Rapid Response: Scene safety trumps patient care but does not replace duty
A New York man collapsed on a sidewalk after police ordered him to exit an ambulance where he is alleged to have assaulted an EMS provider
What happened: A Rochester, New York, AMR EMS crew called law enforcement to remove a patient from the ambulance who was alleged to have assaulted an EMS provider during transport. Police officer body-worn camera video and a fixed pole camera video show police officers ordering the man to leave the ambulance, the man walking to a bench or concrete berm and then the man falling to his knees before collapsing face down. The man was prone for more than 2 minutes as police officers and EMS providers milled about, talked with one another and made phone calls. The video ends shortly after an EMS provider, perhaps from a second ambulance crew, checks the man and asks for his cardiac monitor and drug box. The video released to date does not include the care the man received. He is reported to have died a month later.
Why it matters: This is the latest video to capture a patient’s condition worsening while public safety personnel stand around, seemingly disregarding the patient who moments ago was alleged to have been complaining of breathing difficulty while also assaulting the EMS crew. The video also raises serious questions about scene safety dynamics, an EMS provider’s duty to act and obligation to continue patient care, the interactions between EMS personnel and law enforcement, and how to continue monitoring a patient while not putting yourself in danger.
There is a lot we don’t know about this incident, especially what happened before law enforcement arrived and after patient care resumed on the collapsed man. I also am not an EMS legal or New York EMS regulations expert. Nonetheless, there is much that can be gleaned from this video. After watching the video compilation from the incident, discuss these key takeaways with your partner, shift or entire organization.
1. Safety changes
Patient assessment in the real world isn’t a linear skill sheet. A scene can be safe, become less safe, become dangerous and then become more safe. If during patient assessment, treatment and transport, the patient assaults the EMS provider, the provider has every right to defend against harm; to use time, distance and shielding to protect themselves against harm; and to call for help from law enforcement.
In this incident, when the police arrive, the alleged assault has ended. One EMS provider is outside the ambulance and the other is standing out of reach from the patient, but still in the patient care compartment. The patient gathers his belongings, exits the ambulance and sits on a bench. With multiple police officers on scene and the patient showing no signs of combativeness, the scene was less risky than it had been reported to be earlier.
2. Obligation to patient continues
After sitting down, the patient enters an unfortunate limbo state. He is no longer being assessed and monitored by the original EMS crew, not in law enforcement custody, and the second EMS crew has yet to arrive. The EMS crew likely has an ongoing duty to the patient, who moments ago had been causing them harm, until they can transfer care to the second EMS crew. It is possible to assess a patient from a distance – we do doorway assessments all the time as we walk into a patient’s room to quickly check airway patency, breathing adequacy, level of consciousness and sick or not sick.
Had the crew stood at the side of the ambulance and continued to visually monitor the patient, they would have seen him collapse. At that moment of collapse, there are no EMS personnel in the pole camera’s field of view and four police officers are turned away from the patient. The police officers’ actions don’t indicate that they feel an obligation to check on this man’s welfare, as they pace and standby nearby.
3. Assault on EMS is a crime
We have anecdotally heard for years that a top reason EMS providers don’t report assault and on-the-job violence is that their reports aren’t taken seriously. Though it may have happened off camera or later, there is no indication in this video that the EMS provider’s allegation of assault is being investigated or that the man is being investigated for a physical, violent crime. We don’t see him being questioned or checked for weapons.
EMS agency leaders must regularly meet with their law enforcement counterparts to ensure crimes against EMS providers are thoroughly investigated and prosecuted. If you are an EMS leader, you must make sure your organization has policies and procedures in place for EMS personnel to defend themselves, mitigate violent encounters and report violence. Once violence is reported, it is also a leader’s obligation to take those reports seriously, and ensure the investigation and prosecution to the fullest extent possible allowed by law.
4. EMS needs body worn cameras now
The entire visual story of this incident is told through the point of view of law enforcement body-worn cameras and an intersection pole camera. The indifference of the police officers is a poor look for the Rochester Police Department, but the lack of engagement from and absence of AMR EMS personnel is even worse.
It is legally defensible and operationally wise for EMS agencies to equip all personnel with body-worn cameras. Without video, investigators from Rochester and New York state won’t know the full extent of the assault against the EMS personnel, the attempts to de-escalate or assess the patient, and what EMS personnel were doing in the minutes after the patient left the ambulance until care resumed. Additional video, from the EMS provider point of view, could be critical in investigating the incident and understanding what other EMS personnel could do if they faced a similar situation.
Unfortunately, this incident has many of the same themes as recent incidents in Illinois, Colorado and Tennessee. EMS regularly responds with law enforcement to incidents for patients in distress. Expert analysis of these incidents continues to affirm that EMS is expected to assess the patient, advocate for the patient’s medical care while working collaboratively – neither in deference to or command of – with law enforcement. For the wellbeing of your patients and the continuation of your EMS career, please use these EMS1 resources to better prepare yourself and your agency for violent patient encounters, patients in respiratory distress or failure and co-responding with law enforcement.