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EMTs and Paramedics are Patient Advocates, Too

by  Bob Elling     Apr 10, 2023
holding_hands

When I took my original paramedic training, back in 1978, I remember being told, “It is your role to advocate for your patient.”

I have always taken that comment very seriously and tried to introduce the responsibility for advocacy to my students and coworkers. Read on to learn how EMTs, paramedics and other professionals who work in public safety must consider how to serve the role of patient advocate as well as providing great pre-hospital support.

The Origins of Advocacy in EMS

Advocacy is defined as pleading or arguing in favor of something such as a cause, idea, policy or active support.

A healthcare advocate can be a spouse, relative, friend, or caregiver that you trust. Although all patients should have an advocate, only about 70% do. Older adults are especially likely to benefit from having another person with them during medical visits. 

As we age, we may have more health issues to discuss. Having two people hear the discussion and making sure they understand is much better than just one set of ears, since it can sometimes be difficult for one person to remember everything that’s been discussed. Then there are the complexities of navigating the healthcare system and insurance.

Over the past few decades, the role of a healthcare advocate has developed and is actually offered as a career with training at a number of colleges. Advocates make sure their client's voices and choices are heard!

There are three leading professional organizations that represent patient and health care advocacy:

  • National Association of Healthcare Advocacy (NAHAC) is dedicated to improving patient outcomes through promotion of the profession of healthcare advocacy through education, community, and collaboration.
  • HealthAdvocateX is a national nonprofit with the mission to transform people into active participants in their care. HAdvX educates, connects, and inspires people to include advocacy in all aspects of health and healthcare.
  • Patient Advocate Certification Board (PACB) is a nonprofit organization whose mission is to manage and maintain a universally recognized certification for patient/health advocates; establish and maintain relevant knowledge domains, skills, ethical standards, and best practices for advocates; collaborate with healthcare consumers to achieve patient and family centered care; establish professional development for certified advocates; and promote and professionalize patient advocacy.

In 2021 these three organizations came together to form the Health Advocacy Collaborative Ethics Task Force (HACE). The purpose of their first-ever collaborative project was to review and update the Code of Ethics.

All first responder community organizations should have a “code of ethics”, updated on a regular basis so that the agency and its members have an understanding of what ethical behavior is acceptable for the profession. Most paramedic programs on graduation administer a form of the Oath of Geneva which is a modern day version of the Physician Hippocratic Oath.  Every EMS Provider should be familiar with the EMT Code of Ethics that was written by Charles Gillespie, MD and adopted by the National Association of EMTs in 1978 and revised in 2013.

The HACE document was developed to address important issues such as: professional integrity, privacy and confidentiality, professional education, fostering informed decision making, professional conduct, and respect for diversity, equity, inclusivity and justice.

What is Prehospital Patient Advocacy?

Traditionally, the advocacy role of the prehospital provider has focused on “painting a good picture” for the Emergency Department nurses and physicians of your observation of the environment you picked the patient up from such as a residence, a highway or another public place. 

I have always referred to this role of advocating for the patient on my stretcher as advocacy with a small “a.”  I suspect you have been there before: Your team extricated the patient from entanglement in a crushed motor vehicle on a busy highway. You assessed, prioritized, comforted, splinted, managed, transported and monitored the patient for the past 45 minutes. On arrival at a busy Emergency Department, sometimes with a line of stretchers waiting to talk to the Triage Nurse, you understand that you and your patient will be competing for the attention of the staff. It is your role to clearly and concisely describe the scene and mechanism of injury so decisions on care are not solely based on the patient’s current condition.

Then there are the cases where you have been to the patient’s home numerous times and you know that releasing this patient, who has a vague complaint, such as general body weakness, vomiting, or syncopy, back home tonight is highly likely to end up right back in the ED. The ED staff need to privately know that residence has way too many steps, he told you he has no neighbor or relative nearby to drop in and check on them. It appeared obvious no one has been cooking for him, he states he no longer drives that old car in the driveway since it will not start. The house looks like he is a “hoarder” with many piles of old magazines, newspapers, and pizza boxes, all covered with dust. He has many medications and he seems confused about which ones he should be taking.

Perhaps mentioning the right things you observed might get him an appropriate referral for some help in their home before sending him back there. Some communities have local services such as Visiting Nurses or caregivers, Meals on Wheels® or Geriatric Services. In some cases their assessment may provide some cleaning out of the home and even building a wheel chair ramp to make it easier for him to get around his own home.

Another Type of Advocacy

There is another very important type of patient advocacy which I believe is our role too. I would use an uppercase “A” to describe being this type of patient advocate. That would involve working to change policies, rules, regulations, and laws. This can include creating coalitions of like-minded people, and campaigning to raise awareness of the specific issue of concern.

For a moment let’s consider the advocates who worked hard for many years to convince states there was a need for seat belt laws and all the lives that simple device has saved. The data speaks for itself, from 1975 to 2017, the National Highway Traffic Safety Administration (NHTSA) estimates that 374,276 lives were saved. That’s 14,955 lives saved in 2017 alone and yet they still estimated 2,549 more could have been saved that year if everyone buckled up.

Take one state as an example, in 1984 New York State was the first state to mandate all front-seat passengers wear seat belts. At that time they estimated that 16% wore seat belts without a mandate. In NY today all passengers in motor vehicles age 16 and older are required to wear a seat belt. In 2019 94.2% of those in NY were wearing their seat belts (national rate was 90.7%). On the low end the seat belt use was 70.7% in New Hampshire which is the only state without a seat belt law. As we should all know in addition to what the laws require using safety restraints properly is an ongoing educational process with so many new drivers each year.

Lobbying vs. Advocacy

Is lobbying the same as advocacy? Actually, lobbying is one form of advocacy. Not all advocacy is lobbying yet all lobbying is considered advocacy.

Lobbying is any attempt by individuals or private interest groups to influence the decisions of government; in its original meaning it referred to efforts to influence the votes of legislators, generally in the lobby outside the legislative chamber. Today many organizations retain paid professionals to lobby for their causes. Many organizations will use volunteer advocates to lobby government officials in an effort to educate them or their staff members on specific issues.

Most “not-for profit” organizations can lobby for legislative or policy improvements. It is always good to check with the mission of the group to see to what extent they can advocate or lobby for change. Some organizations have chosen to create separate units responsible for lobbying and advocacy so as to not confuse or conflict that role from other things they do.

Examples of volunteer efforts to lobby legislators for issues often very relevant to first responders would include:

  • The American Heart Association’s You’re the Cure Network grassroots network conducts state and national lobby days. They will educate you on the facts surrounding the issue at hand and teach you best practices for meeting with legislators and their staff.
  • The National Association of EMTs (NAEMT) has an Advocacy program designed to represent their members on issues that impact the EMS work environment and the ability of EMS practitioners to effectively serve their patients. They have State Advocacy Coordinators and conduct an annual “EMS On The Hill Day” to bring EMS professionals together in Washington, DC, to advocate for the needs of patients and the EMS profession.

How Can You Get Involved?

Pick issues that interest you. There are many local, regional, state, or national issues that groups such as professional associations, and disease or condition specific organizations already have campaigns to confront. Do some research using honest credible and reliable sources to see how you can get involved, aide the cause, and effect change. Examples of issues in need of your ongoing support:

  • Stopping The Opioid Crisis
  • Child Restraint Use and Education
  • Strengthening the Links in the Chain of Survival in every zip code!
  • Drowning Prevention and education
  • Hypertension: Identification, Prevention and Control
  • Tobacco: Control and Assist in Quitting
  • Safety at Crash Scenes for Public and Emergency Responders
  • All forms of Abuse (Child, Domestic, Elder)
  • Community Preparation for Disasters
  • Rescuer Suicide Prevention
  • And the list goes on and on…

Advocates can help advance causes by writing letters to the editor of a local newspaper, posting factual, educational information on social media complying with your organization’s SOPs (no patient photos or HIPPA violations).  Making yourself available to the organization’s Advocacy Coordinator as a subject matter expert or spokesperson (if qualified) in your area of expertise and providing testimony in public hearings on an issue. Telling your stories and sharing your experience at the right time with legislators and their staff. Or just plain helping to staff an exhibit or stuffing envelopes.

Some organizations that you might consider approaching as a starting point with your ideas and energy might include:

  1. Associations: National Association of EMTs (NAEMT), International Association of Fire Chiefs (IAFC), International Association of Chiefs of Police (IACP),
  2. Specific disease focused organizations: American Heart & Stroke Association (AHA), American Lung Association, American Cancer Society, American Diabetes Association (ADA), Brain Injury Association of America, National Organization for Rare Disorders (NORD), etc.
  3. Specific problem focused groups: Mothers Against Drunk Driving (MADD),
  4. Labor Unions: (if a member check to see if your union can lobby)
  5. Government: Congressional Fire Service’s Institute, Governor’s Highway Safety Association, local and county level town boards and safety committees.

ECSI exists to support the efforts of advocacy. Sign up to become an ECSI instructor or review our resources to learn more today.

As I have told many of my students over the years, As an excellent EMS provider you can save many lives, as an excellent EMS Educator you can train others to save many more lives and as a excellent Advocate you can work to change policies and the laws and save thousands of lives or prevent the incidents in the first place. Advocacy with both a small “a” and a big “A” are our role and there are plenty of useful causes waiting for your passion and energy!

Some campaigns take a long time so have patience. Making major changes in policy or laws is sometimes a marathon and not a sprint! When I lived in NY, it took our team almost seven years to convince the Senate and Assembly and Governor to put a CPR in the Schools bill in place. Hard work but in the end the team knew it was definitely worth the time and energy and would save many lives. I am still very proud of that frames law signing pen on the wall in my home office.

My advice it to get out there, stretch a little bit, and go for it!  

Read more:

About the author:

Bob Elling, MPA, Paramedic (retired) - has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Times Union Center, and Whiteface Mountain Medical Services. He was an Albany Medical Center Clinical Instructor assigned to the Hudson Valley Community College Paramedic Program. He has served as National and Regional Faculty for the AHA and was involved in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, paramedic program director and associate director of the New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare the EMS provider for their career. Bob is the ECSI Medical Editor for CPR and First Aid Series of products and the Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

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EMTs and Paramedics are Patient Advocates, Too

by  Bob Elling     Apr 10, 2023
holding_hands

When I took my original paramedic training, back in 1978, I remember being told, “It is your role to advocate for your patient.”

I have always taken that comment very seriously and tried to introduce the responsibility for advocacy to my students and coworkers. Read on to learn how EMTs, paramedics and other professionals who work in public safety must consider how to serve the role of patient advocate as well as providing great pre-hospital support.

The Origins of Advocacy in EMS

Advocacy is defined as pleading or arguing in favor of something such as a cause, idea, policy or active support.

A healthcare advocate can be a spouse, relative, friend, or caregiver that you trust. Although all patients should have an advocate, only about 70% do. Older adults are especially likely to benefit from having another person with them during medical visits. 

As we age, we may have more health issues to discuss. Having two people hear the discussion and making sure they understand is much better than just one set of ears, since it can sometimes be difficult for one person to remember everything that’s been discussed. Then there are the complexities of navigating the healthcare system and insurance.

Over the past few decades, the role of a healthcare advocate has developed and is actually offered as a career with training at a number of colleges. Advocates make sure their client's voices and choices are heard!

There are three leading professional organizations that represent patient and health care advocacy:

  • National Association of Healthcare Advocacy (NAHAC) is dedicated to improving patient outcomes through promotion of the profession of healthcare advocacy through education, community, and collaboration.
  • HealthAdvocateX is a national nonprofit with the mission to transform people into active participants in their care. HAdvX educates, connects, and inspires people to include advocacy in all aspects of health and healthcare.
  • Patient Advocate Certification Board (PACB) is a nonprofit organization whose mission is to manage and maintain a universally recognized certification for patient/health advocates; establish and maintain relevant knowledge domains, skills, ethical standards, and best practices for advocates; collaborate with healthcare consumers to achieve patient and family centered care; establish professional development for certified advocates; and promote and professionalize patient advocacy.

In 2021 these three organizations came together to form the Health Advocacy Collaborative Ethics Task Force (HACE). The purpose of their first-ever collaborative project was to review and update the Code of Ethics.

All first responder community organizations should have a “code of ethics”, updated on a regular basis so that the agency and its members have an understanding of what ethical behavior is acceptable for the profession. Most paramedic programs on graduation administer a form of the Oath of Geneva which is a modern day version of the Physician Hippocratic Oath.  Every EMS Provider should be familiar with the EMT Code of Ethics that was written by Charles Gillespie, MD and adopted by the National Association of EMTs in 1978 and revised in 2013.

The HACE document was developed to address important issues such as: professional integrity, privacy and confidentiality, professional education, fostering informed decision making, professional conduct, and respect for diversity, equity, inclusivity and justice.

What is Prehospital Patient Advocacy?

Traditionally, the advocacy role of the prehospital provider has focused on “painting a good picture” for the Emergency Department nurses and physicians of your observation of the environment you picked the patient up from such as a residence, a highway or another public place. 

I have always referred to this role of advocating for the patient on my stretcher as advocacy with a small “a.”  I suspect you have been there before: Your team extricated the patient from entanglement in a crushed motor vehicle on a busy highway. You assessed, prioritized, comforted, splinted, managed, transported and monitored the patient for the past 45 minutes. On arrival at a busy Emergency Department, sometimes with a line of stretchers waiting to talk to the Triage Nurse, you understand that you and your patient will be competing for the attention of the staff. It is your role to clearly and concisely describe the scene and mechanism of injury so decisions on care are not solely based on the patient’s current condition.

Then there are the cases where you have been to the patient’s home numerous times and you know that releasing this patient, who has a vague complaint, such as general body weakness, vomiting, or syncopy, back home tonight is highly likely to end up right back in the ED. The ED staff need to privately know that residence has way too many steps, he told you he has no neighbor or relative nearby to drop in and check on them. It appeared obvious no one has been cooking for him, he states he no longer drives that old car in the driveway since it will not start. The house looks like he is a “hoarder” with many piles of old magazines, newspapers, and pizza boxes, all covered with dust. He has many medications and he seems confused about which ones he should be taking.

Perhaps mentioning the right things you observed might get him an appropriate referral for some help in their home before sending him back there. Some communities have local services such as Visiting Nurses or caregivers, Meals on Wheels® or Geriatric Services. In some cases their assessment may provide some cleaning out of the home and even building a wheel chair ramp to make it easier for him to get around his own home.

Another Type of Advocacy

There is another very important type of patient advocacy which I believe is our role too. I would use an uppercase “A” to describe being this type of patient advocate. That would involve working to change policies, rules, regulations, and laws. This can include creating coalitions of like-minded people, and campaigning to raise awareness of the specific issue of concern.

For a moment let’s consider the advocates who worked hard for many years to convince states there was a need for seat belt laws and all the lives that simple device has saved. The data speaks for itself, from 1975 to 2017, the National Highway Traffic Safety Administration (NHTSA) estimates that 374,276 lives were saved. That’s 14,955 lives saved in 2017 alone and yet they still estimated 2,549 more could have been saved that year if everyone buckled up.

Take one state as an example, in 1984 New York State was the first state to mandate all front-seat passengers wear seat belts. At that time they estimated that 16% wore seat belts without a mandate. In NY today all passengers in motor vehicles age 16 and older are required to wear a seat belt. In 2019 94.2% of those in NY were wearing their seat belts (national rate was 90.7%). On the low end the seat belt use was 70.7% in New Hampshire which is the only state without a seat belt law. As we should all know in addition to what the laws require using safety restraints properly is an ongoing educational process with so many new drivers each year.

Lobbying vs. Advocacy

Is lobbying the same as advocacy? Actually, lobbying is one form of advocacy. Not all advocacy is lobbying yet all lobbying is considered advocacy.

Lobbying is any attempt by individuals or private interest groups to influence the decisions of government; in its original meaning it referred to efforts to influence the votes of legislators, generally in the lobby outside the legislative chamber. Today many organizations retain paid professionals to lobby for their causes. Many organizations will use volunteer advocates to lobby government officials in an effort to educate them or their staff members on specific issues.

Most “not-for profit” organizations can lobby for legislative or policy improvements. It is always good to check with the mission of the group to see to what extent they can advocate or lobby for change. Some organizations have chosen to create separate units responsible for lobbying and advocacy so as to not confuse or conflict that role from other things they do.

Examples of volunteer efforts to lobby legislators for issues often very relevant to first responders would include:

  • The American Heart Association’s You’re the Cure Network grassroots network conducts state and national lobby days. They will educate you on the facts surrounding the issue at hand and teach you best practices for meeting with legislators and their staff.
  • The National Association of EMTs (NAEMT) has an Advocacy program designed to represent their members on issues that impact the EMS work environment and the ability of EMS practitioners to effectively serve their patients. They have State Advocacy Coordinators and conduct an annual “EMS On The Hill Day” to bring EMS professionals together in Washington, DC, to advocate for the needs of patients and the EMS profession.

How Can You Get Involved?

Pick issues that interest you. There are many local, regional, state, or national issues that groups such as professional associations, and disease or condition specific organizations already have campaigns to confront. Do some research using honest credible and reliable sources to see how you can get involved, aide the cause, and effect change. Examples of issues in need of your ongoing support:

  • Stopping The Opioid Crisis
  • Child Restraint Use and Education
  • Strengthening the Links in the Chain of Survival in every zip code!
  • Drowning Prevention and education
  • Hypertension: Identification, Prevention and Control
  • Tobacco: Control and Assist in Quitting
  • Safety at Crash Scenes for Public and Emergency Responders
  • All forms of Abuse (Child, Domestic, Elder)
  • Community Preparation for Disasters
  • Rescuer Suicide Prevention
  • And the list goes on and on…

Advocates can help advance causes by writing letters to the editor of a local newspaper, posting factual, educational information on social media complying with your organization’s SOPs (no patient photos or HIPPA violations).  Making yourself available to the organization’s Advocacy Coordinator as a subject matter expert or spokesperson (if qualified) in your area of expertise and providing testimony in public hearings on an issue. Telling your stories and sharing your experience at the right time with legislators and their staff. Or just plain helping to staff an exhibit or stuffing envelopes.

Some organizations that you might consider approaching as a starting point with your ideas and energy might include:

  1. Associations: National Association of EMTs (NAEMT), International Association of Fire Chiefs (IAFC), International Association of Chiefs of Police (IACP),
  2. Specific disease focused organizations: American Heart & Stroke Association (AHA), American Lung Association, American Cancer Society, American Diabetes Association (ADA), Brain Injury Association of America, National Organization for Rare Disorders (NORD), etc.
  3. Specific problem focused groups: Mothers Against Drunk Driving (MADD),
  4. Labor Unions: (if a member check to see if your union can lobby)
  5. Government: Congressional Fire Service’s Institute, Governor’s Highway Safety Association, local and county level town boards and safety committees.

ECSI exists to support the efforts of advocacy. Sign up to become an ECSI instructor or review our resources to learn more today.

As I have told many of my students over the years, As an excellent EMS provider you can save many lives, as an excellent EMS Educator you can train others to save many more lives and as a excellent Advocate you can work to change policies and the laws and save thousands of lives or prevent the incidents in the first place. Advocacy with both a small “a” and a big “A” are our role and there are plenty of useful causes waiting for your passion and energy!

Some campaigns take a long time so have patience. Making major changes in policy or laws is sometimes a marathon and not a sprint! When I lived in NY, it took our team almost seven years to convince the Senate and Assembly and Governor to put a CPR in the Schools bill in place. Hard work but in the end the team knew it was definitely worth the time and energy and would save many lives. I am still very proud of that frames law signing pen on the wall in my home office.

My advice it to get out there, stretch a little bit, and go for it!  

Read more:

About the author:

Bob Elling, MPA, Paramedic (retired) - has been a career paramedic, educator, author, and EMS advocate since 1975. He was a paramedic with the Town of Colonie EMS Department, Times Union Center, and Whiteface Mountain Medical Services. He was an Albany Medical Center Clinical Instructor assigned to the Hudson Valley Community College Paramedic Program. He has served as National and Regional Faculty for the AHA and was involved in many successful life-saving legislative campaigns with the You’re the Cure Network. He also served as paramedic and lieutenant for New York City EMS, paramedic program director and associate director of the New York State EMS Bureau. He has authored hundreds of articles, videos, and textbooks to prepare the EMS provider for their career. Bob is the ECSI Medical Editor for CPR and First Aid Series of products and the Co-Lead Editor of Nancy Caroline’s Emergency Care in the Streets.

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