Administration and Leadership, Columns

Talented Paramedics Shouldn’t be Fired for Making Mistakes

Issue 11 and Volume 40.

After more than 20 years in this field, I’ve come to realize we treat our EMS workforce like a plentiful and renewable resource, when in fact talent and experience are scarce commodities. If the assumption is that technicians are easily replaced if they make a mistake, then the management viewpoint is often that once an EMT or medic makes a clinical or operational error, you should cut your losses and bring in someone new.

This is particularly true in organizations that focus on just having “butts in seats” instead of clinical excellence.

Fortunately, this isn’t at all how the rest of medicine functions. In many states, a licensed physician who’s been identified as someone who provided less than the standard of care receives a formal review process. Experts are consulted to review the case and, unless it was egregious, the doctor may be assigned to complete specific continuing education or, in more serious circumstances, have their practice monitored or restricted. Rarely does it mean they’re removed from practice.

STATUS

This huge discrepancy between how we treat physicians and how we treat medics seems to center on the lack of status of a paramedic. The lack of status may be due to the education entry requirement, low level of political action and lobbying at both the state and federal levels, and the public’s perception paramedics aren’t professionals. This gives administrators the belief that medics are easily replaced. The fact is, however, that they aren’t easily replaced—particularly our high-functioning senior clinicians.

EMS medical directors and administrators have to develop our medics instead of letting them go due to understandable and expected errors. The management philosophy on the clinical and operations sides of EMS agencies are usually the same: There are a set of clinical rules (protocols) and a set of operations rules. If you don’t follow the rules, the prescribed disciplinary process will be applied with some sort of punishment: Make a medication error, get a day off; cardiovert someone who didn’t need it, get two days off. This is an archaic philosophy that has to change!

As an assistant professor in emergency medicine at the Baylor College of Medicine, I have the opportunity to train medical students, interns, residents and fellows. It’s a great perspective to have when evaluating clinical issues in EMS. Do interns and residents make mistakes in thinking and clinical practice? You bet! Do they go through a formal disciplinary process every time? Of course not! If we got rid of all of the residents who made errors, we’d have no residents in the teaching hospitals.

The fact we don’t always discipline trainees is because their errors are usually expected. That may include errors that we as physicians have made ourselves or seen other physicians at the same level make. The focus, then, is on identifying the error, discovering why the error was made and giving the resident an assignment to demonstrate they’ve been able to rectify the deficiency.

TEACH VS. PUNISH

As a supervising physician for both paramedics and residents, I’d rather work with providers who’ve made errors and have an appreciation for their fallibility than someone who believes they’re some sort of God-like being who doesn’t make mistakes.

Team members with experience and who’ve made mistakes understand when to be aggressive and when to apply caution. They develop an appreciation for “knowing what they don’t know,” and when to seek advice from others. They become mature clinicians and more valuable to the organization, not less.

As EMS medical directors, we have to treat our medics like we do emergency medicine residents. We have to focus on building and developing our clinicians rather than looking for opportunities to punish. Give them homework assignments, directed continuing education, or self-directed learning requirements instead of days off or termination.

As I tell all of my medics: I don’t expect you to be perfect, I expect you to want to be perfect. If the motivation is there to improve, we should do all we can to develop our personnel.