David Givot

“First, I am thrilled that paramedics are finally getting the respect they deserve for being the professionals they can be. The scope of practice is expanding, and patient care modalities are improving, seemingly by the minute. Patient outcomes are also improving as a result, and EMS is passing through puberty and forging into adulthood. On the other hand, autonomy in the hands of the “lesser-motivated,” can be a very dangerous thing. You know as well as I do that there are still plenty of providers who operate from a subjective, complacent, and downright lazy place. Combined with the ever-expanding autonomy, that provider just became more dangerous than he or she ever has been – to the patients and to you. Autonomy in patient care places more pressure for excellence on the provider charged with delivering it, and also on the partner and crew members on scene. Since the base hospital is not involved like it once was, they are likewise less responsible for the errors and omissions of the medics on the scene. Now more than ever, crew members are being held to answer for the mistakes and follies of their coworkers; now more than ever, EMS providers are working without a net. What’s next? I predict (and hope) emergency medical Darwinism is going to force some painful and necessary changes. First, increasing autonomy is going to result in the better and best providing superior patient care. More personal ownership of the results is going to manifest in outcomes such as increased cardiac arrest survival rates, faster and more complete stroke recovery, and significantly better outcomes for STEMI patients, all leading to the brass ring: EMS as a profession, not just a job. On the flip side of that coin, you will see consequences for the not-so-good and completely awful providers. There will be higher instances of licensure action, internal discipline, and wash-out. Unfortunately, all those things will stem from generally preventable negative patient outcomes. The danger for the better provider will be in the penumbra; the murky, gray area of time when providers are self-categorizing. Specifically, the better provider who is aware of the dangerously poor provider but does nothing to fix or flush him or her, is almost certain to be caught up in a bad situation caused by sloppy, complacent, or ultimately negligent patient care that should have been corrected or stopped. The answer is as simple as it is difficult. If you are reading this, it is more likely because you are one of the better, more committed, more professional providers. This transition is up to you. You must dig deep and find the strength necessary to face the issue and force the change; you have to demand more from yourself and from those around you. You must have the willingness to help those providers who want it – and respond to those who need it, but don’t want it – with tough love by showing them the door. In the end, EMS will only ever be as good as you make it. If you lay silent through its evolution, you forfeit the right to complain when it crumbles around you.”
― David Givot, Sirens, Lights, and Lawyers: The Law & Other Really Important Stuff EMS Providers Never Learned in School

“EMS is not a job for the weak. The stressors exceed most anything that ordinary civilians could possibly understand. However, EMS is a community of humans and humans are affected by the stress, whether they recognize it or not, whether they acknowledge it or not, whether they accept it or not, and recognizing, acknowledging, and accepting that the effects are real does not make one weak. In fact, recognizing, acknowledging, and accepting the realities of EMS could save your sanity and your life.”
― David Givot, Sirens, Lights, and Lawyers: The Law & Other Really Important Stuff EMS Providers Never Learned in School