Essential ethics for EMS: cardinal virtues and core principles.

Dutiful attention to virtue, teamwork, beneficence, justice, and respect for patient autonomy provides a coherent approach to addressing many ethical dilemmas in the out-of-hospital setting. Most of the great risks of EMS--abandonment, competence, and safe-driving skills--lie at the ethike or character of those who ply the prehospital art. Proactively fostering the personal and professional virtue of team members may be a kind of moral vaccination against the ethical pitfalls inherent in emergency medical service provision. Future training, education, disaster preparedness drills, and related exercises must include opportunities for character and team building before optimal performance and accountability can be assured. In the steady, almost glacial, maturation of the specialty of EMS medicine, truly the character of those who serve in the "line of fire" of evaluation, management, and transport in the out-of-hospital arena must be girded with more than the armor and shields of technology. Since September 11, 2001, it has become increasingly clear that EMS workers must strengthen their ability to bear the "slings and arrows of outrageous fortune," armed with swords of discipline, virtue, and character to provide the breadth of care that only a well orchestrated team can deliver. Ultimately, humans perform best when they share themselves unselfconsciously, surrendering to an enterprise and cause far greater than themselves. Our citizens, patients, and heroic colleagues deserve no less.