Credibility

[Ridryder 911]

After reading posts from other EMS forums as well of those even here, Myself and others started discussing the credibility of some statements and actions as described from posters and to those in EMS. Does credibility even mean anything in EMS and more so, to those that need EMS (the patients)? How much credibility, do we really have in this profession.

There are many definitions of credibility; Here it is defined by Webster’s Collegiate Dictionary : "the quality or power of inspiring belief. When applied to an information source, credibility centres on three factors: opportunity (is the source in a position to know?) ability (does the source have the skill and competence?) dependability (is the source responsible and trustworthy?)...".

When using the above definition:

Do those that make statements about EMS, actually in the position to do so? Are they currently working in a clinical or educational setting, developmental setting such as EMS division, or even administration or are those that dream and aspire to be those some day?

Do you have the ability to demonstrate such competence? Are you actively practicing in this profession or have the past experience? Have you been exposed to most of the adversities in EMS such as MCI, logged several hundred calls, or had to overcome obstacles and improvise on the spot? Are you still being judged and evaluated on your competencies?

Dependable and trustworthy? Can your partner, crew, and patient trust you? Can your employer place their trust in you to show up on time, be responsible, give 100% of yourself... without being prompted? Have you mastered your profession ? Did you leave your ambulance clean, stocked, paperwork or PCR performed accurately to be billed properly, will it reflect an accurate picture of the patient? Does your co-worker know that they can speak in confidence to you?

Can the patient truly trust your knowledge to know, and are competent that you have mastered your knowledge and skill level 100% most of the time? Can you put on that KED/ Hare traction, recall the APGAR levels without being prompted? Do you continuously read and keep current on treatment, and the system in general, daily, weekly, monthly.. ever?

So take a hard look at your self.. how would others or your self rate you?

[buckeyedoc]

You will find my responses to these wonderful questions in red.

After reading posts from other EMS forums as well of those even here, Myself and others started discussing the credibility of some statements and actions as described from posters and to those in EMS. Does credibility even mean anything in EMS and more so, to those that need EMS (the patients)? How much credibility, do we really have in this profession.

There are many definitions of credibility; Here it is defined by Webster’s Collegiate Dictionary : "the quality or power of inspiring belief. When applied to an information source, credibility centres on three factors: opportunity (is the source in a position to know?) ability (does the source have the skill and competence?) dependability (is the source responsible and trustworthy?)...".

When using the above definition:

Do those that make statements about EMS, actually in the position to do so? Are they currently working in a clinical or educational setting, developmental setting such as EMS division, or even administration or are those that dream and aspire to be those some day?

Do you have the ability to demonstrate such competence? Are you actively practicing in this profession or have the past experience? Have you been exposed to most of the adversities in EMS such as MCI, logged several hundred calls, or had to overcome obstacles and improvise on the spot? Are you still being judged and evaluated on your competencies?

Yes. I have been on MCI's (not many thankfully). I've logged several thousand calls (and not all in private EMS). I feel that I am judged on every run on my competencies. Granted, you can't memorize the entire playbook, but you should be able to treat the common ailments without consulting the manual.

Dependable and trustworthy? Can your partner, crew, and patient trust you? Can your employer place their trust in you to show up on time, be responsible, give 100% of yourself... without being prompted? Have you mastered your profession ? Did you leave your ambulance clean, stocked, paperwork or PCR performed accurately to be billed properly, will it reflect an accurate picture of the patient? Does your co-worker know that they can speak in confidence to you?

Absolutely. I pride myself on being dependable. I hate it when I have to do the work of someone else who is slacking, so I make sure I don't leave my work for someone else. My medic is cleaned (inside and out) at the end of my shift (and during if the run dictates). I make sure that all the monitor batteries are charged so that my relief doesn't get on a code and the monitor dies (that's happened to me, btw). I am anal about my paperwork and, quite frankly, I could care less how it is billed. I am there to treat the patients and not to make the company money. However, my paperwork is complete and concise and conforms with company (and Medicare/Medicaid) policy. Have I mastered my profession? Nope and no one on this forum has. EMS is an ever-evolving beast. If someone was to tell me that they have mastered EMS, I would think one of 2 things. 1) They are full of crap and need to get out of the business or 2) they are such a para-god and need to get out of the business. I know my parner thinks that I am good at my job. Am I that conceited? No, I know my partner and he knows me. Unfortunately, he will be leaving for Air Force BMT at the end of the month and I have to break in a new partner. I trust him and he trusts me. That's why we're a good crew.

Can the patient truly trust your knowledge to know, and are competent that you have mastered your knowledge and skill level 100% most of the time? Can you put on that KED/ Hare traction, recall the APGAR levels without being prompted? Do you continuously read and keep current on treatment, and the system in general, daily, weekly, monthly.. ever?

If I have any doubt about a treatment, I consult the protocol book. If that fails, there's always medical control. However, I know my protocols and I can be found with my nose in the protocol book boning up on things. Can I perform the skills with confidence and compassion? Absolutely. Yes, I can put on the KED and the Hare without issues. The APGAR scores trip me up a bit, but I don't make too many OB runs. I can quote the GCS scale verbatim. Why, because that's what I deal with most of the time. One of my employers makes sure that we are up to date on all current skills and procedures. They are anal about that. I also read the articles and try to stay fresh.

So take a hard look at your self.. how would others or your self rate you?

[becksdad]

Interesting topic. Personally, I would have to agree with buckeye about most of these questions. I like to think that I am competent at my job. Been doing this for several years, have run several thousand calls, comfortable with equipment (KED, Hare, etc.), been on a few MCI's. I read, study, ask questions. We do monthly in-service training sessions, and credential before our Medical Director bi-annually. My regular partners trust me with operations and patient care, and I trust them. The highest compliment I have ever received is when my partner asks me "What do you think?" You see, I am an EMT-B. And we EMT's have kind of a bad rep - sometimes deserved, and mostly our own fault. So this topic just gave me a soapbox to stand on.

Mediocrity seems to be epidemic, not just in EMS, but everywhere. We in EMS cannot afford to be mediocre - the nature of our job demands that we strive to be the best we can be. Would you let someone like you treat your mother? I know of EMT's who really think that it is their job to drive the ambulance and gather information. Period. And some of these same people haven't a clue as to the importance of information they gather. We need to be aware that chief complaints, vital signs and other assessments, histories, and meds all provide a more complete picture to direct any care we provide. And we really need to be able to interpret all this information accurately. It is NOT just the Paramedics job to interpret and treat patients based on presentation. What about the patient who initially presents priority 3, but begins to decline enroute to the hospital? Will we recognize the changes? Are we assessing and re-assessing? We should be.

It is also our job as EMT's to be familiar with at least the fundamentals of ALS procedures and equipment. We should know how to apply a 12 lead, de-fib pads, etc. We should know approximate ETT sizes a particular patient might require, as well as all the equipment needed for intubation and where it is located. We should be familiar with ACLS protocols, what drugs are used, and where they are. We should be able to set up a nebulizer. All of these things and more ARE OUR JOB. We are PARTNERS with Paramedics.We do not have separate jobs - we are a team.

Of course, this is assuming we are competent in BLS procedures and equipment. That is just a minimum requirement. But if we are content with meeting only minimum requirements, whose fault is it that EMT-B's have a generally poor reputation? It is incumbent upon us to change our own reputations. If we can be trusted to have a clean, well stocked truck, to communicate appropriately with our partners, to deal effectively with patients and families, maybe we can be trusted to become real partners. Maybe we can gain some CREDIBILITY. But its up to us.

Sorry if I kind of got off the subject a bit. This is one of my pet peeves. I probably come off sounding really serious, but really I'm not. I have lots of fun at work. And there's always more to learn, so it stays interesting. No, I do not believe any one of us has mastered our chosen profession. Looking back on what I've written here, it might sound like I think I know it all, sorry if it comes off that way. I just think we need to elevate ourselves by taking our own initiative. Thanks for letting me rant.

[chbare]

Ridryder 911, you pose an interesting question. Am I credible? That is hard to answer. I absolutely strive to be the best provider possible. I am always reading and attending continuing education courses. I strive to be the most competent provider possible and I strive to provide the best patient focused care possible. I am employed in a different setting than most EMT's, so this could make me less credible than a street provider when talking about medicine outside of the hospital. My primary form of employment is not EMS, so this could hurt my credibility as it applies to EMS. I believe that both my past and present experiences coupled with my motivation to be the best provider possible make me a well rounded provider when talking about taking care of patients as a whole. I know where I am weak and I am not too proud to seek assistance when confronted with a difficult situation. I have had to deal with mass casualty situation in and out of the field and I am required to care for a variety of patients throughout the life span and health continuum. In addition, I have had to deal with dynamic situations and quickly problem solve my way through complex evolving scenarios. I have earned the respect of my colleagues and I know that this respect is difficult to maintain, and it requires that I give it my all every time I show up to work. I am also aware that I am an ambassador for my profession and I must strive to present my profession in a positive light to my fellow colleagues, patients, and family/friends. Are my statements and posts credible on this website? I leave it to the people who read my posts to make that decision.

Take care,

chbare.

[Ridryder 911]

Thanks for your replies, interesting and insightful. This has been discussed lately among veterans and new ones. With many of the new and younger Paramedics describing their is no such thing as credibility in EMS. The profession has not matured yet to have such measurements.

I don't believe one has to work MCI, etc.. to have such, this was just an example of someone that has probably been in the field long enough to see almost everything once or twice, yet realize each and every emergency is different and especially unique to the patient.

Even here on the forum, I believe we are loosing credibility. I chuckle, lately when I read posts from those that offer advice or make recommendations that..."there is more than one way".... etc. and then only later to read they have not yet completed a Paramedic or RN program (highest level of EMS), or completed any true accredited education level (degree of education, BS, MS, PhD, EdD), and much more humorous is they have never worked in this field or could be considered at the rookie level (<5 years) yet they are spouting and offering advice as an expert in this profession. I doubt they will read this post or respond not really understanding true professional development and education.

Although, I highly encourage discussion, I do believe there should be some form of credibility to those that offer advice or some form of disclaimer "Not all that participate in this forum, actually know what they are talking about, take advice and recommendations at risks"... Unfortunately, many naive readers believe that majority of the posters actually really know what they are talking about.

I know I receive personal IM mail continuously about professional development, education, patient care, etc.. and I am honored that one would do so. I do research and sometimes ask others with more speciality than me for advice for them, to be sure accurate and true information is dispersed.

Now, back to the main topic.. how can we promote more credibility in our profession.. do we even see that this is a problem?

I do, I believe this is some of the reasons we have major problems in this profession. EMS receives poor to low pay, poor working hours, and poor benefits if any. The public does not include us as an essential item, and make sure each community has not just an EMS, but ALS response.

Is this poor perceptions) our fault and what can be done about it?

R/r 911

[Connie31079]

Wow, awesome question, Rid!

Geez, where do I start? I'm glad this question was asked, actually, because it allows me to get some feelings "off of my chest".

First off, am I credible? I'd like to think I am, but it all depends on who you ask, I guess. There are some people out there that I've worked with who like me and would say I'm credible, then there are those out there that I've worked with who can't stand me, for whatever reason, I still don't know.

I get that feeling from some people in here too. For God knows what reason, I feel as if people have labeled me as "weak" and tend to blow off anything that I have to say about almost any given topic.

Another thing I've noticed about EMS is once you've earned a reputation, especially a bad one, it sticks with you, no matter where you go. Doesn't matter if you're a bad medic or an awesome medic, if someone doesn't like you and then spreads it around that "you suck at your job", it'll follow you until the day you die.

All I know is, I've worked hard to get to where I am, and I continue to work hard everyday to give my patients the best care possible. No, I don't always have my nose in a book, study like I know I should, but I probably study more than most medics I know.

I'm not afraid to ask for help if I need it, even though I am an ACP. You'd be surprised at how many ACP's I know who would NEVER ask for help if they were on a call, even if they were up to thier eyeballs in $hit. I'm not like that at all, I'm human, and I know that I don't know everything. I certainly don't have the "paragod" syndrome!!

I treat others the way I'd want to be treated. So, if I'm nice to someone, obviously, I expect them to be nice to me, but unfortunately, it doesn't always end up that way.

One of my biggest problems is that I take everything personally, and I've always been this way, ever since I can remember. People tell me I need to "get a backbone, stand up to people!!"......God knows I've tried, but it's not easy for me. Therefore, when someone speaks badly of me in the way that I've done my job, I go home and cry.

My job is my life. I don't have anything to go home to after every shift. I envy those who have a husband/wife and kids to go home to everyday after work, I go home to an empty apartment. So, when people say I suck at my job, they're attacking the one thing I have going that's positive in my life. Do you know how that feels??

But everyday, I get up, get into that uniform, and go to work with my head held high, and try not to let those people who don't like me get me down. I guess that's all I can do. Keep putting one foot in front of the other.......

[AZCEP]

This may not be the direction you are looking for, but can we really assess something like credibility ourselves? Wouldn't it be applied by someone else?

As a profession, we don't have the credibility due to educational issues. Combine this with the prevailing attitudes that present when we get questioned by other levels of healthcare provider, and you have the makings of a kindergarten class at recess.

We want credibility, but we are unwilling to advance the craft, or ourselves. We want to be respected, but we refuse to respect those we work with. This situation can improve, but the mindset has to change before we can hope to effect one.

Great topic, and hopefully this discussion will lead to something of importance.

[Just Plain Ruff]

I think one more question that needs to be asked and if it was posed on this topic already I must have missed it. Integrity - do you have it?

[Ridryder 911]

Good point!

Here is one of the best definitons, I found from Winkipedia:

Integrity comprises the personal inner sense of "wholeness" deriving from honesty and consistent uprightness of character. The etymology of the word relates it to the Latin adjective integer (whole, complete). Evaluators, of course, usually assess integrity from some point of view, such as that of a given ethical tradition or in the context of an ethical relationship. People who for instance said bad things about their own grandmother might appear to lack a form of integrity.

Actually, I believe the two compliment each other and is hard to have one without the other.

I do think it is a shame, that many have not responded to this question. Ironically, those that so far have answered is the ones', that I predicted would and believe have credibly. It is for some of those that did not answer, I posed the question in the beginning. Apparently, they have answered by default....unless, they would like to rebut.

R/r 911

[paramedicmike]

This may not be the direction you are looking for, but can we really assess something like credibility ourselves? Wouldn't it be applied by someone else?

I was thinking about how to answer this and I saw AZCEP's reply.

My response would have been much more wordy...but it would've said the same thing.

I can't assess my own credibility. For that I think you'll need to speak with friends, coworkers, supervisors etc...

The point about including integrity into the equation is well made. However, I think the same applies.

I strive every day to be as honest, credible, reliable etc...that I can be. Whether or not I have achieved my goals are best determined by those a little less biased than myself when it comes to issues relating to my behaviour.

-be safe.