Drunk, Doped Up and On Duty: What`s a Manager to Do?
After driving to the scene of a house fire, an Iowa firefighter is found to be so intoxicated that his colleagues will not allow him to participate in operations. Later, at the police station, his blood-alcohol level is still above the legal limit of 0.08%.
Two fire trucks collide at a New York City intersection, triggering a multi-vehicle pileup that injures 11. The at-fault driver, an FDNY firefighter, is found to be under the influence of cocaine.
A surprise mid-afternoon inspection at a San Francisco fire station finds several personnel apparently drunk. Five firefighters are suspended pending results of blood tests, which later show some had consumed marijuana as well.
Any group of Americans you survey will likely include individuals with drug or alcohol problems. The emergency services are no exception. EMTs, paramedics, firefighters and even cops can fall victim to these often-dangerous substances.
This can be a serious problem for the EMS manager. Intoxicated providers pose a danger to those they assist, others in the community, themselves and their colleagues, and even to their department. For the sakes of all these potential victims, these people need help.
But how do you identify those with problems? And what do you do once you have?
The extent of drug and alcohol abuse among emergency providers is hard to quantify. A recent Cornell University study of New York City firefighters found that 28% are "risky" drinkers, compared to 29% of the general population. But that's just a cross-section of one department. Many experts suspect that those in stressful jobs may face a greater risk of developing drug and alcohol problems than their counterparts in lower-stress professions.
"I think it would be reasonable to assume that the higher stress-and also the access to drugs-of EMS workers could lead to potentially higher rates," says Susan Foster, vice president and director of policy research and analysis at the National Center on Addiction and Substance Abuse at Columbia University.
"I don't know that there's data that documents that, but if you look at certain medical professions with high stress and greater access to drugs-anesthesiologists, for example-they have somewhat higher rates of abuse."
The risks of EMS providers being intoxicated on duty are obvious, but it's worth reinforcing that such providers may pose a legal liability to their departments. If you don't preempt drug/alcohol use on the job, you may end up on the hook for any damages your people cause.
The safest step is to establish a so-called "drug-free workplace." Information on this is widely available online; start with the Department of Labor's www.dol.gov/elaws/drugfree.htm.
"Basically, it means you spell out what is tolerated and not tolerated when it comes to addictive substances in the workplace," says Foster. "You talk about what types of testing you will employ. You might make sure there are preventive or educational resources available to employees. You'll have to address issues of confidentiality."
Obviously, testing is a major component of such programs. (Your state's laws will have a bearing too; make sure you know what you can and can't legally do.) Most EMS agencies already do pre-employment testing. Post-employment options include regularly scheduled tests; random, unannounced tests; tests based on reasonable suspicion; and post-accident tests.
If an employee tests positive, you may be able to fire him (again, a matter of state law), but a referral to professional help is usually more likely.
"How you proceed is often related to how safety-sensitive the position is," says Foster. "You want to minimize the chance that an addiction problem is going to result in danger to anybody receiving services."
Separately from testing, it's incumbent on EMS managers to know the signs of drug and alcohol abuse, so as to spot problems early. Some are listed at www.drughelp.org/research/workplace.htm.
It's worth noting in conclusion that although drugs are usually illegal and alcohol is not, the issues pertaining to use on the job are similar.
"They can be discussed together in terms of the fact that they're both addictive," says Foster. "They're both substances of abuse, and none of them have a place in the workplace."
-JE
