Following the EMS Code of Ethics: Why It Matters Before the Emergency Starts

In an emergency, every moment counts. Life-or-death decisions often have to be made in seconds, so it’s absolutely crucial to have a strong EMS code of ethics to help guide those decisions.

The EMS code of ethics is a procedural framework for paramedics and EMTs. Today, we’ll explore the general ethics, real-world challenges, and mental/moral preparations to be ready before the crisis begins.

The EMS Code of Ethics: What It Covers

The basic EMT Code of Ethics is based on the core principles of compassion, accountability, and integrity.

The National Association of Emergency Medical Technicians (NAEMT) adopts the following code for EMS professionals:

Professional status as an Emergency Medical Services (EMS) Practitioner is maintained and enriched by the willingness of the individual practitioner to accept and fulfill obligations to society, other medical professionals, and the EMS profession. As an EMS practitioner, I solemnly pledge myself to the following code of professional ethics:

• To conserve life, alleviate suffering, promote health, do no harm, and encourage the quality and equal availability of emergency medical care.
• To provide services based on human need, with compassion and respect for human dignity, unrestricted by consideration of nationality, race, creed, color, or status; to not judge the merits of the patient’s request for service, nor allow the patient’s socioeconomic status to influence our demeanor or the care that we provide.
• To not use professional knowledge and skills in any enterprise detrimental to the public well-being.
• To respect and hold in confidence all information of a confidential nature obtained in the course of professional service unless required by law to divulge such information.
• TTo use social media in a responsible and professional manner that does not discredit, dishonor, or embarrass an EMS organization, co-workers, other health care practitioners, patients, individuals, or the community at large.
• To maintain professional competence, striving always for clinical excellence in the delivery of patient care.
• To assume responsibility in upholding standards of professional practice and education.
• To assume responsibility for individual professional actions and judgment, both in dependent and independent emergency functions, and to know and uphold the laws which affect the practice of EMS.
• To be aware of and participate in matters of legislation and regulation affecting EMS.
• To work cooperatively with EMS associates and other allied healthcare professionals in the best interest of our patients.
• To refuse participation in unethical procedures and assume the responsibility to expose incompetence or unethical conduct of others to the appropriate authority in a proper and professional manner.

Originally written by Charles B. Gillespie, M.D., and adopted by the National Association of Emergency Medical Technicians, 1978. Revised and adopted by the National Association of Emergency Medical Technicians, June 14, 2013.

This universal code guides EMS professionals, although local policies, medical directors, and individual unit leaders may influence how it’s applied in the field. These leaders generally set the scope of practice for their teams.

Common Ethical Dilemmas Faced by EMS Professionals

So, is the EMS code of ethics hard to follow? As you read the code, you will likely notice it's fairly straightforward. However, in real life, situations rarely present themselves in the same concise manner.

It’s common to face ethical dilemmas in the field. Most EMS professionals recognize these questions as they come up and use the code of ethics as a guide.

Compassion fatigue can lead to apathy, becoming one of the most significant ethical challenges. Daily exposure to trauma, chronic cases, or system misuse can cause even the most dedicated professionals to detach emotionally.

For example, responding to the same patient calls repeatedly, such as an unhoused person who calls daily because he wants a ride to the shelter or a hot meal. After responding (yet again), it can eventually cause burnout and lead to frustration on the job.

Other examples might include CPR on terminal patients. Sometimes EMS professionals must do CPR on someone because of legal and procedural obligations, even when the chances of survival are negligible. It can be challenging to "go through the motions," especially when the situation seems futile.

Informed consent and patient autonomy can be another grey ethical area. It’s a significant challenge to navigate care for unconscious patients, those with DNRs, or those who refuse treatment. In situations with limited information and high pressure, EMS professionals must rely on their own moral compass to guide them on the best approach for following the EMS Code of Ethics and treating patients fairly and respectfully.

Preparing for Ethical Dilemmas Before They Arise

How do you prepare for the mental and ethical quandaries in emergency response? Discussion beforehand!

Ethics training and team discussions help EMS professionals clarify values before they’re tested in the field. Similar to practicing life-saving interventions like CPR, intubation, and injections, it's essential to strengthen your "moral muscle memory", too.

The most practical way to handle the training and preparation for ethical dilemmas is to carry out drills and scenario planning. Review and discuss case studies with your team and facilitate peer-to-peer conversations.

These ethical practices should become a regular part of your EMS unit’s training AND ongoing development. It's important to revisit frequently—not to dust off the "Code of Ethics" binder only when your team needs to renew a certification.

The bottom line is that ethics can be a lifeline too. EMS providers face immense pressure to act fast and make critical, difficult decisions. A clear idea of the ethical guidelines can provide a strong compass for navigating difficult situations.

Respect, compassion, and professionalism significantly impact doing the job and doing what's right. It's about working to the best of your ability to treat human life with respect in any situation.

The Role of the Medical Director and Local Policy

The scope of practice will vary based on jurisdiction. Typically, the medical director's license is on the line, so they are the ones who ultimately set and adjust departmental policies.

In 2017, legislation shifted the responsibility from medical directors to agencies in several states, including Virginia and Pennsylvania. While this alleviated some of the duties of medical directors, there are still many issues in their purview.

These issues can include diversion, the handling of narcotics, reporting, and licensure. Fortunately, this is one area where tools like LogRx can alleviate some of the job's stress and help make administrative tasks less of a hassle.

Tracking narcotics and controlled substances on paper can lead to temptation, miscalculations, loss of inventory, and misreporting. Many of these mistakes are inadvertent—when your adrenaline is high in an emergency, it's easy to forget or lose a paper log. Then, after the fact, recreating an accurate log can be difficult.

LogRx offers a real-time tracking solution for all your medication inventory. The simple program works from your team’s hand-held devices—tablets and phones. There’s no need to buy extra hardware or perform extensive training.

The LogRx interface is easy to navigate and simple to use. Even if your team is out of service range, they can track, and LogRx automatically updates once the interface is back in range. .

From the administrative portal, leadership can get a clear overview of the status of every medication. This includes tracking inventory, running reports, and ensuring your organization complies with Federal, State, and Local reporting mandates and requirements.

At LogRx, we understand the field of EMS because we were created by EMS professionals who saw a need for a better tracking system and implemented it. While we may be unable to help your team through every ethical concern or quandary, we know that doing the right thing becomes much easier when you have the right tools.

Please reach out if you'd like to learn how LogRx can help your team be more efficient and accurate in medication tracking. It's an affordable solution that will help prevent diversion, ease the hassle of reporting, and keep everyone on track.