What is “Commitment”?
Commitment as defined is:
- the state or quality of being dedicated to a cause, activity, etc.
- an engagement or obligation that restricts freedom of action.
Some synonyms for commitment are: dedication, devotion, allegiance, faithfulness, fidelity. The first definition is pretty self-explanatory, but the second one is often lost on EMS providers. We’ll chat about that in a bit. If you are a religious person, your first commitment is taught to you to always be your God, which ever one you believe in, no judgements here. Then family, and on down the line. Your job or career falls in there somewhere. You are expected to commit to work schedules, standards, protocols, policies and above all, you are expected by your employer, by DHEC, by families to be committed to your patients. Here is where you ask yourself — am I REALLY committed to all those things? If not, you may suffer from compassion fatigue and it may be time to alter course or perhaps look towards another career.
What Commitments Do I Have to My Job?
Well, the first commitment you have is to be prepared. This doesn’t mean coming in on time with a good looking uniform — although that at times is a challenge. It means being PREPARED.
- Did you get enough rest last night for your 12 or 24-hour shift today?
- Did you party too hard last night?
- Did you get in early enough to properly check off your truck/engine/QRV before hitting the road?
- How about education?
- Did you take all the required ConEd you were supposed to last week?
- Do you know how to properly operate all the equipment on your rig?
- Are you mentally prepared for today?
- Are you able to leave behind the argument with your spouse, the leaky faucet, the sick child at home and dedicate yourself to you mission at hand today?
If not, and you’re distracted, maybe you should take the day off. Yes, it’s going to cause someone to have to pull some OT, but if you’re not COMMITTED to your day at work it could cost you, your crew or your patient their life. I barely scratched the surface on your commitment to your job, I’m sure you are reading this saying “What about this or that?” and you’re probably right, and bless you for coming up with a more extensive list! You are the people we need on our team. You can sit down and evaluate your commitment and that of your peers, subordinates, or employees today; right now. If they don’t measure up, then you, yes you, need to fix it. One caveat, if you don’t want to fix it, don’t want to be bothered, well then check the mirror, Evil Queen, you’re the problem and see the definition above. If you’re just filling trucks with bodies in the seats, it’s only a matter of time before they adopt your attitude and work ethic and someone dies. I promise.
Your Commitment to Your Patients
When you’re at work, can you think of a higher commitment than your patient? I can’t. You have been called to someone’s home, office, church, school at the worst moment of their life. You have the training, experience, equipment, and heart to either make this persons day better or not. If you don’t give every bit of attention, every bit of skill, caring, and effort to them, you are failing. I don’t care if they are the governor’s cousin or a homeless person you are picking up for the third time this week; each of your patients deserves your full attention and care-giving capacity. If you question this, or think that I’m wrong, let me know. If you’re in the habit of short-cutting a patient that may need some O2, or think the drunk just needs a little tough love and drop a 14 gauge in their hand to “re-hydrate” them, you’re not committed. If you’re a medic and you give the “borderline” or full on “over the line” ALS patients to your EMT because you’re tired, burned out, “giving them experience,” or “insert lazy excuse here” then you’re not committed. By the way, those of you that do those things, then change or order them to change vitals or complaints to make the call look BLS, plan on coming and having a chat with us. We’ll commit to changing your thought process.
OK, so what about administration, you ask? Well, ya know I’m gonna tell ya. If you’ve graduated from “Street Medic” to Training Officer, FTO, Deputy Director, or any plethora of admin jobs, then congratulations! You have just leapt into even more commitment. Many, actually most of you do amazing work and the right thing every day with little to no money in your pockets. However, if you are supposed to QA your agencies report or provide updated training on a new piece of equipment, or inventory and stock your units and you just phone it in every day, then you lack commitment and your work ethic will (not may), convey to your peers and subordinates because what you permit, you promote.
If you refuse to re-train, remediate, or even reprimand someone for doing something wrong, utilizing a protocol incorrectly, or even contributing to the harm or death of a patient, then the next time it happens — and it will — you, sir or madam, are just as guilty. This is where we pause a moment and make sure we differentiate between “commitment” and “loyalty.” Loyalty often blurs the lines with commitment. See you have a commitment to you patients, a real, palpable commitment; a legal duty actually. When you let loyalty to a 20-year medic who’s “just trying to get their time in” or loyalty to an agency that isn’t doing the right thing on whatever level, then loyalty may end up costing you things that are dear to you.
Commitment to doing the right thing, every time, on every patient or every inspection, or every QA of a report will supersede loyalty and you’ll feel better about yourself in the long run and your citizens will thank you for it. The next time you say or think “We don’t have time to do the right thing” think about the long term consequences of those thoughts or actions. Would I want someone to think of me both ways, sure, but if I had to pick, I’d take “He’s a committed leader” over “He’s a great guy.”
Commitment Means Giving Up Some Control
I said earlier we’d re-visit the second definition of commitment, as it pertains to us as EMTs and Paramedics. In case you forgot, here you go: “2. an engagement or obligation that restricts freedom of action.” So what does that mean? Well, ya know I’m gonna tell ya. As an EMS worker or firefighter, when you have a patient — for you truck company folks, ask an engine guy what that is — you have a commitment to protect that person’s identity, medical care, and various and sundry other things. Care you use this call as training, discuss optional treatment pathways, or ask an ER nurse or doctor if what you did was correct? Absolutely. It has to be done respectfully, in the right medium, and be within your agencies guidelines. It does NOT mean you snap some photos or take a funny video of the half-naked drunk woman talking to her cat to show the guys back at the station. You have violated patient confidences that have been entrusted to you and oh, the law too. Two Columbia, Ohio paramedics just found out the hard way that taking a video of a patient and sending it out to various folks wasn’t a smart move. During the investigation they admitted that they “took the photographs and sent them as a way to commiserate about the shifts they were working.” There’s some commitment for you. Suspensions up to 30 days were issued. For that record, if you’re photographing patients in South Carolina and you violate their confidences, put some gas in your tank, you’re going to have to drive to Columbia and talk to us about it. If you ask around to those folks that already have for similar infractions, you’ll find they didn’t enjoy their trip home very much.
Just Commit to Doing the Right Thing
To end this column on a positive note, please know that we don’t think this lack of commitment is a rampant, system-wide issue across the state in South Carolina. If I did, I wouldn’t want to lead the Bureau of EMS and Trauma. These are isolated incidents, pockets of bad water; but know this, everything I’ve mentioned above we have seen over the last couple years. I’m only reaching out to you because I might just catch one or two of you on the precipice of not having that commitment, to letting go of your responsibilities because you see others around you doing it every day. To you I say this, no, I implore you; continue to do the right thing, stay committed to your patients, and to your craft. Don’t stray off the tracks. You’ll feel better in the morning when you get off shift and you’ll sleep a lot better when you get home.
Rob Wronski is the South Carolina Department of Health and Environmental Control (SC DHEC) Bureau Chief of EMS. He has served in many roles since becoming a firefighter paramedic in 1991, culminating with his selection as Chief of EMS for the state where he has served for nearly three years. He has held several executive positions including Assistant Chief of the St. Andrews Fire Department in Charleston, Medical Officer of the Mt. Pleasant Fire Department, and a Shift Commander in the Beach Park (IL) Fire Department. His experience includes working in fire-based EMS, including ALS and BLS first response as well as fire based and county based ALS transport.