Friday’s post about the now deleted craigslist letter got me thinking about the need for an in depth set of policies and procedures to help in decision making for everyone involved in an organization. My boss used to like to say that there were so many grey areas in EMS that writing a set of policies and procedures would be exhausting and quickly rendered invalid. I could not disagree more.
I went from a service that had very loose procedural structure to being handed a three inch D-Ring binder filled with my new department’s P&P’s that outlined everything from the procedure to call out from work to how to properly place the pins on my uniform. It was clear and concise and I loved it.
Despite what they might tell you I feel that EMS providers crave structure. If you want proof of that look no further than standing orders and protocols. While a single protocol might not fit the mold for every patient and you might find yourself crossing from protocol to protocol. You might not start at step one and move to step twenty hitting steps two through nineteen along the way but you at least have a framework to work within. Policies and procedures need to be viewed with a similar mindset.
No situation is perfect, and no solution is going to be 100% correct 100% of the time, but I feel like if a policy gives you the answer 50-75% of the time then it is serving its purpose. A prime example would be something like “ambulance crews are expected to be available in the hospital within twenty minutes of their arrival.” Is that 100% achievable? Of course not. There are so many outside factors like patient condition, decontamination needs and ER backups that might prevent this but it sets an expectation and a parameter for crews that if their patient is turned over they should be available in that time frame.
Failure to set expectations for people leads to freelancing and frustration. Rules are enforced from supervisor to supervisor and dispatcher to dispatcher with little consistency. I know that this happens because I was guilty of it. There were things that, when it came to being a supervisor, I was bad at. Some of those were just because of my skill set, others because I just did not find them as important as other things on my plate. Thankfully though, as a group we seemed to have a solid combined skill set to everything we wanted to achieve got taken care of but sometimes it would take some time because when I would work my two days and two nights there was a certain way that I liked to do things and certain priorities that were important to me and that did not match up with the other three supervisors so the field employees would have to adapt to which supervisor was in the seat that day. That is never an easy thing to do for those who looked to us for answers.
I remember in the early days when I was on the road sitting with three or four other ambulances in a single posting location because we all knew that our supervisor’s unwritten expectation was “I don’t care where you go, just make your calls in the time frame you know you should.” On the next night, we would hear a different supervisor sign on and scatter back to our assigned posts because we knew that this particular supervisor would come and check on you, expecting you to be at your exact posting location unless you specifically asked permission to go someplace else.
The funny thing was, if you opened the company’s policies and procedures there was nothing that addressed it. If someone asked a supervisor for something in writing, instead of saying “go look at policy x line y” they would say “hang on let me see if I still have the email.” While the answer might have been in writing it was not easily accessible to everyone who would need to see it.
The bigger department the more structure it needs. Many EMS departments, especially private services, rely heavily on a part-time and per diem workforce to staff their trucks. These folks are not there forty hours a week, and might not see postings or get emails with important company updates and changes so a department needs to not only post changes to policies but they need to be easily accessed by all employees regardless of classification. A great way to do this without killing too many trees is to maintain them online somewhere on the internet or in an intranet.
Finally, once the policies and procedures are established, they need to be constantly reviewed and updated. Nothing made me wince more than when I opened a national policy that was supposed to dictate local practice to see that it was at least ten years old and had not been revised in ages. Our workplace is constantly changing and evolving and how we run our services needs to evolve with it. If a particular policy is too broad or too constricting, then maybe it needs revision. There is no harm in that, and in fact it will help make the workplace more manageable.
EMS providers require structure in almost all aspects of their job from treatment protocols to policies to daily checklists and expectations. Set the bar, and give them the tools to fulfill the department’s goals. Also, give supervisors a guidebook to live by. Give them a leg to stand on when counseling or reprimanding employees. Policies and procedures are a must, and if your department’s set is lacking today is the day to start changing that.