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EMS News in Focus
by Arthur Hsieh

Faking EMS patients: Know the risks

It can be frustrating to follow procedures when you think a patient is faking an illness, but your career is worth it

By Arthur Hsieh

There are several interesting details in the report of a death-in-custody case where a paramedic at the U.S. Border Patrol thought a man who died of a methamphetamine overdose was actually faking a seizure. After reading it a few times, I had two reactions: so what and someone goofed, badly.

First the 'so what?' Many people in police custody will do anything to get out of their predicament. I’m fairly certain that many of you have been called to evaluate a prisoner who was pretending to be ill or injured. It tries our patience. Often we’re frustrated because our protocols require us to manage these “patients” even though we know there isn’t anything wrong.

Second, someone goofed. In a system where people hiding the truth is the norm, it can become very easy to dismiss complaints.

Frankly, I have to salute my brothers and sisters in law enforcement. Their job is to weed through the lies and misperceptions and determine very quickly whether or not to arrest someone. In this incident, the article does not get into detail about the interactions between the suspect and arresting officers in the field, which could have set up a poor dynamic in subsequent engagements between the detainee, other law enforcement officers, and finally the medic. 

I’m not offering this as a defense for the officer’s actions. I’m fairly certain that, like most departments, there are protocols and policies in place to request medical assistance for a detainee. Whether the patient met that criteria will come out through the legal process. 

Meanwhile, it’ll be worth a few minutes for both law enforcement and EMS providers to review any policies and procedures related to detained patients. As frustrating and inefficient as they can be during actual events, you’ll have to ask yourself whether it’s worth your career to take the risk of not following them.

EMS folks, remember to put aside your opinion and evaluate the individual as a patient, not a prisoner. It’ll keep you safe and give the patient the benefit of the doubt. 

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
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Scott Anderson Scott Anderson Tuesday, March 18, 2014 3:25:18 PM Very well put Art. I agree that we need to focus on treating the patient as a patient not a prisoner.
Skip Kirkwood Skip Kirkwood Tuesday, March 18, 2014 4:47:52 PM Clinically speaking, "faking" is a diagnosis of exclusion - arrived at after "ruling out" all other possible illnesses. This is the part that too many medics forget. They let their gut guide the conclusion, rather than first doing the necessary exams (and in this case, getting the patient to the hospital for a head scan, etc.). Unless you are able to rule out the possibilities, nobody should fall prey to jumping to the conclusion that the patient is faking.
Kevin O'Loughlin Kevin O'Loughlin Wednesday, March 19, 2014 9:34:59 AM THe last time I checked we are pramedics to treat patients not to make judgements on who people are even if they are in custody, they are our patients even if they have cuffs on they should all be treated the same. This paramedic should have his license revoked and be charged criminally for his neglect

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