Death in public places, is your organization prepared? We were not
The Chief of the Manatee County Emergency Medical Services in West Bradenton, Fla., shares lessons learned from a recent incident and local fallout
After the incident in West Bradenton, EMS1 reached out to Paul DiCicco, chief of the Manatee County Emergency Medical Services. He shares the hard lessons learned from dealing with a death in public and how other EMS agencies can learn from this unfortunate incident.
By Paul DiCicco, BS, EMT-P
On Wednesday, February 28, I received an email from a county commissioner expressing a complaint from a citizen immediately after the death of an individual in a public park. The complainant was a family member and expressed concerns about the length of time it took to remove the deceased from the park and questioned why the ambulance left the scene. The commissioner received an additional complaint from the funeral home chosen by the family.
I assigned the investigation to the assistant chief of operations to handle. Both the family member and funeral home were contacted, their concerns noted. The assistant chief briefed me on the details of his investigation. He even mentioned that the family member that he talked with worked for our EMS service until early 90s. Given that all involved were satisfied, we made a note to talk with the Sheriff at our next meeting and closed the investigation.
On Thursday, March 22, I arrived at the office just a little past seven in the morning. I began the mundane task of email triage when an email from one of our commissioners immediately caught my eye. Her email was a follow up to a complaint that she received back in late February relating to a family’s concerns about a death in a local public park. With immediate concern and confusion, I began to look into the new facts presented in the email and determined that the individual that she was speaking with was someone that we had not been in contact with. I forwarded the contact information to the individual assigned to the initial investigation. He immediately made contact with her and listened to her concerns. The initial investigation remained open, as we couldn’t bring closure until a meeting was scheduled with the Sheriff’s office.
At 9:50 in the morning, my cellphone rang and I answered. On the phone was one of my paramedics. By the inflection in his voice, I could tell that something was terribly wrong. He asked, “have you read the article in the Sarasota Herald Tribune?” I answered “no” while I quickly pulled up the article. My heart sank as I read the front-page headline: “Ambulance crew left man’s body in Bradenton street for hours.”
As I read through the article, I felt myself become more and more angry. The article poorly portrayed our EMS service, was one-sided, and lacked a substantial amount of facts. As I sat there digesting what was written, I could only come to the conclusion that the damage was now done. There was nothing that I could do to turn this around.
Soon after the article was published, the news rapidly took to social media. Not to my surprise, the public was outraged and demanded policy change and answers. Comments ranged from: our service is terrible, the EMS crew have no ethics or compassion, and the majority of the public wants me fired. While angry about the personal attacks directed to me, I felt horrible for the crew that ran this call. As the chief of the EMS Division, I am their leader and stand behind them. To be frank, there is not another group of people that I would rather go to war with. I was saddened that their amazing talents and abilities were being questioned.
Jurisdiction and responsibility
By local policy, the crew did everything right. In fact, the crew in this case did more. When the victim collapsed, he was walking his two dogs. The dogs remained by his side, even after emergency responders arrived. After the patient was determined to be deceased, feeling concerned, the crew summoned Animal Services. Upon the arrival of Animal Services, one of the crew members asked for the case number, provided her personal cellphone number to the officer, and agreed to foster the animals if no one claimed them.
They remained on the scene of the call for approximately one hour while deputies on scene attempted to locate the family. The crew departed the scene once they were notified that next of kin had been contacted. Despite our crew performing above expectations, the court of public opinion would render a far different verdict.
The initial article published read that a Manatee County ambulance left a body in the middle of the road for three hours, while the patient’s wife sat in a chair holding an umbrella over her dead husband’s body, fearing that red ants would begin to crawl over him.
After the article was published, our public information officer reached out the reporter and editor in an attempt to provide our side of the story, but there was no interest. We were stuck in an unfortunate situation and had to come up with a solution fast.
Fortunately, in Manatee County, we share an excellent working relationship with the Sheriff’s Office. I called the Sheriff and requested a meeting to discuss this incident. The Sheriff immediately put us on the agenda for his next Leadership Team Meeting.
In the days leading up to the meeting, I began to question what went wrong. Manatee County EMS has been doing business for over 40 years. What happened during this incident that differed from other related incidents in the past?
I began to make phone calls to colleagues in other jurisdictions, inquiring about how their local policy addressed death in public places. I was reassured to discover that the majority of agencies had a similar policy to ours.
Our current practice was quite simple. If death was determined outside of a hospital, our crew was to contact the law enforcement agency having jurisdiction. Upon the arrival of law enforcement, pertinent information was exchanged and the scene was turned over to law enforcement and a death investigation was completed. The law enforcement agency having jurisdiction assumed responsibility for the scene and the deceased.
If the death was determined to be from natural causes, the agency worked with family members to determine an appropriate funeral home destination for the deceased. If the deceased could not be identified or next of kin could not be contacted, the deceased was transported to the local Medical Examiner’s office.
Our crew treated these cases like they would a crime scene. Whatever was placed on or in the patient was left and potential evidence was not tampered with as we frequently left the scene prior to the conclusion of the law enforcement officer’s investigation.
One question remained for me. How did EMS assume the blame for an incident we had no control or authority over? Blaming EMS for this incident is similar to accusing a brain surgeon for failing to address an abscess on someone’s foot. The crew that responded to this call had no idea how long it would take for the body to be removed. Had they known this information, I am certain our two agencies would have come up with a better solution.
Policy failures and solutions
On Tuesday, March 27, we held the highly-publicized meeting with the Sheriff. The administrative team loaded up and began to brainstorm possible solutions. One fact remained, if we walked out of this meeting with nothing, public trust and confidence would be further fractured.
During the meeting, we discussed our current policy and came to the realization of two reasons why it failed:
- The first failure noticed was a lack of communication and understanding between our two agencies. Law enforcement did not know that they could call us for further assistance. They assumed that once we departed the scene, we would not return.
- The second failure was plain and simple oversight. Collectively, since there were no past complaints or incidents, the thought of changing the procedure never came to mind on either side.
The solution that we arrived at was predictable. For deaths that occur in public locations, which are determined to be of natural causes, EMS is to load the deceased into an ambulance out of public view. The law enforcement agency having jurisdiction is to work quickly to determine a transport destination.
Depending on the estimated time of arrival of the transport company, EMS is to either wait at the scene until the transport company arrives, or – if the ETA provided is long – the EMS ambulance will transport the deceased to a funeral home selected by the next of kin (within our County) or the Medical Examiner’s office.
The goal established for this procedure was to both provide respect for the deceased and family, and to minimize the amount of time an ambulance was taken out of service to perform this function.
Making an impact on the living
After departing the meeting, I was left wondering if this was the best possible outcome. I have to admit, I am still not convinced. While I believe that the solution we arrived at was the best temporary solution to an obvious problem, it is not a long-term sustainable solution.
I am a firm believer that the mission of EMS is to make an impact on the living by providing rapid assessment and treatment for the sick and injured. Ambulances are a finite resource within any community and should be treated as such. If the closest ambulance to a cardiac arrest call is out of service transporting a deceased person to the morgue, it provides no value to the public with an emergent life-threatening need.
Secondly, our organization prides itself for being on the cusp of the latest, most up-to-date medicine. Statistics have identified the futile effort of transporting cardiac arrest patients requiring CPR to the hospital. For this reason, we have instituted protocols that instruct crews to work patients in the field. If return of spontaneous circulation is achieved, our crews transport to the closest hospital. If efforts are not successful, contact is made with medical control to terminate efforts in the field. I am not willing to compromise our medicine and professional standards to move a deceased victim out of a public area.
In the days following the publishing of our solution, my email and phone have been flooded with mixed responses. One individual told me that I was letting this situation “mission creep” the role of EMS in our community and that because of my decision, it was obvious I had been behind a desk for too long. Other responses ranged from, “thanks for displaying natural common sense,” and “ambulances are for the living, not the dead,” to “you should have just done a show code and transported to the hospital.”
I still believe that we made the best decision possible. It should be noted that this is not a permanent solution, rather a temporary one, until a better method of handling these cases can be determined. Getting this information out to the public let our community begin to heal, and started building public trust.
Lessons learned from a death in public
Here are five lessons we learned through this unfortunate experience:
1. Public trust is at the center of every EMS, fire, law enforcement and first responder organization
Public trust should be valued and held in high esteem by every member of the organization. While our organization took some heavy hits as a result of this incident, our numbers of supporters outweighed those with negative thoughts and comments. Unfortunately, damage was still done and it will take time to rebuild our reputation.
2. Foster and maintain strong relationships with supporting agencies in your response area
Thanks to a close working relationship with the Sheriff and other news venues, our suffering was limited. The Sheriff quickly announced his support of our organization. He worked closely with us to come up with a solution that calmed the public. Our local newspaper, the Bradenton Herald, prior to printing a story, came to our rescue by seeking the truth.
3. Expect the unexpected
You may feel that your organization is running like a well-oiled machine. All it takes is one incident like this to upset the apple cart. I would have never expected this problem to surface and gain as much traction as it did. While reviewing protocols, policy and procedure, make certain to pay close attention to policies that extend outside your organization.
4. Social media exacerbates
I have noticed that people are more likely to hide behind a keyboard or telephone and make negative comments than to address the issue in person. Social media bullying hit our service hard. First responders are a unique group of individuals. One common trait amongst our sister/brotherhood is pride. We take pride in our service to the public and frequently sacrifice a significant portion of our lives to help others. When negative or hateful comments are made about an organization that we belong to, we take it personal.
On a personal level, the crew that responded to this call experienced difficulty dealing with their emotions. Despite support from me and other members of our team, it still hurt. Be sure to publicly support members of your organization. Encourage members of the team to be supportive rather than destructive. Several individuals within our own organization criticized the decision made by the crew this day. I do not believe those comments to be intentional, but rather made out of anger that the organization they belong to was being defamed.
5. Don’t assume anything
After receiving the original complaint from a commissioner and speaking with family members, we assumed we were communicating with all of the parties involved and they were satisfied with our response.
By providing you with a summary of our most recent unwanted moment of fame, I sincerely hope that you can take something away and learn from our unfortunate circumstance. While I was comforted to know that our original policy mirrored many services in the industry, I would not wish this experience on my worst enemy.
About the author
Paul DiCicco, BS, EMT-P, is the chief of Manatee County Emergency Medical Services and can be reached at email@example.com.