This month’s EMS Dashboard Confessional entry is one of the most heartfelt and moving stories that anyone has ever shared with me. The fact that he or she carries this incident around to this day speaks to the need to share these events and learn from them, and to heal from them.
Some years ago, I was the clinical manager for a major EMS system. One day, one of the on-duty medics came to me with concerns about his partner. He stated that his partner had shown up to work that morning obviously intoxicated and they had already responded on one call. He then told me not to worry because “he had not let his partner drive the medic unit while drunk.”
I immediately had the unit put out of service and reminded the reporting medic that although he had not let his partner drive while intoxicated, he had let his partner treat a patient while impaired. I tried talking to the intoxicated medic, but it quickly became obvious that he was in no condition to have a rational conversation, so we had one of the staff drive him home.
I didn’t initiate any formal disciplinary action from the incident, although both medics were counseled. For background, the individual who showed up intoxicated was a strong medic, with a very good track record with our organization. We did try to get him into counseling, but unfortunately he died a few years later of alcohol related issues.
To this day I wonder if I could have done more for him.
Jennifer McCarthy, Director of Clinical Simulation at Seton Hall University and well-respected EMS advocate, shared her thoughts on this story.
“I was sorry to read that the intoxicated provider ultimately died as a result of his or her illness but I do not hold the manager responsible for this unfortunate outcome.
This story serves as an example of second victim syndrome. This syndrome has emerged from the patient safety literature to help describe the long-lasting impacts on clinicians after a patient safety event has occurred. This is not to insinuate that this manager had an error in handling this situation.
There are two aspects to look at how this case was handled, operationally and with human dynamics. From an operational perspective, the manager addresses the immediate public and institutional threat by removing the individual from service. Additionally, the counseling of the partner who responded with him to a patient was equally as important as addressing the intoxicated provider. I would have preferred to read that disciplinary action was taken, although the description of a “counseling” insinuates that the conversations were memorialized as part of progressive discipline. It is critical that any conversation on a subject like this be documented, even if it does not lead to disciplinary action.
Moving to the human dynamics, it’s obvious that there’s pain still evident from this story. The manager did an excellent job offering counseling, but was there a mechanism to offer someone substance abuse treatment, or to require it? More importantly, from a decision-making perspective, this case demonstrates where “strong providers” and “nice guys/gals” can bias leadership and decision-making. As leaders, we start justifying the reasons for the actions instead of maintaining our neutrality during the investigation and outcome process.
This case brings to light the need for tough discussions and truthful, direct approaches with our providers. The shadow of addictive behaviors is very much alive within our industry. The first-hand experiences that each provider faces cannot be normalized. Shifting our culture to be better prepared to face these shadows, have a prepared script to discuss these situations, and programs available to heal from these events is highly encouraged. I’d like to encourage all that have read this post to take one strong actionable step towards addressing our shadows. We can collectively do this in honor of the provider whose life was lost in this example and the manager that had the guts to share the story for us to learn from.”