Why would Emergency Medical Services (EMS) staff need policies on driving? Providing medical care, of course, is the primary task and responsibility of EMS personnel. However, the many hours EMS staff are on the road – almost all of it to and from the scene of a traffic accident or other incident – makes driving one of the highest-risk tasks that they routinely carry out – at all times of day, and in all types of weather. Developing, promulgating, and implementing an official “policy” on driving, therefore, could and probably would help mitigate that risk considerably.
Official policies at any level of government are, in general, mandatory for three principal reasons: (1) they provide operational (and political) guidance to staff; (2) they help ensure compliance with what are sometimes a rather confusing jumble of laws, rules, and regulations; and (3) they offer protection not only for the EMS agency involved but also for individual members of the EMS staff.
The first step to developing a new or revised policy is to set forth the primary goals. In the case of driving, agency vehicles should be operated in a manner that permits the agency’s primary mission to be carried out safely and effectively, and without causing additional risk to the staff and and/or the public at large.
The next step in the process is to keep staff members fully informed about all current rules and regulations. To consider but one example: Lights and sirens are powerful tools, so it should be made clear, in advance, when it is both warranted and acceptable to use them. In this particular operational area, the guidelines postulated must be defined very carefully, because lights and sirens give drivers the authority to take specific risks – e.g., exceeding the speed limit, if and when necessary, proceeding (very carefully) through red lights, and wending their way through and/or around stalled traffic. Some systems have instituted policies requiring that all drivers keep their lights and sirens activated during any response – but other jurisdictions require specific and more limited authorization for their use.
Responsibility, Accountability & Continuing Updates
Laws are created to maintain order. When officials disregard those laws, society assigns, and expects, responsibility and accountability. In the same manner, an intelligent and acceptable policy needs to specify: (a) how authority will be defined; and (b) how both risk and liability may and should be minimized. A well-defined policy should also include the circumstances under which this permissive authority can be “turned on” – and by whom.
Most states already have enacted legislation covering the operation of emergency vehicles, including the use of lights and sirens. Any policy that is enacted must be in compliance with the respective state’s statutes. In some cases, the purpose of the policy may be to bring the agency into compliance with existing laws. In other cases, it may have nothing to do with statute, but is intended solely to meet the needs of that agency.
Nonetheless, the policy should, in all cases, reference the statute under which it falls. After a statute is approved and/or enacted, the agency must then keep up to date with that law. When changes are made to the statute, therefore, the policy must also be updated accordingly.
Good Policies and Reasonable Questions
A “good” policy – i.e., one that is not only legally permissible but also meets operational requirements and, above all, makes common sense – is designed to protect the agency as well as the staff by managing risk, assigning authority, and defining expectations. In that context, among the several questions that should be addressed are: (a) When risks could and perhaps should be taken; (b) Who has the authority to order or take such risks; and (c) When EMS staff are permitted to refrain from taking those risks. Certain ancillary questions – such as who is allowed to waive the policy, and under what circumstance a waiver may be permitted – also should be covered.
By controlling risk, a reasonable and effective driving policy provides protection to the public as well as to emergency responders. Intelligent and effective policies also protect EMS staff by setting forth explicitly what is expected from them and specifying how differing opinions should and will be settled between staff members, between staff and supervisors, and between staff and the public. All of those involved can simply “look up” the answers.
Two additional points worth remembering: (a) Having a reasonable and effective policy in place is important, but it can be “effective” only if it is well known and understood by all EMS staff (including supervisors) likely to be involved. To meet that common-sense requirement, policies should be both published and promulgated – to all personnel who might be directly or even indirectly affected. Those personnel, including supervisors, who will be responsible for enacting the policy must be thoroughly familiar with it. (b) Although this brief discussion focuses primarily on the “driving” policy of a specific jurisdiction, driving itself is only one example of why all official policies matter – not only for legal reasons, but for operational requirements as well. Policies related to guidance, compliance, and protection also should be clearly stated, therefore; they also should be widely spread and promulgated and, most important of all, they should meet the true “golden standard” of all policies: everyday common sense.
To review an excellent example of a well-defined driving policy, visit the University of Texas Police Department’s website (http://www.utexas.edu/police/manual/a5.html).
Joseph Cahill is the director of medicolegal investigations for the Massachusetts Office of the Chief Medical Examiner. He previously served as exercise and training coordinator for the Massachusetts Department of Public Health and as emergency planner in the Westchester County (N.Y.) Office of Emergency Management. He also served for five years as citywide advanced life support (ALS) coordinator for the FDNY – Bureau of EMS. Before that, he was the department’s Division 6 ALS coordinator, covering the South Bronx and Harlem. He also served on the faculty of the Westchester County Community College’s paramedic program and has been a frequent guest lecturer for the U.S. Secret Service, the FDNY EMS Academy, and Montefiore Hospital.