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Home > Topics > EMS Advocacy
July 25, 2013
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The Legal Guardian
by David Givot

Police and EMS: Who’s the boss?

A look behind and beyond the conflict between EMS and law enforcement

By David Givot

My new client sat across from me in my office. He was more frustrated than nervous. He clearly understood the situation and why he was in it, but he was still kicking himself for letting it happen.

“It was a weekend night, like any other weekend night. There was really nothing unusual about the call,” he said calmly, and then went on to tell the rest of the story.

He and his EMT partner had been called out to the scene of a DUI stop by a police agency. When they arrived, one officer told them that they called because the guy seemed altered and they wanted the paramedic to “clear him for booking.” RED FLAG!

Knowing that “clearing for booking” was not even a legal activity, he continued with his regular assessment. Based on his objective findings, the paramedic believed the patient was not under the influence; rather, he was likely having a CVA or some other neurological problem and he directed that the patient be prepared for transport.

“You’re not transporting him. He’s just drunk!” one of the officers told him.

My client was surprised at that response. He made every effort to explain the potential seriousness of the medical situation, but the officers on scene were not having any of it.

Despite the absence of any odor of ETOH and despite the 0.00% reading on the Preliminary Alcohol Screening device, it was the officer’s untrained medical opinion that the patient’s altered mental status was the result of intoxicants and not a stroke.

To make a long story short, the argument ended when the officer told my client that the argument was over and the suspect, not patient, was going to jail, not the hospital.

Why did this happen?

Now, I know what you are thinking: why didn’t the paramedic get his supervisor involved or call the base hospital to speak with the officer or something?

The answer is as simple as it is sad. He was six months out of paramedic school and the only paramedic on scene and he just didn’t know better.

Like many others, he was trained that the most senior medic is the highest medical authority on scene, but the one with the gun is ultimately in charge. So, believing that was true, he did what he was told.

Of course, ten minutes later, when the patient lost consciousness altogether, another paramedic unit was called out and the patient was transported to the hospital, where it was confirmed that he was indeed having a stroke.

The conflict between EMS and law enforcement 

Flash-forward six years.  After a long and complicated trial, the jury agreed that my client was not at fault. Unfortunately, the State EMS Authority sees it differently and they have now launched an investigation. We are still dealing with that.

Strangely, as silly as it seems from the sidelines, this conflict is not uncommon. From coast to coast, there are stories of police interfering with medical care and even with scene safety.

You may recall that a firefighter in Tennessee was arrested because he ordered his engineer to block an additional lane of highway traffic to create a protective barrier for everyone on scene of a traffic collision. Arrested!

Of course, everyone has seen the video of the officer assaulting the provider in Oklahoma.

In another case, two exemplary paramedics were fired after being told by a jailer that the prisoner/patient would “sleep it off” and their nurse would watch him. The patient, who was transported later the same day, died in the hospital five days after that.

Behind the Conflict

In my experience dealing with law enforcement officers, both as a paramedic and a defense attorney, I have found that certain characteristics run like common threads through many well-intentioned cops.

Tunnel-vision may be the most common trait. That is, what they think they see is what they are sure they are seeing and any other explanation can be worked out in court.

Likewise, in my experience, many law enforcement officers tend to be more conclusory than analytical. That is, what they are trained to see, combined with have seen in the past and what they expect to see, is what they are seeing now. In this case, the officer disregarded the 0.00% alcohol reading,  overlooked the fact there were no other objective signs of intoxication and concluded that the disoriented driver was DUI and had to go to jail.  

The resultant conflict, I believe, arises when their “training and experience” is challenged by a doc-in-a-box who knows nothing about law enforcement.

Resolving conflict before it gets out of hand

To make a difficult situation as simple as possible, here is a list of five things to remember if you ever find yourself in a similar predicament:

1. Police officers are trained to be aggressive, assertive, controlling, and correct in all situations. Going head-to-head is not a winning strategy and going toe-to-toe is not going to end well, either for the patient or for you.

Don’t waste your breath telling them how much they don’t know or why they are wrong. Instead, calmly remind them of the liability they are inviting and accepting by not allowing you to do your job; make letting you do your job their idea.

2. If you sense that such a problem may arise, move the patient to the gurney as quickly as possible.

Even police officers know that taking someone off of an ambulance gurney and placing them in a police car creates a bad visual.

3. This is a big one: Call a supervisor!

Let the supervisor handle it. Not only will that help relieve you of much, if not all, of the liability, it is one of the occasions for which supervisors exist.

4. Contact your base hospital and have the officer speak with the nurse or doctor.

While law enforcement officers are trained and practiced in taking control in their natural habitat, the street, they can be far less comfortable when an outsider steps in - particularly when that outsider is a recognized medical professional.

Furthermore, both the base hospital and you can remind them that the conversation is being recorded and that the officer’s disregard for a known or suspected medical condition is now a matter of record.

5. Finally, remain calm and do not let your frustration or fear spin you out of control.

Your interaction should remain cool, calm, and professional. If the officer escalates or attempts to escalate, don’t fall for it; you are a professional patient care advocate and nothing shakes you.

Summary

The very best way to avoid the conflict is to communicate.

Take the time, in advance, to build up relationships between EMS providers and law enforcement. Take the time and make the effort to work with one another to understand and plan how similar situations will be handled in the future.

Develop policies, procedures, and mechanisms that can prevent conflicts and allow everyone to manage the real task at hand: providing a better, safer community.

Finally, always remember that no single part of the system can function in a vacuum. EMS, fire, and police must work together for the community and for each other, because at some point in every career, one will need the other.

About the author

David Givot, Esq., graduated from the UCLA Center for Prehospital Care (formerly DFH) in June 1989 and spent most of the next decade working as a Paramedic responding to 911 in Glendale, CA, with the (then BLS only) fire department. By the end of 1998, he was traveling around the country working with distressed EMS agencies teaching improved field provider performance through better communication and leadership practices. David then moved into the position of director of operations for the largest ambulance provider in the Maryland. Now, back in Los Angeles, he has earned his law degree and is a practicing Defense Attorney still looking to the future of EMS. In addition to defending EMS Providers, both on the job and off, he has created TheLegalGuardian.com as a vital step toward improving the state of EMS through information and education designed to protect EMS professionals - and agencies - nationwide. David can be contacted via e-mail at david.givot@ems1.com.
Comments
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Robert Hutson Robert Hutson Thursday, July 25, 2013 3:26:17 PM I have worked a lot o fscenes with cops. I never have had a problem. We work together. Even if there is a dispute similar to the one you mention I just tell them let's take him to the hospital and get him checked out. If nothing is worong oyu can take him and book him with my help. I will even come draw blood for you. However, the difference is that I am a 10 yr veteran and they know that if I say the guy probably needs to go to the hospital I am not joking. He really needs treatment. So there are some difference in the situation.
Michael McClenon Michael McClenon Thursday, July 25, 2013 3:45:16 PM Dave, I have rarely disagreed in general your observations, opinions and arguments but did you REALLY state "Despite the absence of any odor of ETOH "?
Luke Bourke Luke Bourke Thursday, July 25, 2013 4:06:48 PM The first three rules in Legal issues of EMS #1 Document, #2 Document, #3 Document. Having training and experience on both side's of this situation. As the shift supervisor aka Dispatcher I had a unit roll up on a scene where a man was asking for medical treatment. The Officer refused to allow my guys to check him out. I told them to do a run sheet and document what they knew and the Officers Information. I have come across issues like this many times. Experience makes a difference. Your client probably went straight threw EMT to EMT-P. I have seen this as a problem when it came to Patient care also. As a EMT with years of experience I had problems with the "1 year wonders". When it comes to Medical Care the Sr. EMT is in charge over the Police Officer. But if the Patient is under arrest the Officer is in charge of the Prisoner. Paper work is cheap especially now that it is done on computer pads. And everyone seems to have a video camera on their phones now so Document on your phone.
Skip Kirkwood Skip Kirkwood Thursday, July 25, 2013 5:02:47 PM Good advice, Dave. One unfortunate element - EMTs and paramedics should not have to work these things out at the street level. EMS executives need to get out of their offices and develop relationships with the Chief of Police, the Sheriff, and the local head dude for the State Police or Highway Patrol. We should work at building good inter-agency relationships as an AGENCY priority, not count on luck on the streets. And your state EMS agency is a bunch of morons if they are hassling the medic over this. Shame on the EMS educator who teaches "the guy with the gun is the boss." That is idiotic, immature, unprofessional, and educational malpractice. How about some ADULT education?
Scott Lancaster Scott Lancaster Thursday, July 25, 2013 5:05:55 PM This is BS. What is the state investigating him for? Patient Advocacy? It was the PD who called him to the scene. In my state, there isn't a "PD in charge" mandate, but if the person was in custody, your options are a bit limited. Actually, at MVC's in my state, the Sr. Fire Officer on-scene has legal control of the scene; this goes over great with some of the LEOs in the state, but it set by statute. How about all public safety officials get together and get along?
Skip Kirkwood Skip Kirkwood Thursday, July 25, 2013 5:13:20 PM Scott Lancaster and David Givot, I will be happy to testify on the medic's behalf.
Scot Phelps Scot Phelps Thursday, July 25, 2013 5:52:38 PM I prefer to act a little confused- Mr Police Officer, YOU called ME out of a warm bed to "clear the patient for arrest" because obviously you had some questions if this person was OK to go to jail or not. And I agree- something doesn't seem right- we should take him to the hospital, and if everything is OK, THEN bring him to jail. (Frankly, in 25 years, this never happened to me, it was WAY more common to have the cops try to dump street drunks on us rather than just taking them home or putting them in a cab.)
Joe Mancos Joe Mancos Thursday, July 25, 2013 7:32:18 PM Skip, while I agree that we as leaders do need to extend the hand to each of our Public Safety Partners, the best relations I have ever experienced with law enforcement while riding either the bus or the big red truck came from basically being civil to each other on the street, and building the relationships with each other by communicating. I am still great friends with many the Troopers, Deputies, and Officers that I made those relationships with as much as 20 years ago. Many of those guys are now the leaders for those organizations and that makes great interagency relations being that I'm still in the same area.
Joe Paczkowski Joe Paczkowski Thursday, July 25, 2013 8:06:19 PM So... wait... if the police officer is assessing and coming to a conclusion on the medical needs of the patient, in direct opposition to a licensed healthcare provider, isn't that practicing medicine without a license? (California Business and Professions Code 2052a. Paramedics are covered by "authorized to perform the act... in accordance with some other provision of law). Somehow I doubt that the officer who decided to practice medicine was actually charged with practicing medicine without a license.
Joe Paczkowski Joe Paczkowski Thursday, July 25, 2013 8:09:49 PM ...and if the man with the gun and the power to deprive me of my life, liberty, and property, often without serious consequence if they're wrong, decides to do something I disagree with to a patient, than so be it.
Robert Peugh Robert Peugh Thursday, July 25, 2013 8:41:46 PM EMT 'ALWAYS' wins! They have already done the basic steps to determine is the "patient" or "prisoner" is in the best of health to be placed in a jail cell. It isn't worth the legal ends of this, swallow your damn pride and let the EMT do the job he was trained to do. You can always place the person in Protective Custody and jail him or her later if it warrants. Use common sense for goodness sake!
Dan Greenhaus Dan Greenhaus Thursday, July 25, 2013 8:42:00 PM Respectfully disagreeing with you on this topic. Very few places has EMS in charge of anything when multiple agencies are on scene. If the FD is on scene, they are in charge (although most fire officers work with EMS). If there is a remotely law enforcement matter involved, law enforcement is in charge. I've ran on many many calls where law enforcement is involved. If the call is in the jail, the sheriff's department is involved. I can recall one call where the person was in custody, and the deputy called us because "the person felt sick." The patient wanted to go, the sheriff's department didn't. I had the Sgt come to me (she was cool and respectful), she called the shift Lt, who called the Captain who oversaw the courthouse, who I think ended up calling the Attorney General's office (or whichever political office oversaw the court/jail system), who finally said to let us transport the person. And they wouldn't let us transport the patient where they wanted to go, only to the hospital where the SD had the contract with. I've been on calls (in cities I won't name) where cops called us to bandage up a bleeding person who was in custody, and even if they wanted to go, would not let us transport. or people who were under arrest and just needed to "be checked out" before they could be processed further. Also, many cops don't care if it's an EMS supervisor or a field provider; as the article says, "Police officers are trained to be aggressive, assertive, controlling, and correct in all situations." Unless a LEO supervisor gives them an order, they are right and EMS is wrong. And we won't even mention when ambulances are called for people in lock up, and there is no officer available to escort the ambulance to the hospital for over an hour..... There have been numerous news articles about fire chiefs and apparatus operators getting arrested for failing to move their vehicles during MVAs. And getting PD to shut down a road (especially an expressway or highway) is frequently an uphill battle. Usually requiring the officer to sign off as the person responsible, as well as getting their badge number, and explaining that they will be personally, legally, and financially responsible for anything detrimental that happens to the patient gets them to change their mind, but that's not always the case. I will agree with you on one thing; these things should be hashed out by EMS and PD executives over coffee during business hours, not at 2am on an emergency incident. But if the PD chief tells the EMS chief "I hear what you want, I don't care, my officers are in the right, your guys are wrong, and I don't care if you don't like it" than the EMS executive really has no recourse. The blue shield is still very strong and present, especially when dealing with non-LEO agencies, and if you don't believe that, than I have two bridges and a tunnel to sell you, for cheap. I know several cops, work alongside several awesome cops, and interact with many cops who treat me like an equal (or gasp!!! as a medical professional who they take direction from on medical calls), and most of them work with EMS instead of against EMS (including that Sgt at the jail in my story, she might not remember my name, but always remembered my face). I've also socialized with several cops, and know several EMTs who have gone onto careers in law enforcement. They are cool people. But there are more than a few that treat EMS like a taxi, will call us for BS, convince the patient (and by convince, I mean drag the person into the ambulance and close the doors) that they need to be transported, and others who will call us for an MVA w/ injuries, and once you arrive, will tell you to get off the scene with the patient so they can get the road opened up. It's really sad. and the fact that the State's DOH is investigating the paramedic in the article is really stupid. And sorry for the incredibly long FB post.
Nathan Sanders Nathan Sanders Thursday, July 25, 2013 9:22:39 PM We are fortunate not to have this problem. If the LEO suspects the smallest possibility for the slightest medical problem or traumatic injury, EMS is called to Assist PD for__________. If we state the patient requires transport then that patient is ours. I have never once had an officer argue, and have never once heard from a co worker that they had an officer argue over the decision to transport the pt. I have commanding LEO's state that medical problems are my territory and they will always defer to me as an EMS provider. We tend to work very well with our city and county LEO's.
David Shrader David Shrader Friday, July 26, 2013 12:54:41 PM Long ago (1976) NC law provided that an EMT or Fireman on the scene of an emergency had state law enforcement authority and could make an arrest if someone interfered with them discharging their duties. I was in the first unit to a multi-vehcle collision with entrapment that required 3 ambulances. At some point in the incident a brand new probationary state trooper directed a wrecker to drag a car, from which the driver had not been extricated, out of the road so we could do our work without blocking traffic. I tried reasoning with him and he started yelling at me and threatened to arrest me if I continued to interfere with his direction. As I saw his Sgt. (who I knew) walking up behind him, I calmly said, "No sir. I am placing you under arrest for interfering with us and endangering my patient." He said, "You can't do that!" and the Sgt. walked up to him and said "Yes he can. Hand me your weapon and turn around while I cuff you." He them perp-walked the newbie to his car and placed him in the back seat. When the last patient was loaded, I conferred with the Sgt., thanked him for his help and said that if he thought he could talk some sense into the rookie, I'd drop the charges. I hope that 30 minutes in handcuffs taught him something, but to this day in NC, I live in fear of running into him! He's either got to be retired or the Colonel now.
David Shrader David Shrader Friday, July 26, 2013 12:57:06 PM Skip Kirkwood Me too!
Melinda Teaster Williams Melinda Teaster Williams Friday, July 26, 2013 2:39:48 PM Great advise, but once the Police Officer o/s realizes you are in fact treating them like they are stupid it will turn bad the next time around, but always letting the know they are excepting ALL MEDICAL LIABILITY will allow you to do your job..
Gail Clark Ostergard Gail Clark Ostergard Friday, July 26, 2013 3:05:42 PM good article Melinda Teaster Williams
Melinda Teaster Williams Melinda Teaster Williams Friday, July 26, 2013 3:55:36 PM No matter what we are the patients advicate
Skip Kirkwood Skip Kirkwood Friday, July 26, 2013 3:58:06 PM That is a GREAT story! The SGT should have been immediately promoted to the highest rank. Where did the statute go, and where did common sense go?
Michael P. McCarthy Michael P. McCarthy Saturday, July 27, 2013 8:13:06 AM Mr Givot Obviously an experienced hand on the street side, I also observe that unfortunately medical training is not enough, the EMT PARAMEDIC needs to have a working knowledge of who he is at the site of a medical emergency. Pre-established protocols and instant communication with a supervisor seem to be paramount. It is a shame to lose qualified medical personnel because of a safety officer who is not being properly trained. Should the Police receive some basic cross training?
Aaron Lowe Aaron Lowe Saturday, July 27, 2013 10:19:34 AM Fortunately my service has an outstanding relationship with our local leos and several of our emts are trained as reserve/ part time officers. the police don't hesitate to take our word for it if we feel something is not right with a suspect and they need to be transported to an er.
Pascal Hay Pascal Hay Saturday, July 27, 2013 11:08:46 AM In this case it appears that the officers did have some doubt in their minds as they called EMS to evaluate the patient. True this could have been an automaton response to a policy that the department had in place. Each state governs how we practice. In my state the police are in charge of scene security, the fire department is in charge of the scene, and the senior trained person with the transporting agency is in charge of the patient. I have been called out numerous times to the scene by law enforcement and have rarely had any officer dispute me when I decide that the patient should be evaluated by a physician. I also will let law enforcement transport a patient to the ED based on the physical assessment of that patient. I have on one or two occasions had to explain my findings to law enforcement and why I deduced that the patient should go by EMS vs. law enforcement. There is a city that borders our area of service. On occasion we have dealings with the city law enforcement. For the most part we have never had any major opposition from them. I keep in mind that law enforcement officers are under a large amount of stress. I do not fight with them and anytime I have difficulty with them I know that they have a boss too. So I just run it up the chain of command.
Gina Houx-Kotarski Gina Houx-Kotarski Sunday, July 28, 2013 7:24:45 AM Dave, Great article. It speaks well to scene presence, professional demeanor, and communication. Many (25?) years ago I had a very rude and disrespectful officer tell my patient, "When you are done with the ambulance driver, I want to talk you." I remember telling my patient," When this PARAMEDIC is done with you, that Police car driver can meet you at the hospital". The officer turned around Very angry. Although it sounded right at the time, it set up a VERY contentious scene.
Lynn Jusko Lynn Jusko Tuesday, July 30, 2013 9:49:12 AM I think it's safe to say that the guy with the gun is always the boss no matter what course/class you've taken....No single man has more immediate power than a police officer who can take your life or liberty in the name of justice.... you just have to be smart about it and use all of the suggestions above and document the heck out of it...smart phones are great for capturing conversations. Just don't escalate it because If you do get one of these "god-like cops" they will arrest you and remember, once arrested, always arrested even if the case is later thrown out. Espongement might keep the private sector from seeing it, but I'm sure it's never totally wiped clean.
David Givot David Givot Monday, August 12, 2013 11:36:27 AM Haha!! You got me. You know what I meant. I had to employ some word economy. Good catch, though.
David Givot David Givot Monday, August 12, 2013 11:37:07 AM ABSOLUTELY!!!
Luke Bourke Luke Bourke Friday, January 17, 2014 9:34:27 PM When it comes down to it a EMT can file a complaint with the local DA's office against a Law Enforcement Officer for Reckless Endangerment, Abuse of Office, or anything else you or the DA can think of. Also the Rookie may have been let go. The first year is the time agencies see if the Officer has what it takes to do the job. Problem is many agencies don't take advantage of this year.
Kathy Elwell Kathy Elwell Monday, March 10, 2014 12:24:18 PM This is a great reminder that we are all on the same team. Be respectful and communicate calmly and openly.

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