Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Oklahoma Highway Patrol, Creek Nation EMS, and Abandonment

This is about the incident last week. You know the one. It is supposedly the second most watched video on YouTube. Everybody has been giving their opinions on it. Many commenters on news sites or on EMS forums claim that it is typical of the way police behave. Really? How many of you have been choked by the police while treating a patient?

Here is the video, for the few people, who might not yet have seen it. When the trooper’s dashboard camera is released, we will have much more information about what happened off camera (off camera as far as this video shot from a camera phone is concerned). The most information I have seen on this is at STATter911.[1]

There are plenty of things to comment on with the recent incident between OHP (Oklahoma Highway Patrol) and Creef Nation EMS.

Did the trooper get a bit carried away?

Yes. More than a bit, but not as much as many have suggested.

Should the trooper have waited until they arrived at the ED to interfere with the treatment of a patient by EMS?

Yes. Especially since it appears to be a crime that applies even to on duty OHP troopers. This should apply to any kind of assault/battery/interference with ED hospital personnel – doctors, nurses, techs, aids, janitorial staff, . . . . Nobody working in the ED hospital should be a free target for violence. No manager/administrator/accessory after the fact should ever be involved in this in any way that is not supporting hospital personnel. Everything should be reported. Interference with any report of violence in the the hospital should also be a crime, including especially if the person discouraging reporting is hospital administration. Discouraging the reporting of a crime is being an accessory after the fact, at least it should be, if that is not the interpretation of the law. Administration should be protecting employees, not using them as cannon fodder.

Should the medic have resisted being arrested?

No. He can more easily get the troopers to listen to him if he complies with everything they say. If he resists, things will not get any better. If he is compliant, and they listen, he may be able to convince the troopers to avoid making the biggest mistake of their careers. Others have stated that his partner should not have stopped for police. Again, I disagree. Not cooperating is only going to lead to escalation of the situation. Driving while trying to keep track of the police and trying to keep ahead of the police, while also not endangering other drivers is reckless. Is there any real difference between the medic resisting being arrested on scene and the partner refusing to stop for the police? If they arrest the medic on an ALS call, with no other medic on scene, the police are the ones depriving the patient of continuing care.

With an ALS patient, nobody other than that medic is able to continue care, until another medic shows up.

Should the medic stay in the patient compartment at all times, because leaving the patient compartment is abandonment?

Here is what the medic, Maurice White, responded to.

CowboyXXX wrote: 1st off what respectable Paramedic would get abandon his patient in the back of the ambulance to argue with an officer that was gonna ticket this partner. One key thing is if you have a bad patient in the back of your truck you will run lights and sirens. 2nd if an officer is gonna ticket you take the ticket and argue it in a court of law.[2]

The medic’s response is at the link in the footnote. Here are my comments, particularly on abandonment, which the medic does not really address.

I already mentioned that I agree about not resisting police.

What about using lights and sirens?

That is at the discretion of the medic. Since none of use were there, or even know a bit about the patient, we really are not in a good position to criticize not using lights and/or sirens. Then there is the lack of evidence that lights and/or sirens lead to reduced transport times. There are places where lights and/or sirens may make a significant difference, but where is the evidence to support this as a common style of transport? I rarely ask my partner to use lights and/or sirens during transport.

Lights and/or sirens?

Unless there is a requirement for using both at the same time, the driver should be deciding what is most appropriate for the traffic conditions, and modify that as traffic conditions change. State laws that restrict that judgment on the part of the driver, are dangerous laws. Discouraging critical judgment is dangerous.

What about the abandonment charge?

If an EMS provider leaves the patient compartment and no other EMS provider is in the patient compartment, that EMS provider has abandoned the patient?

Or

If a paramedic transfers care to a basic EMT, the paramedic is guilty of abandonment?

Are these abandonment?

It can be abandonment if a medic transfers care of a patient to someone not authorized to continue the care that needs to be continued. If the medic assesses a patient, sees no need for ALS care, and transfers care to one or more basic EMTs, so what? I have done this many times. When I worked on a 911 responder vehicle, if the patient did not appear to need ALS care, I released the patient to the BLS crew and notified dispatch that I was available. When I have worked with a basic EMT partner, I would never have a break from patient care, if this were abandonment. If I am driving, I am not in the patient compartment.

What about leaving the patient alone in the patient compartment?

If a doctor or nurse walks out of a hospital room, leaving the patient unattended, is that abandonment? Do we need to lock up all of the doctors and nurses? Why would that be different? Do EMS workers smell better? Is it a pheromone treatment?

But doctors and nurses have more than one patient each, so it is different.

The number of patients determines if leaving the room is abandonment? So, if the nurse only has one patient assigned, that nurse may not leave the room until relieved or until another patient shows up. Is that even remotely realistic?

Don’t believe me? Here is a quote from an article on abandonment. The author is a lawyer, paramedic, and has been an administrator. Her assessment is more relevant than mine.

Abandonment is sometimes defined as the unilateral termination of the provider/patient relationship at a time when continuing care is still needed. It is a form of negligence that involves termination of care without the patient’s consent. To prove abandonment, a plaintiff must show that a patient needs care — that a medical provider has entered into a relationship to provide care to that patient, and then either stops providing care or transfers care to a person of lesser training when the patient needs the higher level of training.[3]

So stepping out of the patient compartment, to attempt to explain to the troopers that there is a patient in the back, is not abandonment?

If he got out and fled from police – that would probably be abandonment.

If he got out, flagged down a taxi, and left the scene – that would probably be abandonment.

Getting out of the patient compartment, while the patient is alone in the patient compartment, is not abandonment.

Why do we lie to our students about this? Is EMS so simple that we need to make up stupid stuff to worry about? More likely, we come up with all of these urban legends as a way of trying to have some certainty about the job. This is an absolute rule. Do not disobey. But there are no absolutes in EMS. We need to encourage the people spreading these urban legends to not talk/write without some evidence to support their tales.

Abandonment by leaving the patient compartment.

Trendelenburg.

Lights and Sirens.

MAST/PASG.

Controlled substances are dangerous.

ALS is important in resuscitation.

Et cetera. See my EMS Mythology Starter Kit post, which I need to follow up on.

Many of these lies can be found in the textbooks, state regulations, and protocols. We need to distrust everyone in EMS.

We need to have a better understanding of what we are doing. Maybe then we will not be so gullible when told these silly urban legends. When we are told something, we need to consider. Does that make sense? If we ask this more often; If we then followed up on the other questions raised; we might actually start to act like professionals. In stead we fall for any nonsense somebody tells us. We don’t limit the belief of nonsense to what comes from old timers and/or authority figures. If it is a rumor, it must be true. We always know what we are talking about.

OHP vs. Creek Nation EMS from the beginning, post by post:

Oklahoma Highway Patrol, Creek Nation EMS, and Abandonment 5/31/09

More on Abandonment, OHP and EMS 6/06/09

OHP Trooper Update 6/11/09

OHP Trooper Update II 6/11/09

OHP Trooper Update III 6/13/09

OHP Trooper Update IV – Holy Stammering Obscurantists 6/16/09

OHP Trooper Update V – Over an Hour of the Holy Stammering Obscurantist 6/17/09

OHP Trooper vs. EMS comment from anonymous 6/18/09

Some Corrections on OHP vs. Creek Nation EMS 6/20/09

OHP Trooper Update VI – A little Background on the Participants 6/22/09

OHP Trooper Update VII – A Little More Background on the Participants 6/22/09

Daniel Martin Suspended for 5 Days 6/22/09

Trooper Daniel Martin Subject of a Lawsuit 7/22/09

OHP Official Position – Don’t Get Caught On Camera, Otherwise Good Job. 7/23/09

An Interesting Development in the Daniel Martin Case 7/24/09

Trooper Daniel Martin In Trouble, Again 10/06/09

Maurice White Arrested 01/11/10

Footnotes:

^ 1 UPDATE: Oklahoma troopers officially identified. Medic seen being choked tells more in a comment posted on a website. Read Maurice White’s response.
STATter911
Dave Statter
He has been updating this very frequently. I have not found another site with so much information or such frequent updates.
Article

^ 2 UPDATE: Oklahoma troopers officially identified. Medic seen being choked tells more in a comment posted on a website. Read Maurice White’s response.
STATter911
Dave Statter
Article
The same as Footnote #1.

^ 3 Patient Abandonment: What It Is — and Isn’t
EMS and the Law
W. Ann Maggiore, JD, NREMT-P
2007 Oct 4
JEMS
Article

Then there is a second part on abandonment that is on a different part of abandonment and some of the difficult decisions that need to be made. The most important aspect seems to be – act in the best interest of the patient without endangering yourself.

Patient Abandonment Part Two
EMS and the Law
W. Ann Maggiore, JD, NREMT-P
2008 Feb 7
Article

.

Speak Your Mind