We use our beacons, flash our headlights and cycle through the various sirens, whilst ensuring that we leave enough distance between us and the drivers that haven’t yet noticed us. We avoid rear-ending the driver who slams on the brakes, when they suddenly realise we’re behind them. We’re also careful not to force drivers to enter an intersection, through a stoplight or sign, so that they don’t risk being struck by other vehicles. We take a second, when possible, to signal our thanks for those who have gone out of their way to facilitate our progression.
Growing legal liability on ambulance services naturally increases the pressure on response times, but also results in higher numbers of priority calls. Public perception is of increased numbers of emergency ambulances, therefore how we behave on the roads is under heavier scrutiny than ever before. Most of us have watched video footage of emergency vehicles struggling to get through traffic. We expect drivers on roads to let us pass safely, but how many of us have also watched the aggressive and erratic driving of some paramedics. There are countless emergency services personnel who cause panic and stress amongst drivers en route to calls. If the driver in front of us has been subjected to such emergency driving behaviours in the past, they may be terrified, or even angry, when they see our vehicle approach.
Our expectations of general road users can only match that of our own emergency driving, otherwise any double standards are unreasonable and unfair. Being confident and direct in the driving seat is absolutely necessary to forge safely ahead, but doing this courteously and professionally helps us to maintain a positive image, despite the need for urgency. Such an approach may ultimately keep our patients, other road users, ourselves and our crewmates safe, as well as our excellent reputation intact.
Cleaning Up Our Mess v Destroying The Scene
Once we’ve reached our destination, we attend to an overdose at a bus stop and transport to the emergency department with our now stable patient. Whilst working at the roadside, we drop everything we discard into a rubbish bag and take it with us in the ambulance to dispose of later.
Many of us may notice on our days off, when we go out for a run, or walk the dog, discarded gloves or medical rubbish. We know it just has to be from an ambulance call. Leaving mess and chaos behind at a scene can damage our professional reputation in the public eye.
Whilst occasionally we may find that dangerous environments, bad weather, darkness and urgency prevail, on most calls, good paramedics can tidy up loose ends with very little effort before transporting. We are not exempt from littering in our personal lives, therefore, unless extreme circumstances prevail, we cannot assume to be exempt in uniform. Forming the habit of using a disposable bag, on every call, immediately cuts down the need to even consider this, as we discard everything into it whilst we work. (With the additional benefit of creating a clear working space, it may also help us to avoid confusion in searching for items, and reduce stress on scene.)
Whether in a patient’s home, or out on the street, if we throw everything we dispose of onto the floor as we work, somebody, at some point, has to clean it up. Dropping plastic squares from electrodes onto the floor, bed or couch in an elderly person’s home whilst performing a twelve lead ECG seems innocuous. It leaves them with an invisible slip hazard later on, however, but only takes us a second to drop into a waste container. If we work on a dual response call, particularly with a cardiac arrest, there is usually at least one crewmember left behind to drive the follow up vehicle, whilst the patient is transported under priority conditions. Taking a couple of minutes to dispose of debris from the scene may reduce the psychological trauma experienced by family members or bystanders after the event.
Imagine a loved one is close to death and whisked away in an ambulance, then family members arrive home. We probably don’t want them to see the discarded mess at the scene as a reminder of their pain, before having to collect it up and place in the bin themselves.
Public perception of our professionalism and care extends so much further than clinical interventions. As a good paramedic, we can take countless extra, small measures to ensure that our attention is appreciated, and the trust that we are privileged to feel is protected in the long term.
The Bad
Whilst most of us generally want to do the right thing, sometimes it’s easy to fall into bad habits, get caught up in what we see others get away with, or succumb to pressure from colleagues who choose to discourage our positive behaviours.
Professional Chatter v Gossiping Groups
No matter where we work in the world, most paramedics are accustomed to “ramping” or waiting in corridors and triage areas, with patients. In many countries, this wait may be several hours with each patient we transport, and results in extremely long periods, therefore, of public scrutiny. Whilst some of us may view this waiting period as a form of relief from attending to continuous call outs, equally, some of us may detest the time spent awaiting a bed for our patient. Either way, it is becoming a growing part of our role, and doesn’t look like it will disappear in the near future.
So, we’re standing in the corridor for long periods of time, what a great opportunity to catch up and have a chat with colleagues! We’re talking about jobs we’ve done lately. Perhaps it’s the fascinating but gruesome details of a murder suicide, or the humorously inappropriate behaviour of an intoxicated patient. Maybe we’re discussing our frustrations around a regular caller whom we’ve now attended twice already this shift, or relaying the details of our alcohol fuelled personal shenanigans during days off.
Imagine how our patient, and any family members they have with them, may perceive this? The longer they are listening, and observing our behaviour, the more damaging to our reputations this may be.
The best-case scenario for our professional reputation is that they lose respect for what they had previously considered an admirable career. The worst-case scenario is that the patient, or their escort, is shocked enough to either lodge a complaint, or worry that they may be our next topic of hilarity and scorn.
Such thoughts will undoubtedly return to the patient the next time they consider calling an ambulance. None of us embarked on this career with the aim of causing discomfort or angst, therefore it’s well worth avoiding for both professionalism and our personal job satisfaction.
Promoting Paramedicine v Injuring Our Image
After several hours of waiting, we’re surprised by an unexpected opportunity to take five minutes of time out, as there are no outstanding calls (I hear you laughing at that unlikely story!). We’re parked up near the beach with a much-needed coffee, chatting to our partner, with our feet up on the dashboard. The windows are open to catch that beautiful ocean breeze and we’re playing a favourite song a little louder than usual, just so we can grab that feeling of pseudo freedom we all desperately crave.
The little children walking past with their kindergarten teacher suddenly lose their own happy, innocent sense of freedom, once they get near to our vehicle. They were initially excited to see the ambulance from further away, and their eyes lit up at the teacher’s suggestion to wander over for a visit. The closer they get, however, the more intimidated they start to feel by the noise and demeanour of our crew. Most of us love the adoration children have for our roles and our vehicles, but as we slip into bad habits, it’s easy to forget how we may be perceived.
On our first day at work in an ambulance, we wouldn’t have dreamed of lounging in the seat with our boots up on the dashboard in public. No way would we have cranked the stereo with the windows open from our new office that made us so proud.
Remember