Liability – Part I

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?

Liability.

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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46 thoughts on “Liability – Part I”

  1. “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.”

    There are agencies in the United States that have ALS units ready 24/7 solely for responding to and transporting Erma’s 6 month old neighbor while also getting Erma the help she needs. The Houston Fire Department for example sends paramedics only to certain calls usually by SUV not ambulance. It prevents non-serious patients from being transported to trauma centers, see Houston Ambulance Traffic Control Program. It also re-directs some non-emergency 9-1-1 calls to a nurse line and pays for the first visit including transportation to a clinic.

    1. Not all systems have ALS, and even if they do, if all their ALS units are out, then they cannot send an ALS unit. It does happen. Not to mention if the first unit is out taking care of Erma, the second that would have to respond to the 6 month old is probably further away from the call then the first unit was original, which leads to increased response time and increased chance of death for the 6 month old.

      Additionally, Houston is huge, massive really, and what that article fails to mention is you still have all of the surrounding areas of Harris and Montgomery counties that do not have HFD being bound by the duty to transport laws and they are not able to consult. HFD is only fixing part of the problem, not the whole problem.

    2. What Erma needs is a BLS transport. The question I’d be asking is “Why wasn’t a BLS (or even a transport-only rig) available, and if not, why couldn’t she wait until one was?”

    3. Not all systems have the resources to provide these services. I personally deal with 2 daily callers (at least once a day) for lift asst. The system ties up a fire station and ALS unit to pick these two different people up off the floor each time. When a nursing home is suggested a complaint is filed because they are “affluent” people. In a service with only 3 ALS units for an entire county it is a huge liability and disservice to the rest of the area to be tied up on one persons stubbornness and let another suffer.

  2. “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.”

    There are agencies in the United States that have ALS units ready 24/7 solely for responding to and transporting Erma and her 6 month old neighbor. The Houston Fire Department for example sends paramedics only to certain calls usually by SUV not ambulance. It prevents non-serious patients from being transported to trauma centers, see Houston Ambulance Traffic Control Program. It also re-directs some non-emergency 9-1-1 calls to a nurse line and pays for the first visit including transportation to a clinic.

    1. Not all systems have the resources to provide these services. I personally deal with 2 daily callers (at least once a day) for lift asst. The system ties up a fire station and ALS unit to pick these two different people up off the floor each time. When a nursing home is suggested a complaint is filed because they are “affluent” people. In a service with only 3 ALS units for an entire county it is a huge liability and disservice to the rest of the area to be tied up on one persons stubbornness and let another suffer.

  3. I had a guy just like your 3am prescription refill; he called because his daughter had the flu and was too sick to take him.

    “Do you want to go to the ER? Because that’s the only place I can take you.”

    “No, I just need to go to the pharmacy in [the same city].”

    “Gotcha. Sorry, I can only take you to an ER. Since you don’t want to do that, sign here.”

    If Erma wants to go to the hospital to see the roto-rooter that badly, she’s getting handed over to a private- who may just laugh in our faces. Either way, I tell the chief that I took myself our of service for an hour for something like that, he’d put a boot in my ass so hard I’d be having breakfast with Mark tomorrow. And that’s if NOTHING happened. If we lost a baby because of something like that, they’d never find my body.

  4. I had a guy just like your 3am prescription refill; he called because his daughter had the flu and was too sick to take him.

    “Do you want to go to the ER? Because that's the only place I can take you.”

    “No, I just need to go to the pharmacy in [the same city].”

    “Gotcha. Sorry, I can only take you to an ER. Since you don't want to do that, sign here.”

    If Erma wants to go to the hospital to see the roto-rooter that badly, she's getting handed over to a private- who may just laugh in our faces. Either way, I tell the chief that I took myself our of service for an hour for something like that, he'd put a boot in my ass so hard I'd be having breakfast with Mark tomorrow. And that's if NOTHING happened. If we lost a baby because of something like that, they'd never find my body.

  5. Having worked rural EMS before, I understand the “if this ALS unit is out of service well then whoever is next just is going to have to not get ALS” issue. In fact, I remember several times when mutual aid was required to cover the second BLS call in our district. We simply did not have the staffing at all times for two ambulance even though we did have two units.

    I am very lucky now that I work in an area where ALS is almost never short and that if it is, I have two hospitals pretty close by. What does scare me is we once had a four alarm fire that nearly drew half our system up on one call. We were watching the dispatches and what was left available and it was frighteningly little. We had well over half, if not more, of our tower/truck/ladder apparatus out at one call. A fair portion of our district is high rise apartments in need of those tower/truck/ladder apparatus in addition to engines if anything else was to catch on fire. We were incredibly lucky that nothing else major happened during that fire, as we may have then been presented with the situation of not having the resources we needed available. What then? What would have been said if we could not respond and someone was injured, or worse died? Can we be held liable for doing our job in once place but that risking the care in another? Pardon the rambling, it is getting very late for me.

  6. Not all systems have ALS, and even if they do, if all their ALS units are out, then they cannot send an ALS unit. It does happen. Not to mention if the first unit is out taking care of Erma, the second that would have to respond to the 6 month old is probably further away from the call then the first unit was original, which leads to increased response time and increased chance of death for the 6 month old.

    Additionally, Houston is huge, massive really, and what that article fails to mention is you still have all of the surrounding areas of Harris and Montgomery counties that do not have HFD being bound by the duty to transport laws and they are not able to consult. HFD is only fixing part of the problem, not the whole problem.

  7. Having worked rural EMS before, I understand the “if this ALS unit is out of service well then whoever is next just is going to have to not get ALS” issue. In fact, I remember several times when mutual aid was required to cover the second BLS call in our district. We simply did not have the staffing at all times for two ambulance even though we did have two units.

    I am very lucky now that I work in an area where ALS is almost never short and that if it is, I have two hospitals pretty close by. What does scare me is we once had a four alarm fire that nearly drew half our system up on one call. We were watching the dispatches and what was left available and it was frighteningly little. We had well over half, if not more, of our tower/truck/ladder apparatus out at one call. A fair portion of our district is high rise apartments in need of those tower/truck/ladder apparatus in addition to engines if anything else was to catch on fire. We were incredibly lucky that nothing else major happened during that fire, as we may have then been presented with the situation of not having the resources we needed available. What then? What would have been said if we could not respond and someone was injured, or worse died? Can we be held liable for doing our job in once place but that risking the care in another? Pardon the rambling, it is getting very late for me.

  8. This conversation has went from customer service to absurd…There are jurisdictions accross the country that are making these decisions for their public through the use of triage. Saying that we should not be customer service oriented because the public does not understand EMS is flawed logic. Does the public understand the food service business…NO…but do they stop trying to meet or exceed customer servcie expectations…NO…they develop innovative ways to make the customer happy and that is what EMS must do if it is to survive. As stated in the article the public can vote for or against pay raises and other items. So why would we not want to try, through innovative techniques, to meet the needs of our community.

  9. This conversation has went from customer service to absurd…There are jurisdictions accross the country that are making these decisions for their public through the use of triage. Saying that we should not be customer service oriented because the public does not understand EMS is flawed logic. Does the public understand the food service business…NO…but do they stop trying to meet or exceed customer servcie expectations…NO…they develop innovative ways to make the customer happy and that is what EMS must do if it is to survive. As stated in the article the public can vote for or against pay raises and other items. So why would we not want to try, through innovative techniques, to meet the needs of our community.

    1. Devising innovative ways to make the “customers” of EMS happy has pulled us into the wreck we’re in now.
      The fire service grabbed onto Customer Service and the Phoenix model in an effort to forgo closures. And it worked, until a generation of citizens has been raised knowing the ambulance can not refuse to take them.
      “Saying that we should not be customer service oriented because the public does not understand EMS is flawed logic” I respectfully disagree and am pushing to educate the public on what is and is not a 911 emergency, but it will take time. If we are to dive completely into the customer service model and meet the expectations of our customers in EMS, get ready to see the entire system grind to a halt with BLS rides to a doctor.

      The triage you speak of is the also flawed Criteria based dispatch system and time targets for arrival of transport unit. More on that in Part 2.

      We can all do better to educate our citizens, clients, customers patients, leaders and elected officials about what EMS really SHOULD be and what it COULD be, provided we stop relying on the person who knows the least about what is going on: the customer.

      I thank you for reading and even more for commenting.

    2. i really don’t think justin’s suggesting that we abandon customer service. rather, he is saying that we can provide better and smarter customer service by getting these clients what they need instead of what they want. many of these clients don’t even know what they really need, and they think what they want is the right thing. well, it’s not.

      for example, take the common “i need meds” call:
      what they want: go to the ED or psych hospital to get their meds
      what they need: walgreens (and some money)

      having a system in place to help them get what they need instead of taking them all to the ED is a place to start. with that comes educating them on the basic life skills and how they get what they truly need.

  10. Have protocals established where you aren’t required to transport every stub toe or bug bite or ” I want to go to the ER because I’m shivering” call. We do. I can tell a pt they don’t need to go to the ER in my ambulance. I can call a BLS private service for them too. Sometimes a pt needs help in ways other than medical care. Sometimes its education about medication or how to take care of a problem with a trip to Walmart. Every call doesn’t require an ambulance transport.

  11. If you are a 911 provider, emergencies should and always be your top priority. Erma will just have to wait until another unit can come for her. Many times, we have been in the middle of a transfer (our service does 911 and non emergency transfers, both ALS and BLS do all calls.), and have had to first respond on a call. Since I am the ALS crew member, my partner stays with the transfer, unitl someone responsible, like the fire department ( they do BLS D first response), can sit with the patient, so my partner can come in with me. If the responding unit is BLS, then we either split up the crews or move the patient to the BLS truck.
    Keeping a “customer service”, type of a mind set does not hurt. It is the kindness and compassion that you show that the public and the patient will remember. BUT I don’t think the happy customer and worry over liability should create a problem. Especially in a case like Erma. I have a hard time believing that any court would rule against you if, you made Erma wait at home, to respond to pulseless child call.
    I agree with fire_man85′s comment that we should look at new ways to continue to serve the needs of the community. Do you need to create a designated non emergency transfer service, with in your organization? Do you need more rigs on during certain “peak hours”? If we looked hard enough, there is probably some way that we could meet the needs of those who call. Will we be able to meet everyone’s needs, NO. You can’t please everyone. But there is nothing wrong with trying to improve the existing system.

  12. We had a similar situation with one of our care facilities here in town. I totally understand that they can not drive themselves to the hospital and many of them do not have family near by to take them in. Some of them even require ambulance transport just due to their ongoing medical issues. With this said you do not need to call us at 3 am because the patient has been feeling crummy for 3 days and her doctor wants her to come to the hospital. We are a small community and while we have multiple squads and can staff all with ALS we also have the deadliest section of interstate in the state. It keeps us quite busy. We finally sat down with the staff at the facility and discussed what an “emergency” was. They have started using a ambulance service for the routine “patient just needs to go to the doctor” call and only calling us for the chest pain, difficulty breathing etc calls. We still end up there at least once a day. :) This has actually improved our relationship with the care center.

  13. This conversation has went from customer service to absurd…There are jurisdictions accross the country that are making these decisions for their public through the use of triage. Saying that we should not be customer service oriented because the public does not understand EMS is flawed logic. Does the public understand the food service business…NO…but do they stop trying to meet or exceed customer servcie expectations…NO…they develop innovative ways to make the customer happy and that is what EMS must do if it is to survive. As stated in the article the public can vote for or against pay raises and other items. So why would we not want to try, through innovative techniques, to meet the needs of our community.

  14. Have protocals established where you aren't required to transport every stub toe or bug bite or ” I want to go to the ER because I'm shivering” call. We do. I can tell a pt they don't need to go to the ER in my ambulance. I can call a BLS private service for them too. Sometimes a pt needs help in ways other than medical care. Sometimes its education about medication or how to take care of a problem with a trip to Walmart. Every call doesn't require an ambulance transport.

  15. If you are a 911 provider, emergencies should and always be your top priority. Erma will just have to wait until another unit can come for her. Many times, we have been in the middle of a transfer (our service does 911 and non emergency transfers, both ALS and BLS do all calls.), and have had to first respond on a call. Since I am the ALS crew member, my partner stays with the transfer, unitl someone responsible, like the fire department ( they do BLS D first response), can sit with the patient, so my partner can come in with me. If the responding unit is BLS, then we either split up the crews or move the patient to the BLS truck.
    Keeping a “customer service”, type of a mind set does not hurt. It is the kindness and compassion that you show that the public and the patient will remember. BUT I don't think the happy customer and worry over liability should create a problem. Especially in a case like Erma. I have a hard time believing that any court would rule against you if, you made Erma wait at home, to respond to pulseless child call.
    I agree with fire_man85's comment that we should look at new ways to continue to serve the needs of the community. Do you need to create a designated non emergency transfer service, with in your organization? Do you need more rigs on during certain “peak hours”? If we looked hard enough, there is probably some way that we could meet the needs of those who call. Will we be able to meet everyone's needs, NO. You can't please everyone. But there is nothing wrong with trying to improve the existing system.

  16. We had a similar situation with one of our care facilities here in town. I totally understand that they can not drive themselves to the hospital and many of them do not have family near by to take them in. Some of them even require ambulance transport just due to their ongoing medical issues. With this said you do not need to call us at 3 am because the patient has been feeling crummy for 3 days and her doctor wants her to come to the hospital. We are a small community and while we have multiple squads and can staff all with ALS we also have the deadliest section of interstate in the state. It keeps us quite busy. We finally sat down with the staff at the facility and discussed what an “emergency” was. They have started using a ambulance service for the routine “patient just needs to go to the doctor” call and only calling us for the chest pain, difficulty breathing etc calls. We still end up there at least once a day. :) This has actually improved our relationship with the care center.

  17. agree with pmedic….
    more systems should have the ability and freedom to ‘cancel’ Erma….or refer her to the local convalescent service.
    We do just that in the very system i work, and not only does it free up resources, it helps to maintain my sanity!

  18. agree with pmedic….
    more systems should have the ability and freedom to 'cancel' Erma….or refer her to the local convalescent service.
    We do just that in the very system i work, and not only does it free up resources, it helps to maintain my sanity!

  19. Devising innovative ways to make the “customers” of EMS happy has pulled us into the wreck we're in now.
    The fire service grabbed onto Customer Service and the Phoenix model in an effort to forgo closures. And it worked, until a generation of citizens has been raised knowing the ambulance can not refuse to take them.
    “Saying that we should not be customer service oriented because the public does not understand EMS is flawed logic” I respectfully disagree and am pushing to educate the public on what is and is not a 911 emergency, but it will take time. If we are to dive completely into the customer service model and meet the expectations of our customers in EMS, get ready to see the entire system grind to a halt with BLS rides to a doctor.

    The triage you speak of is the also flawed Criteria based dispatch system and time targets for arrival of transport unit. More on that in Part 2.

    We can all do better to educate our citizens, clients, customers patients, leaders and elected officials about what EMS really SHOULD be and what it COULD be, provided we stop relying on the person who knows the least about what is going on: the customer.

    I thank you for reading and even more for commenting.

  20. i remember seeing a subway poster in tokyo, and it had a picture of a little girl holding a teddy bear. the caption said, essentially and loosely translated, “don’t abuse 911 – what if this little girl is really sick?”

    our two biggest problems – lack of public awareness among a very uneducated (schooling, common sense, critical thinking, and every other sense of the word) public.

  21. i remember seeing a subway poster in tokyo, and it had a picture of a little girl holding a teddy bear. the caption said, essentially and loosely translated, “don't abuse 911 – what if this little girl is really sick?”

    our two biggest problems – lack of public awareness among a very uneducated (schooling, common sense, critical thinking, and every other sense of the word) public.

  22. I am a big believer in the “customer service” model of EMS, because we are after all a service, and I think you’re talking about two different things that may seem intertwined but really aren’t as connected as you think. There are two specific points I want to make on this from your post regarding the “customer service” model:

    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.

    I think it’s important to understand that the powers the person the crews anger in the field is the exact same power an angry customer has. Here’s an interesting comparison, Starbucks versus Dunkin’ Donuts. Both coffee stores share a common product, coffee. Starbucks charges around $5 for a “Venti” (large) and Dunkin’ Donuts charges around $2.50 for a large (large). Surprisingly, the Dunkin’ Donuts brand bean tends to be considered a superior bean… yet they lost customers in droves to Starbucks. Was it because people like paying extra money for coffee? No. It was because Starbucks focused on providing good customer service and a positive customer experience as opposed to Dunkin’ Donuts that lacked that entire part of the equation but focused on donut variety instead. Dunkin’ Donuts took a beating, and the key to their rebound was… customer service. This can be the key to a rebound for EMS as well if we chose to focus on it the way we should… but we don’t nor will we see it as a necessity because in our minds we “save lives” and “they need us”… when in fact the vast majority of the public doesn’t in fact need us, which is why we operate in a pay for service model.

    “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.

    Who’s fault is it that the people, who you are there in theory to serve, have no idea what the actual service you offer is? It is your fault for not properly educating the people you serve about your actual service.

    Using fast food as an example, McDonalds provides a food preparation service. Their customer base is educated to this through advertising, signage, and an actual menu. Sure there will be the occasional ignorant customer who will go in there ordering a Whopper, but how many customers walk into McDonald’s looking for insulin? I tend to think none, if any, because insulin is not associated with fast food restaurants (except that if you eat enough fast food you’ll end up needing it), but it is associated with the medical field which if you want to consider us medical professionals, includes us.

    Finally, just as a parting thought and some food for the gray matter, I often hear a lot of providers complain about this being a thankless job. Sure, there are those occasions when a patient or family will go out of their way to thank you either after the call or they will write a letter, but I think we can agree that those are relatively few and far between. Well, when was the last time you thanked or wrote a letter commending the server or cook at McDonald’s when your order was right and hot? We are not a complimentary or optimistic society seemingly by nature, and I think that’s something responders need to understand. Sure it always seems the supervisors are dragging you in and pointing out what you did wrong as opposed to what you did right, but that’s because that is what they hear about because that is what the culture is.

    To change that, we need to change the culture from focusing on the negatives and start focusing on the positives. We need to change the culture from having a sense of authoritative right to one of privilege. We need to change the culture from they should know to let us explain to you so that you can understand.

    As for liability, well that’s really an entirely different subject and after all that talk about McDonald’s and fast food I need to go get me a Filet-O-Fish now.

    1. I agree that I seldom write letters to the kid at the sandwich shop who gets my order right, but then again, I expect him to, that’s his job. Thanks are great in EMS, but should not be expected. Those of us who are passionate about it and involved in it know that.
      But when the folks who are just stopping by on their way to the FD or medical school hear that they are a service to a customer, I believe they default to the tip jar on the counter mentality. No one is teaching them what that means. I’m sure not.
      It is our fault our patients and citizens have no idea what we offer and we as a service have gone to great lengths not to tell them.
      But lumping EMS into the same model as Crate & Barrel and the coffee at Starbucks misses the part where we are the only game in town. Certainly there are multiple companies in many places, but if I don’t like the service from AMR, I can’t cancel them and call BayShore, I get who I get based on the municipal contract.
      “Customer Service” simply because we’re a “service” still misses the part where the people who call us have no idea what we do.
      If someone wanders into the Starbucks and demands a hamburger because they are the customer and the customer is always right, Starbucks will not give them one just to make their experience a better one. They will smile and suggest the McDonalds next door.
      I want to be able to smile and suggest my clients go “next door” to get what they need from who can give it to them. So I can make coffee for those who need it.
      I would welcome your thoughts on this topic on an upcoming Happy Hour podcast.
      Now I need a coffee. Now.

  23. I am a big believer in the “customer service” model of EMS, because we are after all a service, and I think you're talking about two different things that may seem intertwined but really aren't as connected as you think. There are two specific points I want to make on this from your post regarding the “customer service” model:

    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.

    I think it's important to understand that the powers the person the crews anger in the field is the exact same power an angry customer has. Here's an interesting comparison, Starbucks versus Dunkin' Donuts. Both coffee stores share a common product, coffee. Starbucks charges around $5 for a “Venti” (large) and Dunkin' Donuts charges around $2.50 for a large (large). Surprisingly, the Dunkin' Donuts brand bean tends to be considered a superior bean… yet they lost customers in droves to Starbucks. Was it because people like paying extra money for coffee? No. It was because Starbucks focused on providing good customer service and a positive customer experience as opposed to Dunkin' Donuts that lacked that entire part of the equation but focused on donut variety instead. Dunkin' Donuts took a beating, and the key to their rebound was… customer service. This can be the key to a rebound for EMS as well if we chose to focus on it the way we should… but we don't nor will we see it as a necessity because in our minds we “save lives” and “they need us”… when in fact the vast majority of the public doesn't in fact need us, which is why we operate in a pay for service model.

    “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.

    Who's fault is it that the people, who you are there in theory to serve, have no idea what the actual service you offer is? It is your fault for not properly educating the people you serve about your actual service.

    Using fast food as an example, McDonalds provides a food preparation service. Their customer base is educated to this through advertising, signage, and an actual menu. Sure there will be the occasional ignorant customer who will go in there ordering a Whopper, but how many customers walk into McDonald's looking for insulin? I tend to think none, if any, because insulin is not associated with fast food restaurants (except that if you eat enough fast food you'll end up needing it), but it is associated with the medical field which if you want to consider us medical professionals, includes us.

    Finally, just as a parting thought and some food for the gray matter, I often hear a lot of providers complain about this being a thankless job. Sure, there are those occasions when a patient or family will go out of their way to thank you either after the call or they will write a letter, but I think we can agree that those are relatively few and far between. Well, when was the last time you thanked or wrote a letter commending the server or cook at McDonald's when your order was right and hot? We are not a complimentary or optimistic society seemingly by nature, and I think that's something responders need to understand. Sure it always seems the supervisors are dragging you in and pointing out what you did wrong as opposed to what you did right, but that's because that is what they hear about because that is what the culture is.

    To change that, we need to change the culture from focusing on the negatives and start focusing on the positives. We need to change the culture from having a sense of authoritative right to one of privilege. We need to change the culture from they should know to let us explain to you so that you can understand.

    As for liability, well that's really an entirely different subject and after all that talk about McDonald's and fast food I need to go get me a Filet-O-Fish now.

  24. I agree that I seldom write letters to the kid at the sandwich shop who gets my order right, but then again, I expect him to, that's his job. Thanks are great in EMS, but should not be expected. Those of us who are passionate about it and involved in it know that.
    But when the folks who are just stopping by on their way to the FD or medical school hear that they are a service to a customer, I believe they default to the tip jar on the counter mentality. No one is teaching them what that means. I'm sure not.
    It is our fault our patients and citizens have no idea what we offer and we as a service have gone to great lengths not to tell them.
    But lumping EMS into the same model as Crate & Barrel and the coffee at Starbucks misses the part where we are the only game in town. Certainly there are multiple companies in many places, but if I don't like the service from AMR, I can't cancel them and call BayShore, I get who I get based on the municipal contract.
    “Customer Service” simply because we're a “service” still misses the part where the people who call us have no idea what we do.
    If someone wanders into the Starbucks and demands a hamburger because they are the customer and the customer is always right, Starbucks will not give them one just to make their experience a better one. They will smile and suggest the McDonalds next door.
    I want to be able to smile and suggest my clients go “next door” to get what they need from who can give it to them. So I can make coffee for those who need it.
    I would welcome your thoughts on this topic on an upcoming Happy Hour podcast.
    Now I need a coffee. Now.

  25. i really don't think justin's suggesting that we abandon customer service. rather, he is saying that we can provide better and smarter customer service by getting these clients what they need instead of what they want. many of these clients don't even know what they really need, and they think what they want is the right thing. well, it's not.

    for example, take the common “i need meds” call:
    what they want: go to the ED or psych hospital to get their meds
    what they need: walgreens (and some money)

    having a system in place to help them get what they need instead of taking them all to the ED is a place to start. with that comes educating them on the basic life skills and how they get what they truly need.

  26. What Erma needs is a BLS transport. The question I'd be asking is “Why wasn't a BLS (or even a transport-only rig) available, and if not, why couldn't she wait until one was?”

  27. What Erma needs is a BLS transport. The question I'd be asking is “Why wasn't a BLS (or even a transport-only rig) available, and if not, why couldn't she wait until one was?”

  28. liabilut is important no doubt but it is a two way street but litigation wise it always turns into a one way street – patients have no responsibility just a sense of entitlement as far as i see it

    system needs to be changed – i.e. no emerg calls which easily make up 70-80% of ems should be involve some patient responsibility ….even if it is a small fee but that should of course vary depending on circumstances (i.e. seniors, disable, etc..)

    in any case it won’t happen legal changes also have to happen and that is another matter all together

  29. liabilut is important no doubt but it is a two way street but litigation wise it always turns into a one way street – patients have no responsibility just a sense of entitlement as far as i see it

    system needs to be changed – i.e. no emerg calls which easily make up 70-80% of ems should be involve some patient responsibility ….even if it is a small fee but that should of course vary depending on circumstances (i.e. seniors, disable, etc..)

    in any case it won't happen legal changes also have to happen and that is another matter all together

  30. liabilut is important no doubt but it is a two way street but litigation wise it always turns into a one way street – patients have no responsibility just a sense of entitlement as far as i see it

    system needs to be changed – i.e. no emerg calls which easily make up 70-80% of ems should be involve some patient responsibility ….even if it is a small fee but that should of course vary depending on circumstances (i.e. seniors, disable, etc..)

    in any case it won't happen legal changes also have to happen and that is another matter all together

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