Administration and Leadership, Patient Care, Training

Recommendations for Improving Employee Hiring Practices

Issue 8 and Volume 38.

(This article also appears in the August issue of EMS Insider. EMS Insider, the premier publication for EMS managers, supervisors, chiefs and medical directors, is a must-have resource for the critical, accurate information EMS leaders need. The monthly publication offers quality investigative reporting, exclusive articles, management tips and the very latest news on legislative issues, grants, current trends and controversies. For more about how to become an Insider, go to

A volunteer fire company ambulance company in the Pittsburgh region was investigated in 2008 after a resident filed a complaint alleging he was mistreated by rescue workers. The patient also complained to the FBI and state attorney general’s office, alleging potential false imprisonment and unlawful restraint. He also contacted the American Civil Liberties Union about possible civil rights violations.

In Dallas, a female patient claimed that a paramedic made “sex talk” to her while she was being transported in an ambulance. The patient claimed she was scared and thought she may have been kidnapped by a paramedic imposter.

A Wyoming man was charged with impersonating a paramedic and practicing medicine without a license when he worked as a paramedic for a private ambulance service in Colorado. The Colorado Department of Health stated the ambulance service should have done a background investigation and determined he didn’t have the appropriate training and certification as a paramedic.

An Oklahoma EMS agency faced a negligent hiring claim after a fatal motor vehicle collision involving an ambulance. The driving record of the EMT indicated several issues, including speeding violations, DUI and open container citations.

An old human resources adage goes: “Past performance is usually an indicator of future performance.” This is a useful perspective when considering the need for an employer to carefully select the individuals who may join their agency. A failure to demonstrate due diligence in hiring practices can result in claims of negligent hiring, negligent supervision and malpractice beyond the internal complaints from other employees. In many cases, a review of previous employment references can identify potential issues before the applicant is ever hired.

Standards of Eligibility
Employers should develop applicant standards of eligibility that define the areas that will be evaluated during the assessment of a potential new employee. The requirements for successful completion of each area
of review, in addition to issues that can result in disqualification, should be defined in
the standards.

For instance, an employer may require that an applicant have a valid, unrestricted driver’s license without any suspension or revocation of the license within the past 36 months. Additionally, applicants with five or more active points on their driving record might warrant a staff review for identification of whether a pattern or history of undesirable driving habits exists that could place the agency at higher risk.

The standards of eligibility should include areas such as the following:
>> Employment history;
>> Character references;
>> Driving record;
>> Litigation records;
>> Academic history (including verification of completion of training requirements for the position);
>> Military service history;
>> Criminal history; and
>> Professional certification history.

The standards of eligibility become the framework for the applicant review process, and assist in verifying that all applicants for the agency are handled fairly and consistently.

Background Investigations & Reference Checks
Some states have had standing requirements for a criminal background check before issuing EMS certification. An increase in public scrutiny of medical providers has prompted some jurisdictions to apply the same criminal background check requirements as other healthcare professions, such as physicians and nurses, to EMS providers.

Many agencies cite barriers to obtaining information, including difficulty obtaining criminal record check results and previous employers who decline to provide any information. This is particularly true in cases of termination or involuntary separation of an employee.

However, these barriers can be overcome with the consent of the applicant. Many states will permit an individual to authorize the release of their criminal record history to employers. Likewise, many EMS agencies require applicants to obtain and provide a certified copy of their driving record with their application.

Potential employers can have applicants complete consent forms that provide previous employers the authorization to release information regarding their work performance. In many cases, the consent forms contain language that releases the past employer from liability from their release of information. The agency conducting the reference check can provide a copy of the authorization for release of information to the past employer, which may assist in expediting the background investigation process.

Employers should also review their employment applications to verify they have sufficient information to properly evaluate a potential employee. EMS agencies should consider whether their applicants should be required to provide additional information beyond the standard entry fields on a generic application for employment. The following are examples:

>> Have you ever been suspended, disciplined or permitted to resign in lieu of termination from any job?

>> Have you ever been denied a license or certification for a business, trade or profession (e.g., certified public accountant, real estate broker, physician assistant, EMT or paramedic) or other certifying body or organization?

>> Have you ever been suspended, censured, had restrictions on your ability to clinically practice, or otherwise reprimanded or disqualified as a member of an EMS profession, or another profession or as a holder of public office?

>> Have you ever had a judgment against you in any civil or administrative proceeding, or any proceeding where you were disciplined or found guilty of fraud, deceit, misrepresentation, forgery or medical malpractice?

Agencies that receive reimbursement for ambulance services may not be aware that the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services is required by law to exclude from participation in all federal healthcare programs, individuals and entities convicted of the following types of criminal offenses:
>> Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP or other state healthcare programs;
>> Patient abuse or neglect;
>> Felony convictions for other healthcare-related fraud, theft or other financial misconduct; and
>> Felony convictions relating to unlawful manufacture, distribution, prescription or dispensing of controlled substances.1,2

The OIG recommends that an agency verify an applicant isn’t on the List of Excluded Individuals and Entities during pre-employment activities, with periodic checks after hire.

In many cases, an applicant’s own public postings to blogs and other social media may provide insight into their past work performance and attitudes. Applicants who post complaints regarding patients or healthcare facilities, or post disparaging remarks regarding patients during their tenure with other employers, may be a source of potential problems for a new EMS agency.

Building successful organizations starts with hiring the right personnel for the organization. Careful review of applicants, including a comprehensive background investigation that reviews the past performance of the applicant, can assist in identifying potential risks in applicants.

Southwest Airlines has a hiring practice that is best summarized by the phrase: “Hire for attitude; train for skill.” The investment of time in the pre-employment hiring phase can help EMS agencies find employees who will best fit their organization, and are free from issues or attitudes that could result in harm to patients, the public, fellow employees or the reputation of the organization. An ounce of prevention can prevent a pound of litigation costs.

1. Social Security Act §§ 1128, 1128A and 1156.
2. Office of the Inspector General; U.S. Department of Health and Human Services. (May 8, 2013.) Special advisory bulletin on the effect of exclusion from participation in federal health care programs. Retrieved on June 25, 2013, from