Freelancing is the term given for when a team member does something on their own without being instructed to do so by the team leader. This term is more widely used in the fire service; however, it can happen just as easily in EMS.
While it may be convenient for you and your partner to “just get the job done”, when you start adding additional providers, you may run into issues. My last partner and I were like that. We always knew what the other was doing and we never really had to talk about what we were doing for a patient. If we had a severe respiratory call, I pulled up the Albuterol, Atrovent, and Solu-Medrol and he had them on O2 and got everything set up. I never had to ask him to do anything, it was always done. But, add a fire crew and chaos ensues. So how do you combat that?
One of my biggest weaknesses is that I am not very assertive on scene, until I have to be. In my eyes, as long as everything is getting done correctly and effectively then I’m ok with it. This type of scene management doesn’t work for everyone though. I’ve mentioned in previous blogs that I have very limited patient contact when it comes to skills. I try to let my EMT(s) do everything that they can/want to do. This means that I typically stand back and speak with the family if need be, and document everything getting done. That doesn’t make me a “weak medic”. If need be, I can do everything that needs to be done, and often “refresh” my skills such as starting IV’s. For me, this is a better way to ensure that everything is being done, but also being able to keep an eye on situational awareness.
The problem with this method is that it ensures a certain level of freelancing. By letting everyone do their jobs, it’s getting the work done. But if direct oversight isn’t kept, then something could go wrong VERY quickly. In order for this method to work, I have to pay attention the entire time, which isn’t always possible. That’s where my partnership comes into play. Remember I said my partner and I always knew what the other was doing? Even though he was an EMT at the time (now a medic of his own), he knew what needed to be done. That’s the way we always did it. So in the event that I was preoccupied, he was able to oversee the patient’s care to ensure everything was getting done correctly. Like I said though, this isn’t for everyone. You have to know EXACTLY what your partner is going to do. We didn’t get that way overnight; we were partners for several years to achieve that level of trust. Unfortunately when he wasn’t on the truck, it would take me a call or two to get into a groove of having to “supervise” everything.
Now, that’s when freelancing works. But what happens when it doesn’t work? Utter chaos is a good term for it. The biggest problem is the chances of harm to your patient. When you don’t have a clear “lead” crew member and a bunch of personnel doing things without a clear plan, harm will be done, whether intentionally or not. Skills will be repeated or even skipped over. And without a clear lead member, little to none of it will be documented. This can lead to problems for our patient. Let’s say you respond to a chest pain call, and no one takes the “lead” on the call. Yeah, you may get a 12-lead ECG, but the person who reads the 12-lead doesn’t relay any of the information to the crew. Now another medic administers Nitroglycerin. See the problem here? Well, maybe the patient is having an inferior STEMI, but no one on scene other than the medic that read the 12-lead knows. This could cause harm to your patient, if not death. So you can see the importance of maintaining one “lead” provider and limit the amount of freelancing.
In that scenario, no one was really “at fault”. Everyone did their job as they had been trained (minus the 12-lead confirmation prior to Nitro administration). So no one was purposely trying to harm the patient, but harm is harm. Now what if you had a BRAND new EMT who freelances and does something outside their scope of practice? Well, obviously the EMT will be at fault, but also the highest certified personnel on scene, because they “allowed” this to happen. This is why it is important to have situational awareness on scene at all times. Sometimes that awareness is for outside risks, and sometimes its internal risks, aka the personnel you work with.
Medic Minute 