Background checks and the hiring process?

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Permalink Reply by blair4630 on June 27, 2009 at 4:02am

Hmmm....I see your point. However, no system is full-proof, and bad apples will slip through the cracks of any system. There are police officers who commit crimes after years of employment. There are also teachers, who have fairly stringent checks from what I understand.

That being said, if such standards were to be implemented, I would say it should come from the top, on a federal level, as I see this (as in other discussions), as being the best place to implement anything due to national uniformity. National registry comes to mind, but there more of a testing and certification agency, but roles change over time. Maybe that could be part of the requirement to sit for one of their tests; documentation of completion of specified background check requirements.

It's true, though. Not something we think about much, but we have an incredible amount of access to people in the most private places (I'm talking about homes and such, people), in times when they are very vulnerable. And in many areas the standard is a background check, employment history, and driving history. It does leave a lot of areas to slip through.

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Permalink Reply by Jonathan Gilliam on June 27, 2009 at 6:41am

I definately agree with background checks like this. I'm sick and tired of seeing articles reporting other EMT's and medics either stealing from patients or molesting them. It makes all of us look bad, and I think that a good background check process can weed out almost all of those who are prone to this behavior. But like it was said above, bad apples do make it through. The way I see it is that we can greatly reduce the chances of this sort of thing by doing a good background check. The only thing I'm opposed to is a polygraph. The findings from a polygraph are not admissible as evidence in a criminal case which means there is doubt about its reliability. People can beat it, and people can throw false positives and I just think that it is not a reliable practice. However, thoroughly checking someone's background is definately warranted, as well is a psych eval.

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Permalink Reply by TheCannulator on June 27, 2009 at 8:34am

A fingerprint-based nation-wide criminal records check.

We have a national criminal record check.

A background investigation that will take a trained investigator 40 or more hours to complete, which will reach far beyond the references I gave on my resume.

Why is this useful for EMS? does a Doctor or Nurse need this?

A home visit with interviews of spouse, significant others, or parents (and maybe to see if there is a meth lab in the closet).

It's EMS not ASIO CIA or MI6

A polygraph examination to determine whether or not I have "forgotten" to report anything negative in my history.


Can't say I favour polygraphs as reliable.

A driving records check.

Parking fines or drink driving? Criminal records checks here find the ones that matter.

A physical abilities test.

A Medical and physical "capacity" testing is more relevant. Fitness isn't necessarily indicative, but I get your point.

A drug test (which will be repeated at random throughout my career).


Drug testing worries me. so long as your outside behavior doesn't impair your work ability some say is a a private issue. But certainly worth considering.

A psychological examination by a licensed professional.

We have psychometric testing and psych testing..

I think the type of qualifications that act as barriers. A 3 year degree is cost prohibitive to many. Allowing EMS to function with lower trained employees allows undesirable to infiltrate to profession.

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Permalink Reply by Skip Kirkwood on June 27, 2009 at 8:55am

It sounds like, again, in Australia they are far more organized about this stuff than we are.

But back to the question: Shouldn't EMS folk have to meet the same standards of character, integrity, etc. that are required of LEOs? If not, why not?

Is it right that we wait until they do bad, and then we moan about our tarnished reputation? Or should someone (question who) require something in advance.

I don't think that the doctor or nurse question is on point - except in limited circumstances, they work in facilities and are surrounded by other people. The protest of a violated or robbed patient would most likely be heard by someone, while a medic is out there in the world, the home, a metal box. In this case, I think our standards and procedures need to be MORE stringent that theirs.

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Permalink Reply by Robert Sullivan on June 27, 2009 at 9:06am

I'm sad to hear about this happening in my home town. I already worry about who's going to show up at my parents' house if they call 911, and now I have to worry about their house getting set on fire. I started working in Buffalo (not for R/M) and am not surprised by this.

Because of EMS's pulse and a patch standards, we attract many people washed out of fire and police application processes. Then they go out and play police officer from the ambulance. One of my partners argued with our managers about why he should be allowed to carry a gun to work because he also worked as a security guard. To me, that's a red flag. To those managers, he fills a hole in the schedule.

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Permalink Reply by Skip Kirkwood on June 27, 2009 at 10:18am

Indeed. I grew up just north of Buffalo, my family is still in the area. I hope that this is just one bad apple who got through and not a symptom of the standard personnel practices of EMS in the area.

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Permalink Reply by Ben Waller on June 27, 2009 at 2:50pm

Why don't/shouldn't EMS hire standards rise to the level required for LEOs?

LEOs are entrusted with enforcing laws and with arrest powers, we're not.
LEOs are entrusted with firearms, we're not.
LEOs are often the only public safety representative present in a crisis situation, we usually have at least two people present, so our checks and balances are more extensive.

LEOs have a typical mindset of using force to subdue bad people, we don't.

While we have access to deadly force, we don't have the power to project that force out of arm's reach.
While we can make the patient naked, it's typically done in private, with full efforts to preserve the patient's modesty and dignity. When that privacy doesn't exist, we usually create it by moving the patient into the ambulance prior to complete clothing removal, by having firefighters shield the public's view with tarps or blankets, or something similar.

RN's and physicians have a lot more access to patients in private settings than does EMS, but they don't get LEO-style background checks. They have access to a much larger pharmacopia of dangerous drugs and medical devices/techniques than do EMS providers.

Polygraphs are notoriously unreliable.

Psych tests don't screen out anyone but the obviously insane, and sometimes not them if they're clever enough to mask their sociopathic tendencies.

Psych tests aren't infallible - ever seen a video of a trooper choking a paramedic?

That said, here's what happens in South Carolina...

My state mandates background checks, including digital, biometric fingerprinting at initial certification and at a minimum of the 3-year recertification cycle thereafter. Because we're firefighters as well, we also get the state-mandated background check as part of our firefighter certification at time of hire. We get drug tested at pre-hire, at our annual physical, randomly, and as part of reasonable suspicion after accidents, documented behavior problems, etc.

All candidates must pass a written aptitude test, a physical abilities test, a firefighter physical that meets the NFPA 1582 standard, an oral interview, and a driving check that goes back 10 years or until initial driver's licensure, whichever is appropriate.

We don't do home interviews or visits, because many of our candidates are from out of state and the costs would be prohibitive.

Those are not "lower" standards, they're just standards that are more focused on a cost-effective and more focused background check that's applicable to the realities of the job.

We could argue that U.S. postal employees should get the same level of background check as the CIA...after all, they have the power to disrupt the economy and people's lives, health, well-being, and business. We don't do that, because CIA employees who go bad have the power to cause much more damage than does the average postal employee. Ditto for LEOs vs EMS providers or other public safety personnel.

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Permalink Reply by Skip Kirkwood on June 27, 2009 at 7:57pm

I think we've finally found our area of greatest disagreement, Ben.

There's no nexus between integrity and the "use of force" issue. That argument is a non-starter. The only reason to do all of this is honesty - a LEOs integrity is the only thing that lets him/her occupy a position of public trust. What happens to a cop provent to have lied? Done for. Recently the DA here in Wake County had to dismiss all of the citations written by a state trooper who was found lying. Then he lost his job, because he could no longer testify credibly in court. A paramedic too must be 100% credible - otherwise how can the physician rely on the medic or the PCR. A thorough background process (including the polygraph, which IS admissible and acceptable by courts for civil matters like employment, and not admissible in criminal matters not because it is unreliable, but because it gives a heightened impression of reliability because of its technical nature) should be able to find patterns of dishonesty.

The secondary reason is to identify, in advance, those prone to sexual misconduct. There are court-accepted psychological instruments like the MMPI that will identify those who should not be trusted alone with children, or members of the opposite (or the same) gender, or vulnerable people in general.

Firearms are no big deal - their use is too infrequent to be significant. And on anything more significant than a traffic ticket, there are almost always more than one LEO present. Often a herd.

I'm thinking you must spend time in different hospitals than I do. The physicians in our three major medical centers NEVER spend any time (locked or otherwise) in a room alone with a patient of the opposite gender - and when I've aksed about it, they can't imagine it any other way. Medics are always alone with their patients, isolated in a (relatively) noisy metal box.

I think that we owe it to the citizens we serve to establish, by any means possible, the character of the people to who we entrust them. Just read about the impact of a patient being sexually assaulted, robbed, or in the case of the article I posted, the people whose building(s) were burned by EMS folks. When the media sticks the camera in my face, or when I'm called to testify in the lawsuit, I want to be able to say that we did everything we possibly could do to assure that the people we entrust with EMS in our communties are of the right character.

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Permalink Reply by Ben Waller on June 27, 2009 at 10:17pm

Skip,

I do indeed spend time in different hospitals. We don't have a single "major medical center" in our entire county, or in several of the surrounding counties. Not every hospital has the staffing of the ones in your area, and while not the most desirable option, some of their medical providers do spend time alone in a room with a patient. It's happened to me when I was an ER patient, and in more than one hospital. There are other ways to take care of that problem - onboard cameras, for example. Floor nurses can and do spend time alone with patients on a daily basis as well. BTW, In my system, three-provider staffing is common, so the paramedic isn't always alone with the patient.

As for trust, if the draconian screening isn't catching the unstrustworthy cops, then why should we waste EMS time and effort on it for probable similar success rates?

Pathological liars can and do beat polygraphs. Sociopaths can and do beat psyche tests.
So...if we're going to use them we have to accept that it may screen out some applicants with potential problems while it may not screen out the potential worst offenders. It may also screen out people who would make fine, trustworthy paramedics and who hurry through the psyche test because they think it's BS.

I've also been in court enough to know that good lawyers can make credible cops, paramedics, and doctors look not-to-credible with their courtroom tactics, style, and after-the-fact spin. Credibility is important, but I'm not 100% convinced that psych tests and polygraphs add to that credibility, particularly when it's what paramedics do, not their pre-hire testing that's the focus when one of us is on the witness stand.

Even if psych tests were completely reliable, if we start relying too heavily on them, we're going to put ourselves into a "Minority Report" (Tom Cruise movie reference) crime prevention mode...denying employment due to the percieved inclinations of people that have done nothing wrong. Isn't that at odds with the foundations of American jurisprudence...occasionally letting the guilty go free to ensure that the innocent are not convicted?

And...if the use of force arguement is a non-starter, then why are we watching video of a trooper choking a paramedic? From the comments in the Oklahoman's forum, there are plenty of OK residents that wish that particular trooper had been screened for his violent tendencies in advance. If he was, then the testing didn't do a very good job of predicting future performance.

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Permalink Reply by TheCannulator on June 28, 2009 at 12:24am

We've been for some time( Six Years in a row) regarded as the most trusted profession in the annual Reader's Digest Surveys. In front of Nurses and FFs even PD. Not bad!!

Here our psych testers said we were all nuts anyway going by the testing as Type A control freaks!

Our physicians DO spend time with pt's of the opposite gender isolated. It's their job. Here, where able if alone with an opposite gendered pt we have a second person present.

All the checks and balances will only mitigate risk not remove them. Even our spy agencies with negative vetting programs have had many an undesirable or double agent, despite very intrusive background and credibility testing.

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Permalink Reply by Alan Payne on June 28, 2009 at 3:12am

Gotta agree with the cannulator, here in the UK all staff need a criminal records check (CRB) to be completed you need another CRB to satisfy the Health Professions Council (HPC) who register paramedics nationally and you need a further check if you want to hold an Airport pass to work the Heathrow area. Incidentally each CRB check completed is only valid for 10 weeks, so everytime you go for another job, promotion etc you are required to have another check completed.

It's not perfect but it does bring most things including speeding and Police cautions to light.

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Permalink Reply by Skip Kirkwood on June 28, 2009 at 8:27am

Come on, now, Ben. The fact that nothing is 100% perfect doesn't mean that you shouldn't try.

Surely, you can train someone to beat a poly. The odds of encountering somebody who has had that training might be one in 5 or 10 million - maybe better, for a job that pays below $100K. That kind of training is given where, the CIA?

American jurisprudence? One of the issues in this discussion seems to be the confusion of criminal process (where guilt must be proven beyond a reasonable doubt, and a presumption of innocence attaches), to the rest of the world, where a preponderence of the evidence is sufficient and where all interests are balancing. Nobody has proposed anything illegal - I've merely advocated for brining what are already court approved, legally required processes for a profession with many similar characteristics to the world of EMS. This stuff is all in common use, in most every town, city, and county in the U.S. Hardly draconian - more like thorough.

To each their own.....good luck.

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