SHOULD EMS CANDIDATES RECEIVE PSYCHOLOGICAL SCREENING PRIOR TO HIRING?

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Permalink Reply by Ken Roberts on March 12, 2009 at 7:58pm

John,

I think you hit a great topic here with all of the current news of pedaphila in our profession and instances of rage in both driving and pt care. I believe this should be an issue that needs to be adressed as it has been with any other public safety job that is expected to deal with the community. I also think that anyone who has worked in this field for a great deal of time may have a tough time passing one of these exams so it could potentially cripple the current workforce. I guess the question would be which is more important to the public. Would they preffer to have the resources there when they need them or would they rather wait until one is available and know that the person coming is of sound mind and intention. Great topic.

Ken

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Permalink Reply by Micheal Coldren on March 12, 2009 at 10:37pm

This is a very good topic. I recently had to take a psyc. eval test, as a TEMS medic on our PD's SRT team. I think it is a wonderful idea, however my 1 test alone was $350.00. With the current economic situation and high turnover rate, I'm not sure my small service could affort it. On the other hand if I could prevent the service from bad press, or worse yet a law sute is it that big a cost?

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Permalink Reply by Kevin Dunbar on March 13, 2009 at 12:21am

Police and Fire do, why not EMS? I also took one prior to being a Tac Medic.

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Permalink Reply by John W. Magyar on March 13, 2009 at 3:45am

After reading the replies, I came up with another question. Should people with histories of mental illness be allowed to work in healthcare, especially EMS where there is little to no direct supervision? We get medical histories on new employees (and sometimes preemployment exams) for perspective employees. A company, dept. or hospital wants to make sure a person is physically and mentally fit for the rigors and stress of a job in EMS. This is done for liability reasons to assure there are no preexisting conditions which would endanger the lives/ health of pts. and staff and to assure that the applicant has the ability to perform their duties to minimal acceptable standards. This leads me to another question. Do the physicians who perform
preemployment exams for EMS personnel give enough consideration to mental health as much as they do physical health? If not, should they? Is enough attention being paid to psychological health or should there be more?
Does anyone know of any reasonable type of psychological testing available for EMS personnel short of sending each applicant to a psychologist prior to hiring? How about signs to look for in existing employees who may be at risk of going over the edge? If we see any signs that concern us, what can we do to help the individual (and others) before its too late?
And finally, should the state have regulations in place to report ( and keep a database on) persons who have exhibited inappropriate behavior while on the job and been fired so that the same person doesn't move and take the same problem to other services in a different locale? (Database similar to the J-net system in Pa. for criminal offenses)

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Permalink Reply by JJ Magyar on March 17, 2009 at 7:17pm

I think it is prudent to want to know as much as you can about your employees. I dont think it is realistic. Many people with psychological problems work everyday in all professions with little or no problem. Chances are good a psych profile wont catch that many people to deem unfit for the job. Look at jobs like prisons, law enforcement etc. I know lots of cops and prison workers who are depressed and have other problems but they work without problem. As far as a J-net for EMS good luck. Find an employer who will risk the liability of providing such info and you will find an employer about to go out of business.

So if we did have such testing who will pay. I dont know too many EMS providers who are going to pay to have this expensive test. I dont know many EMS employers who are going to front the cash for a candidate. Last do you really trust the mental health community to fairly and accurately determine if you are fit for duty?

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Permalink Reply by Robin Renfrew on March 18, 2009 at 5:57pm

Here's another question - would it be considered a form of discrimination to have potential employees screened? That runs into a really sticky situation.

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Permalink Reply by Skip Kirkwood on March 21, 2009 at 7:25pm

Your typical professional police department will spend between 40 and 120 hours of a professional investigator's time doing a background check on an applicant. Before hiring they will complete an extensive personal history form, a psychological exam, a drug test, have a home visit where the background investigator checks out their living conditions, family, etc., a physical abilities test, and...a polygraph. All of these tests are conducted according to protocol, and they've withstood years of legal scrutiny.

Why? Because police officers have to be trustworthy, people of character. They have to be physically fit, they go in to people's homes, they get entrusted with dangerous instrumentalities, sometimes they take people's clothes off, they handle controlled drugs, and their profession is built on trust.

Hmm....I think I've just described a paramedic. Why are we so comparatively lackadasical? Do we just not want to know? Or are we more concerned with having a body with a pulse and a patch in a seat?

It's a lame excuse to say "Who will pay?" It's a cost of doing business. If you don't do these things, and something goes wrong, you will pay some other way - workers comp for injured personnel, lawsuits, DEA and OEMS investigations, etc. This is stuff that you do if you want the public trust.

Skip

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Permalink Reply by JJ Magyar on March 22, 2009 at 9:06pm

Well Skip I dont think anyone is saying its not a good idea. Who will pay is far from a lame excuse, it is a reality. Maybe not be a problem for you in Wake County. Your situation is probably not the norm. In these parts our medicare reimbursement is less than it actually cost us to provide the service.

I might add that testing does not rule out illegal or immoral problems. I live within a few miles of a state prison, county prison and 4 federal prisons. We regularly read about corrections officers who are charged with theft, accepting bribes, rape, assault and even smuggling sperm so an inmate could impregnate his wife artificially.

All of these institutions did very intense investigations which proved frugal in these cases.

Again I dont think anyone thinks it's a bad idea. I do think you are a little puffed up because your organization doesnt have to deal with the rigors of a limited budget.

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Permalink Reply by Skip Kirkwood on April 1, 2009 at 8:15am

Let's not get personal, JJ. Wake County is no better off than anybody else - we've been budget cutting for months, and are looking at having to reduce services under some possible scenarios.

I make two points, one of which I made before.

First, if you are trying to run EMS on "reimbursements" you're working with a flawed model and you need to work to change that as soon as possible. The service you provide is to the taxpayers. The taxpayers should pay the cost of making sure that the EMS folks who respond to their calls are appropriately screened. No process is perfect, but that's no excuse for not trying.

Second, it's about priorities. To implement our enhanced hiring process, we will have to give up something. But having recognized the need, it's our job as management to find a way. It may be through partnerships with law enforcement, it may mean extra work for somebody (our shift supervisors will be trained to do backgrounds), and it will cost several thousand dollars for the outside services. And maybe less of something else we'd rather have.

If it's important to us, we will find a way. And if you think we don't have to deal with a limited budget, you're flat wrong. The best I can say is that we are a bit larger than some, so we have some options with flexibility. Too much of this stuff is difficult in American EMS because we are so committed to being independent.....small.....and thus economically and politically weak. This is another example of us, collectively, not being sure whether we are a profession or a hobby.

Skip

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Permalink Reply by John W. Magyar on April 1, 2009 at 2:16pm

Skip, A while back I invited you to come visit us and you said to "grab you up" at the PEHSC conference and take you for a ride. We are located about 80 miles north of Hbg/Hershey area. I wonder if you would consider making some definite plans to come visit us in Lycoming County?
I have read many of your posts and feel you have alot of knowledge and wisdom re: EMS (where we are and where we are going) I guess what I'm saying is that with your involvement with Natl. EMS, maybe you could look at our system and offer some positive ideas to persue. To say that we need to get off the reimbursement issue and on to tax based EMS sounds like a simple solution. In reality, we still have to pay the bills today and keep our services running until the transition occurs, which doesn't look like its going to happen anytime soon. Every area has its own specific problems and there is not one universal cure that fits all. That being said, maybe you will have some specific ideas that could help our rural services.
Don't get the wrong impression. Lycoming County is very well respected and has a much better than average EMS system.
We have both paid and volunteer services, BLS and ALS.
I hope you will be able to find the time to pay us a visit. If so, let me know the time you would be available and date and I will plan the road trip. I'm sure you and JJ will find that you have much more in common than is apparent in these posts.
Have a good one and be safe. John

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Permalink Reply by Skip Kirkwood on April 1, 2009 at 5:03pm

John, I have no idea what obligations will arise from being one of the national faculty at your conference.

How about when the program comes out, you figure out what will work and tell me what you'd like to do. I'm willing to get up early and stay up late (well, relatively speaking, later than my usual 2100 bedtime) to visit in the "after school" hours.

If Ican work it out to come a day early or stay a day late, I will give it a try - but things are a little bit crazy here and so I'm trying to minimize my time away. Now if they relocate the conference to Hawaii......

Skip

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Permalink Reply by Jodi on April 1, 2009 at 6:13pm

Been in this field for going on 40 years. OK I am old. In that time I have only seen a handful of Medics that I would have questioned their abilities. My team has to pass NCIC and state. I personally have had to tell people "No you are not working here". Sometimes it was a small situation, one was not.

But she is going to school to be a Nurse! Anyone can pay to go to school.

Doing a back ground only means they passed a back ground. I know a cop who passed many, He is in Fed. Pen. for assault when he tried to kill his Captain, again. There was a history of DV and nothing done. But he passed back grounds.

Sometimes you have to ask what came first the chicken or the egg. Was there a problem before they came on board or after they had been in the thick of things.

When I started this kind of work there was 350 people in two classes, out of that class of '71 there are 10 of us working still, 5 are in different fields and 5 are still working the streets. many left the field from burn out Heart issues. In this class alone 5% died by thier own hand. I knew 3 and they were good medics and people. After awhile they couldn't take the demand of job and family.

One left a note. " I can't take the pain of the dying pt. I hurt everyday inside and out. I can not stop death so I will become one of the many I could not save"

He was a psych major. And no one saw, not even his teachers.

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