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Thursday, July 25, 2013

Coffee Break Discussion: Police Fire and EMS On Scene Who’s The Boss?

Police and EMS: Who’s the Boss?

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

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The Legal Guardian 
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.
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