A few months back I mentioned how I HATE the term “customer” in fire and EMS because it brings to mind the wrong impression on the delivery side.

Sure we can pound into the heads of our line personnel that they need to be more “customer service oriented” but what does that mean to them?  To me it means ignoring people and putting out a tip jar, getting their order wrong, then refusing to notice.

Let’s all agree that reminding our crews that in many cases the person who they anger in the field can vote your salaries down, or to block your company’s contract renewal.  Besides, they have been told they are customers to you and what is the one thing we know about customers?

“The customer is always right.”

Well that’s just a poor way to run an emergency service, catering to the needs of people who have no idea what service you offer or how it should be administered.

So let’s slowly back away from the customer service model for a moment and take a deep breath.  Let’s assume what we already know, that the general public has no idea what so ever the difference between an emergency and an inconvenience.  So why let these folks determine how the millions of dollars of equipment, staff and vehicles are utilized?

Because we are so afraid of a lawsuit we’ll take anyone in for anything so long as they get the result they wanted.

But what about their neighbor five minutes later?

Imagine I take Erma Fishbiscuit in because her dial a nurse told her to call 911 to arrange her colonoscopy.  Erma demands transport and I am bound by law to oblige her, regardless of her lack of need of an ALS ambulance.  We take her because of a perceived liability, that if we don’t take her and she sues us we will not like it one bit.

5 minutes after getting Erma loaded up a code 3 CPR in progress comes in next door to Erma and a 6 month old child dies before ALS can arrive on scene.  Are we liable for not having more ambulances?  Which liability is greater?  Which liability makes national headlines?

Liability, like patient, has two completely different yet totally accurate definitions.

Liability: …being liable. A responsibility or obligation…

Liability: Something that holds one back. A disability, disadvantage or hindrance.

Well no wonder we use that word.

When we speak of liability in the pre-hospital arena our minds automatically shift to defending our actions in court, right?  We don’t want to be held liable in court do we?

Here’s a shocker: I do want to be held responsible as I have an obligation to both the people who do call me and those who are about to call.

But I am surely in the minority.

It is this fear of court, retribution, lawsuits and bad press that clouds our minds and won’t let us see the real liability, the next call.

Our current liability, taking Erma in for no medical reason, acts as a hindrance, a disadvantage to the EMS system by taking highly trained resources to do the job of a taxi driver.  So why do we not have that resource in most places?


There it is again!  That word gets thrown around so easily it’s starting to give me a headache.

I argue that by taking Erma in we increase the threat of actual violation of responsibility should someone who actually needs EMS intervention is required to wait for it.  How long is an appropriate wait time you ask?  How long was Erma willing to wait?

We, as providers, are indeed locked into rigid 35 year old concepts of when to take people and why.

“Does he want to go?’ the supervisor asked me as I was discussing the finer points of prescription refills with a client on a street corner at 3 AM.

“Yes, but I think we can get him to the pharmacy two blocks over if he just walks.” I answer as the ambulance pulls up.

“We don’t want that liability, take him in.” She answers and the protocols once again trade the actual responsibility liability for the hindrance liability.

So who is liable when the 6 month old dies because the ALS resource was transporting Erma for no medical reason?  What if the child’s parents find out you took her in non emergency for no medical reason?  Can they sue the City, Company, Town, Agency?  You bet they can, and publicly.  All because we are afraid of that word that no one bothered to explain in depth to us.  Even in my semester long Pre-Hospital Medical Legal class liability boiled down to just transport and let the next license up deal with it.

I say we need to rethink liability, both definitions, if we’re going to enact change in this Profession.

Get Erma the ride she needs from someone who can actually help her and be there for the 6 month old neighbor.  That is your obligation.  That is your responsibility.  That is the liability.  And that is exactly why your system will never do it.

Keep in mind that even though I make grand assumptions, I still follow all local protocols and standards, no matter how outdated, wrong or misguided.  So should you.

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