Picture this scenario: Two of your paramedics respond to a scene. Your patient’s wife called for you to treat her husband, who’s threatening suicide. He has been drinking and admits he took some of his pain prescription drugs.
Once the paramedics get to the scene, the husband is agitated and uncooperative. He’s adamant that he doesn’t want to be transported to a hospital. The paramedics try to gain his cooperation and try to get some history and vital signs, but he tells them, “You ain’t touching me” and “I ain’t going to no hospital.”
This is a difficult scenario for the paramedics because they have a patient who isn’t cooperating. According to the medical director’s protocols, however, anyone who’s threatening suicide or can’t pass a series of questions to verify they’re competent to deny treatment and transport must be transported to a hospital facility.
Finding themselves in a quandary, the paramedics decide to call the police. Once the police arrive on the scene and find that the patient is refusing treatment and transport to a hospital, they tell the paramedics there’s nothing they can do because the patient is refusing treatment and transport. The paramedics decide not to transport the patient to the hospital.
The two paramedics on the scene are good employees. They always come to work, are never tardy and generally cause no problems. Several letters from citizens in their personnel file reflect excellent customer service skills over the years. The employees’ files lack disciplinary action. For the most part, these paramedics are excellent employees.
On this particular day, they made a bad decision. The EMS providers decided not to transport the patient who was denying any treatment and transport, and the police officers said they weren’t going to intervene. The providers had the patient sign their standard refusal of care form, and they exited the scene with the patient’s wife protesting.
After the Call
Several hours later, the 9-1-1 center receives another call from the patient’s wife. This time her husband is unconscious with labored breathing. When another ambulance arrives, they have to intubate the patient and transport him to the hospital.
EMS management later discovers what happened, conducts an investigation and suspends each paramedic on the original call for 10 days.
Is it the right decision to suspend both employees? Some would argue that the paramedics in this case should be suspended, and others would argue that they should receive further education to understand the protocols and refine their decision-making skills.
Many would argue that discipline isn’t about punishment for doing something wrong; instead, it’s to change the behavior of the employee’s who made the wrong decision. Others would argue that the paramedics in this situation shouldn’t be suspended because they’re good employees who weren’t unwilling to do the job, rather they weren’t fully aware of all the options available to them in the decision-making process.
They possibly could have called their supervisor and asked what they should do. Or they could have asked the police officers to call one of their supervisors and have them respond to the scene to assist with options to manage the patient who should go to the hospital but was refusing to go.
Some would argue that when you suspend two employees who made a wrong decision, you will take two good paramedics who are generally excellent employees and destroy their motivation for the job.
Some would argue that the suspensions would dampen the employee’s enthusiasm to come to work, never be tardy, and treat patients and family members with excellent customer service skills because the employee didn’t act intentionally or believe they were making a poor decision.
The final step should be to administer the discipline. This final step should come only after the EMS providers have been taught, coached and counseled and the desired results aren’t achieved. Remember, the purpose of discipline is to change behavior, not to punish the employee.
The disciplinary phase should also include an assessment of the desired behavior you’re trying to achieve. The severity of the disciplinary action should be based on the potential consequences the behavior could cause to the department.
During my years, I’ve seen managers in fire and EMS organizations hand out discipline like they were handing out candy. I even worked for one manager who finished every department-wide memorandum with the statement, “Failure to follow this memorandum will result in discipline.” Of course, those memos went over like a lead balloon, and he couldn’t figure out why there was such dissension in the organization or why he couldn’t hold a job anywhere.
Bottom line: Discipline isn’t always the answer. JEMS
This article originally appeared in July 2012 JEMS as “Discipline: The difference between discipline & punishment.”