Embracing the "public safety" aspects - Steve Berry's closing keynote

In his closing keynote at EMS TODAY, Steve Berry (addressing public perception of EMS) urged listeners to adopt some of the professionalism of our public safety counterparts-- fire, law enforcement and the military. He believes we’re a mix of medical and public safety, but that in order to cement an image of EMS in the public’s mind, we should accept that the public affiliates us more with public safety than the medical profession, and we should work with that perception rather than against it. If he were redesigning your EMS system, he said he would purchase Class A uniforms for everyone and would ensure they had access to effective wellness and weight management programs.

What do y'all think of those recommendations?

Check this out - http://connect.jems.com/profiles/blogs/ems-today-closes-with-a-bang


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Comment by Michael Touchstone on April 13, 2009 at 8:05pm
Add to that the fact that a person's first impression leads to very rapid judgments, primarily based upon appearance. Depending on what you read, the process takes 7-15 seconds and in one study judgments could be made in as little a 500ms.

We need to be cognizant of the importance of appearances.
Comment by Skip Kirkwood on April 13, 2009 at 7:45pm
One of the big challenges that folks in EMS face every day is trying to remember that, and act like, the perspective of the patient is the one that matters. We're not there to do what is good, or easy, or fun for us....it's what the patient and their family needs. We miss that in too many of our training programs - the caring and compassion for those who see themselves as being in need.
Comment by Janet Smith on April 13, 2009 at 7:37pm
James makes a good point. There are very nice and caring tatooed paramedics and EMTs. And, the proof is always in the pudding (when it comes to well dressed and groomed people showing their true colors-good and bad) but you've got to get 'em to the table first.

In EMS we only have a short time to interact with patients and the crowd that assembles at an emergency scene. There just isn't enough time to communicate what a great guy or gal you are or your intentions for taking great care of a patient. The perception of whether or not we as EMSers can handle a situation or not is immediately accessed just by how we look and act. I remember many colleagues rolling their eyes as EMS personnel rushed up to a patient's home on the TV show Rescue 9-1-1 week after week. But, that's the expectation for those who wait on the other end of a 9-1-1 call. Why would I even want to have the show communicate a nonchalant attitude? Because it's not cool to rush? We're being invited as strangers into someone's home at a really bad time for them. So, I guess there are just some sacrifices we make so that we aren't feared or suspect.
Comment by Skip Kirkwood on April 3, 2009 at 8:19am
James' point is well taken, as far as it goes. But that's not the choice that needs to be made.

Patients of all ages and other demographic classifcations deserve caregivers who behave appropriately AND whose appearance doesn't frighten them in any way. The problem with tattoos are that they require interpretation - and what may be seen as artistic by some may be seen as racist, or in some other way threatening, by others - who have no choice in their emergency caregivers.

As custodians of the public trust, EMS agencies have the responsibility of protecting the comfort of their patients.
Comment by James Bartus Jr. on April 3, 2009 at 12:33am
I work for hospital based EMS and wouldn't have it any other way. I don't think anyone who cares enough to write here would approve of looking like a slob while practicing medicine. I have a short story to light my opinion of the topic.
Our health system instituted an appearance policy a few years ago and in it included "no visible tattoos." I'm guessing they still prescribe to the view that tattoos are for hoodlums, bikers, and sailors (I apologize to bikers and sailors for that). One emergency nurse I was acquainted with had a full-sleeve tattoo on one arm of waves and surfing. He was the epitome of a professional, even if his appearance did not fit some peoples’ perception. He was smart, polite, and just an all around excellent RN. To contrast there was also an older woman RN who was neatly dressed with no tattoos to speak of. She was a complete and utter B!%@#. She yelled at EMTs, patients, and other nurses. Now who do you want treating you? If you had a problem with the first RN because his tattoos gave you the perception of a hooligan, you picked wrong. Perception is not reality; perception is perception, reality is reality. A 90 y/o patient may not like to see a tattooed RN but a younger patient may relate better to them than to the well dressed crotchety burn-out.
Comment by Skip Kirkwood on March 30, 2009 at 9:06pm
You would have loved a discussion on the NEMSMA list server a few weeks ago. One of our colleagues likened us to the Scottish nobles in Braveheart, where William Wallace chides them for "fighting over Longshanks' table scraps" instead of fighting for Scotland's freedom.

I think I'll don my kilt and go play the pipes for a while!!!!
Comment by Skip Kirkwood on March 30, 2009 at 9:04pm
Thanks Steve! Keep it coming! I know you have more to say, and I invite you to use as much space as you want. You're on target, and I'd love for you to expand on that brief hour.

Comment by Steve Berry on March 30, 2009 at 7:47pm
Cheers to all of you for your experienced insights. I sense we are all on the same page. An EMS culture that has yet to define itself needs this kind of ongoing discussion and passion. In the short hour I was given I was only able to touch briefly on the areas of EMS that are dear to my heart - specifically that we are a profession that should no longer have to just take the scraps from either the public service or emergency medical community. We cannot expect however, to gain the respect from either of these sectors until we learn to respect ourselves - spiritually, mentally, and physically.
Comment by Janet Smith on March 30, 2009 at 12:40pm
Wow, what a great discussion! I particularly like the consensus that all EMSers need to look professional in terms of uniform and overall groomed appearance. It's a public trust thing. Afterall, public safety officials (fire and law enforcement) are turning over citizens' care and/or hospitals are turning over patients' care to EMS personnel whom they don't really know other than the fact they arrive in an ambulance wearing a uniform that communicates they meet local and state regulations enabling them to transport patients according to a clearly visible skill level. Patients' family members have only the overall appearance of the medics who respond to inform their trust. Consequently, a company goes a long way in preserving public trust from all the people who interact with EMS by simply uniforming EMS ambulance crews in a professional manner. The rest of the issue is purely market driven with the uniform being a distinguishing element of brand and function. A good example is how air medical providers have distinguished themselves. Air medical personnel are typically uniformed in flight jumpsuits. They look professional and the jumpsuit immediately communicates an official medical rank on the scene of an emergency and in a hospital emergency department where flight medics prepare a patient for air transport. The function of the public safety uniform (Badges, Flying Cross type shirts/ Pants that can carry tape and sissors, etc.) for EMS personnel facilitates an immediate recognition that the EMS personnel are credentialled and therefore allowed at an emergency scene for the purpose of caring for patients. The uniform also insinuates that hospital personnel can relinquish a patient's care to uniform wearing ambulance crews who will transport in-hospital patients to an off-site location. When the uniform deviates from the perception of whom is considered an "official" member of an EMS scene, perception suffers. Unkept and/or very casually dressed EMS crews contradict the perception of a professional EMS organization. To over indulge crew comfort in terms of uniform will cause those companies to spend more money and energy than a professional uniform would have cost to mold their less that stellar brand to a perception of quality among those who must trust them.

So, my recommendation is to uniform EMS personnel professionally and consistently with a bent for communicating the personnel's "offical" capacity at the emergency scene or in a medical facility setting. If a company wants to emphasize their personnel's "clinical" purpose, that requires business-to- business communications that exceed the branding capability of a uniform alone to include customer education efforts, marketing strategy, and a determined focus for communicating the company's priority for customer service.
Comment by Skip Kirkwood on March 29, 2009 at 9:40pm
Lots of good food for thought there, Joe.

I'm not sure that "academy style" and academic learning are incompatible. Much of the first generation of paramedics were trained academy style, including Johnny and Roy, and about the first 15 years of the highly-regarded Hawaii Medical Association EMS program. Not semi-military, but definitely 40+ hours per week of high intensity instruction.

What I'd like to see us embrace in the pre-service preparation of paramedics includes that affective domain stuff that you mention (working as a team, helping your colleagues, being safe, being able to stand on your own two feet and have command presence), along with the personal accountability and the ability to be a good employee - show up on time, properly dressed, address people respectfully, etc.

For the academic side, it seems that Annapolis, West Point, Colorado Springs and New London have figured out how to blend college level academics with this stuff.

A couple of the things I've figured out from studying both LASD and the military academies - it isn't cheap, and it isn't easy. Purpose-built functional facilities, low instructor to student ratios, standards that are enforced, uncompromising values. Maybe I'm old, traditional, etc. (for sure I'm old) but I think that duty and honor, and honesty and self-sacrifice, are good for people, and for the communities that we serve.

How about 3 minutes of hard, fast, deep compressions? Make you breathe heavy?

Maybe we're in a chicken-and-egg dilemma. Why do anything difficult or demanding when, apparently, in much of the country the pay is so low to make it unreasonable to demand very much. On the other hand, if you never demand anything, why would anybody pay more? Who is going to, and how can we, break that cycle?
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