMS reveals itself in the character of each individual, operational guidelines and quality assurance programs.
Attributes of an EMS professional
Just because someone works within the professional community does not automatically make them a professional. To be considered a professional, a person must possess certain attributes. These criteria are especially important in highly visible professions, in which the community places a great deal of trust, particularly EMS.
Society expects us to be able to care for any member of the community, regardless of age or condition, at any time. If you think about this for a moment, you'll realize what a terrific responsibility we have, especially because the community offers little forgiveness for preventable failures. Also, a unique characteristic of EMS is that our personnel are trusted to enter someone's home, be privy to private information and see strangers when they're most vulnerable.
Thus, our profession demands that we possess certain attributes in order to carry out our tasks under the conditions described. Professionalism, although made up of many aspects, has basic characteristics common to all professions. These characteristics can be rolled up under three headings: scholarship, discipline and values.
Scholarship: Again, society expects us to be able to care for any patient, regardless of the variables. We must, at all times, be competent in our expected skills and be able to perform accordingly. However, our skills are perishable; that is, if we don't use it, we lose it. Therefore, we must seek out opportunities to practice our skills while keeping up with various methods and algorithms.
According to Wikipedia (an online resource), "being scholarly means being self-critical, carefully inspecting your own work from a skeptical point of view, while finding weaknesses and possible ways of overcoming them." Most EMS professionals spend their initial training with such scholarly intentions, but many lose this focus with experience, which leads to an increased comfort with their work environment and protocols.
Discipline: The word "discipline" is often associated with punishment. However, in this case, it simply suggests a high degree of self-control in behavior. It's much like the discipline of a long-distance runner. Discipline in EMS is manifested primarily through appearance, integrity and bearing.
Appearance is important to the professional. Knowing what you're doing isn't enough; you must also look the part. As Loma Linda University's Daved van Stralen, MD, once asked, "Care to fly with commercial pilots who show up in shorts and Hawaiian shirts? Or have your surgeon come in with cut-off jeans and a t-shirt to tell you the cancer cannot be removed?" To act professional includes looking professional. Your appearance is your first line of communication with your patient and your community. Instilling this sense of confidence in your patient is an essential part of your care.
Anyone who has served in the Armed Forces should be familiar with the term "bearing." This means that people and your environment shouldn't change your professional demeanor or attitude. Whether you're caring for a homeless person or a wealthy person, the rude or the kind, a true professional doesn't change their demeanor. Although you'll be judged by your appearance, you must avoid judging your patients and their conditions.
This isn't to say that professionals in EMS can't act with empathy or concern; in fact, these traits are desirable and should be expected from all professionals. We can't force providers to care or be empathetic, but we can teach the behaviors associated with empathy and compassion, hoping that new providers internalize the message. It's rare to meet a person who cares for all their patients, 100% of the time; we're only human after all. But even in the face of challenging patients, a true professional's bearing doesn't falter.
Values: The above traits are a direct extension of the professional's values. You can be the most knowledgeable and skilled caregiver, but your ability to communicate your values is what allows you to put your knowledge and skills to work. The professional must have a well-established set of personal values that they're not willing to compromise for convenience or quickness. The professional examines their values to ensure that they're in line with the ethical code of their field. Ultimately, the EMS professional values scholarship, discipline and internalizes an ethical code of conduct that has the best interests of the patient in mind.
Although the definition of professional may be a topic of some contention, the behaviors and conduct of a professional are not. Prehospital providers must be disciplined enough to commit themselves to lifelong learning, their patients and the improvement of the field in order to expand our special body of knowledge. Good patient care is the ultimate result of a true professional at their best. We can't forget that character is one of the most important aspects of being a professional and that professional behavior must be self-generated and modeled for new generations of EMS providers. We can retain our right to be called professionals if we uphold the criteria of professionalism.
James Goss is lead paramedic instructor for the Riverside Campus of the Northern California Training Institute and faculty at Loma Linda University's Emergency Medical Care Program in Loma Linda, Calif.
Lindsey Simpson is a paramedic instructor at the UCLA Daniel Freeman paramedic program in Los Angeles and a student of Emergency Medical Care at Loma Linda University.
Josh Higgins is a student of Emergency Medical Care at Loma Linda University.
Acknowledgement: The authors would like to thank Dr. Daved van Stralen and Chad Cossey for their input.
1.Grace JJ: "The Need to be more professional Ú whatever that means." Naval War College Review. May-June 1975.