This feature is part of our Paramedic Chief Digital Edition, a regular supplement to EMS1.com that brings a sharpened focus to some of the most challenging topics facing paramedic chiefs and EMS leaders everywhere. To read all of the articles included in the Spring 2017 issue, click here.
By Doug Wyllie
Body-worn cameras for law enforcement have been a hot topic ever since the officer-involved shooting death of Michael Brown in Ferguson, Missouri, in August 2014. The equipment existed prior to that time, but the adoption rates of body-worn cameras by law enforcement agencies went through the roof following the incident.
What is less well known is that as police adoption of BWCs started, EMTs and paramedics began discussing the probability of BWCs coming to EMS. In fact, BWCs have been part of the conversation — albeit at a lower level and with far less public discourse — for at least the past five years, if not longer.
In the past several months, that conversation has begun heating up, in part because of the increase in violence against EMS providers — attacks by patients, caregivers and bystanders on EMTs and paramedics.
This violence has always existed and it has been largely excused incorrectly with the thinking that a person in an altered mental state — diabetic shock, drunkenness and the like — could not be held responsible for his or her actions. Plus, there were not sufficient ways to document the assault. It was really just the provider’s word against the patient’s word. Now, with body-worn cameras, documentation of an assault is all but automatic.
BWCs certainly increase the likelihood that assault charges will be taken seriously. But what other issues should EMS leaders consider when thinking about the purchase and use of BWCs? What other benefits might there be? What are some of the potential problems?
Here are five things for paramedic chiefs, EMS leaders and policymakers to consider.
1. Video supports more accurate reporting and documentation
Just as has been the case with law enforcement, EMS providers increasingly accept the fact that bystanders will be recording video of them in the home, on the street and even in the patient care compartment, so there should also be a record that captures the EMS provider’s point of view.
For EMS, in addition to supplying evidence of an assault this may be a boon for better documentation of patient care. Any omission of care that was provided (or not provided) from the patient care report can cause problems down the road, especially if legal action is taken against the provider.
At any call there is a lot going on, and remembering everything that happened and including every last detail in a patient care report can be daunting. Recollection after a high-stress, rapidly unfolding event can in fact be quite inaccurate. With BWCs, paramedics and EMTs can review the video and ensure that their reports are accurate and complete.
“For any responder who responds to a thousand or 10,000 calls in the course of a year, documentation isn’t always good enough to refresh the recollection to be able to answer questions about it,” said David Givot, an EMS defense attorney. “For example, let’s say you go on a hundred chest pains in a couple-month period of time. It’s not hard to conceive that someone might remember the facts about one patient and assign them to another patient. When you have a video and audio recording of it, there’s no mistaking it — there’s no misremembering.”
2. Video can be an excellent training tool
If pictures are worth a thousand words, video may be worth millions. While ensuring the appropriate protection around distribution and usage of video (more on that later) video can be added to case review training. Instead of merely having the training officer or the medical director read from the patient care report, EMTs in training can actually see what happened at the call with a video recording.
Video is especially helpful for the high-risk, low-frequency types of calls. Even if a provider works in a busy urban system, he or she can go months or even years between a really sick pediatric call, but maybe your crewmates have a call and you’re able to learn from it by watching what they did.
“Paramedic students study on what’s normal so that when they get out they can readily identify what’s not normal. What’s not normal doesn’t always jump out as being what it is,” Givot said. “If they have video and audio to hear the words that the patients use to describe certain things and to see what the skin color looks like, to see what tripod position looks like, it’s going to be way more valuable than just trying to describe it to 30 different imaginations in the classroom.”
3. Adding video adds another layer to HIPAA and information security concerns
Because of HIPAA, which governs the electronic transmission of private medical information, patient records are tightly controlled. Every EMS organization has to ensure that they have the right policies in place to protect any type of data from improper release or transmission. This has been the case for years, and most agencies have a good handle, with the assistance of their lawyers, on what can and cannot be shared and with whom. But video adds another dimension to this security issue.
“The biggest problem is implementing and creating a system where the images and the audio are so thoroughly encrypted and protected that they can’t possibly get out,” Givot said. “If that mechanism is not in place, then this really good tool can end up being really dangerous.”
Policies must be in place to account for the protection of all data, and video is just another layer — albeit a layer consisting of many terabytes of data — that must be accounted for and protected.
4. Policy must be crafted to determine activation of cameras
This is a three-pronged piece of policy: when cameras are to be worn, by whom and what level of discretion providers will have in deciding to not activate them.
Givot said that as long as the images and audio are protected and access is restricted, he believes that there’s more upside to having cameras on at all times.
There have been instances in which EMTs or paramedics have been given the opportunity to wear body armor on the job and elected to only wear it sometimes, like calls on which they think they’re going to need it.
That’s not how body armor works. Body armor — like a firearm or a parachute — is something a police officer or paramedic will need quite suddenly and quite desperately. If that need arises and the safety equipment is not available, there’s a high probability that you’ll never have a need for it again.
BWCs are no different. Once issued, they need to always be on the provider’s body and always recording.
Policy should not allow for one provider to wear a camera while a colleague in the ambulance does not. That will cause confusion and produce an incomplete record of an incident.
EMS providers also need to be aware of local or state regulations which may govern the need to get consent from a patient or other bystanders when inside a private home or business. Givot described this as an intriguing legal challenge to understand before recording.
“When one is out in public there’s no expectation of privacy, so video recording in public is really not a problem. But when one is communicating with a health care provider, there is an expectation of privacy,” Givot said. “If that exists, then you need to get consent to record. And if that’s the case, do you need to get that consent before turning it on?”
Furthermore, policy must be carefully crafted such that the discretion of the provider to turn off the camera must clear a very high hurdle. The cameras should be on at the outset of every call. Scenarios in which the cameras can or should be shut off, such as when interviewing an underage victim of a sexual assault, need to be clearly articulated in the policy document.
5. Storage of terabytes of video data is costly and complex
In addition to the very important policy issues related to provider discretion, how video files are accessed or transmitted and other concerns related to the purchase of BWCs, data storage has to be high on the agenda for EMS leaders.
When BWCs first came on the market for police, the elephant in the room that nobody talked about was data storage. The public pressure was so high for agencies to “just get it done” and adopt BWCs that some agencies rushed in without adequately considering the cost and complexity of video storage.
EMS leaders should seek to learn from the mistakes of their law enforcement colleagues and have a mature conversation about the ongoing costs of video storage.
Conclusion
Video is inevitable, and EMS leaders should be asking the right questions — and getting the right answers — to make informed decisions as they purchase and deploy body-worn cameras.
Leaders must take into consideration not only the initial purchase cost but also repair and replacement costs and storage costs. There also must be some acknowledgement of training costs and that providers will now have one more device that needs to be charged and ready to use as part of their standard EMS equipment.
About the author
Doug Wyllie is editor at large for Police1, providing police training content on a wide range of topics and trends affecting the law enforcement community. Wyllie has authored more than 1,000 articles and tactical tips, and he hosts the Policing Matters podcast. Doug is a member of International Law Enforcement Educators and Trainers Association, an associate member of the California Peace Officers’ Association and a member of the Public Safety Writers Association.
