Professionalism and the lack thereof.

[ERDoc]

When I was a volley, many moons ago, we had some requirements. We had to have pants of some sort at all times on calls. No shorts, no sandals or other form of open footwear (Crocs weren't around yet). We had to wear something with our company name on it and our level of certification. We were issued winter jackets, windbreakers, short sleeved polo shirts and a jumpsuit. Basically, you had to be wearing one of them to be on the bus (yup, I said bus intentionally) or on-scene. Any shirt you wore under the jacket or windbreaker had to be appropriate (ie no profanity, nudity, etc). They were pretty basic rules that no one seemed to have trouble following. We looked fairly professional and it was never an issue. We also had a huge budget so that if something was even a little worn or dirty it was replaced.

[Eydawn]

I've got one for you.

I'm on my local Search and Rescue team. Our uniform is orange vests or orange hunting shirts with the team patch and MRA patch (and medical patches as appropriate). Pants are up to you- hiking pants, BDU's, etc. We wear red jackets with the team patches as our outer layer. All our shirts and jackets have our last name on them (first initial as well if there are duplicates). Are we totally uniform in how everyone looks? No. Are we readily identifiable when we field? You bet. Do we all look professional? Absolutely.

Is any of this provided for us? No, we're a non-profit, non-taxpayer funded organization. We run on donations (I'm currently in the middle of a giant pain in the arse fundraiser) and our members pay dues. The county sheriff, who we operate with, provides us with workman's comp insurance and fuel for the response vehicle- that's IT. We buy our own shirts, we buy our own patches (provided with our first set on graduation from training), and we buy the jackets. We take pride in our appearance, and understand that this is the norm for our group.

We respond from work, home, social obligations... we keep our equipment in the car, and we change into our uniforms in our vehicle if necessary. Again- shirts, pants, boots... much like an EMS uniform. It doesn't slow us down, and often we are responding to very high risk situations (much more so, I would venture to say, than the run of the mill EMS call...)

It's all about where you decide to put your emphasis. If you want to be professional, you will make it happen. Pride in appearance changes how your view yourself, and changes how you view professionalism. Can you be an excellent provider in your jammies? Sure. But I bet the receiving facility and everyone you interact with will view you ALL THE BETTER if you look professional too.

Wendy

CO EMT-B

[azemt2007]

Well I agree with most everyone on this issue. Having worked in several different systems across 3 states and now in my current part time position, I see and have seen several incidents of this behavior. Personally I attribute it to one main factor, pay. You really do get what you pay for. EMS in general has the lowest pay of any first responder and as such, it is hard to attract people of quality when they can make more money managing a taco bell. Secondly, private services use and abuse their employees to the limit to make the bottom line. Of any industry I have been involved in, EMS has the highest employee turnover rate. Now I'm not condoning this blatant disregard for professionalism and compassion, but am looking at the root cause. This medic/crew definitely didn't care about what they do or the people in need. They probably were not well mannered before taking the job and will probably never be. I feel until the industry wakes up and realizes that paramedics are true professionals, we will continually see this kind of behavior and representation of our industry. I mean look at hollywood...have you ever seen a paramedic made to look smart or heroic? Not since the days of Emergency! And I think that is due to the overwhelming image/impression of what Joe Q. Public has of EMS/Paramedics.

[Bernhard]

Bernhard, I agree entirely. As long as it's neatly trimmed and doesn't contain last night's dinner to be consumed as a snack today...

Carl, I'm not bearded. That was Vorenus - the other German guy here.

Speaking of look: I know people in this profession who always look fresh from dressing cabin, others who instantly look like 48hrs straight forward disaster medicine in their first 10 minutes in service. Nothing of that compares to their competence in work. So, look alone doesn't count - I myself am somewhere in the middle... Said this, I'm always behind having my people in vollie department look well dressed. Cleaned shoes, washed clothes, tucked in shirts, collars right outside (my mother would be proud of me). A lot of this requires organizational coordination: issuing of enough parts (costs real money!), opportunity to store the pieces properly, access to proper shoe care products, cleaning workflow and so on. Some things are still on my todo list. It's my third year in leading this vollie group, introduced new set/organizing of clothes two years ago and we're already recognized by the public as "professional aid group", even compared to neighbouring squads. This in return gives the members a good feeling. But doesn't save them from high-level ongoing education, though.

In my career EMS department, they switched to pool clothing, which in my eyes was the best decision ever. That means there is a stock of every size of clothes (sweat shirts, polo shirts, jackets, trousers), the only personal thing is the belt, the velcro name tag and the pair of safety shoes (latter issued by the department). Now the appearance is uniform instead of dependent on which year's clothings design you entered the department. The clothes are clean and hygienic (changed each shift or if severe dirty/infected, whatever comes first).

It took some time to organize things the way, that always enough clothes are available in all needed sizes. Just some under- and oversized colleagues were issued their own set of clothes.

Negative is, that helmets (we rarely need one) and working gloves (same) are not issued but stocked in number of staff on the ambulance - if you need one, it's always too large or too small, which is bad for the protection level ( I seem to be the only one to make it fit before shift starts). And in career EMS we don't have any sufficient rain/sun or cold protection for the head, only the sloppy hood from the jacket. So in winter there is a variety of head cover. However, management doesn't seem to really care, they rant about own personal items brought in and once hung a paper on the blackboard, but it doesn't have consequences.

Just in my vollie service even belts, helmets, sun caps, fleece bonnet, working gloves are issued personally - but there the staff is a finite number. And it has consequences if someone shows up without proper personal equipment.

So, I think it's a mix of personal will with good organizational support and a management that really cares. If any of this doesn't work, you get a sloppy medic/EMT soon.

BTW, next thing I have in mind to improve personal appearance is a simple but large mirror in the changing rooms.

[Vorenus]

It took some time to organize things the way, that always enough clothes are available in all needed sizes. Just some under- and oversized colleagues were issued their own set of clothes.

Negative is, that helmets (we rarely need one) and working gloves (same) are not issued but stocked in number of staff on the ambulance - if you need one, it's always too large or too small, which is bad for the protection level ( I seem to be the only one to make it fit before shift starts). And in career EMS we don't have any sufficient rain/sun or cold protection for the head, only the sloppy hood from the jacket. So in winter there is a variety of head cover. However, management doesn't seem to really care, they rant about own personal items brought in and once hung a paper on the blackboard, but it doesn't have consequences.

Just in my vollie service even belts, helmets, sun caps, fleece bonnet, working gloves are issued personally - but there the staff is a finite number. And it has consequences if someone shows up without proper personal equipment.

So, I think it's a mix of personal will with good organizational support and a management that really cares. If any of this doesn't work, you get a sloppy medic/EMT soon.

BTW, next thing I have in mind to improve personal appearance is a simple but large mirror in the changing rooms.

I`d love to have pool clothing, it`s imho the best way to provide clothes.

Around here, I`ve also noticed that the volley service attached to our station is in many ways better equipped in contrast to us when it comes to clothing - on the one side, it`s nice for them to have all the fancy things, on the other side I see it as a little bit of a shame, that the career ems personell has to drive around in somewhat worse clothes. But that`s due to the fact, that our clothes/money is issued from another department.

[DFIB]

Well I agree with most everyone on this issue. Having worked in several different systems across 3 states and now in my current part time position, I see and have seen several incidents of this behavior. Personally I attribute it to one main factor, pay. You really do get what you pay for.

I don't think you are, but have to ask, You aren't saying that self worth and pride incerases and decerases with pay? Because that would mean that poor wages would justify a lack of pride in self and paractice.

Bernhard - Your organization sounds first class! We should all be so fortunate. I provide all my personal equipment, helmet, gloves and uniforms. In this enviroment it is a challenge to keep people looking professional. Management doesn't help. In my opinion it is wasy to permissive with the EMTs.

Do you send your laundry out to wash or does the crew wash clothes in house?

Edited November 1, 2011 by DFIB

[Bernhard]

Bernhard - Your organization sounds first class! We should all be so fortunate.

First, it's mandatory for the organization/company here to issue protective clothing to staff, if career or volunteer. Disclaimer: In theory. In reality this varies greatly...

Second: it took a long time. We started looking sloppy and totally scary - I somewhere have a photograph from 20 years ago, where every single provider has a totally different look, including a lot of private stuff Reaching a first real uniform level took almost 10 years, including fund raising. But it totally was worth the effort. And you (as a organization) simply have to take the first step...

BTW, I can fully support the statement what effect proper clothing has on the public. Not on the most patients, they don't care. But bystanders and general public seem to care much. We gained a great reputation from the uniform looks, leading into significant donation raise and increase of booking for (paid) standby services (and therefore more money for training & equipment). Again: good looks have to be backed up by a high-level of emergency abilities, else it's worthless. But this really could be a circle.

Do you send your laundry out to wash or does the crew wash clothes in house?

In our career service there is central laundry service (even state central for the whole EMS company, which is state wide). In our local vollie service I'm at the moment organizing this. Not easy, but the solution is near. main problem now is the space in our present station for realizing the workflow. Most probably has to wait until we get a new station (hopefully spring 2012, the landlord's offer just came in today - yippie!).

[rock_shoes]

1) So the fact that I don't show up in a sparkly uniform all the time and am a volunteer in a rural setting means that I'm "under-trained" and have no idea what my role is?

I’m certain that isn’t the intent. The truth of the matter is that every EMT- B in existence is undertrained when it comes to being able to provide emergency health services to the public. This is not a slag against you personally. It’s a simple fact about EMS training standards.

2) The fact that I have had to run a call in jeans and a t-shirt means that I'm unprofessional and that the patient isn't going to get the proper/good quality care?

Without unusual or extenuating circumstances it does. If you have time to drive to the hall and jump in the ambulance, you have 30 seconds to put on a proper uniform somewhere in there. If a call literally lands at your feet as has happened to me in the past by all means deal with it as best you can at the time. In my experience a uniform has one primary purpose. Instant Recognition. It’s in everyone’s best interest (patients in particular) that there is zero confusion about who has shown up to help and what their purpose is.

3) Because I'm in a rural volunteer situation.. that means that I don't care for myself properly and don't have access to EMT classes?

Not all rural volunteer EMS providers are rednecks that walk around with beer cans and a cigarette/dip in our mouth all the time with minimal training. We quite frequently have training at my station, we also have an EMT class in our county, and in a neighboring county.

Just out of curiosity. What kind of call volume does your service have? Is it enough that you should be looking to make the service full time paid?

I know most of us have come across as being rather harsh on this one but please stick around. There’s lot’s to be learned from the various personalities here at the city.

[WhiskeyTangoFoxtrot]

I may regret making this my first post but here goes:

Professionalism is in a sad and sorry state in EMS for a couple of reasons in my opinion. The first is that we do not have the long history and rigourous hiring standards of our counterparts in Fire and Police. Fire departments have a paramilitary history where they can smack down the new people and they are strict in their hiring practice, not to mention the history and PR that comes along with being a Fire Fighter; in general there is an instant sense of pride and belonging when you get hired on to a fire department ( I leave out volunteer systems though in my experience the same can hold true depending on the service). Police officers also go through rigourous hiring processes and psycological evaluations. When your first partner is an old burned out medic it becomes difficult to find the sense of pride.

Secondly we have kids straight out of school getting into EMS that have not worked a day in their lives and thought EMS sounded cool. They have little respect for what they have undertaken and the effect they will have on other people. As a fire fighter these young people get a mentoring system where they work with a team and earn their way up the ranks. In EMS we work with one other person that may or not be as experienced/proffesional as would be hoped for. We have a certain autonomy on the ambulance that leads to bad behaviour without appropriate supervision and/or leadership (I speak from personal experience as I was, shamefully, incredibly unproffessional when I started in this industry).

I don't think people new to the industry really understand the humility of a person entrusting the care of their family member to us. I don't think they understand the significance of the responsibility of what they are taking on.

To improve proffessionalism we first need a better mentoring system, where newbees can be taught the significance of what we are doing and the importance of how we present ourselves both personally and as an industry. We need a better work environment with reasonable work hours and high expectations from supervisors that walk that walk and show what a proffessional looks and acts like. Pride in the proffession comes from working with people that take pride in it in the first place. If the rest of the service is taking pride in what they do and presenting themselves well, if they support their collegues that are experiencing burn out, we will get better people representing our industry.

I feel sorry for the guy that yelled at a doctor. He doesn't feel respected, he doesn't respect himself or his carreer and he has no concept that he will never get that respect so long as he behaves the way he is. Respect is earned not demanded, so If he doesn't feel respected then earn it by shutting up and working harder for it instead of blowing up at the doctor and looking like an a**.