violation or not

[HERBIE1]

Can't be sure , But it looks like fake blood to me from a moulage kit.

Looks like plenty of fresh incidents I've seen but it's hard to tell from a picture.

[letmesleep]

Fake or real, I see this photo being used as an example of what seems to be happening more and more often online. The use of "Myspace" and "Facebook" has changed EMS in a negative light (in my opinion). We are seeing more photos, call situations, work related stories being shared with the entire world. The real issue is that more information is slipping through the cracks, and is killing us as professionals. When pictures like this hit the "world wide web" there is a question of being real or not, which forces the public to decide. Do they know if this is a training photo?

It would seem to be that the question being asked is if this is a HIPPA or HIPAA (depending if your the OP, or the rest of us.......just joking ellis8934, relax) if the photo is a real pt. I agree that there may be a lot to consider, but my question is it worth the risk to your career, the pt, the pt's family? We need to take more care presenting on the web.

[fireflymedic]

I'd venture to say I don't think it's real from the looks of it - however if it isn't I always put up (if I post pictures up from my classes or whatever) that there were no violations. It's just smarter not to post pics unless they are training pics and you specify them as such. There was an incident about a year ago I believe where a medic took a picture of a car involved in a fatal accident, which was posted on their myspace. It was discovered by the family and they were disciplined by the state. Funny thing was a very similar pic appeared in the newspaper and no one said a word about it. But as a general rule I steer away from pics unless needed to relay to docs condition of car, and then after they are seen are immediately deleted. I don't want them ending up where they shouldn't. Just be oh so careful of what you do and if it's just a training photo - tell us !

[HERBIE1]

I'd venture to say I don't think it's real from the looks of it - however if it isn't I always put up (if I post pictures up from my classes or whatever) that there were no violations. It's just smarter not to post pics unless they are training pics and you specify them as such. There was an incident about a year ago I believe where a medic took a picture of a car involved in a fatal accident, which was posted on their myspace. It was discovered by the family and they were disciplined by the state. Funny thing was a very similar pic appeared in the newspaper and no one said a word about it. But as a general rule I steer away from pics unless needed to relay to docs condition of car, and then after they are seen are immediately deleted. I don't want them ending up where they shouldn't. Just be oh so careful of what you do and if it's just a training photo - tell us !

Good point about accident victims and pictures. I know many places use them to show surgeons the extent of damage to a vehicle. I was wondering if they had a dedicated camera for this, or if someone just used their cell phone cameras. Around here, the docs take our word for what the damage is- intrusion, steering wheel intact, windshield starred, etc. I honestly think that most docs have a hard time correlating injuries vs the condition of the car- especially now that cars have safety cages that protect the passengers so well. Every day we see mangled cars that look horrible, yet folks walk away without a scratch on them. We tell the ER's that the exterior of the car was essentially destroyed, yet the person presents clinically fine. Obviously with a badly damaged car, your index of suspicion for serious injuries jumps, you make the ER aware of the damage, so they can look for potential injuries that may not be immediately apparent.

We all know about mechanisms of injuries, the physics of what happens to the body with rapid deceleration, and honestly it's amazing more people don't have things like torn aortic arches or ruptured spleens.

[fireflymedic]

You make a good point with that Herbie - I utilize my own phone for those purposes. There are a few docs especially that tell us I want to see it with my own eyes (two of which were former medics). I have absolutely no problem accomodating them as they can correlate what I'm bringing them and more importantly why the service asked for our intervention especially if they are discharged shortly after arriving and moderate observation.

As for the tears - a run that particularly holds obvious in my mind was an older couple that was involved in a fairly mild low speed accident. Was hit in right front quarter panel at approx 30 mph. The lady on the impact side was completely fine - just a few bruises and scratches. The gentleman in the driver's seat was dead - all the energy transferred into his seat and he absorbed it. Died of an aortic dissection. Was it already stressed and that just did it? maybe. Were there other factors? Possibly, but who knows. It just really made me think. Especially when I've seen some accidents I'm convinced the person is dead and then turn out to be fine. You just never know.

[HERBIE1]

You make a good point with that Herbie - I utilize my own phone for those purposes. There are a few docs especially that tell us I want to see it with my own eyes (two of which were former medics). I have absolutely no problem accomodating them as they can correlate what I'm bringing them and more importantly why the service asked for our intervention especially if they are discharged shortly after arriving and moderate observation.

As for the tears - a run that particularly holds obvious in my mind was an older couple that was involved in a fairly mild low speed accident. Was hit in right front quarter panel at approx 30 mph. The lady on the impact side was completely fine - just a few bruises and scratches. The gentleman in the driver's seat was dead - all the energy transferred into his seat and he absorbed it. Died of an aortic dissection. Was it already stressed and that just did it? maybe. Were there other factors? Possibly, but who knows. It just really made me think. Especially when I've seen some accidents I'm convinced the person is dead and then turn out to be fine. You just never know.

To your point about people being discharged shortly after we bring them in, all nicely packaged and immobilized...

Often times, we "know" that a person is fine, and they probably have a simple sprain at most, and as soon as the doc does a quick clinical exam, they are off our backboard and sitting in a chair. Obviously the exam the doc does is not difficult, but they have the license and authority to be able to take a "calculated risk". Years ago, ANYONE who we brought in with a collar and backboard automatically got at least a cross table C-spine Xray- no questions asked. Now, with overcrowding and limitations on resources and money, docs are using our reports, their judgment, clinical skills and experience to clear people without incurring the added cost and time of an Xray. Sign of the times, I guess.

It would be nice if we were allowed to clinically clear some of our potential backboard cases here, but for 100 good, conscientious providers who would do the right thing, there is always someone who is just plain lazy and dangerous. Sad, but true.

[wrmedic82]

Its funny you say that herbie cuz I have talked with 2 ER docs who use the NEXUX for clearing c-spine and love it. Both docs are also medical directors for EMS, and will not allow their medics to clear c-spine using the same technique. It all comes down to liability and how much or little of it do you want.

[Richard B the EMT]

I am unsure of specifics, but it is my understanding that a lawsuit is in progress regarding the mother of a lady killed in a DWI accident (the lady in question was not the driver), where some unfeeling person keeps sending pictures of the deceased lady, still in the wrecked car, to the mother. The LEOs have been trying to find the source of the original picture, probably someone's cell phone camera, but every time they shut down a posted copy of the accident on the internet, another page goes up, and a link sent to the mother.

HIPAA or not, the deceased person's rights continue to be violated, causing emotional hurt to her mother.

Then, there was a string, here on EMT City, showing people continuing to have a good time on a beach in Italy, scant yards away from a dead person who had not yet been removed by the authorities. Some commented on this as directed disrespect towards the deceased, because she was a "Gypsy", or a "Roma", kind of like the deceased was some kind of non human entity, and unworthy of respect.

[Lone Star]

It's always been my understading that even though the patient dies, it still does not free us from the restrictions and policies of HIPAA.

Pictures showing up in newspapers or on the evening news aren't governed by the policies of HIPAA, but are protected under the first amendment. The press isn't governed by the same rules as we as healthcare providers are, which means that what we hold 'sacred' means little to them.

[HERBIE1]

Its funny you say that herbie cuz I have talked with 2 ER docs who use the NEXUX for clearing c-spine and love it. Both docs are also medical directors for EMS, and will not allow their medics to clear c-spine using the same technique. It all comes down to liability and how much or little of it do you want.

Hey- the docs get the big bucks for making those decisions. It all boils down to the level of training of their providers (ALS or BLS), the call volume,the experience of the EMS folks, their con ed requirements, QA and QI, how many providers they have, and how well the EMS director knows his people. I know studies have come out that support the use of a prehospital protocol, but there is also a huge difference from system to system, or even county to county. It's hard to make blanket statements as to the safety or efficacy when there are so many variables from system to system.

I don't blame the docs for being leery of things like this.